HLA-B gene methylation and expression in Behçet's syndrome: a potential role of epigenetics in the pathogenesis

OBJECTIVES

The HLA-B51 locus has the strongest association with Behçet's syndrome (BS). The presence of a CpG island in the HLA-B gene led us to examine the role of epigenetic regulation in BS.

METHODS

HLA-B51 genotyping was performed via sequence-specific PCR in 15 index familial BS cases, 17 affected relatives, 26 unaffected relatives, 46 sporadic BS cases, and 41 healthy controls. HLA-B methylation level was determined using the Zymo OneStep qMethyl kit, and HLA-B51 mRNA level was assessed by quantitative real-time PCR in 14 index familial BS cases, 15 affected relatives, 15 unaffected relatives, 11 sporadic BS cases, and 10 healthy controls.

RESULTS

HLA-B51 carrier ratio was 13/15 in index familial cases, 13/17 in affected relatives, 22/26 in unaffected relatives, 8/25 in healthy controls, and 35/47 in sporadic BS cases. HLA-B51 expression level in HLA-B51+ BS cases was 2.2-fold higher than in their unaffected relatives (p=0.0149) and 1.3-fold higher than in healthy controls (p=0.0188), while sporadic BS cases had a 2.7-fold higher level than healthy controls (p=0.0487). HLA-B promoter methylation was significantly lower in HLA-B51+ familial BS cases than in unaffected relatives (0.4-fold, p=0.01), affected relatives (0.36-fold, p=0.0219), and healthy controls (0.34-fold, p=0.0371) and slightly lower in HLA-B51+ sporadic BS cases than in healthy controls (0.71-fold, p=0.2347). There was an inverse correlation between HLA-B promoter methylation and HLA-B51 expression in HLA-B51+ sporadic BS cases (p=0.0164).

CONCLUSIONS

This study indicates epigenetic involvement associated with the HLA-B51 locus in BS, both in familial and sporadic cases. Further studies with larger sample sizes are needed to confirm our results.

Increase in subcutaneous adipose tissue in the frontal scalp may be associated with androgenetic alopecia and metabolic syndrome

OBJECTIVE

Recent studies have suggested that androgenetic alopecia (AGA) may be associated with other disorders, especially metabolic syndrome (MetS). This study aimed to determine whether a connection exists between MetS and AGA based on the thickness of the subcutaneous adipose tissue in the scalp.

PATIENTS AND METHODS

This cross-sectional study included 34 participants with AGA who had MetS and 33 participants with AGA who did not have MetS. The Hamilton-Norwood scale was employed for classifying AGA and MetS was identified using the US National Cholesterol Education Programme Adult Treatment Panel III (NCEP-ATP III criteria). The body mass index (BMI), blood pressure, and lipid profiles of the participants were assessed. Hepatosteatosis and the thickness of the subcutaneous adipose tissue in the scalp were examined using ultrasonography.

RESULTS

Compared with the control group, the MetS+AGA group had higher BMI (p = 0.011), systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001) and waist circumference (p = 0.003). Furthermore, the MetS+AGA group had a higher prevalence of dyslipidemia, hypertension (HT) and diabetes mellitus (DM) and higher rates of grade 6 alopecia than the control group (p = 0.019). Compared with the control group, those with MetS had thicker subcutaneous adipose tissue in the frontal scalp (p = 0.018).

CONCLUSIONS

The subcutaneous adipose tissue in the frontal scalp was thicker in individuals with AGA who had high Hamilton scores. The concomitance of AGA and MetS may be associated with a high increase in subcutaneous adipose tissue and less favorable metabolic parameters.

The significance of a novel inflammatory biomarker, presepsin, in predicting disease prognosis in patients with COVID-19

OBJECTIVE

This study aims at determining the significance of a novel inflammatory biomarker, presepsin, in predicting disease prognosis in patients with COVID-19.

PATIENTS AND METHODS

This retrospective study was concluded at the University Hospital between April and August 2020. The study involved 88 COVID-19 patients (48 men and 40 women). The patients were categorized into two groups: the patients admitted to the COVID-19 clinic, described as the moderate COVID-19 patients (Group-1; n=44), and those admitted to the internal medicine outpatient clinic, who were the mild COVID-19 patients (Group-2; n=44). The groups were compared using inflammatory markers: presepsin, C-Reactive Protein to Albumin Ratio, Neutrophil to Lymphocyte Ratio, and procalcitonin.

