Ramadan diurnal intermittent fasting modulates SOD2, TFAM, Nrf2, and sirtuins (SIRT1, SIRT3) gene expressions in subjects with overweight and obesity

AIM

A growing body of evidence supports the impact of intermittent fasting on normalizing body metabolism and lowering oxidative stress and inflammation. Mounting evidence confirms that oxidative stress and chronic inflammation trigger the way for the development of metabolic diseases, such as diabetes. This research was conducted to evaluate the impact of Ramadan intermittent fasting (RIF) on the expression of cellular metabolism (SIRT1 and SIRT3) and antioxidant genes (TFAM, SOD2, and Nrf2).

METHODS

Fifty-six (34 males and 22 females) overweight and obese subjects and six healthy body weight controls were recruited and monitored before and after Ramadan.

RESULTS

Results showed that the relative gene expressions in obese subjects in comparison to counterpart expressions of controls for the antioxidant genes (TFAM, SOD2, and Nrf2) were significantly increased at the end of Ramadan, with percent increments of 90.5%, 54.1% and 411.5% for the three genes, respectively. However, the metabolism-controlling gene (SIRT3) showed a highly significant (P < 0.001) downregulation accompanied with a trend for reduction in SIRT1 gene at the end of Ramadan month, with percent decrements of 61.8% and 10.4%, respectively. Binary regression analysis revealed significant positive correlation (P < 0.05) between high energy intake (>2000 Kcal/day vs. <2000 Kcal/day) and expressions of SOD2 and TFAM (r = 0.84 and r = 0.9, respectively).

CONCLUSION

Results suggest that RIF ameliorates the genetic expression of antioxidant and anti-inflammatory, and metabolic regulatory genes. Thus, RIF presumably may entail a protective impact against oxidative stress and its adverse metabolic-related derangements in non-diabetic obese patients.

Reactive oxygen species in biological systems: Pathways, associated diseases, and potential inhibitors-A review

Reactive oxygen species (ROS) are produced under normal physiological conditions and may have beneficial and harmful effects on biological systems. ROS are involved in many physiological processes such as differentiation, proliferation, necrosis, autophagy, and apoptosis by acting as signaling molecules or regulators of transcription factors. In this case, maintaining proper cellular ROS levels is known as redox homeostasis. Oxidative stress occurs because of the imbalance between the production of ROS and antioxidant defenses. Sources of ROS include the mitochondria, auto-oxidation of glucose, and enzymatic pathways such as nicotinamide adenine dinucleotide phosphate reduced (NAD[P]H) oxidase. The possible ROS pathways are NF-κB, MAPKs, PI3K-Akt, and the Keap1-Nrf2-ARE signaling pathway. This review covers the literature pertaining to the possible ROS pathways and strategies to inhibit them. Additionally, this review summarizes the literature related to finding ROS inhibitors.

Food Polyphenols and Type II Diabetes Mellitus: Pharmacology and Mechanisms

Type II diabetes mellitus and its related complications are growing public health problems. Many natural products present in our diet, including polyphenols, can be used in treating and managing type II diabetes mellitus and different diseases, owing to their numerous biological properties. Anthocyanins, flavonols, stilbenes, curcuminoids, hesperidin, hesperetin, naringenin, and phenolic acids are common polyphenols found in blueberries, chokeberries, sea-buckthorn, mulberries, turmeric, citrus fruits, and cereals. These compounds exhibit antidiabetic effects through different pathways. Accordingly, this review presents an overview of the most recent developments in using food polyphenols for managing and treating type II diabetes mellitus, along with various mechanisms. In addition, the present work summarizes the literature about the anti-diabetic effect of food polyphenols and evaluates their potential as complementary or alternative medicines to treat type II diabetes mellitus. Results obtained from this survey show that anthocyanins, flavonols, stilbenes, curcuminoids, and phenolic acids can manage diabetes mellitus by protecting pancreatic β-cells against glucose toxicity, promoting β-cell proliferation, reducing β-cell apoptosis, and inhibiting α-glucosidases or α-amylase. In addition, these phenolic compounds exhibit antioxidant anti-inflammatory activities, modulate carbohydrate and lipid metabolism, optimize oxidative stress, reduce insulin resistance, and stimulate the pancreas to secrete insulin. They also activate insulin signaling and inhibit digestive enzymes, regulate intestinal microbiota, improve adipose tissue metabolism, inhibit glucose absorption, and inhibit the formation of advanced glycation end products. However, insufficient data are available on the effective mechanisms necessary to manage diabetes.

