Serum interleukin-6 and high sensitivity C-reactive protein levels and their correlation with the vitiligo disease activity and extent: A cross-sectional study of 58 patients.

Vitiligo is an acquired depigmenting disorder due to the destructive loss of melanocytes, clinically presenting as hypopigmented or depigmented macules and/or patches. Many theories have been proposed to explain its etiopathogenesis among which cell-mediated immunity is one of the crucial links. Estimation of vitiligo activity and extent in a patient is important in tailoring an optimal treatment regimen. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (HsCRP) are sensitive indicators for systemic inflammation and are found to be relevant in determining vitiligo disease activity. This study was conducted to estimate serum levels of IL-6 and HsCRP in vitiligo patients and to correlate them with the disease activity and extent in order to assess if these serum markers serve as objective indicators of vitiligo disease activity. This was a hospital-based cross-sectional study of 58 vitiligo patients diagnosed clinically irrespective of age, gender, and any ongoing or past treatment. Disease activity and extent were calculated using the vitiligo disease activity (VIDA) score and vitiligo area severity index (VASI), respectively. Serum levels of IL-6 and HsCRP were obtained and their correlation with VIDA and VASI values were statistically analyzed. A weak negative statistically insignificant correlation was found between IL-6 and VIDA (P = 0.092). No correlation was found between VIDA and HsCRP (P = 0.998). A weak positive, statistically insignificant correlation was found between VASI and IL-6 as well as between VASI and HsCRP (P = 0.175 and P = 0.238, respectively). Although statistically insignificant, the patients who were not on immunosuppressive therapy showed higher mean values of IL-6 and HsCRP compared to those who were on immunosuppressive therapy. In contrast to the findings of previous studies, our study found a weak negative correlation between VIDA and IL-6 levels possibly attributable to the difference between the mean levels of IL-6 among the subgroups of patients who were, and were not on immunosuppressive therapy. The VIDA score and HsCRP levels did not show any statistical correlation. However, patients who were not on immunosuppressive therapy showed a higher albeit statistically insignificant mean value of HsCRP. Our observations suggest that any ongoing and/or treatment in the recent past, especially immunosuppressive therapy, and any co-morbidities should be essentially considered while investigating for sensitive serum markers of inflammation as determinants of vitiligo disease activity.

Evaluation of Inflammatory Status in Chronic Kidney Disease Patients and a Comparison Between Hemodialysis and Peritoneal Dialysis Patients.

Introduction Inflammation is a common denominator in patients with chronic kidney disease (CKD), which is not explained by the pre-morbid risk factors and can lead to atherosclerosis and increased cardiovascular mortality. We have compared inflammatory markers like high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in patients with CKD undergoing continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) in both pre-dialysis phase at baseline and post-dialysis phase at three months to determine which dialysis has a more inflammatory burden on the patient. Materials and methods Fifty CKD patients diagnosed with end-stage renal disease (ESRD) who fulfilled eligibility criteria were recruited in this prospective observational study over two years. We measured levels of IL-6, hs-CRP, serum albumin, and body mass index (BMI) in both pre-dialysis and post-dialysis phases. Our results were obtained by analyzing 50 patients of ESRD who were planned for renal replacement therapy in the form of bridge dialysis, out of which 25 were put on HD and CAPD each. Pre-dialysis assessment was done at baseline and post-dialysis at three months. Each group served as its own control. IL-6 and hs-CRP levels were performed using commercially available kits employing the enzyme-linked immunosorbent assay (ELISA) method. Results Inflammatory markers (hs-CRP, IL-6) were elevated in both the pre-dialysis and post-dialysis phases of CKD, regardless of the dialysis modality. hs-CRP was significantly elevated in the HD group as compared to the CAPD group; however, the difference in IL-6 between the two groups was not significant. Albumin and BMI were significantly low in both groups from baseline, with patients on HD exhibiting lower albumin than the CAPD group, although the result was insignificant. Conclusion Markers of inflammation, like hs-CRP and low albumin, are more pronounced in HD than in CAPD. We conclude that the inflammatory burden is higher in patients undergoing HD.

Adiponectin and Inflammatory Marker Levels in the Elderly Patients with Diabetes, Mild Cognitive Impairment and Depressive Symptoms.

Some studies suggest that low-grade inflammation and adipokines may be involved in mild cognitive impairment (MCI) and depression in subjects with type 2 diabetes; however, the available data concerning the elderly population are limited. Therefore, we conducted novel research to determine the serum adiponectin, hs-CRP and TNF-α levels in elderly diabetic patients with MCI and depressive symptoms and to identify the factors associated with MCI in this group. A total of 178 diabetic patients (mean age 84.4 ± 3.4 years) were screened for MCI and depressive symptoms. Various biochemical and biomarker data were collected. We found that patients with MCI and depressive symptoms demonstrated lower adiponectin levels and high hs-CRP and TNF-α. In this group, adiponectin concentration was negatively correlated with hs-CRP, TNF-α, HbA1c, and GDS-30 scores and positively correlated with MoCA scores. Multivariable analysis found the risk of MCI to be associated with higher TNF-α levels, fewer years of formal education, an increased number of comorbidities, and the presence of CVD. We concluded that low-grade inflammation and the presence of adipokines are associated with MCI and depressive symptoms in elderly diabetics. Further research should evaluate the suitability of Hs-CRP, TNF-α, and adiponectin as diagnostic markers for MCI and potential therapeutic targets.

