1H NMR spectroscopy-based interventional metabolic phenotyping: a cohort study of rheumatoid arthritis patients.

1H NMR spectroscopy-based metabolic phenotyping was used to identify biomarkers in the plasma of patients with rheumatoid arthritis (RA). Forty-seven patients with RA (23 with active disease at baseline and 24 in remission) and 51 healthy subjects were evaluated during a one-year follow-up with assessments of disease activity (DAS-28) and 1H NMR spectroscopy of plasma samples. Discriminant analysis provided evidence that the metabolic profiles predicted disease severity. Cholesterol, lactate, acetylated glycoprotein, and lipid signatures were found to be candidate biomarkers for disease severity. The results also supported the link between RA and coronary artery disease. Repeated assessment using mixed linear models showed that the predictors obtained from metabolic profiles of plasma at baseline from patients with active RA were significantly different from those of patients in remission (P=0.0007). However, after 31 days of optimized therapy, the two patient groups were not significantly different (P=0.91). The metabolic profiles of both groups of RA patients were different from the healthy subjects. 1H NMR-based metabolic phenotyping of plasma samples in patients with RA is well suited for discovery of biomarkers and may be a potential approach for disease monitoring and personalized medication for RA therapy.

Application of the FLIPSY pulse sequence for increased sensitivity in 1H NMR-based metabolic profiling studies.

Metabolite profiling relies on optimal precision of the acquired data, which requires, among others, a high signal-to-noise ratio (S/N). In addition, increased S/N will increase the likelihood of identification of new biomarkers. Here we introduce, for the first time in metabolite profiling studies by 1H NMR, an approach to enhance the precision of multivariate regression models by use of the FLIPSY (flip angle adjustable one-dimensional NOESY) pulse sequence, augmented by a homospoil pulse after the presaturation period to provide superior baseline quality. Unlike NOESYPRESAT, the standard one-dimensional (1D) sequence generally used in metabonomic studies, FLIPSY incorporates a variable flip angle, allowing use of the Ernst angle for excitation and thus optimization of S/N ratios according to spin lattice relaxation times (T1) of individual resonances. T1 values of metabolites present in human urine were determined by inversion-recovery experiments and subsequently used in calculations of optimal experimental conditions. Comparison of human urine analysis by the FLIPSY and NOESYPRESAT demonstrated an increase of S/N ratio in the former case that amounts to approximately 7% when measured for the hippurate doublet at delta 7.84. An orthogonal projection to latent structures discriminant analysis (O-PLS-DA) model exhibited superior discrimination between controls and simulated phenylketonuria urines when using data generated by the FLIPSY as compared to NOESYPRESAT.

How does media coverage effect the consumption of antidepressants? A study of the media coverage of antidepressants in Danish online newspapers 2010-2011.

BACKGROUND: The news media has become a major source of health information for the public, and hence vital in the individuals' opinions and decisions about health topics. The first decrease in the usage of antidepressants in Denmark in over a decade happened alongside an intensive period of media coverage about antidepressants. OBJECTIVES: The aim of this study was to examine the Danish media's coverage of antidepressants during 2010-2011 in order to explore what influence it could have had on the change in the use of antidepressants. METHODS: Three media theoretical concepts, agenda-setting, priming and framing, were used to explain the media influence with regard to which subject the public should think about, which criteria the public should judge the subject by, and how the public should think about the subject. All articles about antidepressants in the main Danish Internet newspapers from 2010-2011 were analyzed via quantitative and qualitative content analyses. The quantitative analysis was used to determine agenda-setting (number of articles) and, by coding articles, how priming was used in the descriptions of antidepressants. In the qualitative analysis, all articles were analyzed and condensed to determine which frames were used. RESULTS: Quantitative results: 271 articles were included. Agenda-setting was shown by a marked increase in the number of articles about antidepressants. Eight main codes were identified, with the negatively-associated side effects being the major one, thereby priming the public to use side effects as a criterion when judging antidepressants. Qualitative results: Two main frames were identified: 1) economic profits vs. medicine safety, and 2) the necessity of antidepressants. Both frames presented a critical view on antidepressants. CONCLUSION: It is believed that the media's agenda-setting, priming and framing of antidepressants led the public to have a more skeptical view on antidepressants, which may have probably contributed to a decrease in the usage of antidepressants.

