Can the Diagnosis of Metabolic Syndrome and the Severity of the Disease Be Determined with the Help of Inflammatory Biomarkers?

Objective:Metabolic syndrome (MS) is defined by a cluster of interdependent physiological, biochemical, and clinical risk factors and linked to a state of chronic inflammation. YKL-40 is known as an inflammatory glycoprotein, which is secreted by various cell lines during inflammation. Thus, we aimed to assess the association of serum YKL-40 levels with the presence and severity of MS.Methods:In this prospective cross-sectional study, a total of 177 consecutive patients [n=114 MS present and n=63 MS absent] were enrolled. MS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Serum YKL-40 and hs-CRP levels were measured for all participants.Results:Serum YKL-40, hs-CRP and white blood cell count (WBC) were significantly higher in the MS present group (p<0.05). There was a graded relationship between increasing number of MS components and serum YKL-40 level (p<0.05). In addition, serum YKL-40 level was positively correlated with hs-CRP level (r=0.467, p<0.001) and WBC count (r=0.251, p=0.001). In multivariable regression analysis, serum YKL-40 [1.022 (1.011–1.033), p<0.001] and hs-CRP [1.346 (1.111–1.632), p=0.002] were remained as independent predictors for the presence of MS. In the ROC curve analysis, using a cut-off level of 147.0, YKL-40 well predicted the presence of MS with a sensitivity of 73.7% and specificity of 69.8% (AUC: 0.785; 95% CI: 0.718–0.853, p<0.001).Conclusion:In this study, we demonstrated that serum YKL-40 level was significantly associated with the presence of MS. According to these findings, we concluded that serum YKL-40 may be a novel and useful indicator for MS. (Anatol J Cardiol 2016; 16: 953-8)

The aim of this study was to evaluate the efficacy of treatment with mud pack in knee osteoarthritis (OA) and to determine whether mud pack effects serum levels of YKL-40 and high-sensitivity C-reactive protein (hsCRP) which are reported to be biological markers for articular damage or inflammation in patients with OA. Forty-four patients with the diagnosis of knee OA assigned into two groups were treated with local natural mineral-rich mud pack or hot pack. Treatments were applied for 6 days a week for 2 weeks as a total of 12 sessions. Patients were assessed at baseline, post-treatment, and 3 months after the treatment. VAS, range of motion, 15-m walking time, WOMAC index, Nottingham Health Profile, serum YKL-40, and hsCRP levels were the outcome measures. Pain intensity and joint stiffness decreased in both groups at all follow-ups. Physical activity status was found to persist for 3 months after treatment only in mud pack group. Serum mean YKL-40 and hsCRP levels of the patients were higher compared to healthy control group. Serum YKL-40 level increased significantly only in hot pack group 3 months after the treatment (P < 0.017). No significant change was observed in hsCRP levels in both groups during the whole follow-up periods (P > 0.05). Mud pack and hot pack therapy were both demonstrated to be effective in symptomatic treatment of knee OA until the end of the 2-week treatment period, whereas only mud pack therapy was shown to be effective in functional status over time. In the hot pack group, increased serum YKL-40 level 3 months after the treatment might indicate persistence of cartilage degradation. Maintenance of YKL-40 level in mud pack therapy seems to slow down the progression of knee OA.

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Increased serum YKL-40 and C-reactive protein levels are associated with angiographic lesion progression in patients with coronary artery disease

Serum and BALF YKL-40 levels are predictors of survival in idiopathic pulmonary fibrosis

Background: There is excess and premature mortality in schizophrenia (SZ), from both natural and unnatural causes, when compared to the general population. In a 15-year follow-up study of SZ patients, 22% had died, of which greater than 50% died from cardiovascular and respiratory diseases. Inflammation has been linked to all stages of atherosclerosis. Recent studies suggest a role of C-reactive protein (CRP) as a risk marker for cardiovascular disease (CVD). CRP is a blood-borne protein that is produced by hepatocytes and regulated by inflammatory cytokines. The purpose of this study was to test whether high risk of cardiovascular disease was associated with increased levels of serum high-sensitivity CRP (hsCRP) progressively during the course of schizophrenia development. Methods: Serum hsCRP contents were compared among first-episode antipsychotic-naive patients with SZ (FEAN-SZ, n = 24), early course SZ patients with duration of illness 20 years patients currently with (n = 21) and those without (n = 19) treatment with lipid lowering drugs (LLD). In addition, age- and gender-matched healthy control subjects (HC, n = 25) were used for baseline comparisons with FEAN-SZ group. The high risk of CVD in human subjects was determined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP-III) guidelines. The hsCRP measures were categorized as low risk, 3 mg/l. Results: Similar to HC subjects, 79% FEAN-SZ patients had low-risk hsCRP values with only 8% and 13% in average- and high-risk values, respectively. However, as disease progressed, 33% of clinically stable ECSZ patients who were not identified at high risk of CVD had average- and high-risk values, respectively. Among CSZ patients without LLD, 79% had high risk and 21% had average risk of hsCRP values. Following LLD therapy, these values remained relative high with 62%, 29%, and 9% in high-, average-, and low-risk hsCRP values, respectively. In addition, levels of hsCRP were inversely correlated with levels of HDL cholesterol. Conclusion: Our present data support the notion that the addition of hsCRP to the ATP-III global risk score provides a more accurate assessment of CVD risk in SZ patients. Serum hsCRP may also be an early marker of CVD risk in schizophrenia. On the other hand, Lp(a) levels, considering as a “Heart Attack” cholesterol and a strongly inherited risk factor for CVD, were not elevated in either ECSZ or CSZ patients in the present study. (Supported in part by the American Heart Association and MH58141 grants.)