RESULTS

Serum presepsin levels (195.29 vs. 52.12 pg/ml) were significantly higher in the Group-1 compared to the Group-2 (p=0.001). The gender distribution and average age were similar in both groups (p > 0.05). While ferritin, lactate dehydrogenase, D-Dimer, platelet lymphocyte ratio, C-Reactive Protein to Albumin Ratio (p=0.001), erythrocyte sedimentation ratio, C-Reactive Protein and presepsin were significantly higher in the Group-1 compared to Group-2 (p<0.05), while hemoglobin and lymphocyte were significantly lower in the Group-1 than in Group-2 (p<0.05).

CONCLUSIONS

Serum presepsin levels were found to be significantly higher in moderate clinical group COVID-19 patients compared to mild group. Presepsin, a new inflammatory biomarker, may be useful in predicting the prognosis and early treatment of COVID-19 infection.

The novel predictor of metabolic risk in patients with polycystic ovary syndrome: could it be the visceral adiposity index?

OBJECTIVE

Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder in women of reproductive age, often accompanied by high androgen levels, irregular menstrual cycles and polycystic ovaries. In addition, patients with PCOS also present with an increase in abdominal adipose tissue and insulin resistance. Recently, the gender-specific mathematical formulation called visceral adiposity index (VAI) has been widely used in assessing cardiometabolic risk. This study aimed at comparing the VAI values of patients with PCOS, patients with idiopathic hirsutism (IH) and a control group.

PATIENTS AND METHODS

We obtained demographic data, laboratory results and anthropometric measurements of patients from the hospital database. We retrospectively grouped all cases included in the study as PCOS (n = 52), IH (n = 57) and control (n = 58) according to the diagnoses. We also took venous samples for hormone and biochemical tests in the early follicular phase of the menstrual cycle, at least 8-10 hours after fasting in the early morning hours. Finally, we evaluated the variables using SPSS 22.0 software (IBM Corp., Armonk, NY, USA).

RESULTS

We included 167 female individuals in the study. Of these, 57 (34.1%) were diagnosed with IH, while 52 (31.1%) were diagnosed with PCOS. The control group comprised 58 (34.8%) healthy female individuals. The median age of the study group was 25 years [interquartile range (IQR) = 8 years]. The age, height, weight, body mass index (BMI) and waist circumference values of the groups were similar. We found that the VAI values among the groups were significantly different (p = 0.028). Post-hoc analysis determined that this was due to the difference between the group with PCOS and the control group. In addition, we found significantly high HOMA-IR, fasting insulin and androgen levels in the group with PCOS (p < 0.001).

CONCLUSIONS

After comparing data in groups with similar BMI levels, we found significantly high VAI values in patients with PCOS. The results reinforce the idea that VAI is a useful marker easily obtained in daily practice for assessing the cardiometabolic risk of patients with PCOS.

The novel biomarker, neopterin, can predict the severity of COVID-19

OBJECTIVE

SARS-CoV-2 infection primarily affects T-lymphocytes, particularly CD4+ and CD8+ T cells. However, there is a need for simpler and less expensive laboratory tests with predictive values comparable to CD4+ cell counts. Thus, the goal of this study was to investigate the role of neopterin levels in predicting intensive care and mortality in coronavirus disease patients in 2019.

PATIENTS AND METHODS

This retrospective study included 87 hospitalized patients who were diagnosed with COVID-19. Patients were divided into two groups: those receiving intensive care (Severe COVID-19; S-COVID-19) and those receiving non-intensive care (Moderate COVID-19; M-COVID-19). Patients' clinical characteristics, serum neopterin levels, and other laboratory data were compared across groups.

RESULTS

The average age was 63.9±155.2 years, and 44 (%) of the participants were male. WBC (p = 0.008), neutrophil (p = 0.002), HDL (p = 0.009), ferritin, calcium, albumin, LDH, APTT, lymphocyte, INR, D-dimer, troponin, prothrombin time sedimentation, and PaO2 (p = 0.001) were all associated with death. The neopterin level in the M-COVID-19 group was 3 (min-max; 3.1-5.9) and 3.2 (2.3-7) in the S-COVID-19 group, with no statistically significant difference (p = 0.456). Gender differences between groups were not significant (p = 0.183). According to the ROC analysis, if parameters such as age, D-Dimer, troponin, ferritin, albumin, LDH, CRP, procalcitonin, and PaO2 exceed the cut-off values and lymphocyte levels are below, it can predict the need for intensive care and mortality in COVID-19 patients.