Inflammatory Trajectory of Type 2 Diabetes: Novel Opportunities for Early and Late Treatment.

Low-grade inflammation (LGI) represents a key driver of type 2 diabetes (T2D) and its associated cardiovascular diseases (CVDs). Indeed, inflammatory markers such as hs-CRP and IL-6 predict the development of T2D and its complications, suggesting that LGI already increases before T2D diagnosis and remains elevated even after treatment. Overnutrition, unhealthy diets, physical inactivity, obesity, and aging are all recognized triggers of LGI, promoting insulin resistance and sustaining the pathogenesis of T2D. Once developed, and even before frank appearance, people with T2D undergo a pathological metabolic remodeling, with an alteration of multiple CVD risk factors, i.e., glycemia, lipids, blood pressure, and renal function. In turn, such variables foster a range of inflammatory pathways and mechanisms, e.g., immune cell stimulation, the accrual of senescent cells, long-lasting epigenetic changes, and trained immunity, which are held to chronically fuel LGI at the systemic and tissue levels. Targeting of CVD risk factors partially ameliorates LGI. However, some long-lasting inflammatory pathways are unaffected by common therapies, and LGI burden is still increased in many T2D patients, a phenomenon possibly underlying the residual inflammatory risk (i.e., having hs-CRP > 2 mg/dL despite optimal LDL cholesterol control). On the other hand, selected disease-modifying drugs, e.g., GLP-1RA, seem to also act on the pathogenesis of T2D, curbing the inflammatory trajectory of the disease and possibly preventing it if introduced early. In addition, selected trials demonstrated the potential of canonical anti-inflammatory therapies in reducing the rate of CVDs in patients with this condition or at high risk for it, many of whom had T2D. Since colchicine, an inhibitor of immune cell activation, is now approved for the prevention of CVDs, it might be worth exploring a possible therapeutic paradigm to identify subjects with T2D and an increased LGI burden to treat them with this drug. Upcoming studies will reveal whether disease-modifying drugs reverse early T2D by suppressing sources of LGI and whether colchicine has a broad benefit in people with this condition.

Systemic Immune-inflammation Index in Evaluation of Inflammation in Rheumatoid Arthritis Patients.

Objective: To evaluate the systemic immune-inflammation (SII) index in patients with rheumatoid arthritis (RA) stratified by systemic inflammatory status. Methods: Seropositive patients with RA (n=58) were divided into two groups based on serum hs-C-reactive protein (hs-CRP) levels: RA patients with hs-CRP levels of at or 3 mg/L or above (high systemic inflammatory status; n=38) and RA patients with hs-CRP levels of less than 3 mg/L (low systemic inflammatory status; n=20). The control group comprised 31 healthy individuals. Blood samples were tested for the next parameters: leukocytes, neutrophilic granulocytes, lymphocytes, thrombocytes [platelet (PLT)], high-sensitivity hs-CRP, sed rate [erythrocyte sedimentation rate (ESR)], neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR). The SII index was derived as Neu x PLT/Lym. Results: In patients with RA, the SII index was elevated compared with that of healthy individuals and positively correlated with hs-CRP, erythrocyte sedimentation rate, NLR, MLR, PLR, tender joint count, and swollen-to-tender joint count ratio. Patients with RA who had hs-CRP levels of 3 mg/L above exhibited a statistically significant increase in the SII compared with those with hs-CRP levels below 3 mg/L. Additionally, within the cohort of RA patients with hs-CRP levels at or above 3 mg/L, a positive correlation was found between the SII index and both NLR and PLR. The SII index was positively correlated with NLR, MLR, and PLR in RA patients with hs-CRP levels below 3 mg/L. The cut-off point of the SII index for distinguishing between RA cases with hs-CRP levels 3 mg/L and those with hs-CRP levels 3 mg/L or higher was ≥323.4, with a sensitivity of 77.6% and a specificity of 54.8%. Conclusions: The serum SII index can be a potentially useful marker for evaluating the inflammatory process and clinical progression of RA.

Efficacy of inflammation-based stratification for add-on celecoxib or minocycline in major depressive disorder: Protocol of the INSTA-MD double-blind placebo-controlled randomised clinical trial.