Prevalence and epidemiological characteristics of vaginal candidiasis in the UAE

Vaginal candidiasis (VC) continues to be a health problem to women worldwide. Although the majority of VC cases are caused by Candida albicans (C. albicans), non-albicans Candida spp. like C. glabrata and C. tropicalis are emerging as important and potentially resistant opportunistic agents of VC. The objective of this study was to evaluate the prevalence and epidemiology of VC in the UAE through retrospective analysis of pertinent data compiled by the microbiology and infection control unit at Latifa Hospital, Dubai between 2005 and 2011. The incidence of VC significantly increased from 10.76% in 2005 to 17.61% in 2011; average prevalence was 13.88%. C. albicans occurred at a frequency of 83.02%, C. glabrata at 16.5% and C. tropicalis at 1.2%. A single C. dubliniensis isolate was identified in the sample population. The percentage of C. albicans significantly decreased from 83.02% in the sample population as a whole to 60.8% in subjects over 45 years of age (P < 0.01) and that of C. glabrata, C. tropicalis and C. krusei significantly increased from 13.88%, 0.9% and 0.03% to 29.7%, 6.7% and 1.4% (P < 0.05) respectively. The incidence of VC in the UAE is on the rise and the frequency of non-albicans Candida spp. is noticeably increasing especially in postmenopausal women.

Quercetin Antagonizes the Sedative Effects of Linalool, Possibly through the GABAergic Interaction Pathway

Sedatives promote calmness or sleepiness during surgery or severely stressful events. In addition, depression is a mental health issue that negatively affects emotional well-being. A group of drugs called anti-depressants is used to treat major depressive illnesses. The aim of the present work was to evaluate the effects of quercetin (QUR) and linalool (LIN) on thiopental sodium (TS)-induced sleeping mice and to investigate the combined effects of these compounds using a conventional co-treatment strategy and in silico studies. For this, the TS-induced sleeping mice were monitored to compare the occurrence, latency, and duration of the sleep-in response to QUR (10, 25, 50 mg/kg), LIN (10, 25, 50 mg/kg), and diazepam (DZP, 3 mg/kg, i.p.). Moreover, an in silico investigation was undertaken to assess this study's putative modulatory sedation mechanism. For this, we observed the ability of test and standard medications to interact with various gamma-aminobutyric acid A receptor (GABA_A) subunits. Results revealed that QUR and LIN cause dose-dependent antidepressant-like and sedative-like effects in animals, respectively. In addition, QUR-50 mg/kg and LIN-50 mg/kg and/or DZP-3 mg/kg combined were associated with an increased latency period and reduced sleeping times in animals. Results of the in silico studies demonstrated that QUR has better binding interaction with GABA_A α3, β1, and γ2 subunits when compared with DZP, whereas LIN showed moderate affinity with the GABA_A receptor. Taken together, the sleep duration of LIN and DZP is opposed by QUR in TS-induced sleeping mice, suggesting that QUR may be responsible for providing sedation-antagonizing effects through the GABAergic interaction pathway.

Elevated Levels of Estrogen Suppress Hepcidin Synthesis and Enhance Serum Iron Availability in Premenopausal Women

Clinical and experimental observations have long suggested that elevated levels of estrogen associate with increased serum iron availability. Additionally, recent work has shown that estrogen can downregulate hepcidin synthesis in vitro. This study aims at assessing whether the ability of estrogen to downregulate hepcidin synthesis translates into changes in serum iron status. Hepcidin synthesis was evaluated in MCF-7, Hep-G2 and SKOV-3 cells treated with increasing concentrations of estrogen and cultured for up to 24 h post treatment. The correlation between levels of serum estrogen, hepcidin and iron was assessed using serum samples collected from 153 premenopausal women at random and samples collected from 6 women at days 1, 5, 10, 16, 21 and 28 of the monthly cycle. Estrogen-treated MCF-7 cells showed a significant reduction in hepcidin synthesis, especially at 20 nM/24 h E2 treatment. Hepcidin synthesis was also significantly reduced in Hep-G2 and SKOV-3 cells at 20 nM/24 h E2 treatment. In serum samples collected at random, estrogen (P=0.022; R=−0.213) and iron (P=0.028; R=−0.316) correlated negatively with hepcidin and positively with each other (P=0.033; R=0.319). An overall similar pattern was also observed in monthly cycle-timed samples. These findings suggest that elevated levels of estrogen reduce hepcidin synthesis as means of enhancing serum iron content in menstruating women.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) and metabolic syndrome components among young adult females

AIMS

Occurrence of metabolic syndrome (MetS) in the United Arab Emirates (UAE) is rising steadily, with subsequent increase in the prevalence of type 2 diabetes and cardiovascular disease (CVD). Recent studies have shown that PCSK9 plays a substantial role in atherogenic dyslipidemia. Hence, the aim of this study was to assess level of PCSK9 and its relationship with MetS components among young adult females.

