Iloprost therapy acutely decreases oxidative stress in patients affected by systemic sclerosis.

BACKGROUND: Oxidative stress has been considered a leading factor in the pathogenesis of systemic sclerosis (SSc). Consistently with this hypothesis the determination of urinary isoprostanes, a reliable method for evaluation of oxidative stress, has recently showed increased levels of isoprostanes in SSc patients. Data about the effect on oxidative stress of accepted therapies for SSc such as iloprost therapy are lacking. OBJECTIVE: The aim of this prospective study was to verify whether iloprost therapy in patients with SSc acutely reduces oxidative stress assessed by determination of 8-Iso PGF2alpha urinary levels. METHODS: urine samples were obtained before and after a five-day cycle of iloprost infusion and urinary 8-Iso PGF2alpha levels were determined using a commercially available enzyme immunoassay. RESULTS: Consistent with previous reports, we found an increased level of oxidative stress in SSc patients with respect to healthy controls. Basal urinary 8-iso PGF2alpha levels in SSc patients were significantly higher than those in healthy controls [2002(1122-3575) pg/mg creatinine vs. 334(225.7-441) pg/mg creatinine, p<0.001]. Moreover, as expected, urinary 8-iso PGF2alpha levels after iloprost therapy were significantly lower than basal levels [1277.5 pg/mg creatinine (742.7-2017.3) vs. 2002 pg/mg creatinine (1122-3575), p=0.001] but persisted significantly elevated respect to the levels of healthy controls (p<0.001). The effect of iloprost on oxidative stress appeared significant in patients with early and limited form of disease. CONCLUSIONS: This prospective open-label explorative study suggests that standard course of iloprost therapy may acutely reduce oxidative stress in SSc patients. This effect appears to be more consistent in the early phases and in the limited subset of disease. Further larger trials are needed to confirm our results and to explain the pathway of such reduction, its clinical significance and potential therapeutic implications.

Urinary glycosaminoglycans in patients with systemic lupus erythematosus.

OBJECTIVE: Several investigations indicate that glycosaminoglycans (GAG) are important components of the glomerular basement membrane (GBM) and that they play a remarkable role in the control of charge-selectivity in the glomerular capillary wall. In order to evaluate the possible use of GAG as a marker of glomerular disease, we evaluated urinary GAG excretion in 37 patients with systemic lupus erythematosus (SLE) grouped by disease activity and kidney involvement and in 17 healthy controls. METHODS: GAG were isolated from urine by using ion-exchange chromatography on DEAE Sephacel. GAG composition was determined by cellulose acetate electrophoresis and expressed as relative percentages by densitometric scanning of Alcian Blue stained strips. RESULTS: Total GAG levels were significantly increased only in active extra-renal SLE patients. Qualitative analysis of urinary GAG revealed the presence of a low sulphated chondroitin sulphate-protein complex (LSC-PG), whose frequency was higher in patients compared to controls. Moreover, inactive SLE was characterized by an alteration of the chondroitin sulphate/heparan sulphate ratio. CONCLUSION: These variations suggest the presence of an abnormal permeability of the renal filter in patients without other appreciable signs of kidney alteration. Therefore, qualitative-quantitative urinary GAG analysis could represent an additional diagnostic approach.

Additive effects of Simvastatin beyond its effects on LDL cholesterol in hypertensive type 2 diabetic patients.

