Resistin - concentrations in persons with type 2 diabetes mellitus and in individuals with acute inflammatory disease

Resistin is a recently discovered signal molecule, which could help elucidation of the pathophysiology of the insulin resistance and its correlation with obesity. As little information was available about resistin determination in venous blood at the time of our study, we focused on the question whether any correlation exists between persons with type 2 diabetes mellitus, with systemic inflammation, healthy persons and resistin concentrations and laboratory markers of inflammation, peptone, BMI. Differences of resistin values in these types of volunteers were studied as well.

METHODS

Persons under study were divided into 3 groups: group A - with clinical signs of inflammatory disease of respiratory tract, leukocytosis > 10000/ul and CRP concentration > 50 mg/l (n = 35); group B - with well controlled type 2 DM treated by oral antidiabetic drugs, without clinical signs of inflammation and negative case history of acute disease (n = 12); group C - without clinical signs of inflammation and negative case history of acute disease (n = 77). For all volunteers we determined BMI index and examined resistin, leptin, interleukin 6, TNF-alpha, Na, K, Cl, insulin, cholesterol, HDL-cholesterol, LDL-cholesterol, triacylglycerols, creatinine, uric acid, ALT, AST, GMT, P, Mg and albumin in serum.

RESULTS

Persons with clinical signs of severe inflammation had higher concentrations of Il6, CRP, resistin and a markedly lower BMI, decreased values of glucose, sodium, triacylglycerols, cholesterol, LDL-cholesterol and HDL-cholesterol compared to diabetics of type 2 (p < 0.05). Persons with clinical signs of severe inflammation showed significantly higher concentrations of TNF-alpha, Il6, CRP, resistin, glucose, leptin and considerably lower values of albumin, sodium and HDL-cholesterol than healthy individuals (p < 0.05). Persons with type 2 DM had markedly higher values of BMI, CRP, glucose, triacylglycerols, LDL-cholesterol, GMT and leptin, compared to healthy volunteers (p < 0.05). None of the three groups differed markedly in age or sex. Healthy volunteers show a significant correlation between leptin and resistin (correlation coefficient 0.82); this correlation was not found in patients with inflammation and type 2 DM. The group of volunteers with inflammations was found to have a significant positive correlation between resistin and inflammatory markers (correlation coefficient 0.3-0.5), negative correlation between resistin and cholesterol. We also found positive correlations between leptin and BMI as well as negative correlations between leptin and CRP. No significant correlations between resistin and other studied parameters were found in persons with type 2 DM.

CONCLUSION

In healthy population a correlation was found between leptin and resistin concentrations in serum. In patients with severe inflammatory disease a correlation between resistin concentration and laboratory markers of inflammation was shown, however, no correlation was found between leptin and resistin. Resistin concentration in the serum of these patients is significantly higher ( p < 0.01) compared to healthy subjects and well controlled persons with type 2 DM with signs of insulin resistance. This may be due to a direct effect of inflammatory cytokines on resistin production. In persons with type 2 DM no significant correlations were found between resistin and other individual parameters ( insulin sensitivity markers, BMI or leptin). Resistin concentrations in persons with type 2 DM do not differ from concentrations of common population.

[First experience with the cobalt binding capacity (ACB) test in the diagnosis of acute coronary syndrome (a pilot study)]

INTRODUCTION

Commonly used laboratory markers of coronary damage in individuals with acute coronary syndrome (ACS) are not specific for myocardial ischemia and prove only irreversible myocardial damage. There have been concerns recently of a laboratory test able to distinguish sufficiently an individual with myocardial ischemia and typical IHD symptoms from patients without IHD. Since 1994 several works about cobalt binding capacity of albumin (ACB) have been published in which a unique diagnostic sensitivity and specificity of this test for estimations of the presence of myocardial ischemia has been described. In February 2003 this test was approved by FDA for making an early diagnosis of ACS. GOAL OF THE WORK: To verify a possibility to use ACB test for making an early diagnosis of ACS.

