The Relationship between Plasma Taurine Levels and Diabetic Complications in Patients with Type 2 Diabetes Mellitus.

Background: Taurine has an active role in providing glucose homeostasis and diabetes causes a decline in taurine levels. This paper investigates the relationship between taurine and diabetic complications, patients' demographic features, and biochemical parameters. Methods: Fifty-nine patients with type 2 diabetes mellitus (T2DM), and 28 healthy control subjects between the ages of 32 and 82 were included in the study. The mean age of subjects was 55.6 ± 10.3 and mean diabetes duration was 10.2 ± 6.0 years. The most commonly accompanying comorbidity was hypertension (HT) (64.5%, n = 38), and the most frequent diabetic complication was neuropathy (50.8%, n = 30). Plasma taurine concentrations were measured by an enzyme-linked immunoassay (ELISA) kit. Results: Plasma taurine concentrations were significantly lower in diabetic patients (0.6 ± 0.1 mmol/L) than controls (0.8 ± 0.2 mmol/L) and in hypertensive (0. 6 ± 0.1 mmol/L) patients (p = 0.000, p = 0.027 respectively). Conclusion: Plasma taurine levels were decreased in patients with T2DM and this was not related to FBG, HbA1c, and microalbuminuria. With regard to complications, we only found a correlation with neuropathy. We suggest that taurine levels may be more important in the development of diabetes; however, it may also have importance for the progression of the disease and the subsequent complications. We further assert that taurine measurement at different times may highlight whether there is a causal relationship in the development of complications.

Association of Plasma Pentraxin-3 Levels with Retinopathy and Systemic Factors in Diabetic Patients.

BACKGROUND: Diabetic retinopathy (DR) is mainly caused by metabolic factors, vascular inflammation, and endothelial dysfunction. We aimed to evaluate the relationship of DR with inflammatory and biochemical alterations in type 2 diabetics. METHODS: A total of 89 diabetic patients with retinopathy [(DR (+) (n = 30)], without retinopathy [(DR (-) (n = 32)], and 27 control subjects were involved in the study. Demographic properties, biochemical values, ophtalmologic evaluation, C-reactive protein (CRP), and pentraxin-3 (PTX-3) levels were recorded. RESULTS: There was significant difference between controls, DR (-) and DR (+) groups with regard to serum PTX-3 levels. Control group had the lowest and DR (+) group revealed the highest PTX-3 levels. Severity of retinopathy was not related with CRP or PTX-3 levels. Duration of diabetes was longer, systolic blood pressure (SBP) and urinary albumin-creatinine ratio (UACR) were significantly higher in DR (+) subjects than DR (-) subjects. Multivariate analysis revealed that PTX-3 level and SBP were the variables that had a significant effect on DR (P = 0.002, OR = 1.61, and P = 0.021, OR = 1.06, respectively). CONCLUSIONS: Plasma PTX-3 levels may be a valuable predictor of DR-like factors such as duration of diabetes, hypertension, and UACR. Although inflammation has an important role in DR, we think that biomarkers reflecting inflammation is not sufficient to predict development and progression of DR; but follow up with PTX-3 levels along with ophthalmological evaluation may be useful. A single determination may not reflect the variations over time, so repeat measures may provide knowledge if PTX-3 is just a biomarker or has a causal role.

The relationship between circulating irisin, retinol binding protein-4, adiponectin and inflammatory mediators in patients with metabolic syndrome

ABSTRACT Objective We wanted to investigate whether there is a relationship between circulating irisin, retinol binding protein-4 (RBP-4), adiponectin and proinflammatory mediators implicated in the development of insulin resistance (IR) in metabolic syndrome (MetS). Subjects and methods In 180 individuals, including controls and patients with MetS, we measured fasting plasma insulin, high sensitivity C-reactive protein (hsCRP), pentraxin-3 (PTX-3), interleukin-33 (IL-33), irisin, RBP-4, and adiponectin using ELISA kits. Results While fasting plasma hsCRP, PTX-3, IL-33, irisin, RBP-4 concentrations were higher, adiponectin levels were lower in patients with MetS than in controls. A correlation analysis revealed that plasma irisin levels were positively associated with MetS components such as waist circumference and waist-hip ratio, low density lipoprotein (LDL) and markers of systemic inflammation such as PTX-3, hsCRP, uric acid, and RBP-4. Adiponectin levels were negatively associated with waist circumference, waist-hip ratio, PTX-3 and LDL. Conclusions Although the precise mechanisms are still unclear, irisin, RBP-4, adiponectin and PTX-3 are hallmarks of the MetS, which is related to low-grade inflammation. It is conceivable that irisin and adiponectin might contribute to the development of MetS and may also represent novel MetS components. Future clinical studies are needed to confirm and extend these data.

