Refik Ali Sari

Lipid peroxidation, some extracellular antioxidants, and antioxidant enzymes in serum of patients with rheumatoid arthritis

Abstract The aims of our study were to assess whether the increased oxidative stress in inflamed joints is reflected by serum lipid peroxidation and also to check alterations in the levels of extracellular antioxidants and antioxidant enzyme activities in patients with rheumatoid arthritis. Serum malondialdehyde and ceruloplasmin levels and the activity of CuZn superoxide dismutase were higher, while transferrin levels and the activities of glutathione peroxidase and catalase were lower in patients (n=37) than in healthy controls (n=30). Disease activity score correlated positively with serum malondialdehyde level and CuZn superoxide dismutase activity. Probably, superoxide radicals in serum could be dismutated to produce hydrogen peroxide by increased CuZn superoxide dismutase activity, but hydrogen peroxide could not have been detoxified due to decreased activities of serum glutathione peroxidase and catalase. Hydrogen peroxide possibly converted to hydroxyl radical by iron due to lower transferrin level might have led to increased serum lipid peroxidation in patients with rheumatoid arthritis.

Serum Oxidant/Antioxidant Status of Patients with Systemic Lupus Erythematosus

Abstract The levels of malondialdehyde and ceruloplasmin, and superoxide dismutase activity were higher, while transferrin concentration and the activities of glutathione peroxidase and catalase were lower in serum of patients with systemic lupus erythematosus (n=24) compared with healthy controls (n=20). Disease activity index correlated positively with serum malondialdehyde level (r=0.47, p<0.05), erythrocyte sedimentation rate (r=0.41, p<0.05) and C-reactive protein concentration (r=0.41, p<0.05), while it correlated negatively with serum superoxide dismutase (r=0.42, p<0.05) and glutathione peroxidase (r= −0.44, p<0.05) activities in patients. No such correlations were found in healthy control subjects. It remains to be seen whether correlations found between disease activity score and serum malondialdehyde level, and also activities of serum superoxide dismutase and glutathione peroxidase enzymes observed in the present study may be used to predict prognosis in patients with systemic lupus erythematosus.

Diastolic function abnormalities in active rheumatoid arthritis evaluation by conventional Doppler and tissue Doppler: relation with duration of disease.

ObjectiveThe aim of this study was to evaluate left ventricular diastolic function in patients with active rheumatoid arthritis (RA), analyzing conventional Doppler and tissue Doppler echocardiographic imaging (TDI) which is a new echocardiographic application, with special regard to disease duration.MethodsFifty-two patients with active RA and 47 healthy persons were included in this study. Duration of disease ranged from 3 to 324 months (mean 76±85 months). All patients and the control group were evaluated by M-mod, two-dimensional, conventional Doppler echocardiography and TDI.ResultsAmong conventional Doppler transvalvular mitral flow parameters, late diastolic flow velocity (A) and deceleration time (DT) values were higher in patients with RA than that in the control group (p<0.001). E (early diastolic flow velocity)/A ratio was found to be lower in patients with RA than that in the control group (p<0.001). Mitral annular early diastolic velocity (Em), among TDI parameters, was found to be lower in patients with RA than that in the control group (p<0.001). Em/Am (mitral annular late diastolic velocity) ratio was found to be lower in RA patients compared with that in the control group (p<0.001). The relation was found between A (r=0.43, p=0.001), DT (r=0.30, p=0.03), E/A ratio (r=0.40, p=0.004), Em (r=0.32, p=0.02), Em/Am ratio (r=0.30, p=0.03), and E/Em (r=0.32, p=0.02), with disease duration in patients with RA.ConclusionAt present, it is concluded that active RA patients, in the absence of clinical evidence of heart disease, show diastolic dysfunction characterized by impaired E/A ratio, Em/Am ratio, and DT. The relation between diastolic dysfunction and disease duration suggests a subclinical myocardial involvement.