Introduction: Different lines of evidence confirm the involvement of the immune system in the pathophysiology of major depressive disorder. Up to 30% of depressed patients present with an immune-mediated subtype, characterized by peripheral inflammation (high-sensitive C-reactive protein (hsCRP) ≥ 3 mg/l) and an atypical symptom profile with fatigue, anhedonia, increased appetite, and hypersomnia. This immune-mediated subtype of MDD is associated with poorer response to first-line antidepressant treatment. Consequently, strategies for immune-targeted augmentation should be prioritised towards patients with this subtype. Meta-analyses have shown modest but heterogeneous treatment effects with immune-targeted augmentation in unstratified MDD cohorts, with celecoxib and minocycline as most promising first-line treatment options. However, no study has prospectively evaluated the effectiveness of a priori stratification by baseline inflammation levels for add-on celecoxib or minocycline in MDD. Methods: The INSTA-MD trial is a multicentre, 12-week, randomised, double-blind, placebo-controlled, parallel-group stratified clinical trial of adjunctive minocycline or celecoxib to treatment-as-usual for patients with MDD. Two hundred forty adult patients with Major Depressive Disorder who failed to remit with one or two trials of antidepressant treatment will be enrolled and allocated to high-hsCRP (hsCRP ≥3 mg/L) or low-hsCRP (hsCRP <3 mg/L) strata, where disproportional stratified sampling will ensure equally sized strata. Participants in each hsCRP stratum will be randomised to augment their ongoing antidepressant treatment with either adjunctive minocycline, celecoxib or placebo for a duration of 12 weeks, resulting in six treatment arms of each 40 participants. The primary objective is to evaluate the efficacy of immune-targeted augmentation with minocycline or celecoxib versus placebo, and the use of baseline hsCRP stratification to predict treatment response. Additionally, we will perform a head-to-head analysis between the two active compounds. The primary outcome measure is change in the Hamilton Depression Rating Scale (HDRS-17) total score. Secondary outcome measures will be response and remission rates, and change in inflammation-specific symptoms, adverse events and therapy acceptability (adherence). Further exploratory analyses will be performed with an array of peripheral inflammatory biomarkers, metabolic outcomes and physiological data. Expected impact: The aim of INSTA-MD is to advance the use of immune-targeted precision psychiatry, by supporting the implementation of targeted hsCRP screening and treatment of immune-mediated MDD as a cost-effective intervention in primary care settings. Based on previous studies, we expect immune-targeted augmentation with minocycline or celecoxib to yield a superior remission rate of 15-30% compared to treatment as usual for immune-mediated cases of MDD. By treating immune-related depression early in the treatment algorithm with repurposed first-line anti-inflammatory treatments, we can significantly improve the outcomes of these patients, and reduce the global societal and economic burden of depression. Ethics and dissemination: This protocol has been approved by the Medical Ethics Review Board (CTR - 04/08/2023). Registration details: Trial registration number NCT05644301 (Clinical trial.gov), EU-CT 2022-501692-35-00.

Comparison of Biomarkers of Oxidative Stress, Inflammation, and Endothelial Function Among Vegetarians and Non-vegetarians of Vijayapura, India: A Pilot Study.

BACKGROUND: The known impact of diet on the pathophysiology of various chronic diseases and the current dietary transition in the country make it essential to assess the influence of dietary patterns specific to this region on inflammation, oxidative stress, and endothelial functions. OBJECTIVE: This study compared oxidative stress, inflammation, and endothelial functions among vegetarians and non-vegetarians in Vijayapura, Karnataka, India. METHODS: The present cross-sectional comparative study involved apparently healthy vegetarians (n=35) and non-vegetarians (n=35) aged 20-40. The anthropometric measurements like height (cm) and weight (kg) were recorded, and the BMI was calculated. The physiological parameters like systolic and diastolic blood pressure and pulse rate were recorded. Serum high-sensitivity C-reactive protein (hs-CRP), serum malondialdehyde (MDA), and serum nitric oxide (NO) were estimated as markers of inflammation, oxidative stress, and endothelial function, respectively. Statistical analysis was done using SPSS Statistics version 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). RESULTS: The average age of vegetarians and non-vegetarians was 25.22 ± 7.63 years and 25.60 ± 5.64 years, respectively. Anthropometric and physiological parameters were comparable between the two groups. However, there was a trend for higher mean body weight among non-vegetarians (53.94± 6.73 vs. 57.22±7.18) with a marginal non-statistically significant p-value (p=0.052). Vegetarians showed significantly higher serum MDA levels than non-vegetarians (2.14 (0.93-2.91) vs. 0.64 (0.35-1.32); p=0.000), while hs-CRP (vegetarians - 0.01 (0.005-0.034) vs. non-vegetarians - 0.03 (0.01-0.04); p=0.18) and serum NO levels (vegetarians - 6.72 (5.46-8.39) vs. non-vegetarians - 5.43 (2.87-9.16); p=0.215) were similar in both groups. CONCLUSION: The results were intriguing and contrasting, as serum MDA is remarkably higher among vegetarians than non-vegetarians, pointing toward greater oxidative stress among the former and possibly indicating a dietary imbalance among vegetarians, which needs further exploration.