BACKGROUND: Experimental evidence indicates that statins might have direct vascular effects independently from low-density lipoprotein (LDL) cholesterol reduction and we reported that the reduction in urinary albumin excretion rate during Simvastatin treatment in type 2 diabetic patients was not correlated with LDL-cholesterol decrease. However in humans there are no data regarding possible additional effects of Simvastatin on blood pressure and urinary albumin excretion beyond its capacity to lower serum cholesterol. PATIENTS AND METHODS: Twenty-six microalbuminuric hypertensive type 2 diabetic patients (diastolic blood pressure - after four months wash-out from the previous antihypertensive therapy - consistently > 90 and < 100 mmHg; plasma LDL-cholesterol > 3.9 and < 6.5 mmol L-1) were enrolled in the study. In random order, these patients received Simvastatin (20 mg day-1) or Cholestyramine (6 g three times a day) for a period of 10 months and after three months of wash-out (cross-over) the sequence was reversed for an additional 10 months. Blood pressure, lipid parameters, glycated haemoglobin and urinary albumin excretion were measured during the study. Additionally, in eight patients, urinary glycosaminoglycan excretion (GAG) was also measured during the study. RESULTS: Simvastatin and Cholestyramine were equally effective in reducing total and LDL cholesterol. Only during Simvastatin treatment a significant reduction in diastolic blood pressure and both 24 h urinary albumin and GAG excretion rates were observed, while no significant changes were seen with Cholestyramine treatment. CONCLUSIONS: Our results clearly show for the first time that the reduction of blood pressure, together with 24 h urinary albumin excretion rate - two established cardiovascular risk factors, obtained during Simvastatin therapy in hypertensive type 2 diabetic patients - is in large part independent from the reduction of LDL Cholesterol.

Structural determinants in the C-terminal domain of apolipoprotein E mediating binding to the protein core of human aortic biglycan.

Apolipoprotein (apo) E-containing high density lipoprotein particles were reported to interact in vitro with the proteoglycan biglycan (Bg), but the direct participation of apoE in this binding was not defined. To this end, we examined the in vitro binding of apoE complexed with dimyristoylphosphatidylcholine (DMPC) to human aortic Bg before and after glycosaminoglycan (GAG) depletion. In a solid-phase assay, apoE.DMPC bound to Bg and GAG-depleted protein core in a similar manner, suggesting a protein-protein mode of interaction. The binding was decreased in the presence of 1 m NaCl and was partially inhibited by either positively (0.2 m lysine, arginine) or negatively charged (0.2 m aspartic, glutamic) amino acids. A recombinant apoE fragment representing the C-terminal 10-kDa domain, complexed with DMPC, bound as efficiently as full-length apoE, whereas the N-terminal 22-kDa domain was inactive. Similar results were obtained with a gel mobility shift assay. Competition studies using a series of recombinant truncated apoEs showed that the charged segment in the C-terminal domain between residues 223 and 230 was involved in the binding. Overall, our results demonstrate that the C-terminal domain contains elements critical for the binding of apoE to the Bg protein core and that this binding is ionic in nature and independent of GAGs.

Modifications of low density lipoprotein induced by the interaction with human plasma glycosaminoglycan-protein complexes.

Glycosaminoglycan (GAG)-protein complexes from human plasma were separated into low charge (LC-GP) and high charge (HC-GP) components. LC-GP and HC-GP differed with respect to GAG and protein composition and to molecular size. The in vitro interaction of both GAG-protein complexes with human LDL was investigated. LC-GP did not precipitate LDL. On the contrary, HC-GP formed insoluble complexes with LDL, following a biphasic behaviour on increasing HC-GP concentration. In the presence of a HC-GP/LDL ratio higher than 0.02 the interaction stoichiometry was shifted towards the formation of soluble complexes. Papain treatment of HC-GP completely prevented LDL precipitation. Moreover, the extent of HC-GP-induced precipitation of LDL was markedly reduced by the simultaneous addition of LC-GP. Data obtained with standard GAGs showed that heparin (HE) and chondroitin-6-sulphate (C6S) were the most effective ligands in precipitating LDL. However, the shape of precipitation curves was markedly different. C6S behaved similarly to HC-GP, suggesting that GAG chains could play an important role in insoluble complex formation with LDL. Steady-state fluorescence anisotropy investigation indicated that HC-GP induced a significant decrease in the microviscosity of LDL hydrophobic region. This effect was no longer detectable after either addition of LC-GP or papain treatment of HC-GP. Differential scanning calorimetry (DSC) demonstrated that both lipid and protein components of LDL were affected by the interaction with HC-GP. The temperature of irreversible thermal unfolding of apo B100 was shifted to a lower value and a second peak appeared in the region of the reversible melting of cholesterol esters. Both the fluorescence anisotropy and the DSC data obtained with standard HE and C6S indicated that GAG chains were directly involved in affecting physico-chemical properties of complexed LDL. These results suggest that the interaction with plasma HC-GP could modify LDL structural properties. However, LC-GP is likely to act as a modulator, probably preventing the interaction between HC-GP and circulating LDL.