CONCLUSIONS

Although we did not find statistically significant results with neopterin in terms of mortality in COVID-19 individuals in our study, more thorough, prospective, randomized controlled studies with expanded patient populations at various phases of the disease are needed.

Investigation on the prevalence of thyroid cancer in Graves' patients in northeastern part of Turkey: is surgery a better option for patients with Graves' disease who develop antithyroid drug-related major adverse events?

OBJECTIVE

To determine the prevalence of thyroid cancer in Graves' patients who underwent surgical intervention with and without a history of anti-thyroid drug related major adverse events.

PATIENTS AND METHODS

The data of 530 patients with Graves' disease between 2015 and 2020 were retrospectively reviewed. Preoperative ultrasonography reports and thyroid-stimulating hormone receptor antibody values and postoperative histopathological findings were available for 94 patients that had undergone total thyroidectomy procedure. We compared the prevalence of thyroid cancer between patients with and without a history of anti-thyroid drug related major adverse events.

RESULTS

Thyroid cancer was detected in 31 of 94 patients that had undergone total thyroidectomy. Of these patients, 18 had at least one nodule; however, thyroid cancer was incidentally detected in 13 patients without nodule. The 31 patients had the following cancer subtypes: 22 had papillary microcarcinoma, 8 papillary carcinoma and 1 noninvasive follicular thyroid neoplasm with papillary-like nuclear features. While thyroid cancer was present in half of the patients operated owing to anti-thyroid drug-related major adverse event, it was detected in 30% of the patients operated due to other reasons.

CONCLUSIONS

In the present study, the prevalence of thyroid cancer among patients with Graves' disease was found to be much higher than those of other studies in the literature, suggesting that surgery can be considered primarily for the treatment of Graves' disease. Considering the surgical option in the first plan instead of radioactive iodine therapy appears to be reasonable in patients who develop anti-thyroid drug-related major adverse events.

THE FAMILIAL HYPOCALCIURIC HYPERCALCEMIA PRESENTED WITH ADVANCED HYPERCALCEMIA AND EXTREMELY HIGH PARATHORMON LEVELS (CASE REPORT)

Familial Hypocalciuric Hypercalcemia (FHH) is a rare benign condition inherited in an autosomal dominant pattern with high penetrance. This rare genetic condition is detected in approximately 2% of cases examined as primary hyperparathyroidism (PH). The Calcium Sensing Receptor (CaSR) gene's inactivating mutations result in a calcium-parathormone level-saturation curve shift to the right. Generally, the calcium level does not exceed 11,5 mg/dl and the PTH is seen normal. In our case and in her family, extreme high blood calcium levels up to 14 mg/dl and accompanying advanced parathyroid hormone levels rising up to five times the upper limit of normal were detected. Due to these high PTH levels and advanced hypercalcemia, she was thought to have PH as a primary diagnosis. The case and her family are an interesting phenomenon that do not clinically fit classical FHH.

Establishing a new screening 17 hydroxyprogesterone cut-off value and evaluation of the reliability of the long intramuscular ACTH stimulation test in the diagnosis of nonclassical congenital adrenal hyperplasia

OBJECTIVE

Nonclassical congenital adrenal hyperplasia (NCAH) is a common genetic transmitted endocrinological disease. The validity of screening by using a 17 hydroxyprogesterone (17 OH-P) cut-off level of 2 ng/ml is controversial due to the frequent overlap with the polycystic ovary syndrome (PCOS). The availability of the standard intravenous cosyntropin (ACTH) formula is a problem in many countries including our country and the diagnostic test is performed by using the intramuscular depot form. In this study, we aimed to determine our own cut-off value for screening and to test the reliability of long intramuscular ACTH stimulation test in our patients.

PATIENTS AND METHODS

One hundred and seventy-five fertile age women whose basal follicular phase 17 OH-P level above 2 ng/ml were included in the study. All of the patients underwent an intramuscular long cosyntropin (ACTH) stimulation test.

