Clinical approach to the inflammatory etiology of cardiovascular diseases

Inflammation is an obligatory marker of arterial disease, both stemming from the inflammatory activity of cholesterol itself and from well-established molecular mechanisms. Raised progenitor cell recruitment after major events and clonal hematopoiesis related mechanisms have provided an improved understanding of factors regulating inflammatory phenomena. Trials with inflammation antagonists have led to an extensive evaluation of biomarkers such as the high sensitivity C reactive protein (hsCRP), not exerting a causative role, but frequently indicative of the individual cardiovascular (CV) risk. Aim of this review is to provide indication on the anti-inflammatory profile of agents of general use in CV prevention, i.e. affecting lipids, blood pressure, diabetes as well nutraceuticals such as n-3 fatty acids. A crucial issue in the evaluation of the benefit of the anti-inflammatory activity is the frequent discordance between a beneficial activity on a major risk factor and associated changes of hsCRP, as in the case of statins vs PCSK9 antagonists. In hypertension, angiotensin converting enzyme inhibitors exert an optimal anti-inflammatory activity, vs the case of sartans. The remarkable preventive activity of SLGT-2 inhibitors in heart failure is not associated with a clear anti-inflammatory mechanism. Finally, icosapent ethyl has been shown to reduce the CV risk in hypertriglyceridemia, with a 27 % reduction of hsCRP. The inflammation-based approach to arterial disease has considerably gained from an improved understanding of the clinical diagnostic strategy and from a better knowledge on the mode of action of numerous agents, including nutraceuticals

Pharmacological aspects of ANGPTL3 and ANGPTL4 inhibitors: new therapeutic approaches for the treatment of atherogenic dyslipidemia

Among the determinants of atherosclerotic cardiovascular disease (ASCVD), genetic and experimental evidence has provided data on a major role of angiopoietin-like proteins 3 and 4 (ANGPTL3 and ANGPTL4) in regulating the activity of lipoprotein lipase (LPL), antagonizing the hydrolysis of triglycerides (TG). Indeed, beyond low-density lipoprotein cholesterol (LDL-C), ASCVD risk is also dependent on a cluster of metabolic abnormalities characterized by elevated fasting and post-prandial levels of TG-rich lipoproteins and their remnants. In a head-to-head comparison between murine models for ANGPTL3 and ANGPTL4, the former was found to be a better pharmacological target for the treatment of hypertriglyceridemia. In humans, loss-of-function mutations of ANGPTL3 are associated with a marked reduction of plasma levels of VLDL, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Carriers of loss-of-function mutations of ANGPTL4 show instead lower TG-rich lipoproteins and a modest but significant increase of HDL. The relevance of ANGPTL3 and ANGPTL4 as new therapeutic targets is proven by the development of monoclonal antibodies or antisense oligonucleotides. Studies in animal models, including non-human primates, have demonstrated that short-term treatment with monoclonal antibodies against ANGPTL3 and ANGPTL4 induces activation of LPL and a marked reduction of plasma TG-rich-lipoproteins, apparently without any major side effects. Inhibition of both targets also partially reduces LDL-C, independent of the LDL receptor. Similar evidence has been observed with the antisense oligonucleotide ANGPTL3-LRX. The genetic studies have paved the way for the development of new ANGPTL3 and 4 antagonists for the treatment of atherogenic dyslipidemias. Conclusive data of phase 2 and 3 clinical trials are still needed in order to define their safety and efficacy profile

Effect of soy on metabolic syndrome and cardiovascular risk factors : a randomized controlled trial