METHOD

98 individuals, patients of the Department of Internal Medicine of the hospital in Sternberk, hospitalised for suspicion of ACS but not indicated for direct PTCA, have been examined. Respondents with ACS diagnosis were examined via coronarography. All the respondents were examined for cTnI, myoglobin, and ACB immediately at the admission (0) and 2, 6, and 12 hours after admission. Cobalt binding capacity of albumin has been given in absorbance units. The group of respondents was subsequently divided into subgroups according to presence of ACS and subgroups of respondents with/without AMI.

RESULTS

55 respondents (56%) have been diagnosed with ACS. 16 respondents (16%) from them suffered from non-Q AMI and 39 respondents (40%) suffered from unstable AP (UAP). 43 respondents (44%) suffered from noncoronary sternal pain. Patients with ACS had ACB values significantly higher at admission and 2 and 6 hours after admission compared to respondents without ACS (0: 0.62 +/- 0.17 vs. 0.4 +/- 0.11, 2: 0.61 +/- 0.13 vs. 0.44 +/- 0.12, 6: 0.58 +/- 0.16 vs. 0.45 +/- 0.1, p < 0.01). In ACB dynamics monitoring in defined groups of respondents no significant differences have been identified among ACB values of individual takings. There were no significant differences in ACB values 12 hours after admission (0.53 +/- 0.12 vs. 0.44 +/- 0.16) in cut-off absorbance ACB 0.5 the diagnostic sensitivity at admission was 69% and specificity 89%, 2 hours later 87% and 71% and 6 hours after admission 64% and 69%. 12 hours after admission ACB assessment has not been possible to be used for ACS diagnosing (AUC of 0.55). First 2 hours after admission ACB test was more specific and sensitive for diagnosing ACS compared to cTnI test (0: AUC 0.83 vs. 0.61, p = 0.015, 2: AUC 0.87 vs. 0.71, p = 0.04). However, ACB test could not be used in respondents with ACS to distinguish between acute myocardial infarction and unstable angina pectoris (UAP) (AUC: ACB-0 0.51, ACB-2 0.56, ACB-6 0.51, ACB-12 0.57).

CONCLUSION

ACB test is a quick, cheap and easy examination which is very specific and sensitive for early diagnosing of acute coronary syndrome without regard whether it is caused by UAP or AMI (up to 6 hours after admission) compared to commonly used markers. This test could significantly contribute to the next fate of a patient (diagnostic procedures, patient's prognosis).

[Use of assessment of aggregation of thrombocytes induced by cationic propyl gallate to estimate recurrence of cardiovascular complications]

INTRODUCTION

Recently resistance to an acetylsalicylic acid (ASA) administration has been a frequently mentioned problem. However, to identify ASA nonresponsive patients (ASA resistance) is difficult and common examination procedures can contain important preanalytic, analytic and postanalytic mistakes. Recently a possibility to use aggregometry after induction with cationic propyl gallate (CPG) has been discussed in this context; it's a robust, highly sensitive, and specific method for ASA resistance estimates. We asked ourselves following questions during our work:

GOAL

a) Experience patients with acute coronary syndrome (ACS) ASA resistance more often than healthy volunteers?; b) Are aggregation values in both patients with different metabolic homeostasis disorders and patients with risk factors for atherosclerotic complications different?; c) Change results of measured aggregation induced by CPG in patients treated with identical ASA therapy during a several years long monitoring; respectively are patients assessed differently during the monitoring?; d) Is it possible to use one-shot aggregation assessment following CPG to estimate ASA resistance or is it necessary to repeat the examinations?; e) Is recurrence of ACS complications more frequent during two years of monitoring of patients with ACS history resistant to 100 mg doses of ASA per day?