The effects of supervised aerobic training on dyslipidaemia among diabetic older patients.

BACKGROUND: Higher prevalence rates of diabetes and its complications have been reported among individuals with poor physical activity and a sedentary lifestyle. This study explored the influence of six months of moderate-intensity supervised aerobic training on the serum lipid profile, hs-CRP level, and variable-related correlations in prediabetic and type 2 diabetes patients (T2DM). DESIGN: The study was based on a two-arm parallel group pretest‒posttest comparative design. METHODS: A total of 50 subjects who were diagnosed with diabetes for more than five years and aged 30-70 years were included in this study. The subjects were classified into two groups on the basis of their glycated haemoglobin (HbA1c%) values: Group 1 (patients with the prediabetes; HbA1c % ≤ 6.5, n = 25) and Group 2 (patients with the T2DM; HbA1c % ≥ 6.5, n = 25). Blood sugar, HbA1c %, insulin, lipid profile, and highly sensitive CRP (hs-CRP) were measured via colorimetric and immunoassay techniques at baseline and six months postintervention with moderate aerobic exercise. RESULTS: The results revealed that participation in moderate aerobic training interventions for six months resulted in a significant reduction in BMI, fasting blood sugar, glycosylated haemoglobin, hs-CRP, and lipid profile parameters such as T-Cholest, TG, and LDL-C as well as significant improvement in the level of insulin with a reduction in the values of HOMA-IR towards normal values in the patients with prediabetes (P < 0.01) in group 1 and patients with diabetes in group 2 (P < 0.001). The change in VO2max with good physical fitness significantly improved with the exercise program after six months. The reduced levels of hs-CRP, HOMA-IR, and lipid profile and improved levels of insulin were significantly positively correlated with the levels of glycated haemoglobin (HbA1c%) in the patients with prediabetes (P < 0.01) and those with diabetes (P < 0.001) following six months of moderate aerobic training interventions. Moreover, hs-CRP was positively correlated with T-Cholest, TG, and LDL-C (p = 0.01) and negatively correlated with HDL-C. The data revealed improved glycemic control factors, lipid profiles, and hs-CRP levels as cardio-predictive markers in patients with both prediabetes and diabetes as well. These findings suggest that the anti-inflammatory effect of physical activity gained from moderate exercise training for six months may counteract increased cardiovascular complications associated with increased CRP levels and lipid profiles in prediabetes and T2DM patients. CONCLUSIONS: Moderate aerobic training for six months favourably affects glycemic parameters, lipid profiles, and inflammatory hs-CRP indicators and improves VO2max, an indicator of physical fitness, in prediabetic and diabetic patients. The data obtained suggest the positive effect of moderate exercise training as a protective modulator of cardiovascular disorders, including the dyslipidaemic profile, glycaemic control, and hs-CRP inflammatory markers, in prediabetes and T2DM patients. Thus, regular exercise, owing to its anti-inflammatory effects and ability to improve cardiorespiratory fitness, lipid profiles, blood glucose levels, and insulin resistance, may help reduce the severity of cardiovascular diseases in prediabetes and T2DM patients and healthy controls. TRIAL REGISTRATION: Retrospectively registered with ClinicalTrials.gov PRS under trial identifier ID: NCT06246435 dated 30/01/2024.

Obesity Mediates the Association Between Serum Copper and Inflammation: A Cross-sectional and Mendelian Randomization Study.

Copper is an important biological trace element, but its overexposure can be harmful to the human body. Herein, we aimed to assess the association between serum copper levels and inflammation. A total of 5231 participants were analyzed from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2016. Participants with higher serum copper levels had higher values of systemic inflammation indexes. The concentration of high-sensitive C-reactive protein (hs-CRP) increased with serum copper concentration (ß = 2.8, p < 0.001). Participants with high and very high copper levels had higher ORs (odds ratios) of having inflammation (high: OR 2.92 (0.77-11.04), p = 0.074; very high: OR 8.66 (3.18-23.54), p = 0.011), which were further exacerbated in people with diabetes and males. Body mass index (BMI) and body fat percentage are two main mediators in the association between serum copper and hs-CRP, accounting for 12.62% and 19.72%, respectively. The random-effects inverse variance-weighted (IVW) analysis revealed that there was a genetic causal relationship between serum copper and obesity (OR 1.15, p = 0.014). Our results suggest that serum copper is positively associated with inflammation, which may be mainly mediated by obesity.

Effect of Phytosterols on Serum Levels of C-Reactive Protein: A Time- and Dose-Response Meta-analysis of Randomized Controlled Trial.