METHODS

This study was carried out on 137 adult females over 18 years of age residing in the UAE. Subjects were categorized into two groups according to waist circumferences (WC): normal (<80cm; n=41) and large (≥80cm; n=96). Anthropometric and biochemical parameters in the fasting state (glucose, insulin, lipid profile, and PCSK9) were determined using conventional techniques. Homeostasis model assessment of insulin resistance (HOMA-IR) and MetS scores were calculated as appropriate.

RESULTS

PCSK9 was lower in subjects with large WC compared to normal WC (p=0.016). PCSK9 correlated negatively with measures of obesity (p<0.05), and positively with IR (r=0.425, p<0.001). Multiple linear regression analysis revealed that the strongest predictor of PCSK9 was IR (B=6.213; p<0.001), followed by WC (B=-2.488; p<0.001) and triglycerides (B=0.897; p=0.013).

CONCLUSION

Results from this study demonstrate that PCSK9 correlates with some components of metabolic syndrome and central obesity in young females. Such findings support the suggestion of using PCSK9 inhibitors in the management of MetS to modify risk for development of CVD.

Age group-associated variations in the pattern of Hp type distribution in Jordanians

The relationship between haptoglobin (Hp) type and life expectancy was investigated by determining the pattern of Hp type distribution in 790 unrelated Jordanians divided into four age groups: A (1-19 years), B (20-39 years), C (40-59 years) and D (60-85 years). While the frequency of Hp 2-2 gradually decreased from 0.576 in A to 0.393 in D, the frequency of Hp 2-1 gradually increased from 0.348 in A to 0.526 in D. Hp2 allele decreased from 0.750 in A to 0.656 in D while that of Hpl allele increased from 0.250 in A to 0.344 in D. Hp type distribution in A, B and D age groups was in agreement with the Hardy-Weinberg equilibrium (HWE). These findings demonstrate that the pattern of Hp polymorphism varies in different age groups, indicating that life expectancy might be Hp phenotype-associated. Additionally, the results suggest that Hp 2-2 phenotype might be an age-associated risk factor.

Case series: clonidine has no systematic effects on PR or QTc intervals in children

This study retrospectively examined the effects of clonidine, both alone and combined with psychostimulants, on the electrocardiograms (ECGs) of children and adolescents. Two pediatric cardiologists, blinded to treatment condition, examined pre- and posttreatment ECGs in 42 subjects treated with clonidine for attention-deficit/hyperactivity or tic disorder. While ECG variability was found, it did not appear to be related to any systematic effect of clonidine, either alone or in combination with psychostimulants. These data do not rule out the possibility of rare idiosyncratic reactions to clonidine with or without psychostimulants, though none occurred in this sample.

Protein antioxidants in thalassemia

It is common knowledge that thalassemic patients are under significant oxidative stress. Chronic hemolysis, frequent blood transfusion, and increased intestinal absorption of iron are the main factors that result in iron overload with its subsequent pathophysiologic complications. Iron overload frequently associates with the generation of redox-reactive labile iron, which in turn promotes the production of other reactive oxygen species (ROS). If not neutralized, uncontrolled production of ROS often leads to damage of various intra- and extracellular components such as DNA, proteins, lipids, and small antioxidant molecules among others. A number of endogenous and exogenous defense mechanisms can neutralize and counteract the damaging effects of labile iron and the reactive substances associated with it. Endogenous antioxidant enzymes, such as superoxide dismutase, catalase, glutathione peroxidase, and ferroxidase, may directly or sequentially terminate the activities of ROS. Nonenzymatic endogenous defense mechanisms include metal binding proteins (ceruloplasmin, haptoglobin, albumin, and others) and endogenously produced free radical scavengers (glutathione (GSH), ubiquinols, and uric acid). Exogenous agents that are known to function as antioxidants (vitamins C and E, selenium, and zinc) are mostly diet-derived. In this review, we explore recent findings related to various antioxidative mechanisms operative in thalassemic patients with special emphasis on protein antioxidants.