METHOD

103 patients of an average age 69 were assessed. All of them suffered from ACS without ST segment elevations and were treated conservatively; in addition to it all of them were treated with 100 mg ASA/day. They were assessed at the onset of ACS and after 3, 12 and 24 months. The examination consisted of taking patient history, clinical examination, BMI determination, laboratory test for cholesterol, HDL, LDL, triacylglycerols, and glucose, and of an aggregation of thrombocytes assessment under standard conditions (spontaneous and after CPG induction).

RESULTS AND CONCLUSION

a) ASA resistance is more frequent in patients with ACS compared to healthy volunteers (45% to 6%, p < 0.001). b) Patients with type II DM, smokers, patients with low HDL cholesterol levels or high triacylglycerols levels are ASA resistant more often (< 0.05). c) Results of measured aggregation of thrombocytes don't change during administration of the identical dose of 100 mg ASA/day during 2 years of monitoring. Respondents usually are assessed identically during monitoring (responsive/ASA nonresponsive). d) ASA resistance can be estimated from one-shot aggregation assessment following induction with CPG. e) Two years after diagnosing the ASA resistance a percentage of cardiovascular complications recurrence is higher in patients with history of ACS (p < 0.001). One-shot assessments of the CPG induced thrombocytes aggregation and the spontaneous aggregation are sensitive in 81% of patients with ACS history and specific in 100% of patients at risk of recurrence of cardiovascular complications. If these results are confirmed it could lead to a change in interventions in patients with ASA resistance proved by this method.

Adiponectin concentrations as a criterion of metabolic control in persons with type 2 diabetes mellitus?

Adiponectin (ADP) is an adipocytokin with many antiatherogenic properties; its decreased level is associated with numerous atherogenic diseases and syndromes (e.g. diabetes mellitus (DM), dyslipidemia, endothelial dysfunction, hypertension, and obesity). Decreased ADP values in blood may be an independent risk factor of atherosclerotic (ATS) complications.

AIM OF THE STUDY

1) Do persons with type 2 diabetes have lower ADP values than individuals without DM but with a high risk of ATS complications? 2) Do ADP values differ between persons with well controlled and persons with uncontrolled type 2 diabetes? We examined 109 patients of the Metabolic Center of Hospital Sternberk. Out of them, 58 had type 2 diabetes, others were individuals with variously expressed risk factors of early atherosclerosis (obesity, hypertension, age, family history, smoking, dyslipidemia, etc.). In all persons under this study the following parameters were determined in peripheral venous blood: adiponectin, resistin, leptin, ObRe, cholesterol, HDL-cholesterol, triacylglycerols, glucose, HbA1c, creatinine, urea, ALT, AST, CRP, homocysteine, thrombocyte aggregation after CPG induction. The whole group was divided according to the presence of type 2DM into two subgroups; persons with diabetes were divided into the well controlled and uncontrolled subgroups. All data obtained were processed statistically using the software SPSS for Windows and Medcalc. The adiponectin/BMI index correlated negatively with HbA1c value (correlation coefficient -0.37, p = 0.00053), triacylglycerols (-0.4, p = 0.000001), P-glucose (-0.3, p = 0.0017), uricemia (-0.35, p = 0.0007) and positively with HDL-cholesterol value (0.6, p=0.00001). Women had higher adiponectin values than men. Persons with hypertension and with diabetes mellitus, individuals with atherogenic lipotype or persons with inflammation signs had lower values than individuals without these diseases and syndromes. Persons with wellcontrolled diabetes mellitus had higher values than persons with uncontrolled diabetes (medians of the adiponectin/BMI index 9.7 vs. 6.7, p < 0.01). Persons with type 2 diabetes mellitus have lower ADP values than persons with a high ATS risk without diabetes mellitus. Persons with wellcontrolled diabetes mellitus (DM) and with satisfactory compensation have significantly higher ADP levels (independently of other metabolic parameters of DM control). ADP may be a new marker of metabolic control in persons with a high risk of atherosclerotic complications.