Development of a bioassay-coupled HPLC-SPE-ttNMR platform for identification of α-glucosidase inhibitors in apple peel (Malus ×domestica Borkh.).

This work describes an analytical platform based on a high-resolution α-glucosidase inhibition assay in combination with hyphenation of high-performance liquid chromatography, solid-phase extraction, and tube-transfer nuclear magnetic resonance spectroscopy, i.e., HPLC-SPE-ttNMR/high-resolution α-glucosidase assay. The platform enables fast screening for individual α-glucosidase inhibitory analytes in complex matrices, followed by structural identification targeted these α-glucosidase inhibitors, as demonstrated by a proof-of-concept study with extract of 'Pink Lady' apple peel. A scout-separation produced a high-resolution biochromatogram and a HPLC chromatogram, which were used for pinpointing HPLC peaks displaying α-glucosidase inhibition. Active analytes were cumulatively trapped on SPE cartridges and the structures identified by (1)H NMR experiments obtained in the HPLC-SPE-ttNMR mode. (-)-Epicatechin (1), reynoutrin (3) and avicularin (4) were identified as active compounds. IC(50) of the active compounds were determined along with six structurally related compounds. Quercetin was the most potent inhibitor with an IC(50) of 8.1±0.4µM. The platform proved to be an efficient method for the identification of α-glucosidase inhibitors.

Parental consanguinity and family history of coronary artery disease strongly predict early stenosis.

BACKGROUND: Coronary artery disease (CAD) is a multifactorial disease with acquired and inherited components. AIM: We investigated the roles of family history and consanguinity on CAD risk and age at diagnosis in 4284 patients. The compounded impact of diabetes, hyperlipidemia, hypertension, smoking, and BMI, which are known CAD risk factors, on CAD risk and age at diagnosis was also explored. METHODS: CAD was determined by cardiac catheterization. Logistic regression and stratification were performed to determine the impact of family history and consanguinity on risk and onset of CAD, controlling for diabetes, hyperlipidemia, hypertension, smoking, and BMI. RESULTS: Family history of CAD and gender significantly increased the risk for young age at diagnosis of CAD (p<0.001). Consanguinity did not promote risk of CAD (p=0.38), but did affect age of disease diagnosis (p<0.001). The mean age at disease diagnosis was lowest, 54.8 years, when both family history of CAD and consanguinity were considered as unique risk factors for CAD, compared to 62.8 years for the no-risk-factor patient category (p<0.001). CONCLUSIONS: Family history of CAD and smoking are strongly associated with young age at diagnosis. Furthermore, parental consanguinity in the presence of family history lowers the age of disease diagnosis significantly for CAD, emphasizing the role of strong genetic and cultural CAD modifiers. These findings highlight the increased role of genetic determinants of CAD in some population subgroups, and suggest that populations and family structure influence genetic heterogeneity between patients with CAD.

Human urine as test material in 1H NMR-based metabonomics: recommendations for sample preparation and storage.

Metabonomic approaches are believed to have the capability of revolutionizing diagnosis of diseases and assessment of patient conditions after medical interventions. In order to ensure comparability of metabonomic 1H NMR data from different studies, we suggest validated sample preparation guidelines for human urine based on a stability study that evaluates effects of storage time and temperature, freeze-drying, and the presence of preservatives. The results indicated that human urine samples should be stored at or below -25 degrees C, as no changes in the 1H NMR fingerprints have been observed during storage at this temperature for 26 weeks. Formation of acetate, presumably due to microbial contamination, was occasionally observed in samples stored at 4 degrees C without addition of a preservative. Addition of a preserving agent is not mandatory provided that the samples are stored at -25 degrees C. Thus, no differences were observed between 1H NMR spectra of nonpreserved urines and urines with added sodium azide and stored at -25 degrees C, whereas the presence of sodium fluoride caused a shift of especially citrate resonances. Freeze-drying of urine and reconstitution in D2O at pH 7.4 resulted in the disappearance of the creatinine CH2 signal at delta 4.06 due to deuteration. A study evaluating the effects of phosphate buffer concentration on signal variability and assessment of the probability of citrate or creatinine resonances crossing bucket border (a boundary between adjacent integrated regions) led to the conclusion that a minimum buffer concentration of 0.3 M is adequate for normal urines used in this study. However, final buffer concentration of 1 M will be required for very concentrated urines.