The Emerging Role of Sirtuin 1 in Cellular Metabolism, Diabetes Mellitus, Diabetic Kidney Disease and Hypertension.

Despite diagnostic and therapeutic approaches, diabetic kidney disease (DKD) is the most common cause of end-stage renal disease worldwide. Sirtuins, a group of nicotinamid adenine dinucleotide (NAD) dependent enzymes, can deacetylase target enzymes that regulate a wide variety of cellular processes regarding protein, carbohydrate and lipid metabolism, mitochondrial homeostasis and programmed cell death mechanisms including autophagy and apoptosis. Among sirtuins, sirtuin 1 (SIRT1) has been the most studied one in the pathogenesis and progression of DKD. In recent years, the relation between SIRT1 and hypertension was also evaluated.In the present review, we aimed to represent the mechanisms of SIRT1 in glucose and lipid metabolism and in the pathogenesis of diabetes mellitus. We also sought to highlight the emerging role of SIRT1 in the pathogenesis and treatment of DKD and hypertension.

The relationship between colonization of Oxalobacter formigenes serum oxalic acid and endothelial dysfunction in hemodialysis patients: from impaired colon to impaired endothelium.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients receiving hemodialysis (HD). Oxalic acid is a uremic retention molecule that has been extensively studied in the pathogenesis of calcium-oxalate stones. Oxalobacter formigenes (O. formigenes), a component of the colonic microbiota, plays an important role in oxalate homeostasis. Little is known regarding the colonization of HD patients by O. formigenes and the exact role of this bacterial species in oxalic acid metabolism in these patients. We hypothesized that oxalic acid may be insufficiently degraded in HD patients due to under colonization of the colon by O. formigenes in these patients. To test this hypothesis, we sought to quantitatively measure fecal O. formigenes levels and serum oxalic acid levels in HD patients. We also suggest that increased oxalic acid levels may be associated with endothelial dysfunction and aortic stiffness, both of which are commonly observed in HD patients. Increased colonization with O. formigenes via the ingestion of prebiotics and probiotics could potentially decrease serum oxalic acid levels and improve cardiovascular outcomes in HD patients.

Peri-aortic fat tissue and malnutrition-inflammation-atherosclerosis/calcification syndrome in end-stage renal disease patients.

PURPOSE: Thoracic peri-aortic fat tissue (PFT) is considered as a metabolically active organ in atherosclerosis. Malnutrition, inflammation and atherosclerosis/calcification (MIAC) are the most commonly encountered risk factors of cardiovascular disease in end-stage renal disease (ESRD) patients. Calcification of the aorta was found to be an important cardiovascular risk marker predicting future events, morbidity and mortality in this population. We aimed to investigate the relationship between PFT, MIAC syndrome and thoracic aortic calcification (TAC) in ESRD patients. METHODS: Seventy-nine ESRD patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and 20 control subjects were enrolled in this cross-sectional study. PFT and TAC were assessed using a 64-MDCT scanner. Patients with serum albumin <3.5 g/dL were defined as patients with malnutrition; those with serum C-reactive protein level >10 mg/L had inflammation, and those with coronary artery calcification score (CACS) >10 had atherosclerosis/calcification. RESULTS: TAC and PFT were significantly higher in ESRD patients compared with control subjects. There was a statistically significant relationship between PFT and TAC in ESRD patients (r = 0.458, p < 0.0001). PFT was found to be significantly increased when the MIAC components increased. PFT was positively associated with age, BMI, uric acid, hemoglobin and CAC. The multivariate analysis revealed that age and uric acid were independent predictors of increased PFT. Twenty-four (30.4 %) patients had none, 30 (37.9 %) had one component, 17 (21.5 %) had two components, and 8 (10.2 %) had all MIAC components. PFT was highest among patients having all three components (28.6 cm(3)) and lowest among those who do not have the MIAC syndrome (8.54 cm(3)). TAC was highest among patients having all three components (179.2 HU) and lowest among those who do not have the MIAC syndrome (0 HU). CONCLUSIONS: We found a relationship between PFT and MIAC syndrome in ESRD patients.

Amlodipine-induced gingival hyperplasia in chronic renal failure: a case report.

Amlodipine is a dihydropyridine calcium channel blocker that is used in the management of both hypertension and angina. Amlodipine induced side effects are headache, dizziness, edema, flushing, palpitations, and rarely gingival hyperplasia. The exact reason of amlodipine-induced gingival hyperplasia is not known. We presented a case with chronic renal failure (CRF) that developed gingival hyperplasia due to amlodipine use, which improved after ceasing the drug.

The relationship among acute-phase responce proteins, cytokines, and hormones in various gastrointestinal cancer types patients with cachectic.

BACKGROUND: Acute-phase response proteins (APRPs), cytokines, and hormones have been claimed to be an independent, important factor of cancers. We suggest that in gastrointestinal system cancers, changes in APRP, cytokines, and hormones are associated. METHODS: C-reactive protein (CRP), albumin, interleukin 1α (IL-1α), IL-1ß, IL-6, IL-8, IL-10, tumor necrosis factor α (TNF-α), midkine, vascular endothelial growth factor-A(VEGF-A), VEGF-C, VEGF receptor 1 (VEGFR1), leptin, adiponectin, and ghrelin serum levels are studied in 148 gastrointestinal system cancer types and 40 healthy controls. RESULTS: We found statistically significant differences and correlations between groups. We found significantly higher serum CRP, IL-1α, IL-1ß, IL-6, IL-8, IL-10, TNF-α, VEGF-A, VEGF-C, VEGFR1, and leptin concentrations in patients with esophageal, gastric, pancreas, colon, and rectum cancers than controls (p < 0.001, p < 0.0001). But, we found lower levels of the serum albumin, midkine, adiponectin, and ghrelin in patients with esophageal, gastric, pancreas, colon, and rectum cancers compared to control subjects (p < 0.05, p < 0.001). CONCLUSIONS: Cachexia in gastrointestinal system cancer types is associated with changes in APRP, cytokines, and hormone concentrations. This may be reflected between the outcomes in malignancies and the biomarkers.

Is valproate promising in cardiac fatal arrhythmias? Comparison of P- and Q-wave dispersion in bipolar affective patients on valproate or lithium-valproate maintenance therapy with healthy controls.

Autonomic nerve system is considered to be involved in bipolar affective disorder (BAD) or to be influenced by valproate monotherapy or valproate plus lithium combination. We planned to assess the effects of medication on atrial and ventricular conduction. The electrocardiography records were performed with eligible 15 patients with valproate, 20 patients with lithium-valproate combination use in euthymic phases of BAD and 20 healthy participants. The blood valproate and lithium concentrations in groups were in normal range. The difference in P maximum, P minimum, maximum QTc were statistically insignificant. Minimum QTc (F = 6.36; df = 2; P = 0.003) and QT dispersion (QTD) (F = 5.57; df = 2; P = 0.006) were statistically significant among the groups. There were no significant differences between patient groups among ECG parameters. Minimum QTc was significantly longer in combination group than healthy controls, whereas the QTD values in both patient groups were significantly lower than controls'. Valproate might have some preventive effects on ventricular electrical conduction because of lower QTD in both patient groups. Thus, valproate seems to have cardiac conduction stabilizing effect beside its mood stabilizing aspect. However, this finding needs replication and further corroboration in well-designed studies.