Resistin - concentrations in persons with type 2 diabetes mellitus and in individuals with acute inflammatory disease

Resistin is a recently discovered signal molecule, which could help elucidation of the pathophysiology of the insulin resistance and its correlation with obesity. As little information was available about resistin determination in venous blood at the time of our study, we focused on the question whether any correlation exists between persons with type 2 diabetes mellitus, with systemic inflammation, healthy persons and resistin concentrations and laboratory markers of inflammation, peptone, BMI. Differences of resistin values in these types of volunteers were studied as well.

METHODS

Persons under study were divided into 3 groups: group A - with clinical signs of inflammatory disease of respiratory tract, leukocytosis > 10000/ul and CRP concentration > 50 mg/l (n = 35); group B - with well controlled type 2 DM treated by oral antidiabetic drugs, without clinical signs of inflammation and negative case history of acute disease (n = 12); group C - without clinical signs of inflammation and negative case history of acute disease (n = 77). For all volunteers we determined BMI index and examined resistin, leptin, interleukin 6, TNF-alpha, Na, K, Cl, insulin, cholesterol, HDL-cholesterol, LDL-cholesterol, triacylglycerols, creatinine, uric acid, ALT, AST, GMT, P, Mg and albumin in serum.

RESULTS

Persons with clinical signs of severe inflammation had higher concentrations of Il6, CRP, resistin and a markedly lower BMI, decreased values of glucose, sodium, triacylglycerols, cholesterol, LDL-cholesterol and HDL-cholesterol compared to diabetics of type 2 (p < 0.05). Persons with clinical signs of severe inflammation showed significantly higher concentrations of TNF-alpha, Il6, CRP, resistin, glucose, leptin and considerably lower values of albumin, sodium and HDL-cholesterol than healthy individuals (p < 0.05). Persons with type 2 DM had markedly higher values of BMI, CRP, glucose, triacylglycerols, LDL-cholesterol, GMT and leptin, compared to healthy volunteers (p < 0.05). None of the three groups differed markedly in age or sex. Healthy volunteers show a significant correlation between leptin and resistin (correlation coefficient 0.82); this correlation was not found in patients with inflammation and type 2 DM. The group of volunteers with inflammations was found to have a significant positive correlation between resistin and inflammatory markers (correlation coefficient 0.3-0.5), negative correlation between resistin and cholesterol. We also found positive correlations between leptin and BMI as well as negative correlations between leptin and CRP. No significant correlations between resistin and other studied parameters were found in persons with type 2 DM.

CONCLUSION

In healthy population a correlation was found between leptin and resistin concentrations in serum. In patients with severe inflammatory disease a correlation between resistin concentration and laboratory markers of inflammation was shown, however, no correlation was found between leptin and resistin. Resistin concentration in the serum of these patients is significantly higher ( p < 0.01) compared to healthy subjects and well controlled persons with type 2 DM with signs of insulin resistance. This may be due to a direct effect of inflammatory cytokines on resistin production. In persons with type 2 DM no significant correlations were found between resistin and other individual parameters ( insulin sensitivity markers, BMI or leptin). Resistin concentrations in persons with type 2 DM do not differ from concentrations of common population.

Application of determined NT-proBNP in physical standardized exercise

Natriuretic peptides can be used as markers of heart failure, its severity and also in the differential diagnosis of dyspnea. Moreover, the dynamics of natriuretic peptides in physical standardized exercise may be used in the assessment of latent heart failure.

AIM OF THE STUDY

Can determination of NT-proBNP be used in the diagnosis of exercise-induced ischemia or latent heart failure? 18 probands (10 men, 8 women) under study were risk persons with unspecified ECG, without signs of manifest heart failure. They were subjected to ergometric bike exercises up to the subjective maximum, SPECT myocardium with estimated ejection fraction of the left ventricle at peak ergometric exercise. The following parameters were followed-up: a) before ergometric exercise: NT-proBNP, CRP, TNF-alpha, Hb, Htc, lactate b) at subjective maximum: NT-proBNP, Hb, Htc, lactate c) 30 min after stopping the exercise: NT-proBNP d) 60 min after stopping the exercise: NT-proBNP. The volume blood changes were taken into account (estimation from the dynamics of Htc, Hb with calculation of metabolic changes of NT-proBNP). To evaluate the dynamics of NT-proBNP, the group was divided into subgroups according to the results obtained in ergometric exercises.