The aim of this study was to estimate serum fetuin-A levels in lean and obese women with polycystic ovary syndrome (PCOS) and to find possible relationships between fetuin-A, metabolic factors and androgens in these patients. In 25 lean (18-38 years, BMI 17.5-25.0 kg/m2) and 15 obese women (20-41 years, BMI 28.1-53.2 kg/m2) with PCOS, anthropometric indices and body composition were measured. Fasting serum fetuin-A, adiponectin, leptin, glucose, lipids, hsCRP, insulin, androgens and SHGB levels were estimated. There was no significant difference in serum fetuin-A levels between lean and obese patients: 0.54 ± 0.13 g/L and 0.60 ± 0.14 g/L, respectively. We noted a correlation between BMI and leptin levels (r = 0.88; p < 0.0001) and a nearly significant negative correlation between BMI and adiponectin levels (r = -0.53; p = 0.11) in all subjects. In lean patients, we found a correlation between fetuin-A levels and ALT activity (r = 0.44; p < 0.05). In all participants, fetuin-A correlated directly with DHEA-S levels (r = 0.44; p < 0.03). Serum fetuin-A levels were similar in lean and obese women with PCOS. We found an association between fetuin-A levels and ALT activity in lean patients and between fetuin-A levels and DHEA-S in all women. The role of fetuin-A in the mechanisms of insulin resistance, and its potential impact on androgenic hormones production in women with PCOS, need to be tested in further studies.

Metabolic syndrome is a group of metabolic risk factors which are associated with an increased risk of cardiovascular disease and type2 diabetes. Nowadays, several studies have shown that the burden of metabolic syndrome is increasing among epileptic patients, and leads to MS-associated complications, including cardiovascular disease. However, getting published documents has been limited in Ethiopia and the study area. Therefore, we aimed to analyze the magnitude and associated factors of metabolic syndrome among epileptic patients in Dessie Comprehensive Specialized Hospital in compression with respective controls. Hospital-based comparative cross-sectional study design was implemented from June 25 to August 20, 2021. A total of 204 participants with an equal number of cases and controls (n = 102 each) were included. The data was collected through face-to-face interviews and biochemical analyses such as fasting blood glucose and lipid profiles were done through the enzymatic technique. The magnitude of metabolic syndrome was determined using both National Cholesterol Education Program Adult Treatment Panel III and International Diabetes Federation definition criteria. The STATA version 14 was used for statistical data analysis, and a comparison of categorical and continuous variables was done with χ2 and an independent t-test, respectively. The multivariable binary logistic regression analysis was used to identify factors associated with metabolic syndrome, and variables having a P-value of <0.05 were considered statistically significant. The prevalence of metabolic syndrome among the epileptic group was (25.5% in National Cholesterol Education Program Adult Treatment Panel III and 23.5% in International Diabetes Federation criteria), whereas it was 13.7% in National Cholesterol Education Program Adult Treatment Panel III and 14.7% in International Diabetes Federation criteria among control groups. According to the International Diabetes Federation criteria, low physical activity (adjusted odds ratio = 4.73, 95% CI: 1.08-20.68), taking multiple antiepileptic drugs (adjusted odds ratio = 8.08, 95% CI: 1.52-42.74), having a total cholesterol level of ≥ 200 mg/dl (adjusted odds ratio = 5.81, 95%: 1.32-41.13) and body mass index (adjusted odds ratio = 1.57, 95% CI = 1.16-2.11) were significantly associated with metabolic syndrome among epileptic participants. Applying National Cholesterol Education Program Adult Treatment Panel III criteria, taking multiple antiepileptic drugs (adjusted odds ratio = 6.81, 95% CI: 1.29-35.92), having a total cholesterol level > 200 mg/dl (adjusted odds ratio = 7.37, 95% CI: 1.32-41.13) and body mass index (adjusted odds ratio = 1.53, 96% CI: 1.16-2.01) were also significantly associated. The prevalence of metabolic syndrome among epileptic patients was higher than that of control groups and reaches statistically significant by National Cholesterol Education Program Adult Treatment Panel III. Being on multiple antiepileptic drugs, body mass index, having low physical activity and raised total cholesterol were significantly associated with metabolic syndrome among the epileptic group. Therefore, it is better to focus on controlling weight, having sufficient physical exercise, and regular monitoring of total cholesterol levels in epileptic patients.