INTRODUCTION: Phytosterols are recognized for their cholesterol-reducing effects and are commonly used as dietary supplements or added to foods due to their potential cardiovascular benefits. However, evidence regarding the impact of phytosterol supplementation on inflammatory markers remains inconclusive. AIM: This systematic review and meta-analysis aim to evaluate the effect of phytosterols in reducing levels of C-reactive protein (CRP) and high-sensitivity CRP (hs-CRP). METHODS: A systematic literature search of the primary databases was conducted up to May 2024 to identify eligible studies. The measurement of effect sizes was determined using WMD (weighted mean difference) and 95% CI. RESULTS: For the meta-analysis, 14 publications (19 study arms) for hs-CRP and 10 publications (16 study arms) for CRP were included. The pooled analysis showed that the administration of phytosterol did not significantly reduce CRP compared to control with WMD= -0.04 mg/l (95% CI: -0.28 to 0.20, P = 0.74). However, phytosterol supplementation significantly decreased the hs-CRP level compared to the control group with WMD of -0.25 mg/l (95% CI: -0.42 to -0.07, P = 0.006). The WMD for hs-CRP reduction was - 0.36 mg/l (95% CI: -0.53 to -0.18, P < 0.001) for supplementation with a phytosterol dose ≥ 2000 mg/day compared to the control group. CONCLUSIONS: Phytosterol supplementation may be effective in reducing hs-CRP levels.

Use of E-Cigarette, Traditional Cigarettes, and C-Reactive Protein: The Cross Cohort Collaboration.

This cross-sectional study included 18,797 participants from six longitudinal cohorts (CARDIA, FHS Gen III, HCHS/SOL, MESA, MiHeart, and REGARDS). 5,806 of them were with high-sensitivity C-reactive protein (hs-CRP) measurements. We found that among exclusive electronic cigarette (EC) use was associated with significantly lower high-sensitivity C-reactive protein (hs-CRP) levels compared to exclusive combustible cigarette use, suggesting a potentially lower inflammatory burden. hs-CRP levels in dual users and former smokers currently using EC were comparable to those observed in exclusive cigarette smokers. In contrast, individuals who exclusively used ECs showed no significant difference in hs-CRP levels compared to never smokers. These findings have important implications for tobacco regulation, public health, and clinical practice, highlighting the need for continued monitoring of EC-related health impacts.

Application of hs-CRP in Assessment of Tissue Inflammation Following Implantation of Biodegradable Polymer in Experiment.

Implants made of biodegradable polymers are replaced by regenerating tissues through inflammation. The changes occurring in tissues and the organism are of practical interest for studying the biocompatibility of the material and searching for systemic markers in the blood that reflect inflammation in peri-implantation tissues. The highly sensitive C-reactive protein (hs-CRP) measurements in blood and morphometric studies of tissue surrounding the implant were carried out in the experiment within three months of implantation of a biopolymer consisting of polycaprolactone (PCL) and polytrimethylene carbonate (PTMC). During the first month, tissue inflammation decreased, and the blood level of hs-CRP did not increase. The polymer biotransformation began in the tissues after a month of implantation and was accompanied by inflammation moving deeper into the matrix. Proliferation of inflammatory cells in tissues was reflected in an increase in the hs-CRP level three months after polymer installation. The result achieved confirmed the polymer's bioinertness. The level of hs-CRP in the blood of the animals correlated with the level of inflammation in peri-implantation tissues, reflecting the activity of inflammation in the process of polymer biotransformation. This inflammation protein can be recommended for assessing tissue processes following implantation of biopolymers and their biocompatibility.

A Comparative Study on Levels of hs-CRP and Lipid Profile in Prediabetic and Normal Population.

This study aimed to compare high-sensitivity C-reactive protein (hs-CRP) and lipid profile levels between prediabetic and normal populations and explore correlations between hs-CRP and lipid profile in prediabetic individuals. The study was conducted among Group A comprising 75 prediabetic individuals, and Group B, which included 75 non-diabetic controls from the general population. Results showed that the mean hs-CRP level in Group A (1.717) significantly exceeded that of Group B (0.917) (p = 0.001). Pearson correlation analysis revealed significant positive linear relationships between hs-CRP and lipid profile parameters, indicating that as total cholesterol, triglycerides (TGs), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL) increased, hs-CRP also increased. A significant negative linear relationship was observed between hs-CRP and HDL. Moreover, a positive linear relationship existed between hs-CRP and glycemic parameters (fasting blood sugar (FBS), postprandial blood sugar (PPBS), and Glycated haemoglobin (HbA1c)). It is concluded that elevated hs-CRP, an inflammatory marker, correlated with dysregulated lipid profiles, and glycemic parameters, indicating its potential role in assessing inflammation in prediabetic individuals and its association with dyslipidemia and glucose metabolism.

Maternal Soluble Programmed Death Ligand-1 (sPD-L1) and T-regulatory Cells (Tregs) Alteration in Preeclampsia: A Cross-Sectional Study From Eastern India.