Oxidant/antioxidant status in men with Behçet’s disease

Behçet’s disease (BD) is a chronic, progressive disorder that affects many systems of the body including the eye. The aim of this study was to assess whether the increase in oxidative stress in the affected tissues is reflected by lipid peroxidation and to check for alterations in antioxidants and antioxidant enzyme activities in patients with BD. Erythrocyte antioxidant potential (AOP), glutathione (GSH) and GSH-dependent enzymes (glutathione peroxidase (GSH-Px), glutathione reductase (GRD) and glutathione-S-transferase (GST), catalase (CAT), Cu–Zn superoxide dismutase (Cu–Zn SOD) activities, malondialdehyde (MDA) and some trace elements (zinc, Zn; copper, Cu; manganese, Mn) levels in men with BD. Erythrocyte CAT, GSH-Px activities, MDA, GSH, AOP and serum Zn values were significantly lower in patients with BD than in the control group. However, erythrocyte Cu–Zn SOD, GRD activities, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and Cu values were significantly higher in patients with BD than in the control group, but GST activity and serum Mn values were unchanged. In conclusion, our results confirm the presence of oxidative stress in patients with BD and suggest that the severity of BD may arise from impaired antioxidant mechanisms. Therapy with antioxidants may lead to the increase in the antioxidant defense system and thus improvement in clinical symptoms.

Trace elements and some extracellular antioxidant proteins levels in serum of patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic progressive autoimmune disorder with a wide spectrum of clinical and immunological abnormalities. In this study, we aimed to investigate the levels of serum zinc (Zn), copper (Cu), magnesium (Mg), manganese (Mn), iron (Fe), ceruloplasmin (Cp), transferrin (Trf), and albumin (Alb) in SLE and whether it is related to the severity of the clinical condition of this chronic disease. Cp and Cu levels were higher, while Trf, Alb, Zn, Mg, Mn, and Fe levels were lower in serum of patients with SLE (n=27) compared with healthy controls (n=20). The mechanisms by which these alterations occur in certain inflammatory conditions need to be elucidated. It is also obscure whether these alterations are a cause or a consequence of the inflammation. As a conclusion, alterations in the levels of the parameters in SLE may not be a reason for, but in fact a consequence of the disease itself.

Serum lipoprotein(a) level and its clinical significance in patients with systemic lupus erythematosus.

Abstract: Systemic lupus erythematosus (SLE) is a classic autoimmune disease characterised by the production of autoreactive T cells and autoantibodies that may affect every organ system. It has long been established that there is a close association between cholesterol- rich lipoproteins (such as low-density lipoprotein-cholesterol) and cardiovascular disease in patients with SLE. In this study, we evaluated total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, VLD-cholesterol, apolipoprotein A-1, apolipoprotein B, and cholesterol-rich serum lipoprotein(a) [Lp(a)], which is accepted to be an independent risk factor for cardiovascular disease and for atherosclerosis, in 24 patients (mean age ± SD 31.4 ± 9.7 years, range 16–47, 22 F) with active SLE. Twenty-six healthy age- and sex-matched (mean age ± SD 29.7 ± 11.3 years, range 18-49 years, 22 F) subjects were included as a control group. In patients with SLE Lp(a) levels, total cholesterol, triglycerides and VLDL-cholesterol were found to be higher and HDL-cholesterol, apolipoprotein A-1 to be lower than those of controls. In conclusion, beacuse serum Lp(a) levels are significantly higher (P<0.01) in patients with SLE, these patients have a risk of developing cardiovascular disease and atherosclerosis. Patients with SLE should be followed up with this in mind.