A study of haptoglobin phenotypes in patients with chronic renal failure

BACKGROUND

This study has investigated the association between haptoglobin (Hp) polymorphism and the occurrence of chronic renal failure (CRF) in Jordanians.

METHODS

Blood specimens were collected from 159 patients with CRF resulting from various predisposing conditions and from 200 healthy unrelated controls. Hp phenotyping was conducted using polyacrylamide gel electrophoresis.

RESULTS

The Hp 2-2 phenotype was over-represented in CRF patients in general (0.547), patients with hypertension (0.622) and patients with diabetes mellitus (0.633). The Hp 2-1 phenotype was over-represented in patients with chronic glomerulonephritis (0.549) and patients with reflux nephropathy (0.445). In patients with polycystic kidney disease (PKD), only Hp 2-1 and Hp 2-2 were detected, occurring at a frequency of 0.214 and 0.786, respectively. The frequency of Hp 2 allele in PKD patients was 0.893 compared with 0.706 in the control group. Hp-type distribution was in agreement with the expectations of a population in Hardy-Weinberg equilibrium in all groups except for the hypertensive patients.

CONCLUSIONS

Haptoglobin homozygosity seems to represent a possible risk factor for CRF in hypertensive, diabetic and PKD patients; Hp heterozygosity may lead to chronic glomerulonephritis.

Endocarditis due to Streptococcus acidominimus

It has been reported in recent years that the causative microorganisms, affected population, and clinical presentation of infective endocarditis have changed. We report on a 15-year-old boy with ventricular septal defect who was diagnosed with Streptococcus acidominimus endocarditis.

Estrogen-dependent changes in serum iron levels as a translator of the adverse effects of estrogen during infection: a conceptual framework

Elevated levels of estrogen often associate with increased susceptibility to infection. This has been attributed to the ability of estrogen to concomitantly enhance the growth and virulence of pathogens and suppress host immunity. But the exact mechanism of how estrogen mediates such effects, especially in cases where the pathogen and/or the immune components in question do not express estrogen receptors, has yet to be elucidated. Here we propose that translating the adverse effects of estrogen during infection is dependent to a significant degree upon its ability to manipulate iron homeostasis. For elevated levels of estrogen alter the synthesis and/or activity of several factors involved in iron metabolism including hypoxia inducible factor 1α (HIF-1α) and hepcidin among others. This leads to the inhibition of hepcidin synthesis in hepatocytes and the maintenance of ferroportin (FPN) integrity on the surface of iron-releasing duodenal enterocytes, hepatocytes, and macrophages. Intact FPN permits the continuous efflux of dietary and stored iron into the circulation, which further enhances pathogen growth and virulence on the one hand and suppresses host immunity on the other. This new conceptual framework may help explain a multitude of disparate clinical and experimental observations pertinent to the relationship between estrogen and infection.

Relationship of salivary adipocytokines, diet quality, physical activity, and nutrition status in adult Emirati females in United Arab Emirates

AIMS

The United Arab Emirates (UAE) ranks as the fifth most obese country with increasing cardio-metabolic risks. In this paper, relationships of salivary adipocytokines (markers of cardio-metabolic syndrome), diet quality and physical activity in 90 normal-weight, overweight and obese (30 subjects in each group) Emirati adult females were investigated.

METHODS

A cross-sectional research design was adopted. Anthropometric measurements, diet quality and physical activity questionnaires were administered. Overnight fasting saliva was collected to determine levels of adiponectin, interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α).

RESULTS

Salivary adiponectin was significantly lower, while TNF-α was higher in obese than normal-weight subjects. IL-10 displayed a lower trend in obese subjects. Though diet quality and physical activity did not exhibit significant differences among the three groups, better diet quality and higher physical activity level were reported among normal-weight subjects. Salivary TNF-α correlated positively with body mass index (BMI) (r = 0.37; p < 0.001) and waist circumference (r = 0.31; p < 0.001), while adiponectin correlated negatively with BMI (r = -0.28; p < 0.05). IL-10 showed negative trend in correlation with obesity measures. Correlations were not observed between diet quality and physical activity with salivary adipocytokines. Interestingly, a significant negative correlation emerged between diet quality and neck circumference (r = -0.24; p < 0.05).