RESULTS

initial values of NT-proBNP within normal limits (< 59 pmol/l, 500 ng/l) in 94%, the submaximal pulse rate was reached in 94%, ischemic changes in ECG were observed in 59%, typical clinical signs of heart ischemia were recorded in 35%. Signs of heart dysfunction according to SPECT were found in 47% and ischemic symptoms were observed in 43%. In general, the plasmatic volume decreased by 24% at maximal exercise. Lactate concentration in the plasma increased in all cases. Conversion of NT-proBNP into volume blood changes revealed that increased NT-proBNP occurred only in 22%. Differences between NT-proBNP before exercises and at maximal exercise prior and after correction into volume blood changes were statistically insignificant. 30 and 60 min after the exercise, no significant differences were found in NT-proBNP concentrations. Dividing into subgroups according to the results of ergometric exercises, showed no significant differences in NT-proBNP concentrations. Dynamics of NT-proBNP changes during and after ergometric exercises cannot be used for the diagnosis of exercise-induced heart failure. The high stability of NT-proBNP related to physical activity was confirmed.

Application of determined NT-proBNP in physical standardized exercise

Natriuretic peptides can be used as markers of heart failure, its severity and also in the differential diagnosis of dyspnea. Moreover, the dynamics of natriuretic peptides in physical standardized exercise may be used in the assessment of latent heart failure.

AIM OF THE STUDY

Can determination of NT-proBNP be used in the diagnosis of exercise-induced ischemia or latent heart failure? 18 probands (10 men, 8 women) under study were risk persons with unspecified ECG, without signs of manifest heart failure. They were subjected to ergometric bike exercises up to the subjective maximum, SPECT myocardium with estimated ejection fraction of the left ventricle at peak ergometric exercise. The following parameters were followed-up: a) before ergometric exercise: NT-proBNP, CRP, TNF-alpha, Hb, Htc, lactate b) at subjective maximum: NT-proBNP, Hb, Htc, lactate c) 30 min after stopping the exercise: NT-proBNP d) 60 min after stopping the exercise: NT-proBNP. The volume blood changes were taken into account (estimation from the dynamics of Htc, Hb with calculation of metabolic changes of NT-proBNP). To evaluate the dynamics of NT-proBNP, the group was divided into subgroups according to the results obtained in ergometric exercises.

RESULTS

initial values of NT-proBNP within normal limits (< 59 pmol/l, 500 ng/l) in 94%, the submaximal pulse rate was reached in 94%, ischemic changes in ECG were observed in 59%, typical clinical signs of heart ischemia were recorded in 35%. Signs of heart dysfunction according to SPECT were found in 47% and ischemic symptoms were observed in 43%. In general, the plasmatic volume decreased by 24% at maximal exercise. Lactate concentration in the plasma increased in all cases. Conversion of NT-proBNP into volume blood changes revealed that increased NT-proBNP occurred only in 22%. Differences between NT-proBNP before exercises and at maximal exercise prior and after correction into volume blood changes were statistically insignificant. 30 and 60 min after the exercise, no significant differences were found in NT-proBNP concentrations. Dividing into subgroups according to the results of ergometric exercises, showed no significant differences in NT-proBNP concentrations. Dynamics of NT-proBNP changes during and after ergometric exercises cannot be used for the diagnosis of exercise-induced heart failure. The high stability of NT-proBNP related to physical activity was confirmed.