A reversed phase HPLC method for the simultaneous determination of all monosaccharides contained in galactosaminoglycan isomers from human aorta proteoglycans.

Monosaccharides obtained by reduction and hydrolysis of galactosaminoglycan isomers, are entirely determined as their perbenzoyl derivatives by reversed phase HPLC, without removal of hexosamines prior to benzoylation. The method is suitable for the analysis of arterial proteoglycan constituent galactosaminoglycans, providing specific, precise and reproducible results. Moreover, synthesis and characterization of tri-O-benzoyl-1,6-L-anhydroidose and N-benzoyl-tetra-O-benzoyl-alpha- and -beta-D-galactosamine have been accomplished.

Extremely high HDL levels in a patient with multiple symmetric lipomatosis.

An extreme form of hyperalphalipoproteinemia was studied in a patient affected by multiple symmetric lipomatosis (MSL); four relatives and three MSL controls were also evaluated. Plasma lipids and apolipoproteins were measured and overall lipoprotein profile was assessed by density gradient ultracentrifugation. The patient showed a plasma HDL-cholesterol of 138 mg/dl and an apo A-I of 218 mg/dl; moreover significantly high HDL levels were found in two unaffected relatives. The hypobetalipoproteinemia trait was also found both in the patient and in one of his daughters. We suggest that some pre-existing conditions may enhance lipoprotein metabolism alterations in this lipid storage disease.

[Separation and quantification of glycosaminoglycans using HPLC]. / Separazione e quantificazione dei glicosaminoglicani mediante HPLC.

Biochemical studies of proteoglycans (PGs) involve the characterization of their polysaccharide chains. In fact, PGs display a considerable heterogeneity with respect to type and size of the saccharide chains, to the ratio of iduronic to glucuronic acid and to the degree of sulphation. Several HPLC methods have been described for separation and identification of glycosaminoglycans (GAGs), which usually employ molecular sieving and disaccharide analysis, after specific enzyme digestion of GAGs. In order to separate intact GAGs, we utilized both high performance gel permeation and ion exchange chromatography, using a Spherogel TSK 4000SW and a Spherogel TSK DEAE 25W respectively. HPLC gel permeation chromatography makes it possible to separate only HA from other GAGs. This procedure can be useful to purify biological preparations from HA, so allowing GAG study in non-aggregating conditions. HPLC ion exchange chromatography was performed on GAG standard mixtures and the suitability of the method was tested on GAGs extracted from intima and media preparations of human thoracic aorta. In our chromatographic conditions HA eluted at 0.5 M NaCl, HS at 0.54 M NaCl, DS at 0.61 M NaCl and C6S at 0.65 M. C4S coeluted with DS and C6S. To determine DS concentration the samples were reanalyzed after chondroitinase AC treatment; the differences in uronic acid content between the original samples and the digests represented the total amount of C4S and C6S. Our data indicate a good reproducibility of the method that allows a rapid and accurate determination of intact GAGs in biological samples.

[Characterization of plasma glycosaminoglycans in hemodialysis patients]. / Caratterizzazione dei glicosaminoglicani plasmatici nel paziente in emodialisi.