Background: Cardiovascular diseases are currently the commonest cause of death worldwide. Different strategies for their primary prevention have been planned, taking into account the main known risk factors, which include an atherogenic lipid profile and visceral fat excess. Methods: The study was designed as a randomized, parallel, single-center study with a nutritional intervention duration of 12 weeks. Whole soy foods corresponding to 30 g/day soy protein were given in substitution of animal foods containing the same protein amount. Results: Soy nutritional intervention resulted in a reduction in the number of MetS features in 13/26 subjects. Moreover, in the soy group we observed a significant improvement of median percentage changes for body weight ( 121.5 %) and BMI ( 121.5 %), as well as for atherogenic lipid markers, namely TC ( 124.85 %), LDL-C ( 125.25 %), non-HDL-C ( 127.14 %) and apoB ( 1214.8 %). Since the majority of the studied variables were strongly correlated, three factors were identified which explained the majority (52 %) of the total variance in the whole data set. Among them, factor 1, which loaded lipid and adipose variables, explained the 22 % of total variance, showing a statistically significant difference between treatment arms (p = 0.002). Conclusions: The inclusion of whole soy foods (corresponding to 30 g/day protein) in a lipid-lowering diet significantly improved a relevant set of biomarkers associated with cardiovascular risk

An expression signature of the angiogenic response in gastrointestinal neuroendocrine tumours: correlation with tumour phenotype and survival outcomes.

BACKGROUND: Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are heterogeneous with respect to biological behaviour and prognosis. As angiogenesis is a renowned pathogenic hallmark as well as a therapeutic target, we aimed to investigate the prognostic and clinico-pathological role of tissue markers of hypoxia and angiogenesis in GEP-NETs. METHODS: Tissue microarray (TMA) blocks were constructed with 86 tumours diagnosed from 1988 to 2010. Tissue microarray sections were immunostained for hypoxia inducible factor 1α (Hif-1α), vascular endothelial growth factor-A (VEGF-A), carbonic anhydrase IX (Ca-IX) and somatostatin receptors (SSTR) 1–5, Ki-67 and CD31. Biomarker expression was correlated with clinico-pathological variables and tested for survival prediction using Kaplan–Meier and Cox regression methods. RESULTS: Eighty-six consecutive cases were included: 51% male, median age 51 (range 16–82), 68% presenting with a pancreatic primary, 95% well differentiated, 51% metastatic. Higher grading (P=0.03), advanced stage (P<0.001), high Hif-1α and low SSTR-2 expression (P=0.03) predicted for shorter overall survival (OS) on univariate analyses. Stage, SSTR-2 and Hif-1α expression were confirmed as multivariate predictors of OS. Median OS for patients with SSTR-2+/Hif-1α-tumours was not reached after median follow up of 8.8 years, whereas SSTR-2-/Hif-1α+ GEP-NETs had a median survival of only 4.2 years (P=0.006). CONCLUSION: We have identified a coherent expression signature by immunohistochemistry that can be used for patient stratification and to optimise treatment decisions in GEP-NETs independently from stage and grading. Tumours with preserved SSTR-2 and low Hif-1α expression have an indolent phenotype and may be offered less aggressive management and less stringent follow up

Precipitation extremes over La Plata Basin –Review and new results from observations and climate simulations

Monthly and daily precipitation extremes over La Plata Basin (LPB) are analyzed in the framework of the CLARIS-LPB Project. A review of the studies developed during the project and results of additional research are presented and discussed. Specific aspects of analysis are focused on large-scale versus local processes impacts on the intensity and frequency of precipitation extremes over LPB, and on the assessment of specific wet and dry spell indices and their changed characteristics in future climate scenarios. The analysis is shown for both available observations of precipitation in the region and ad-hoc global and regional models experiments. The Pacific, Indian and Atlantic Oceans can all impact precipitation intensity and frequency over LPB. In particular, considering the Pacific sector, different types of ENSO events (i.e. canonical vs Modoki or East vs Central) have different influences. Moreover, model projections indicate an increase in the frequency of precipitation extremes over LPB during El Niño and La Ninã events in future climate. Local forcings can also be important for precipitation extremes. Here, the feedbacks between soil moisture and extreme precipitation in LPB are discussed based on hydric conditions in the region and model sensitivity experiments. Concerning droughts, it was found that they were more frequent in the western than in the eastern sector of LPB during the period of 1962–2008. On the other hand, observations and model experiments agree in that the monthly wet extremes were more frequent than the dry extremes in the northern and southern LPB sectors during the period 1979–2001, with higher frequency in the south.Published211-2304A. Clima e OceaniJCR Journalrestricte