Objectives: The aim of this study was to investigate YKL-40 in migraine patients during migraine attacks. Methods: In this prospective study, 30 migraine patients with aura (MWA) and 30 migraine patients without aura (MWOA) who presented to the Neurological Outpatient Department of Konya City Hospital during a migraine episode as well as 28 healthy controls were included. According to the manufacturer’s recommendations, serum YKL-40 levels were determined using an ELISA kit (FineTest). Statistical analysis of the data was performed with the IBM SPSS version 20.0 program. Results: The mean gender and age were similar between groups (p&gt;0.05). The serum YKL-40 level was 3575 ± 604.975 pg/ml in the MWA group, 3339 ± 492.689 pg/ml in the MWOA group and 3190 ± 544.018 pg/ml in the control group. YKL-40 levels were significantly higher in MWA than in the control group (p=0.028). YKL-40 levels were similar in the MWA and MWOA groups (p=0.302). No significant difference was found between the group with MWOA and the control group (p=0.915). Conclusion: Although YKL-40 levels are increased in patients with migraine with aura during an attack, comprehensive studies with a larger sample are needed to clarify the relationship between YKL-40 and migraine.

YKL-40, a new acute-phase protein, is shown to be elevated in inflammatory diseases, such as rheumatoid arthritis, type 2 diabetes mellitus, and coronary artery diseases. However, there is no data indicating a relationship between YKL-40 and periodontal disease. Interleukin-6 (IL-6) is the major regulator of acute-phase protein synthesis and one of the most studied inflammatory markers in periodontal disease. The purpose of the present study is to evaluate YKL-40 and IL-6 levels in gingival crevicular fluid (GCF) and serum of patients with periodontal disease and healthy individuals. Periodontally healthy individuals (n = 15), patients with gingivitis (n = 15), and patients with severe chronic periodontitis (CP) (n = 15) without any systemic disease were included in the study. Clinical measurements were recorded; GCF and blood samples were obtained from each participant. GCF and serum YKL-40 and IL-6 levels were analyzed by enzyme-linked immunosorbent assay. Statistical analysis was performed by parametric and non-parametric tests. Total amounts of YKL-40 and IL-6 in GCF as well as serum YKL-40 and IL-6 levels were significantly higher in patients with gingivitis and CP compared with healthy controls (P <0.01). YKL-40 levels in GCF and serum as well as serum IL-6 levels were significantly higher in patients with CP compared with patients with gingivitis (P <0.01). YKL-40 levels in GCF as well as serum YKL-40 and IL-6 levels increased from gingivitis to periodontitis. Within the limits of the present study, the YKL-40 molecule might be a potential novel inflammatory marker of periodontal disease.

976 Stromal contribution to elevated YKL-40 in human cancer

BackgroundLittle is known about statin underutilization among diabetes mellitus patients cared for in community health centers, which tend to serve socioeconomically disadvantaged populations. Implications of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on preexisting gaps in statin treatment in this population are unclear.Methods and ResultsWe included 32 440 adults (45% male, 63% nonwhite, 29% uninsured/Medicaid) aged 40 to 75 years with diabetes mellitus who received care within 16 community health center groups in 11 states in the Community Health Applied Research Network during 2013. Statin prescribing was analyzed as a function of concordance with the National Cholesterol Education Program Adult Treatment Panel 2001 and ACC/AHA 2013 guidelines. More patients’ treatments were concordant with the ACC/AHA (52.8%) versus the National Cholesterol Education Program Adult Treatment Panel (36.2%) guideline. Female sex was associated with lower concordance for both (odds ratio [OR] 0.90, CI 0.85‐0.94; and OR 0.84, CI 0.80‐0.88, respectively). Being insured, an Asian/Pacific Islander, or primarily Spanish speaking were associated with greater concordance for both guidelines: 35.5% (11 526/32 440) were concordant with neither guideline, the majority (79.7%) having no statin prescribed; 28.2% (9168/32 440) were concordant with ACC/AHA but not the National Cholesterol Education Program Adult Treatment Panel. 8.7% of these patients had a low‐density lipoprotein cholesterol >160 mg/dL despite having a moderate‐ or high‐intensity statin prescribed. And 11.6% (3772/32 440) were concordant with the National Cholesterol Education Program Adult Treatment Panel but not with ACC/AHA. Most of these patients had a low‐density lipoprotein cholesterol between 70 and 99 mg/dL with no or a low‐intensity statin prescribed.ConclusionsOpportunities exist to improve cholesterol management in diabetes mellitus patients in community health centers. Addressing care gaps could improve cardiovascular disease prevention in this high‐risk population.