[Personal experience with determination of NT-proBNP in clinical practice]

INTRODUCTION AND OBJECTIVE

Recently in the literature information is found on estimation of natriuretic peptides in the differential diagnosis of dyspnoea. Because in the Czech Republic since the beginning of 2002 routine estimation of NT-proBNP is available (analyzer Elecsys 2010), the objective of our work was to find out whether it is possible to use in the everyday practice of a district hospital estimation of NT-proBNP to differentiate dyspnoea with affection of the heart muscle from other types of dyspnoea.

METHOD

A group of 33 patients from the medical department of the Sternberk hospital was examined who attended on account of dyspnoea and lacked signs of acute coronary syndrome. All probands were diagnosed on the basis of defined criteria; according to the final diagnosis the patients were divided into three groups: group "LV" was formed by dyspnoic patients with organic affection of the left ventricle and signs of congestion in the lesser circulation, group "non-LV" was formed by patients where no organic affection of the left ventricle was found but other heart disease was present. Group "non-C" was formed by patients where a cardiac cause of dyspnoea was ruled out. In all patients on admission NT-proBNP was assessed.

RESULTS

33 probands were examined, 18 men and 15 women, mean age 74.5 years. 25 probands the dyspnoea was classified as dyspnoea with affection of one of the cardiac compartments [19 of them had signs of organic affection of the left ventricle (group "LV")]; in 6 probands no signs of organic left ventricular affection were found (group "Non-LV"). The remaining 8 patients had no signs of any disease of the heart muscle, valves, septa, endocardium and pericardium (group "Non-C). The baseline values of NTpro-BNP were closely associated with the NYHA classification (grade II--median 55.3 pmol/l (469 ng/l, grade III--median 399.3 pmol/l (3384 ng/l), grade IV--median 724.7 pmol/l (6294 ng/l), the differences were statistically significant, p < 0.05). The dyspnoic probands with concurrent affection of some cardiac compartment (groups "LV" and "Non-LV") had a NT-pro BNP concentration significantly higher than probands without affection of the heart (group "Non-C") (median 589.5 pmol (4996 ng/l as compared with 62.9 pmol/l (533 ng/l, p < 0.01). In the group of probands with heart disease probands with affections of the left ventricle (group "LV") had significantly higher NT-proBNP values than subjects without affection of the LV and without any heart disease (groups "Non-LV" and "Non-C") (median 670.6 pmol/l (5683 ng/l) as compared with 187.5 pmol/l (1589 ng/l), p < 0.01). In hospitalized probands after treatment along with improved cardiopulmonary compensation also a significant drop of NT pro-BNP occurred (median 303 pmol/l (3967.7 ng/l to 211 pmol/l (2561 ng/l), p < 0.05). When looking for associations between anamnestic, laboratory and clinical data we found that the value of NT-proBNP is associated with dyspnoea with cardiac affection (groups "LV" + "Non-LV", correlation coefficient 0.48), with the left ventricular ejection fraction (correlation coefficient 0.52) and the baseline NYHA classification (correlation coefficient 0.36). In the examined group we did not find an association between NT-proBNP and age, sex, diabetes mellitus, hypertension, the presence of atrial arrhythmias, aortal stenosis, or the width of the left atrium. When using as cut-off for NT-proBNP 59 pmol/l (500 ng/l), the sensitivity of NT-proBNP for dyspnoea with affection of the cardiac compartments was 92% and the specificity 67%.

CONCLUSION

Assessment of NT-proBNP is an important diagnostic acid in the differential diagnosis of dyspnoea.

Preliminary experience with resistin assessment in common population

Resistin is a signal peptide produced by adipose tissue. Mice models have confirmed that resistin may play an important role in insulin resistance. Its function in the human organism has not been elucidated yet. Since in common population the resistin concentrations are not known (no validated commercial set is available), we performed resistin assessment using the ELISA method (with satisfying analytical characteristics) in a population of 123 non-obese probands without signs of insulin resistance and/or inflammation. Mean resistin values amounted to 14.3 ng/ml (reference limit of 7.3-21.3 ng/ml).