Nutraceutical approach for the management of cardiovascular risk \u2013 a combination containing the probiotic Bifidobacterium longum BB536 and red yeast rice extract: results from a randomized, double-blind, placebo-controlled study

BACKGROUND: Probiotics incorporated into dairy products have been shown to reduce total (TC) and LDL cholesterolemia (LDL-C) in subjects with moderate hypercholesterolemia. More specifically, probiotics with high biliary salt hydrolase activity, e.g. Bifidobacterium longum BB536, may decrease TC and LDL-C by lowering intestinal cholesterol reabsorption and, combined with other nutraceuticals, may be useful to manage hypercholesterolemia in subjects with low cardiovascular (CV) risk. This study was conducted to evaluate the efficacy and safety of a nutraceutical combination containing Bifidobacterium longum BB536, red yeast rice (RYR) extract (10\u2009mg/day monacolin K), niacin, coenzyme Q10 (Lactoflorene Colesterolo\uae). The end-points were changes of lipid CV risk markers (LDL-C, TC, non-HDL-cholesterol (HDL-C), triglycerides (TG), apolipoprotein B (ApoB), HDL-C, apolipoprotein AI (ApoAI), lipoprotein(a) (Lp(a), proprotein convertase subtilisin/kexin type 9 (PCSK9)), and of markers of cholesterol synthesis/absorption. METHODS: A 12-week randomized, parallel, double-blind, placebo-controlled study. Thirty-three subjects (18-70\u2009years) in primary CV prevention and low CV risk (SCORE: 0-1% in 24 and 2-4% in 9 subjects; LDL-C: 130-200\u2009mg/dL) were randomly allocated to either nutraceutical (N\u2009=\u200916) or placebo (N\u2009=\u200917). RESULTS: Twelve-week treatment with the nutraceutical combination, compared to placebo, significantly reduced TC (-\u200916.7%), LDL-C (-\u200925.7%), non-HDL-C (-\u200924%) (all p\u2009&lt;\u20090.0001), apoB (-\u200917%, p\u2009=\u20090.003). TG, HDL-C, apoAI, Lp(a), PCSK9 were unchanged. Lathosterol:TC ratio was significantly reduced by the nutraceutical combination, while campesterol:TC ratio and sitosterol:TC ratio did not change, suggesting reduction of synthesis without increased absorption of cholesterol. No adverse effects and a 97% compliance were observed. CONCLUSIONS: A 12-week treatment with a nutraceutical combination containing the probiotic Bifidobacterium longum BB536 and RYR extract significantly improved the atherogenic lipid profile and was well tolerated by low CV risk subjects. TRIAL REGISTRATION: NCT02689934

Visualización y análisis de la humedad del suelo en superficie medida in situ y estimada por satelites en un sitio de la Llanura Pampeana