The relationship between circulating irisin, retinol binding protein-4, adiponectin and inflammatory mediators in patients with metabolic syndrome.

OBJECTIVE: We wanted to investigate whether there is a relationship between circulating irisin, retinol binding protein-4 (RBP-4), adiponectin and proinflammatory mediators implicated in the development of insulin resistance (IR) in metabolic syndrome (MetS). SUBJECTS AND METHODS: In 180 individuals, including controls and patients with MetS, we measured fasting plasma insulin, high sensitivity C-reactive protein (hsCRP), pentraxin-3 (PTX-3), interleukin-33 (IL-33), irisin, RBP-4, and adiponectin using ELISA kits. RESULTS: While fasting plasma hsCRP, PTX-3, IL-33, irisin, RBP-4 concentrations were higher, adiponectin levels were lower in patients with MetS than in controls. A correlation analysis revealed that plasma irisin levels were positively associated with MetS components such as waist circumference and waist-hip ratio, low density lipoprotein (LDL) and markers of systemic inflammation such as PTX-3, hsCRP, uric acid, and RBP-4. Adiponectin levels were negatively associated with waist circumference, waist-hip ratio, PTX-3 and LDL. CONCLUSIONS: Although the precise mechanisms are still unclear, irisin, RBP-4, adiponectin and PTX-3 are hallmarks of the MetS, which is related to low-grade inflammation. It is conceivable that irisin and adiponectin might contribute to the development of MetS and may also represent novel MetS components. Future clinical studies are needed to confirm and extend these data.

The impact of obesity and insulin resistance on iron and red blood cell parameters: a single center, cross-sectional study.

OBJECTIVE: Obesity and iron deficiency (ID) are the 2 most common nutritional disorders worldwide causing significant public health implications. Obesity is characterized by the presence of low-grade inflammation, which may lead to a number of diseases including insulin resistance (IR) and type 2 diabetes. Increased levels of acute-phase proteins such as C-reactive protein (CRP) have been reported in obesity-related inflammation. The aim of this study was to investigate the impact of obesity/IR on iron and red blood cell related parameters. MATERIALS AND METHODS: A total of 206 patients and 45 control subjects of normal weight were included in this cross-sectional study. Venous blood samples were taken from each patient to measure hemoglobin (Hb), serum iron (Fe), iron-binding capacity (IBC), ferritin, CRP, fasting blood glucose, and fasting insulin. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated for each patient. IR was determined using the HOMA-IR formula. RESULTS: Subjects were divided into 3 groups according to BMI. There were 152 severely obese (BMI: 42.6±10.1), 54 mildly obese (BMI: 32.4±2.1), and 45 normal-weight (BMI: 24.3±1.3) patients. Hb levels in severely obese patients and normal controls were 12.8±1.3 g/dL and 13.6±1.8 g/dL, respectively. We found decreasing Fe levels with increasing weight (14.9±6.9 µmol/L, 13.6±6.3 µmol/L, and 10.9±4.6 µmol/L for normal controls and mildly and severely obese patients, respectively). Hb levels were slightly lower in patients with higher HOMA-IR values (13.1±1.5 g/dL vs. 13.2±1.2 g/dL; p=0.36). Serum iron levels were significantly higher in the group with low HOMA-IR values (13.6±5.9 µmol/L vs. 11.6±4.9 µmol/L; p=0.008). IBC was found to be similar in both groups (60.2±11.4 µmol/L vs. 61.9±10.7 µmol/L; p=0.23). Ferritin was slightly higher in patients with higher HOMA-IR values (156.1±209.5 pmol/L vs. 145.3±131.5 pmol/L; p=0.62). CONCLUSION: Elevated BMI and IR are associated with lower Fe and hemoglobin levels. These findings may be explained by the chronic inflammation of obesity and may contribute to obesity-related co-morbidities. People with IR may present with ID without anemia.

Diagnostic and prognostic value of tumor M2-pyruvate kinase levels in patients with colorectal canhcer.