Background Studies have shown that aberrant reactions of the immune system play an important role in the pathogenesis of preeclampsia. The immune checkpoint molecules programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) system and the T-regulatory cells (Tregs) system are decisive in the regulation of immune responses and can be the target molecules in preeclampsia. In this study, an attempt has been made to evaluate the soluble PD-L1 (sPD-L1) in the serum of preeclampsia cases and correlate it with Tregs and inflammatory markers to have an insight into the link between these immunomodulatory molecules in the pathogenesis of preeclampsia. Materials and methods Ten normal fertile women, 20 trimester-matched normal pregnancy cases, and 20 preeclampsia cases were enrolled in the study. Serum sPD-L1, transforming growth factor beta 1 (TGF-ß1), and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA). High-sensitive C-reactive protein (hsCRP) was estimated using a clinical biochemistry autoanalyzer. Tregs were evaluated using flow cytometry. Results and discussion The immune checkpoint molecule PD-L1 inversely correlated with Tregs in preeclampsia cases. Associated inflammation was seen by raised IL-6 and hsCRP. The breakdown of immunological tolerance is mainly caused by the dysregulating the Tregs/Th17 balance, which leads to conditions of autoimmunity and chronic inflammatory disorders. PD-L1 can be the link between this immunological misbalance. Conclusion Our study, showing an increase in sPD-L1 and TGF and a decrease in Tregs with an increase in inflammatory markers like IL-6 and hsCRP levels in preeclampsia, has potential implications for early diagnosis and management of the condition. PD-L1 and Tregs can be target molecules for early management of preeclampsia.

Statin Therapy and C-reactive Protein in Patients with Kidney Disease: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

BACKGROUND: Increased levels of inflammation markers in patients with kidney disease, particularly chronic kidney disease (CKD) is an important risk factor. This study explored whether the effect of more potent statins on inflammation in CKD patients is dose-dependent, whether there is any difference between the hydrophilic and lipophilic statins concerning their effects on inflammation markers in patients with CKD, and whether the duration of treatment with statins has any effect on markers of inflammation in these patients. METHODS: A systematic literature search of Scopus, PubMed, and ISI Web of Science databases from inception to August 2022 was performed. Eligible studies were stratified based on a target population, intervention duration, dosage and type of statins (high intensity statin and moderate/ low intensity), and solubility of statins. Publication bias was evaluated using Begg's regression asymmetry test for visual inspection of funnel plots. Non-linear effects of dosage of statins and treatment duration were also examined by fractional polynomial modeling. RESULTS: Meta-analysis of 10 RCTs (12 studies) on 264 patients with kidney disease and 254 controls showed a significant hs-CRP lowering effect of the dose of statin. Both hydrophilic and lipophilic statins had significant hs-CRP lowering effects. Meta-analysis of 6 publications (7 studies) evaluating the impact of statins on CRP in 235 patients and 197 control subjects showed a significant negative association between treatment with statins group and CRP levels. CONCLUSION: Statin treatment decreases significantly the levels of CRP and hs-CRP in patients with kidney disease.

Correlation Between Hemoglobin A1c (HbA1c) and High-Sensitivity C-Reactive Protein (hs-CRP) in Myocardial Infarction Patients and Their Six-Month Mortality Follow-Up.

Background Acute coronary syndrome (ACS), encompassing unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI), poses significant global health challenges because of its associated high mortality and morbidity rates. Vascular inflammation plays a crucial role in the pathogenesis of atherosclerosis, and it is often assessed using biomarkers such as high-sensitivity C-reactive protein (hs-CRP). Hyperglycemia, common in myocardial infarction patients, is linked to increased complications and mortality, with glycosylated hemoglobin A1c (HbA1c) serving as a key indicator of long-term glycemic control. Objective This study investigates the correlation between hs-CRP and HbA1c levels in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM) and evaluates their impact on six-month mortality outcomes. Methods A prospective observational study was conducted with 80 patients diagnosed with AMI. Data collection included demographic information, medical history, clinical assessments, laboratory investigations (including hs-CRP and HbA1c levels), and imaging studies. Patients received standard treatment and were followed up for six months. Statistical analyses were performed to examine the relationships between hs-CRP, HbA1c, and clinical outcomes. Results Higher HbA1c levels at admission were significantly correlated with elevated hs-CRP levels (p < 0.05). Both biomarkers showed a reduction at six months, correlating with improved glycemic control and reduced inflammation. Each unit increase in HbA1c was associated with a 21% increase in the hazard of mortality, and, similarly, each unit increase in hs-CRP was associated with a 17% increase in the hazard of mortality. The positive correlation between HbA1c and hs-CRP suggests that HbA1c can serve as an independent marker for predicting mortality in this patient population. Conclusion The study demonstrates a significant correlation between hs-CRP and HbA1c levels in patients with AMI and T2DM, with both biomarkers serving as strong predictors of six-month mortality. HbA1c, because of its positive correlation with hs-CRP, could be used as an independent marker for assessing the risk of adverse outcomes in these patients. These findings highlight the importance of managing both glycemic control and inflammation in diabetic patients with ACSs.