Glycosaminoglycans are heteropolysaccharides composed of disaccharide repeating subunits, each one containing a uronic acid component (glucuronic or iduronic acid) and a hexosamine (N-acetyl-glucosamine or N-acetyl-galactosamine, which may be differently sulphated). The presence of GAGs in human plasma has been demonstrated in several studies; they are bound to plasma proteins through non-covalent linkages. However, very little is known about either their origin or their physiological role. Due to their anionic charge, they may influence some metabolic processes, such as blood coagulation, and they could also have a role in urolithiasis and atherogenesis. Moreover, they may be important in modulating the metabolism of some lipoproteins by affecting the rate of their catabolism. Modifications of GAG pattern have been described in a few pathological conditions such as mucopolysaccharidosis, connective tissue diseases and kidney diseases. A high frequency of accelerated atherosclerosis has been observed in haemodialysis patients (HD), probably associated with the altered lipoprotein profile, which is often described in these subjects. Since GAGs may play a role in lipoprotein metabolism, we isolated and characterized plasma GAGs from a group of HD patients and a group of normal matched subjects. Quantitative analysis of plasma GAGs showed a significant increase of these polysaccharides in the HD group. Circulating levels of GAGs were 8.21 +/- 1.89 micrograms/ml in control subjects, and 15.08 +/- 3.13 micrograms/ml in the HD group (p < 0.0001). The isolation of plasma GAGs by ion-exchange chromatography produced two uronic acid containing families: a low-charge (peak I) and a high-charge (peak II) species. Both of these contained GAGs associated with plasma proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lipid and lipoprotein profile in psoriasis]. / Assetto lipidico e lipoproteico nella psoriasi.

Psoriasis is a common relapsing dermatosis characterized by an increased epidermal cell proliferation. In this work we studied the lipid and lipoprotein pattern in 17 patients affected by long-standing psoriasis and in 20 normal controls. Total cholesterol, triglyceride, HDL-cholesterol and Apolipoprotein AI and B levels were measured; VLDL, LDL and HDL chemical composition was assessed by preparative ultracentrifugation. Plasma lipid and lipoprotein levels were significantly lower in the patient group; chemical analysis of the main lipoprotein classes showed compositional abnormalities consistent with an accelerated turnover of these particles. We believe that epidermal cell proliferation can play a role in determining these changes.

[Study of the interaction between plasma proteoglycans and LDL by means of fluorescence spectroscopy]. / Studio dell'interazione tra proteoglicani plasmatici ed LDL mediante spettroscopia di fluorescenza.

The relevance of the interaction between LDL and PGs in the development of atherosclerotic processes is well known. However, the exact nature of the interaction and the consequent structural and/or conformational modifications of the lipoprotein remain to be clarified. It has been demonstrated that after this interaction the LDL particle is not recognized by specific cellular receptors and enters the scavenger pathway operating in different cell types. These effects have been shown by using aortic PGs, but PGs are also present in the plasma compartment and may interact constantly with LDL, taking part in the regulation of lipid metabolism. In order to assess the capability of plasma PGs to induce LDL modifications, we investigated their interactions by studying the changes in the organizational parameters of LDL by fluorescence spectroscopy. Plasma PGs were isolated by DEAE Sephacel ion exchange chromatography and Sephacryl S300 gel filtration in two different families: a low-charge PG and a high-charge PG. Human LDL was prepared from plasma of normolipemic donors by ultracentrifugal flotation between 1.025-1.045 g/ml. Steady-state anisotropy measures were obtained by analyzing the rotational diffusion rate of DPH after incubation of LDL with plasma PGs in a physiological ratio. In our experimental conditions, LDL incubation with plasma low-charge PG did not modify DPH fluorescence anisotropy, whereas LDL treatment with highly charged PGs induced a marked decrease of this parameter, suggesting a significant effect on LDL microviscosity. The data show that both the charge and the GAG composition of PGs appear to be critical factors in LDL-PG interaction.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural and functional modifications of human aorta proteoglycans in atherosclerosis.