BACKGROUND/AIMS: Screening for precancerous lesions is important for the diagnosis and treatment of colorectal tumors. We investigated M2-pyruvate kinase levels in patients with colorectal polyps and carcinoma and assessed factors affecting M2-pyruvate kinase levels. MATERIALS AND METHODS: Eighty-five patients who had undergone colonoscopic examination and who were diagnosed with a neoplastic lesion were included. Patients were divided into two groups according to the macroscopic diagnosis of polyp or carcinoma. According to histopathological evaluation, specimens were grouped as nonneoplastic lesions, tubular adenoma, tubulovillous adenoma and adenocarcinoma. M2-pyruvate kinase levels were measured with the Tumor M2-pyruvate kinase ELISA kit. RESULTS: Mean M2-pyruvate kinase levels were 76.1±57.73 (13.1-288.22) IU/ml. We did not find a correlation between M2-pyruvate kinase levels and age, gender, smoking, alcohol and aspirin consumption and colorectal cancer family history. There was a relationship between body mass index and M2-pyruvate kinase level (p=0.022). The carcinoma group had the highest levels of M2-pyruvate kinase both endoscopically and histopathologically (p=0.009, p=0.019 respectively). M2-pyruvate kinase levels of patients who died were significantly higher than patients who survived (p=0.001). Enzyme values were significantly lower in diabetic patients than nondiabetics (p=0.04); and chronic renal failure patients had higher levels (p=0.045). CONCLUSION: Serum M2-pyruvate kinase levels may be useful in distinguishing malignant and benign lesions of the colon and may provide insight in terms of survival.

Can mean platelet volume determine the severity of liver fibrosis or inflammation in patients with chronic hepatitis B?

AIMS: We aimed to determine whether mean platelet volume (MPV) is one of the variables that determine the severity of liver fibrosis and inflammation. MATERIALS AND METHODS: Patients with chronic hepatitis B virus (HBV) infection were divided into two groups: patients with fibrosis scores of 0-3 and 4-6 and patients with histologic activity index scores of 0-9 and 10-18 (according to the Ishak Scoring System). The independent variables determining the severity of liver fibrosis and inflammation were investigated. RESULTS: Two hundred and thirty-eight patients were included in this retrospective study. The fibrosis scores of 29 patients (12.2%) were higher than 3. The independent variables that determined the severity of the fibrosis score were a high level of serum γ-glutamyl transferase and a low blood platelet count (odds ratio and P values were 1.016 and 0.004 for γ-glutamyl transferase, and 0.986 and 0.002 for blood platelet count). The histologic activity indexes of 38 patients (16%) were higher than 9. The independent variables determining the severity of liver inflammation were serum HBV DNA, γ-glutamyl transferase, and globulin levels and the MPV [odds ratio and P values were, respectively, 0.1001 and 0.046 for HBV DNA (×10); 1.016 and 0.004 for γ-glutamyl transferase; 2.247 and 0.039 for globulin; and 1.488 and 0.004 for the MPV]. The sensitivity, specificity, and positive predictive value and negative predictive value of the model predicting the severity of liver inflammation were 60.5, 83, 40.3, and 91.7%, respectively (area under the receiver-operating characteristic curve=0.775, P=0.0001). CONCLUSION: MPV may provide useful information to predict the degree of liver inflammation along with other markers.

Association of serum fetuin-A levels with heart valve calcification and other biomarkers of inflammation among persons with acute coronary syndrome.

PURPOSE: Fetuin-A is a multifunctional hepatic secretory protein that inhibits dystrophic vascular and valvular calcification. Our aim was to evaluate the relationship among fetuin-A levels, heart valve calcification and other biomarkers of inflammation in patients with acute coronary syndrome (ACS). METHODS: The associations among serum fetuin-A concentrations, mitral annular (MAC) and aortic valve calcification and other biomarkers of inflammation (hs-CRP, ferritin, fibrinogen, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), albumin levels) were evaluated in ACS patients and healthy controls. The study included 95 patients (mean age 61.8 ± 12.10 years) and 81 healthy controls (mean age 48.33 ± 9.19 years). RESULTS: Fetuin-A levels were significantly lower in patients with ACS than in healthy controls (0.76 ± 0.23 and 1.10 ± 0.45 g/L, respectively; p < 0.001). Fetuin-A was lower in patients with mitral annular calcification (p = 0.007) and aortic (p = 0.001) valve calcification. In patients with ACS, there was a negative correlation among serum urea (r = -0.377; p < 0.001) and creatinine (r = -0.232; p = 0.024) levels and fetuin-A, and a negative correlation among WBC (r = -0.156; p = 0,132), ESR (r = -0.214; p = 0.037), hs-CRP (r = -0.220; p = 0.032) levels and fetuin-A. A positive correlation was seen between albumin and fetuin-A (r = 0.362; p < 0.001). Multivariate logistic regression analysis revealed that fetuin-A was the variable that had a significant effect on ACS (p = 0.020 OR = .015; (95% CI)(0.000-0.520). CONCLUSION: Fetuin-A levels decrease in patients with acute coronary syndromes, independent of heart valve calcification. Fetuin-A may therefore act as a negative acute phase protein after myocardial infarction.