PosterEl agua almacenada en el suelo es una variable que controla múltiples procesos y circuitos de retroalimentación dentro del sistema climático, mediando los ciclos del agua y la energía (Seneviratne et al., 2010). En los últimos años se han logrado avances significativos en la caracterización de la humedad de suelo (HS) a escala regional, a través de estimaciones mediante teledetección y la puesta en funcionamiento de nuevas redes de medición in situ. Cada una de estas fuentes de información presenta características intrínsecas, como el rango dinámico de HS, los periodos de disponibilidad de datos y la frecuencia temporal de adquisición de los mismos. Por lo expuesto, resulta de suma importancia elaborar metodologías de visualización de la HS que nos permitan evaluar las cualidades de cada fuente de información previniendo la aplicación de supuestos y filtros adicionales sobre la dinámica natural de la HS que cada una de estas fuentes brinda. En el presente trabajo se proponen estrategias para explorar la HS de estaciones in situ y de los sistemas satelitales SMOS y SMAP. El estudio se enfoca en un sector de la llanura Pampeana de Argentina que ofrece como ventajas, además de contar con mediciones de HS in situ, paisajes relativamente homogéneos en cuanto a tipos y usos del suelos y un relieve extremadamente plano, que junto con un clima subhúmedo ofrecen un laboratorio natural de condiciones de HS.Fil: Cappelletti, L.M. Universidad de Buenos Aires - Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Investigaciones del Mar y la Atmósfera (CIMA/UBA-CONICET), Buenos Aires, Argentina; Institut Franco-Argentin d'Études sur le Climat et ses Impacts, Unité Mixte Internationale (UMI-IFAECI/CNRS-IRD-CONICET-UBA), Argentina.Fil: Sorensson, A. Universidad de Buenos Aires - Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Investigaciones del Mar y la Atmósfera (CIMA/UBA-CONICET), Buenos Aires, Argentina; Institut Franco-Argentin d'Études sur le Climat et ses Impacts, Unité Mixte Internationale (UMI-IFAECI/CNRS-IRD-CONICET-UBA), ArgentinaFil: Jobbágy, Esteban G. Universidad Nacional de San Luis. Instituto de Matemática Aplicada San Luis. Grupo de Estudios Ambientales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaRuscica, R. Universidad de Buenos Aires - Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Investigaciones del Mar y la Atmósfera (CIMA/UBA-CONICET), Buenos Aires, Argentina; Institut Franco-Argentin d'Études sur le Climat et ses Impacts, Unité Mixte Internationale (UMI-IFAECI/CNRS-IRD-CONICET-UBA), Argentina.Fil: Salvia, Maria Mercedes. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Fernández Long, M. Universidad de Buenos Aires. Facultad de Agronomía; Argentina.Fil: Gattinoni, Natalia N. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Clima y Agua; ArgentinaFil: Spennemann, P.C. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Servicio Meteorológico Nacional; Argentina Universidad Nacional de Tres de Febrero; Argentin

The i148m Pnpla3 polymorphism influences serum adiponectin in patients with fatty liver and healthy controls

BACKGROUND: Reduced adiponectin is implicated in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH), and the I148M Patatin-like phospholipase domain-containing 3 (PNPLA3) polymorphism predisposes to NAFLD and liver damage progression in NASH and chronic hepatitis C (CHC) by still undefined mechanisms, possibly involving regulation of adipose tissue function. Aim of this study was to evaluate whether the I148M PNPLA3 polymorphism influences serum adiponectin in liver diseases and healthy controls. METHODS: To this end, we considered 144 consecutive Italian patients with NAFLD, 261 with CHC, 35 severely obese subjects, and 257 healthy controls with very low probability of steatosis, all with complete clinical and genetic characterization, including adiponectin (ADIPOQ) genotype. PNPLA3 rs738409 (I148M) and ADIPOQ genotypes were evaluated by Taqman assays, serum adiponectin by ELISA. Adiponectin mRNA levels were evaluated by quantitative real-time PCR in the visceral adipose tissue (VAT) of 35 obese subjects undergoing bariatric surgery. RESULTS: Adiponectin levels were independently associated with the risk of NAFLD and with the histological severity of the disease. Adiponectin levels decreased with the number of 148\u2009M PNPLA3 alleles at risk of NASH both in patients with NAFLD (p\u2009=\u20090.03), and in healthy subjects (p\u2009=\u20090.04). At multivariate analysis, PNPLA3 148\u2009M alleles were associated with low adiponectin levels (<6\u2009mg/ml, median value) independently of NAFLD diagnosis, age, gender, BMI, and ADIPOQ genotype (OR 1.67, 95% c.i. 1.07-2.1 for each 148\u2009M allele). The p.148\u2009M PNPLA3 variant was associated with decreased adiponectin mRNA levels in the VAT of obese patients (p\u2009<\u20090.05) even in the absence of NASH. In contrast, in CHC, characterized by adiponectin resistance, low adiponectin was associated with male gender and steatosis, but not with PNPLA3 and ADIPOQ genotypes and viral features. CONCLUSIONS: The I148M PNPLA3 variant is associated with adiponectin levels in patients with NAFLD and in healthy subjects, but in the presence of adiponectin resistance not in CHC patients. The I148M PNPLA3 genotype may represent a genetic determinant of serum adiponectin levels. Modulation of serum adiponectin might be involved in mediating the susceptibility to steatosis, NASH, and hepatocellular carcinoma in carriers of the 148\u2009M PNPLA3 variant without CHC, with potential therapeutic implications