CONCLUSION

Our findings demonstrate that salivary adipocytokines correlate with obesity measures and can serve as convenient adjunct method in predicting cardio-metabolic risks in the population.

Plasma levels of Apolipoprotein A1 and Lecithin:Cholesterol Acyltransferase in type 2 diabetes mellitus: Correlations with haptoglobin phenotypes

BACKGROUND

Previous studies have demonstrated that hemoglobin-haptoglobin (Hb-Hp) complex plays a role in developing vascular complications in type 2 diabetes mellitus (T2DM). The complexes bind with Apolipoprotein A1 (ApoA1) of high-density lipoprotein (HDL), affecting the function of Lecithin:Cholesterol Acyltransferase (LCAT), and impairing the reverse cholesterol transport mechanism (RCT). This study investigated the influence of Hp phenotypes on serum levels of ApoA1 and LCAT in patients with T2DM.

METHODS

The study comprised 131 T2DM patients and 111 matching healthy controls. Fasting blood glucose, HbA₁C, and lipid profile were determined by chemistry autoanalyzer, LCAT and ApoA1 by ELISA, and Hp phenotypes by gel electrophoresis.

RESULTS

Irrespective of Hp phenotypes, fasting blood glucose, HbA₁C, and lipid profile were significantly higher in patients than in controls, while HDL-cholesterol, ApoA1, and LCAT were lower. ApoA1 correlated positively with LCAT (r=0.223, p=0.024) and HDL-cholesterol (r=0.255, 0.003) in patients only. When Hp polymorphism was taken into account, the levels of LCAT and ApoA1 were significantly lower in patients with Hp2-2 than that in patients of Hp1-1 and/or Hp2-1. Correlations between ApoA1 and each of HDL-cholesterol and LCAT (r=0.239, p=0.046, and r=0.252, p=0.040, respectively) were also observed, but only in patients with Hp2-2 phenotype.

CONCLUSIONS

The reduced levels of LCAT and ApoA1 observed in this study support the suggestion that T2DM patients with Hp2-2 phenotype could have altered RCT mechanism and increased risk of developing cardiovascular disease.

Waist circumference is a major determinant of oxidative stress in subjects with and without metabolic syndrome

AIM

Oxidative stress (OS) plays a major role in pathogenic mechanisms associated with metabolic syndrome (Mets) yet the main component of Mets contributing most to OS is not well elucidated. Hence, the aim of this study was to investigate the oxidative-antioxidative status in Mets subjects and to determine the main predicting component of OS.

METHODS

Anthropometric measures, fasting blood glucose, lipid profile, antioxidant enzymes [catalase, superoxide dismutase (SOD) and glutathione peroxidase (GPx)], reduced glutathione (GSH), malondialdehyde (MDA) and protein carbonyl were assessed in 172 adult UAE residents. International Diabetes Federation criteria were used for Mets diagnosis. Mets Scores (0-5) were calculated and assigned per subject based on number of components.

RESULTS

Of all participants, 22.1% had Mets and 49.4% had large waist circumference (WC). Significant lower levels of catalase, SOD, GPx and GSH, and higher levels of MDA and protein carbonyl were observed in subjects with Mets. In addition, catalase, SOD, GPx, and GSH correlated negatively, while MDA and protein carbonyl correlated positively with almost all Mets components. Similar trend of correlations was noticed with Mets Scores. When adjusted for age and gender, linear regression analysis revealed that subjects with large WC demonstrated significantly lower levels of antioxidative enzymes and GSH, and higher levels of MDA and protein carbonyl. Consequently, WC emerged as the best predictor of OS.

CONCLUSIONS

The degree of OS is dependent on the Mets Scores, and WC contributes independently to increased OS among adults in UAE.