Oxidative lipid, protein, and DNA damage as oxidative stress markers in vascular complications of diabetes mellitus.

PURPOSE: The purpose of this study was to determine the effects of diabetic complications on oxidation of proteins, lipids, and DNA and to investigate the relationship between oxidative damage markers and clinical parameters. METHODS: The study group consisted of 69 type 2 diabetic patients (20 patients without complication, 49 patients with complication) who attended internal medicine outpatient clinics of Istanbul Education and Research Hospital and 19 healthy control subjects. In serum samples of both diabetic patients and healthy subjects, 8-hydroxy-2'deoxyguanosine (8-OHdG), as a marker of oxidative DNA damage, N(ε)-(hexanoyl)lysine (HEL) and 15-F2t-iso-prostaglandin (15-F2t-IsoP). as products of lipooxidative damage, advanced oxidation protein products (AOPP), as markers of protein damage, and paraoxonase1 (PON1) as antioxidant were studied. RESULTS: 15-F2t-IsoP (p < 0.005) and AOPP (p < 0.001) levels were significantly higher in diabetic group than control group while there were no significant differences in levels of 8-OHdG and HEL between the two groups. AOPP (p < 0.001) and 8-OHdG (p < 0.001) were significantly higher in diabetic group with complications compared to diabetic group without complications. CONCLUSIONS: Increased formation of free radicals and oxidative stress, under conditions of hyperglycaemia, is one of the probable causes for evolution of complications in diabetes mellitus. Our study supports the hypothesis that oxidant/antioxidant balance is disturbed in diabetic patients.

The effects of renal replacement therapy on plasma, asymmetric dimethylarginine, nitric oxide and C-reactive protein levels.

PURPOSE: Asymmetric dimethylarginine (ADMA), nitric oxide (NOx), and C-reactive protein (CRP) are important risk factors for endothelial dysfunction and mortality in the end stage renal diseases population. The aim of the study was to investigate the relationship between renal replacement therapy and endothelial dysfunction. METHODS: Plasma NOx, ADMA and CRP levels were examined in randomized selected 30 patients with chronic kidney diseases (CKD), 28 patients receiving continuous ambulatory peritoneal dialysis (PD) and 30 patients receiving regular hemodialysis (HD) and age-matched 20 healthy controls. The duration of dialysis was from 4, 5 to 11, and 6 years, respectively. RESULTS: CKD patients had higher plasma ADMA (1.26+/-0.53 micromol/L) and CRP levels (1.02+/-025 mg/L) and lower NOx levels (28.6+/-5.4 micromol/L) than controls (0.45+/-0.20; 0.65+/- 0.45; 32.5+/-37 respectively, P < 0.001). Plasma NOx and CRP levels were higher in HD patients (32.9+/-5.5 micromol/L, P < 0.05 and 4.59+/-3.18 mg/L, P < 0.001) and plasma ADMA and CRP levels were higher in PD patients (1.82+/-0.98 micromol/L, P < 0.001 and 2.40+/-1.53 mg/L, P < 0.001) than in CKD patients. PD patients had higher plasma ADMA levels (P < 0.05) and lower plasma NOx and CRP levels than HD patients (P < 0.001 and P < 0.001). Plasma ADMA levels were negatively correlated with NOx levels in all patient groups (P < 0.001). Plasma CRP levels in CKD and HD patients were positively correlated with plasma urea levels (r:0,437, P < 0,001) and duration of dialysis (r:0,370, P < 0.01), respectively. CONCLUSION: CRP and ADMA may be emerging as important risk factors for atherosclerosis in dialysis patients. Reduced NO elaboration secondary to accumulation of ADMA and elevated inflammation may be important pathogenic factors for endothelial dysfunction in both dialysis treatment strategies.