Proteoglycans (PGs) were extracted from minced normal human aorta intima and media and adjacent atherosclerotic plaques. Samples obtained from each individual artery which showed different degrees of atherosclerotic involvement were studied separately. Comparing normal and atherosclerotic areas from the same aorta, the hexuronic acid content was always lower in the atherosclerotic minces. Atherosclerotic samples always contained a higher percentage amount of chondroitinase AC resistant material. PGs were sequentially extracted with increasing guanidine hydrochloride (GuHCl) concentrations. 0.4 M GuHCl extracted about 13% of total PGs, containing mostly chondroitin sulphate (CS), whilst 4 M GuHCl extracted about 50% of total PGs, containing CS, dermatan sulphate (DS), heparan sulphate and hyaluronic acid. PGs from atherosclerotic minces showed a higher DS amount, based on electrophoretic glycosaminoglycan (GAG) analysis. PGs extracted with 4 M GuHCl were further characterized by gel-chromatography and by CsCl density gradient centrifugation. The relative content of PGs with highest hydrodynamic size appeared to be markedly reduced in all the atherosclerotic samples. LDL/GAGs and LDL/PGs interactions were studied by affinity chromatography. GAGs obtained by papain digestion of PGs extracted from atherosclerotic areas contained a glycosaminoglycuronan interacting more strongly with human LDL than GAGs from normal areas of the same artery. The complete elution of PGs required higher NaCl concentration than GAGs. Moreover, PGs from atherosclerotic samples showed higher affinity for LDL than PGs from normal areas of the same aorta.

Plasma lipids in beta-thalassemia minor.

Because total cholesterol levels have been found to be lower in patients affected by thalassemia major and intermedia, we examined the plasma lipid pattern of 628 beta-thalassemia trait carriers and 4552 controls in order to evaluate whether the plasma lipid impairment is also present in the heterozygous state. Total cholesterol and low density lipoprotein (LDL)-cholesterol levels were significantly lower in beta-thalassemia trait carriers when compared to controls, whereas plasma triglycerides and high density lipoprotein (HDL)-cholesterol levels did not differ between the two groups. We suggest that accelerated erythropoiesis and increased uptake of LDL by macrophages and histiocytes of the reticuloendothelial system are the main determinants of low plasma cholesterol levels in heterozygous thalassemia.

[Nutritional habits of homozygote beta-thalassemic subjects]. / Indagine sulle abitudini alimentari di soggetti beta-talassemici omozigoti.

An investigation on eating habits of a group of 40 patients with beta-thalassemia major has been carried out mainly to evidentiate iron intake whose absorption is strikingly increased in this disease. Questionnaires were used to obtain information. Daily food intake, the mean consumption of various types of food and the level of the more significant nutrients were calculated, using the National Institute of Nutrition tables. A high consumption of meat and a low consumption of fruits and vegetables were observed. A high proportion of proteins (particularly of animal origin) and a low proportion of lipids and carbohydrates was observed in comparison with the recommended levels of nutrients. Iron intake was slightly lower but its absorption may be increased because of the high proportion of calories of animal origin. A manipulation of the diet seems to be necessary to reduce the risk of iron loading.

Plasma lipids and lipoproteins pattern in beta-thalassemia major.

We studied serum lipids and lipoproteins in 20 patients with beta-thalassemia major, under high transfusion programme and regular chelation therapy, and in 20 control subjects. Total cholesterol, HDL-cholesterol, HDL2-and HDL3-cholesterol, apolipoprotein A and B levels were significantly lower in patients with Cooley's anemia, whereas free cholesterol, triglycerides and the HDL-/HDL3-cholesterol ratio did not differ in the two groups. We think that liver damage plays an important role in determining the altered lipoprotein pattern in beta-thalassemia major. However, other factors may contribute to cause such lipid changes.

[Post-heparin lipase activity in beta-thalassemia major: preliminary data]. / Attivita lipasica post-eparinica nella beta-thalassemia major: dati preliminari.