ObjectiveThis study aimed to compare serum levels of CD163, YKL-40, and VILIP-1 between children with autism spectrum disorder (ASD) and healthy controls, while also investigating their association with the severity of ASD and language development.MethodsThe study included 40 ASD-diagnosed patients (aged 18−72 months) and 40 age-matched healthy controls. Childhood Autism Rating Scale, Preschool Language Scale-4, and Ankara Development Screening Inventory were administered to children in the ASD group. Serum CD163, YKL-40 and VILIP-1 levels were measured with an enzyme-linked immunosorbent assay kit.ResultsIn the ASD group compared to the control group, serum VILIP-1 levels were significantly higher (p = 0.046). No significant differences were observed in mean serum CD163 and YKL-40 levels between patients and controls (p = 0.613, p = 0.769). Interestingly, a positive correlation was observed between CD163 and YKL-40 levels and ASD severity (p < 0.001 for both). Additionally, CD163 and YKL-40 levels showed significant predictive value for ASD severity. While no significant associations were found between CD163 and YKL-40 levels and language development, a negative correlation was observed between VILIP-1 levels and language development (p < 0.001).ConclusionOur findings highlight that the levels of CD163 and YKL-40 significantly predicted ASD severity, indicating a potential role of neuroinflammation in the development of ASD.

Initiation of a fibrotic process has been suggested as part of the intestinal response to chronic inflammation in inflammatory bowel disease. YKL-40 has been proposed as a new serum marker of fibrosis. We studied compared the serum levels of YKL-40 in patients with ulcerative colitis or Crohn's disease with inflammatory and healthy controls. YKL-40 serum levels were measured in 179 patients with inflammatory bowel disease (94 ulcerative colitis, 85 Crohn's disease), in 23 with intestinal inflammation of other causes, and 70 matched healthy controls using a commercially available enzyme-linked immunosorbent assay. YKL-40 levels were assessed in terms of disease activity, type and localization. Mean serum YKL-40 levels were 102.6+/-82.7 ng/ml in ulcerative colitis patients and 112.2+/-83.7 ng/ml in Crohn's disease patients, significantly higher than in healthy controls (64.1+/-21.4 ng/ml) but not significantly different from inflammatory controls (77.8+/-23.1 ng/ml). Disease activity and C-reactive protein levels were significantly correlated with YKL-40 levels in both ulcerative colitis and Crohn's disease. Crohn's disease patients with ileum localization had significantly higher YKL-40 levels than those with ileocolonic or colonic disease. Patients with stenotic disease had mean YKL-40 levels not significantly different than those with nonstenotic disease. Serum levels of YKL-40 are increased in patients with inflammatory bowel disease, and this is associated with the inflammatory process rather than with the degree of fibrosis.

Background:Metabolic Syndrome (MS) is a clinical entity characterized by the cluster of insulin resistance, glucose intolerance, atherogenic lipid profile, hypertension, abdominal obesity.CRP (C- reactive protein) is an acute-phase reactant and nonspecific marker of inflammation, produced predominantly in hepatocytes as a pentamer of identical subunits in response to several cytokines. The CRP in plaque deposition is highly complex, exerting pro-atherogenic effects in many cells involved in atherosclerosis. Materials and Methods:A cross sectional study was conducted by Department of Internal Medicine of Government Thanjavur Medical College Hospital, Thanjavur, Tamilnadu, South India, a tertiary care centre catering to rural population. A total of hundred patients were included in the study. The components of metabolic syndrome were defined according to the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria and World Health Organization (WHO) guidelines for South Asians.According to the guidelines, hs-CRP level of less than 1.0 mg/L is considered as low risk, 1.0 to 3.0 mg/L as moderate risk, and greater than 3.0 mg/L as high risk. Blood sample was drawn in the morning after 10 hours of fasting, to measure venous plasma glucose, serum total cholesterol, serum high density lipoprotein (HDL) cholesterol,serum triglyceride levels (TG) and hsCRP. Results:A highly positive correlation was established between hS-CRP and all the components of metabolic syndrome except for HDL cholesterol which showed a negative correlation. A univariate type of analysis had shown a statistically significant association between hsCRP and the metabolic syndrome components. The result further showed that hS-CRP level was found to be 1.12mg/dl when only one component of metabolic syndrome was present, whereas the mean level had raised to 2.89mg/dl when all the five components of metabolic syndrome was present. Conclusion:Hence hs- CRP can probably be used as a surrogate marker of chronic inflammation in patients with metabolic syndrome and the patients with high hsCRP should primarily be targeted with life style modification at an early age, treatment with low dose aspirin and lipid lowering medications before it culminates in overt CVD.