A possible clonidine-trazodone-dextroamphetamine interaction in a 12-year-old boy

A 12-year-old boy on a dextroamphetamine-clonidine-trazodone treatment regimen had a recurrence of insomnia, and his bedtime trazodone dose was doubled from 50 mg to 100 mg. Within 45 mins after taking the first 100-mg trazodone dose on an empty stomach, the patient had a syncopal episode associated with hypotension, bradycardia, and sedation. The drug reaction could have resulted from either trazodone or clonidine, but it is more likely to have resulted from a pharmacodynamic clonidine-trazodone interaction, presumably aggravated by rapid absorption (on an empty stomach) of a recently increased dose of trazodone. It is conceivable but less likely that the psychostimulant was a clinically significant factor. However, a drug interaction between clonidine and D-amphetamine does not need to be postulated to explain this child's syncopal reaction. The authors advise that (1) if trazodone and clonidine are used concurrently, the doses of both agents should be changed slowly, (2) blood pressure and pulse should be carefully monitored at baseline and then periodically during treatment, and (3) administration of trazodone on an empty stomach, and especially dose increases on an empty stomach, should be avoided. Physicians should remain aware that trazodone has the potential to produce hypotension and sedation, especially when combined with other agents (such as clonidine) that might produce the same adverse effects.

Metformin enhances LDL-cholesterol uptake by suppressing the expression of the pro-protein convertase subtilisin/kexin type 9 (PCSK9) in liver cells

PURPOSE

Metformin (MF) intake associates with reduced levels of circulating low-density lipoprotein-cholesterol (LDL-C). This has been attributed to the activation of AMPK, which differentially regulates the expression of multiple genes involved in cholesterol synthesis and trafficking. However, the exact mechanism underlying the LDL-C lowering effect of MF remains ambiguous.

METHODS

MF-treated Hep-G2 and HuH7 cells were evaluated for cell viability and the expression status of key lipid metabolism-related genes along with LDL-C uptake efficiency.

RESULTS

MF treatment resulted in decreased expression and secretion of PCSK9, increased expression of LDLR and enhanced LDL-C uptake in hepatocytes. It also resulted in increased expression of activated AMPK (p-AMPK) and decreased expression of SREBP2 and HNF-1α proteins. Transcriptomic analysis of MF-treated Hep-G2 cells confirmed these findings and showed that other key lipid metabolism-related genes including those that encode apolipoproteins (APOB, APOC2, APOC3 and APOE), MTTP and LIPC are downregulated. Lastly, MF treatment associated with reduced HMG-CoA reductase expression and activity.

CONCLUSIONS

These findings suggest that MF treatment reduces circulating LDL-C levels by suppressing PCSK9 expression and enhancing LDLR expression; hence the potential therapeutic utility of MF in hypercholesterolemia.

Total antioxidant capacity and ischemia modified albumin in beta thalassemia

BACKGROUND

Total antioxidant capacity (TAC) and ischemia modified albumin (IMA) are common parameters used to assess the status of oxidative stress under different conditions. This study reports on TAC and levels of IMA in patients with beta-thalassemia major.

METHODS

Blood specimens were collected from 98 subjects (55 beta-thalassemia major patients and 43 healthy controls). Serum levels of IMA and TAC were determined using conventional biochemical methods. Serum levels of ferritin, iron, TIBC, ALT, bilirubin, total protein, and albumin were measured using automated chemistry analyzers.

RESULTS

Levels of TIBC were significantly lower, and those of ferritin, iron, percentage of transferrin saturation, ALT, total and direct bilirubin were significantly higher in patients than in controls. No significant differences were observed between patients and controls with respect to total protein and albumin. TAC levels, expressed as mM Trolox equivalents, were significantly lower in patients than in controls (0.197 +/- 0.106 vs. 0.274 +/- 0.122, p < 0.01). Serum levels of IMA (ABSU) were significantly higher in patients than in controls (0.543 +/- 0.124 vs. 0.452 +/- 0.085, p < 0.01). Spearman univariate analysis demonstrated significant inverse correlations of TAC with both IMA and ferritin (r = -0.307, p < 0.05 and r = -0.395, p < 0.01, respectively) and significant direct correlation of IMA with ferritin (r = 0.519, p < 0.01).

CONCLUSIONS

This study demonstrates the presence of a significant inverse correlation between total antioxidant capacity and IMA; this further argues for the inclusion of IMA as one of the oxidative stress markers in thalassemic patients.