We studied serum lipids and post-heparin triglyceride lipase activities in 8 patients with Beta-Thalassaemia Major, under high transfusion programme and regular chelation therapy and in 8 control subjects. Total cholesterol and HDL-cholesterol were significantly lower in patients with Cooley's anaemia, whereas triglyceride levels did not differ in the two groups. Post-heparin triglyceride lipase activities were determined according with the method of Krauss et A1. using glyceryl-tri-(1-14C)oleate as substrate and NaCl to inactivate the extrahepatic lipase. These enzymatic activities (both hepatic and extrahepatic) resulted significantly lower in thalassaemic patients. We suppose that the decreased levels of these enzymatic activities could play a role in determining the decrease of HDL-cholesterol that we observed in our thalassaemic patients.

[Changes in HDL subfractions in patients with type I diabetes mellitus before and after metabolic control]. / Modificazioni delle subfrazioni delle HDL nei pazienti con diabete mellito di tipo I prima e dopo compenso metabolico.

In order to further investigate the behaviour of high density lipoproteins in diabetes mellitus, we studied HDL subclasses, HDL2 and HDL3, in 10 patients with newly detected, untreated insulin-deficient diabetes before starting insulin treatment and after getting a good metabolic control. We used the extractive method of Abell to determine HDL-cholesterol after LDL and VLDL precipitation with polyanions and HDL3-cholesterol after HDL2 precipitation with dextransulphate 15,000 m.w. After insulin therapy, we observed a significant increase in HDL-cholesterol and a decrease in serum triglycerides. Only HDL2-cholesterol, but not HDL3-cholesterol, raised; moreover, we found a significant inverse relationship between HDL-cholesterol (and also HDL2-cholesterol) and triglycerides. So, we think that an increase of lipoprotein lipase activity, owing to insulin treatment, could account for our results.

[HDL2 and HDL3 cholesterol in hepatic cirrhosis]. / IL colesterolo delle HDL2 e HDL3 nella cirrosi epatica.

In order to further investigate plasma lipoproteins abnormalities secondary to serious liver damage, we studied plasma lipids and lipoproteins, and in particular HDL subfractions (HDL2, HDL3), in 12 patients with cirrhosis of the liver and in 12 sex, age and weight matched healthy volunteers. Enzymatic methods were used to determine total cholesterol and triglycerides, while the extractive method of Abell et al. was used for the determination of HDL-cholesterol levels after LDL and VLDL precipitation with polyanions (MnCl2 and Na-heparin) and of HDL3-cholesterol values after HDL2 precipitation with dextran-sulphate 15,000 m.w. Total cholesterol and HDL-cholesterol levels were significantly lower in cirrhotic patients compared to normal subjects. We must emphasize that only HDL3-cholesterol was decreased in cirrhotics, whereas HDL2-cholesterol values were normal or high. We suggest that a diminished activity of hepatic triglyceride lipase might account for the decrease in HDL3-cholesterol in liver cirrhosis.

[Experimental electrocardiography research. A study in the rat of the cardiovascular effects of verapamil]. / Ricerche di elettrocardiografia sperimentale. Studio nel ratto degli effetti cardiovascolari del verapamil.

Electrocardiographic changes induced by Verapamil, drug inducing inhibition of transmembrane movement of calcium into cardiac cells and mobilization of intracellular Ca++, have been studied in 10 anesthetized rats. Authors observed that Verapamil has: 1) negative chronotropic action on SA node; sometimes appears a superior nodal rhythm; 2) inconstantly, negative dromotropic action with prolonged atrioventricular conduction and "period of Luciani-Wenckebach'; 3) effective antiarrhythmic action; 4) no protective action towards peripheric vascular epinephrine effects; 5) remarkable negative inotropic action, whose Authors consider indirect signs the electrocardiographic changes, which indicate severe coronary failure, and the death of 6 rats by acute pulmonary edema.