Levels of soluble E-selectin in patients with active Behçet’s disease

Behçet’s disease is a systemic vasculitis of unknown aetiology. Endothelial cell injury plays an important role in the pathogenesis and immunopathology of Behçet’s disease. E-selectin is expressed by activated endothelial cells. Because the selectin adhesion molecules are shed from activated cells, soluble forms of these proteins can be used as activation markers of endothelium (E-selectin). The pathogenesis of Behçet’s disease (BD) is closely related to endothelial cells, leucocyte functions and immunity. The aim of this study was to investigate circulating E-selectin adhesion molecules, which are known to play a significant part in the immune response especially by regulating interaction of the leucocytes with endothelium in BD. Plasma E-selectin concentrations were evaluated in 23 patients with BD and 20 healthy control subjects. The disease activity was evaluated by clinical manifestations (oral aphthous ulcer, genital ulceration, positive pathergy test, skin lesions, eye involvement, thrombophlebitis and arthritis) and by laboratory investigations [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)]. The patients were newly or previously diagnosed cases not taking any drug for BD. Levels of E-selectin were measured with commercially available sandwich enzyme- linked immunosorbent assay (ELISA) kits using human sE-selectin (cat. no: BMS 205). Plasma E-selectin concentrations of patients and controls were compared with the Mann-Whitney U test. Statistical significance was assigned to p values lower than 0.05. Serum levels (mean±SD) of soluble E-selectin (sE-selectin) were significantly higher in 23 patients with BD than in 20 healthy controls (53.2 ± 18.2 ng/ml vs 33.8 ± 7.5 ng/ml, p < 0.0001). A statistically significant positive correlation was observed between sE-selectin levels and CRP and ESR in patients with BD (r = 0. 78, p < 0.001 and r = 0.56, p < 0.01, respectively). Increases in the E-selectin in BD may be a direct consequence of the leucocyte and endothelium activations observed during the disease process. The noninvasive investigations can be used as biochemical markers for inflammation. This may provide additional information regarding disease activity along with the traditional indices such as ESR and CRP.

Serum adenosine deaminase and cytidine deaminase activities in patients with systemic lupus erythematosus.

Abstract We evaluated serum total adenosine deaminase, its isoenzymes adenosine deaminase-1 and adenosine deaminase-2, and cytidine deaminase activities in 24 patients with active systemic lupus erythematosus, and in 26 healthy control subjects, and found the means±SD values to be 21.38±5.96 IU/l, 3.74±2.12 IU/l, 17.72±5.02 IU/l and 17.89±4.62 IU/l, respectively in the patients, and 14.97±4.71 IU/l, 4.01±1.35 IU/l, 10.91±3.91 IU/l and 7.39±3.97 IU/l, respectively in the control subjects. When compared to the healthy controls, serum total adenosine deaminase, adenosine deaminase-2 and cytidine deaminase levels were significantly higher (p<0.001) in systemic lupus erythematosus patients, but the decrease of adenosine deaminase-1 level was not statistically significant (p>0.05). The increased adenosine deaminase-2 may be of macrophage origin. It closely correlated with clinical signs of active systemic lupus erythematosus. The membranes of polymorphonuclear neutrophils may be damaged, and cytidine deaminase may be released into serum. In conclusion, serum total adenosine deaminase, adenosine deaminase-2 and cytidine deaminase activities may serve as useful indicators for evaluating disease activity in patients with active systemic lupus erythematosus.

A case of acute generalized exanthematous pustulosis (AGEP) possibly induced by iohexol.

Acute generalized exanthematous pustulosis (AGEP) is an uncommon disease manifested as an erythematous pustular eruption. It is usually caused by systemic medication. We describe a patient with acute generalized pustular eruption induced by iohexol. A 52‐year‐old woman developed fever and a generalized pustular eruption on the neck, trunk and extremities three days after taking iohexol. The culture from pustules was sterile. Other systemic and laboratory examinations were normal. A skin biopsy from a lesion on the trunk showed the features of a drug‐induced pustular eruption as a subcorneal blister including neutrophils and eosinophils, mild spongiosis, and a sparse infiltrate at neutrophils and eosinophils in the papillary dermis. The patient had no history of psoriasis. The lesions resolved with systemic corticosteroid therapy within one week and did not relapse. According to our investigation, iohexol‐induced AGEP has not been previously reported. We present an interesting case.

Trace elements and disease activity score in patients with rheumatoid arthritis

AbstractIn this study, we aimed to investigate the levels of serum Zn, Cu, Mg, Mn, and Fe in rheumatoid arthritis and whether they are related to the severity of the disease. The sera from 29 patients with rheumatoid arthritis were studied and compared with those from healthy controls (n = 22). Although serum Fe, Mg and Mn levels were lower in the rheumatoid arthritis group than in the control group, the difference was not statistically significant. Significantly higher Cu (p < 0.001) and lower Zn serum levels (p < 0.012) were found in rheumatoid arthritis than in controls.A statistically significant positive correlation was present between Cu levels and disease activity score (DAS), and there was a negative correlation between Zn levels and DAS.We think that alterations of the level of some trace elements in rheumatoid arthritis are a consequence of and not one of the causes of the disease, as in many other chronic inflammatory disorders.