The relationship between haptoglobin polymorphism and serum ceruloplasmin ferroxidase activity

The antioxidative potential of haptoglobin is type dependent; Hp2-2 has much lower antioxidative capacity than Hp1-1 or Hp2-1. It is therefore possible that other antioxidants may compensate for decreased antioxidative capacity in Hp2-2 individuals. Haptoglobin polymorphism was correlated with ceruloplasmin ferroxidase activity in a sample population of unrelated black Jordanians. Hp2-1 was the predominant type, occurring at a frequency of 0.518 and Hp2 was the common allele, occurring at a frequency of 0.6455; no Hp0-0 individuals were observed in the sample population. In general, haptoglobin concentration was highest among Hp1 homozygotes and lowest among Hp2 homozygotes, while ceruloplasmin ferroxidase activity was highest among Hp2 homozygotes and lowest among Hp1 homozygotes. Furthermore, ceruloplasmin ferroxidase activity was higher at haptoglobin concentrations >85 mg/dl compared with that at haptoglobin concentrations of 30-85 mg/dl, which was also higher than at haptoglobin concentrations <30 mg/dl, irrespective of haptoglobin type. These results suggest that ceruloplasmin ferroxidase activity is both haptoglobin type and concentration dependent.

Vitamin A levels are decreased but not influenced by glucose- or lipid-lowering medications in subjects with type 2 diabetes

Background and aim

Type 2 diabetes (T2D) is a complex polygenic disease with unclear mechanisms. Clinical studies on the association of vitamin A with T2D in humans are still controversial. Herein, we aimed to investigate the plasma levels of vitamin A, predictor factors, and its correlations with clinical phenotypes in Emirati population. The effect of glucose-and lipid-lowering medications on vitamin A levels was also studied.

Methods

A cross-sectional cohort comprised 158 T2D-subjects and 90 healthy controls were recruited from the United Arab Emirates National Diabetes Study (UAEDIAB). All anthropometric, clinical, and biomedical measurements were collected. Plasma levels of vitamin A were determined using ELISA assay.

Results

Levels of vitamin A were significantly lower in T2D-subjects compared to healthy control (p < 0.01). Vitamin A levels were unaffected by gender base and inversely correlated with age, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), waist circumference, triglycerides, and body mass index (BMI). Regression analysis revealed that HbA1c and age are predictors for vitamin A. Intake of glucose- or lipid-lowering medications showed no effect on vitamin A levels.

Conclusion

HbA1c and age are predictors for low levels of vitamin A among Emirati-T2D subjects. No influence of glucose and lipid-lowering medications on the plasma levels of vitamin A.

Combined intake of glucose-and lipid-lowering medications further elevates plasma levels of PCSK9 in type 2 diabetes patients

BACKGROUND AND AIM

This study examined the status of plasma levels of protein convertase subtilisin/kexin 9 (PCSK9) in association with glucose-and lipid-lowering medications in subjects with type 2 diabetes (T2D).

METHODS

This study comprised 177 diabetics and 115 non-diabetic subjects recruited from the United Arab Emirates National Diabetes Study (UAEDIAB). Clinical and biomedical data were collected by standard techniques. Plasma levels of PCSK9 were determined using ELISA.

RESULTS

PCSK9 levels were higher in diabetics than non-diabetics (P < 0.001). Diabetics with disease duration >5 years, HbA1c > 7.0%, or male subjects, had significantly higher levels of PCSK9 than their counterparts (P < 0.05). Regression analysis revealed that HbA1c and age are predictors for PCSK9 in T2D subjects. Diabetic subjects with abnormal lipids profile on lipid-lowering medications had a higher level of PCSK9 compared to those with normal lipids profile (85.6 ± 40.5 vs. 63.7 ± 39.5 ng/ml, respectively; P < 0.01). Diabetics on combined intake of insulin and oral glucose-lowering drugs had higher levels of PCSK9 than those not taking any (86.1 ± 41.6 vs 69.7 ± 36.1 ng/ml, respectively; P < 0.05). The highest levels of PCSK9 however, were in diabetics on combined lipid- and glucose-lowering therapy when compared to those, not on any (96.2 ± 34.0 vs 66.0 ± 35.1 ng/ml, respectively; P < 0.01).

CONCLUSIONS

Age and HbA1c are the most predictors for the elevated levels of PCSK9 in Emirati T2D subjects. Combined therapy of glucose-and lipid-lowering medications further elevates plasma levels of PCSK9 in diabetic subjects.

Haptoglobin polymorphism modulates cardiometabolic impacts of four consecutive weeks, dawn to sunset Ramadan intermittent fasting among subjects with overweight/obesity

AIMS

Haptoglobin (Hp) is a multifaceted marker of inflammation, and mediates the interplay between obesity, inflammation, and cardiometabolic dysfunction. However, the role of the Hp phenotype in modulating intermittent fasting (IF)-induced cardiometabolic changes remains to be elucidated.