RESULTS

17 OH-P levels were above 10 ng/ml in 16 of 175 (9.14%) patients who were compatible with the diagnosis of NCAH. There was no significant difference between NCAH, PCOS and idiopathic hyperandrogenism (IH) groups in terms of hirsutism and hyperandrogenemia. In ROC analysis, 3.19 ng/ml was found to be a reliable cut-off value (AUC: 0.698, 95% GA: 0.540-0.855, p <0.05). In the extended intramuscular ACTH stimulation test, sensitivity increased from 56.2% to 91.6% at 180th minute CONCLUSIONS: Our study gives a perspective about the detection of screening threshold value for the diagnosis of NCAH and the availability of the intramuscular long ACTH stimulation test.

Clinical significance of ADAMTS1, ADAMTS5, ADAMTS9 aggrecanases and IL-17A, IL-23, IL-33 cytokines in polycystic ovary syndrome

PURPOSE

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. A disintegrin and metalloproteinase with thrombospondin-like motifs (ADAMTS) are involved in inflammation and fertility. The aim of this investigation was to evaluate the serum levels of ADAMTS1, ADAMTS5, ADAMTS9, IL-17, IL-23, IL-33 and to find out the relationship between these inflammatory cytokines and ADAMTSs in PCOS patients.

METHODS

A case-control study was performed in a training and research hospital. Eighty patients with PCOS and seventy-eight healthy female volunteers were recruited in the present study. Serum ADAMTS and IL levels were determined by a human enzyme-linked immunoassay (ELISA) in all subjects.

RESULTS

The IL-17A, IL-23 and IL-33 levels were significantly higher in the PCOS patients compared to the controls (p < 0.05). We could not find significant difference between the groups in terms of ADAMTS1, ADAMTS5 and ADAMTS9 levels. IL-17A had positive correlations with LDL cholesterol and IL-33 and negative correlations with ADAMTS1, ADAMTS5, and ADAMTS9. IL-33 had positive correlation with LDL cholesterol and IL-17A. In ROC curve analysis, PCOS can be predicted by the use of IL-17A, IL-23 and IL-33 which at a cut-off value of 8.37 pg/mL (44 % sensitivity, 83 % specificity), 26.75 pg/mL (36 % sensitivity, 64 % specificity) and 14.28 pg/mL (83 % sensitivity, 39 % specificity), respectively.

CONCLUSIONS

The results of the study might suggest that ADAMTS and IL molecules have a role in the pathogenesis of the PCOS. Further efforts are needed to establish causality for ADAMTS-IL axis.

Serum nesfatin-1 levels in overt and subclinical hyperthyroidism

AIM

Nesfatin-1 was recently discovered anorexigenic peptide in the brain which is derived from nucleobindin-2. Central and peripheral administration of nesfatin-1, inhibits food intake, dose-dependently. Hyperthyroid patients have increased appetite and food intake with a craving for carbohydrate-rich food, at the beginning of disease, but the physiological mechanisms underlying this behavior is not known exactly. In this study, we investigated whether nesfatin-1 is involved in the regulation of appetite and body weight in hyperthyroidism, or not.

METHODS

A total of 70 patients with subclinical (35) and overt hyperthyroidism (35) compared with 35 control patients. Serum nesfatin-1 level was measured from all samples by commercial ELISA kit.

RESULTS

Serum nesfatin-1 levels were similar between three groups (P=0.293). After adjusting for age and body mass index, nesfatin-1 levels in control group was not different from subclinical and overt hyperthyroid group, respectively (P=0.567 and P=0.519).

CONCLUSION

These data showed that serum nesfatin-1 levels do not significant change in overt and subclinical hyperthyroidism.

Dental age assessment in orthodontic patients with and without skeletal malocclusions

BACKGROUND

The aim of this report was to investigate the dental development in an orthodontic patient population with and without different sagittal skeletal malocclusions.

SETTING AND SAMPLE POPULATION

Department of Orthodontics, Faculty of Dentistry, Ataturk University, Turkey.

MATERIAL AND METHODS

A retrospective study was performed on a sample of panoramic radiographs taken from 525 orthodontic patients (Class II: 186, Class III: 177, Class I: 162) aged between 9.00 and 15.00 years. Dental age (DA) from panoramic radiographs was assessed. Statistical analyses showing the differences between chronological age (CA) and DA were compared by using the one-way anova, paired, and Student's t-tests.