Evaluating the effects of empagliflozin in preventing myocardial injury in patients undergoing percutaneous coronary intervention: A double-blind, randomized clinical trial.

Introduction: Percutaneous Coronary Intervention (PCI) is a fundamental procedure for coronary artery disease management, yet the risk of adverse events such periprocedural myocardial injury (PMI) persists. This double-blind, randomized clinical trial aims to assess the efficacy of empagliflozin in preventing myocardial injury during PCI procedure. Methods: A total of 90 patients were randomly assigned to two groups A and B; Group A as the intervention group received empagliflozin 25 mg 24 hours before and empagliflozin 10 mg 1-2 hours before coronary intervention and group Bas the control group received placebo at similar intervals. The primary outcome involved comparing baseline, 8-hour, and 24-hour cTnI and baseline and 24-hour hs-CRP levels after PCI in both groups to measure the incidence of periprocedural myocardial injury (PMI) and anti-inflammatory effects of empagliflozin. Results: Baseline cTnI levels with P=0.955, 8 hours after PCI with P=0.469, and 24 hours after the intervention with P=0.980 were not statistically different in the two groups. Baseline levels of hs-CRP in both intervention and control groups were not statistically significantly different (P=0.982). Also, there was no statistically significant difference in hs-CRP levels 24 hours after PCI in two groups (P=0.198). Finally, the results showed that MACEs did not occur in any of the groups. Conclusion: The results of this trial could not express the advantages of acute pretreatment with empagliflozin in preventing PCI-related myocardial injury.

Association Between High-Sensitivity C-Reactive Protein (hs-CRP) Levels With Lipids and Micronutrients.

BACKGROUND AND AIMS: Elevated high-sensitivity C-reactive protein (hs-CRP) levels are associated with an increased risk of cardiovascular disease, indicating systemic inflammation. Abnormal lipid levels and deficiencies in certain vitamins and minerals could also contribute to elevated hs-CRP levels. By broadly looking at the cross-correlations between inflammatory, lipid, and micronutrient markers, we aim to highlight the key associations at the serological levels. METHODS: A retrospective analysis was conducted on 1,014 free-living individuals who tested for cardiovascular and micronutrient panels along with hs-CRP at Vibrant America Clinical Laboratory. RESULTS AND CONCLUSION: Based on parametric t-tests, significant variations between the sexes (Ma1) were observed for cholesterol, high-density lipoprotein (HDL), triglycerides, vitamin A, vitamin D3, serum copper, and valine. Pearson's correlation showed a high-significant positive correlation between hs-CRP and triglycerides, folate, serum copper, and manganese.

Neutrophil-Lymphocyte Ratio and High Sensitivity C-Reactive Protein as Markers of Heart Failure Severity: A Study at the University of Port-Harcourt Teaching Hospital Heart Failure Clinic.

BACKGROUND: Systemic inflammatory markers, such as the Neutrophil-Lymphocyte Ratio (NLR) and high-sensitivity Creactive protein (hs-CRP), have been linked to cardiovascular diseases, including heart failure (HF), and increased mortality rates. This study aimed to assess NLR and hs-CRP levels in chronic HF patients and determine the relationship between these markers with HF severity. METHODS: A descriptive cross-sectional study was conducted on 136 chronic HF patients at the University of Port-Harcourt Teaching Hospital. Informed consent was obtained, and participants completed a questionnaire. Blood samples were collected for a complete blood count, hs-CRP, and N Terminal-pro-Brain Natriuretic Peptide measurements. Echocardiography was performed for all study participants. RESULTS: The mean age was 59 years and 51.5% were males. Among the participants, 27(19.9%) had an NLR >2, while 91(66.9%) had elevated hs-CRP levels. There was a non-significant positive correlation between NLR and CRP values (r=0.131, p=0.128). Elevated hs-CRP levels were found in 67.1% and 66.7% of patients with left ventricular systolic and diastolic dysfunction, respectively. However, elevated NLR >2 was found in only 21.5% and 17.6% of these patients respectively. Highly sensitive-CRP significantly correlated with NT-Pro-BNP (0.410<0.0001) but not with NYHA classification, Ejection Fraction, and Anemia. CONCLUSION: Highly sensitive CRP was a more reliable inflammation marker in HF patients than NLR. High hs-CRP levels could predict rising NT-Pro-BNP and were associated with left ventricular systolic dysfunction than NLR. The Neutrophil Lymphocyte ratio, while cheap and accessible in the study environment, was unable to predict worsening HF possibly due to typically lower NLR values in blacks.