METHODS

Hp phenotype was determined for the study subjects. Cardiometabolic markers were assessed before and at the end of four consecutive weeks, dawn to sunset IF.

RESULTS

A total of 114 subjects (75 males and 39 females, 38.7 ± 11.7 years, body mass index (BMI) of 30.41 ± 5.09 kg/m²) were recruited. Hp2-2 (n = 55, 48.2 %) and Hp2-1 (n = 53, 46.5 %) were the predominant phenotypes. Significant reductions were observed in serum Hp, IL-6, TNF-α, triglycerides (TG), total cholesterol (TC), LDL, BMI, and fat mass (FM), while a significant elevation was observed in serum CD163, HDL, and IL-10 at the end of the IF month for the whole population. Based on the Hp polymorphism, significant decreases in Hp, BMI, FM, TG, LDL, and TNF-α, with significant increases in HDL and CD163 levels were observed among subjects with Hp2-2 and Hp2-1 phenotypes. A more pronounced reduction in FM was reported in subjects with Hp2-2 in comparison with Hp2-1.

CONCLUSION

Hp gene polymorphism modulates IF-induced changes in cardiometabolic markers.

CLINICAL TRIAL REGISTRATION NUMBER

ISRCTN18205186; https://trialsearch.who.int/?TrialID=ISRCTN18205186.

Modulation of Anti-Oxidant, Anti-Inflammatory and Metabolism-Controlling Genes Expressions by Ramadan Intermittent Fasting: A Prospective Observational Study

Objectives

A mounting evidence confirms the effect of caloric restriction and intermittent fasting in ameliorating body oxidative stress and inflammation. A growing body of evidence supports that chronic inflammation and increased level of oxidative stress augment the way for the development of metabolic diseases, such as diabetes and cancers. Objectives: This research was conducted to examine the effect of Ramadan diurnal intermittent fasting (RDIF) on the gene expression of cellular metabolism (SIRT1 and SIRT3) and antioxidant genes (TFAM, SOD2, and Nrf2).

Methods

One-hundred fourteen (75 males and 39 females) overweight and obese subjects and twelve healthy body weight controls were followed-up before and after Ramadan. Dietary, anthropometric and biochemical assessments were performed before and at the end of Ramadan fasting month.

Results

Results showed that the relative gene expressions in obese subjects in comparison to counterpart expressions of controls showed a significant (P &lt; 0.001) increase in the anti-inflammatory cytokine (IL-10), along with significant (P &lt; 0.001) reductions in the proinflammatory cytokines (IL-6 and TNF-alpha). Expression of TFAM, SOD2, and Nrf2 significantly increased at the end of Ramadan (90.5%, 54.1%, and 411.5%, respectively). However, the metabolism-controlling gene (SIRT3) showed a highly significant (P &lt; 0.001) downregulation accompanied by a trend for reduction in the SIRT1 gene at the end of Ramadan month, with % decrements of 61.8% and 10.4%, respectively.

Conclusions

Results suggest that RIF ameliorates the genetic expression of antioxidant and anti-inflammatory and metabolic regulatory genes. Thus, RIF presumably may entail a protective impact against oxidative stress and its adverse metabolic-related derangements in non-diabetic obese patients.

Funding Sources

University of Sharjah, UAE.

PCSK9 Inhibitors as Adjunctive Therapies in Hypercholesterolemia: Benefits, Limitations, and Possible Alternatives

The clinical application of statins as anti‐hypercholesterolemia medications, while very beneficial, remains limited by intolerance and side effects. Statins increase the production of proprotein convertase subtilisin/kexin type 9 (PCSK9), which degrades low‐density lipoprotein (LDL) receptor and limits circulating LDL cholesterol (LDLC) uptake. PCSK9 also promotes cardiomyocyte and vascular smooth muscle cell apoptosis and vascular injury. Several PCSK9 inhibitors (evolocumab, alirocumab, and inclisiran) are highly effective at reducing plasma LDLC levels and moderately effective at protecting against cardiovascular disease. However, their long‐term use needs to take the following issues into account: i) PCSK9 deficiency leads to various pathologies like heart failure and liver steatosis, ii) PCSK9 regulates lipid homeostasis, iii) depletion of circulating PCSK9 may itself upregulate PCSK9 expression, and iv) the cost of available inhibitors is beyond the reach of most people. Therefore, the long‐term safety and affordability of PCSK9 inhibitors needs to be revisited and additional therapeutic options need to be explored.