RESULTS

Both genders were advanced in dental maturity when compared with the reference samples (p = 0.000). The mean difference between CA and DA in orthodontic patients with different skeletal malocclusions was approximately twice the difference in the Class I group. However, the difference between CA and DA was statistically significant for girls in Class III group (p = 0.021).

CONCLUSION

The results of this study showed that DA of patients with sagittal skeletal malocclusions was approximately twice more advanced when compared with patients without sagittal skeletal anomaly patterns.

Human ? defensin-1 and -2 expression in the gingiva of patients with specific periodontal diseases

BACKGROUND AND OBJECTIVE

beta defensin antimicrobial peptides are important in epithelial innate immunity, and their differential expression is associated with periodontal diseases. The aims of this study were to determine the mRNA expression of human beta defensin-1 and -2 in the gingival tissue of patients with gingivitis, aggressive periodontitis and chronic periodontitis, and to evaluate the relationship between defensin expression and type and/or severity of periodontal destruction.

MATERIAL AND METHODS

Fifteen patients in each group with gingivitis, aggressive periodontitis and chronic periodontitis, and 10 healthy subjects, were included in the study (n=55). The periodontal status of the subjects was determined by periodontal clinical measurements and radiographical evaluations. Transcriptional levels of human beta defensin-1 and -2 genes in gingival samples were assessed by using the quantitative real-time polymerase chain reaction technique, and the data were evaluated statistically by the relative expression Software Tool 2 for groupwise comparisons.

RESULTS

Expression of the human beta defensin-1 gene was lower in gingivitis and aggressive periodontitis groups, and significantly higher in the chronic periodontitis group, than in the control group (p<0.001). Human beta defensin-2 mRNA expression in the gingivitis group was lower than in the control group; however, the difference was statistically significant only in half of the gingivitis patients (p<0.001). Human beta defensin-2 mRNA levels were higher in some chronic periodontitis patients, but lower in the others when compared with the control group (p<0.001). Expression of the human beta defensin-2 gene increased in the aggressive periodontitis group relative to the control group.

CONCLUSION

This study suggests that human beta defensin-1 and -2 genes in the gingival epithelium show differential expression in patients with specific periodontal diseases, and aggressive and chronic periodontitis types demonstrate different gingival beta defensin-1 and -2 expression patterns.

Evaluation of Lateral Mechanical Tension in Thin-Film Tissue Constructs

Fibroblast-populated collagen matrices provide a simplified tissue model for wound healing and development processes. A technology (CELLDRUM Technology) evaluating lateral mechanical tension in fibroblast-populated collagen matrices (tissue constructs) with a thickness of 1 mm was introduced. Defined mechanical boundary conditions together with the known number and orientation of the cells revealed precise data on the average tension exerted by a single cell. Circular cell-populated collagen gels were manufactured inside the CELLDRUM on top of a flexible membrane. The collagen matrix was then excited by a sound pulse. The resulting resonance oscillation was monitored by a laser-based deflection sensor and frequency and damping were analyzed giving information on mechanical properties of the tissue construct. Several evaluation experiments were performed. Calf serum enhanced contractile forces of fibroblasts dose dependently. After the gels were treated with cytochalasin D for 24 h, the cell forces were reduced by 42% of control. The remaining tension was attributed to the extracellular matrix remodeling occurring during cell growth and to other cytoskeletal structures like microtubules and intermediate filaments. We also found that only after a few hours of culture fibroblast-seeded collagen gels began developing significant mechanical tension. A mechanical tension profile of proliferating fibroblasts in collagen gels over culture time was obtained.

Observation of bacteria and fungi in infected root canals and dentinal tubules by SEM

The aim of this study was to observe the root canal flora and possible penetration of microorganisms into dentinal tubules in teeth with necrotic pulps. Ten infected maxillary and mandibular molars with periapical lesions were extracted and fixed in 2.5% phosphate-buffered glutaraldehyde solution for nine days. After separation from the crowns, longitudinal grooves were cut in the roots, and they were split into two halves. The specimens were prepared for SEM. The root canals and the dentinal tubules of the fractured dentin were scanned systematically from the cervical to the apical area of the root. Cocci and rods were seen in 6 specimens. Penetration of bacteria into the dentinal tubules ranged from 10 to 150 microns. In 4 specimens, the root canals were heavily invaded by yeasts. The antimicrobial effect of routinely used endodontic disinfectants also on yeasts may be considered in persistent root canal infections.