CONTEXTE: Les marqueurs inflammatoires systémiques, tels que le ratio neutrophiles-lymphocytes (NLR) et la protéine C-réactive ultrasensible (hs-CRP), ont été liés aux maladies cardiovasculaires, y compris l'insuffisance cardiaque (IC), et à des taux de mortalité accrus. Cette étude visait à évaluer les niveaux de NLR et de hs-CRP chez les patients atteints d'IC chronique et à déterminer la relation entre ces marqueurs et la gravité de l'IC. MÉTHODES: Une étude descriptive transversale a été menée sur 136 patients atteints d'IC chronique à l'Hôpital Universitaire de PortHarcourt. Le consentement éclairé a été obtenu et les participants ont rempli un questionnaire. Des échantillons de sang ont été prélevés pour une numération formule sanguine complète, hs-CRP, et des mesures de peptide natriurétique de type B terminal (NT-pro-BNP). Une échocardiographie a été réalisée pour tous les participants à l'étude. RÉSULTATS: L'âge moyen était de 59 ans et 51,5% étaient des hommes. Parmi les participants, 27 (19,9%) avaient un NLR >2, tandis que 91 (66,9%) avaient des niveaux élevés de hs-CRP. Il y avait une corrélation positive non significative entre les valeurs de NLR et de CRP (r=0,131, p=0,128). Des niveaux élevés de hs-CRP ont été trouvés chez 67,1% et 66,7% des patients atteints de dysfonction systolique et diastolique du ventricule gauche, respectivement. Cependant, un NLR élevé >2 n'a été trouvé que chez 21,5% et 17,6% de ces patients respectivement. La hs-CRP a significativement corrélé avec le NT-pro-BNP (0,410<0,0001) mais pas avec la classification NYHA, la fraction d'éjection et l'anémie. CONCLUSION: La hs-CRP était un marqueur inflammatoire plus fiable chez les patients atteints d'IC que le NLR. Des niveaux élevés de hs-CRP pouvaient prédire une augmentation du NT-pro-BNP et étaient associés à une dysfonction systolique du ventricule gauche plutôt que le NLR. Le ratio neutrophiles-lymphocytes, bien que bon marché et accessible dans l'environnement de l'étude, n'a pas pu prédire l'aggravation de l'IC, probablement en raison de valeurs de NLR typiquement plus basses chez les noirs. MOTS-CLÉS: Insuffisance cardiaque, Marqueurs inflammatoires, Ratio neutrophiles-lymphocytes, hs-CRP, chronique.

Socioeconomic adversity, maternal nutrition, and the prenatal programming of offspring cognition and language at two years of age through maternal inflammation.

Increasing rates of child neurodevelopmental vulnerability are a significant public health challenge. The adverse effect of socioeconomic adversity on offspring cognition may be mediated through elevated prenatal maternal systemic inflammation, but the role of modifiable antecedents such as maternal nutrition has not yet been clarified. This study aimed to examine (1) whether prenatal factors, with an emphasis on maternal nutrition, were associated with prenatal maternal systemic inflammation at 28 weeks' gestation, including the metabolomic marker glycoprotein acetyls (GlycA); (2) the extent to which the association between prenatal maternal nutrition and child cognition and language at age two years was mediated by elevated maternal inflammation in pregnancy; (3) the extent to which the associations between prenatal socioeconomic adversity and child neurodevelopment were mediated through prenatal maternal nutrition and GlycA levels. We used a prospective population-derived pre-birth longitudinal cohort study, the Barwon Infant Study (Barwon region of Victoria, Australia), where 1074 mother-child pairs were recruited by 28 weeks' gestation using an unselected sampling frame. Exposures included prenatal factors such as maternal diet measured by a validated food frequency questionnaire at 28 weeks' gestation and dietary patterns determined by principal component analysis. The main outcome measures were maternal inflammatory biomarkers (GlycA and hsCRP levels) at 28 weeks' gestation, and offspring Bayley-III cognition and language scores at age two years. Results showed that the 'modern wholefoods' and 'processed' maternal dietary patterns were independently associated with reduced and elevated maternal inflammation respectively (GlycA or hsCRP p < 0.001), and also with higher and reduced offspring Bayley-III scores respectively (cognition p ≤ 0.004, language p ≤ 0.009). Associations between dietary patterns and offspring cognition and language were partially mediated by higher maternal GlycA (indirect effect: cognition p ≤ 0.036, language p ≤ 0.05), but were less evident for hsCRP. The maternal dietary patterns mediated 22 % of the association between socioeconomic adversity (lower maternal education and/or lower household income vs otherwise) and poorer offspring cognition (indirect effect p = 0.001). Variation in prenatal GlycA levels that were independent of these dietary measures appeared less important. In conclusion, modifiable prenatal maternal dietary patterns were associated with adverse child neurocognitive outcomes through their effect on maternal inflammation (GlycA). Maternal diet may partially explain the association between socioeconomic adversity and child neurocognitive vulnerability. Maternal diet-by-inflammation pathways are an attractive target for future intervention studies.