Zuhal Yildirim

The importance of serum lipids in exudative diabetic macular edema in type 2 diabetic patients.

Abstract:  To evaluate the relationship between serum lipid levels and exudative diabetic maculopathy in patients with nonproliferative diabetic retinopathy, 27 patients with exudative diabetic macular edema were included in group A and 27 patients without exudative diabetic macular edema were included in group B. All 54 patients have nonproliferative diabetic retinopathy. Blood cholesterol, triglyceride, high‐density lipoprotein (HDL) cholesterol, low‐density lipoprotein (LDL) cholesterol, very low‐density lipoprotein (VLDL) cholesterol, hemoglobin A1c (HbA1c), and hemoglobin levels were measured in patients in group A and group B. The mean concentration of cholesterol in group A (224.30 ± 49.49 mg/dL), in group B (197.78 ± 41.49 mg/dL); triglyceride in group A (199.11 ± 90.51 mg/dL), in group B (160.78 ± 65.30 mg/dL); HDL in group A (43.48 ± 10.62 mmol/L), in group B (42.37 ± 10.92 mmol/L); LDL in group A (150.59 ± 43.96 mg/dL), in group B (124.37 ± 40.28 mg/dL); VLDL in group A (40.52 ± 16.54 mg/dL), in group B (37.89 ± 23.70 mg/dL); HbA1c in group A (9.62 ± 2.50), in group B (7.36 ± 1.62 g/dL); and hemoglobin in group A (13.46 ± 1.6 g/dL), in group B (13.90 ± 1.77 g/dL). Serum cholesterol (P= 0.38), LDL (P= 0.026), and HbA1c (P= 0.000) levels were different between the two groups. Triglyceride, HDL, VLDL, and hemoglobin levels were not different between the two groups. We must consider regulation of high blood sugar and elevated total serum cholesterol or LDL levels in patients with macular edema and high hard exudates.

Effects of Taurine in Cellular Responses to Oxidative Stress in Young and Middle‐Aged Rat Liver

Abstract:  Aging is related with an increased cellular level of lipid peroxides and reactive oxygen species (ROS). The useful effects of taurine as an antioxidant in biological systems have been attributed to its capability to stabilize biomembranes, to scavenge ROS, and to decrease the peroxidation of unsaturated membrane lipids. The aim of the present study was to investigate the effects of taurine on malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GPx), thioredoxin reductase (TR), and endothelial nitric oxide synthase (eNOS) in young and middle‐aged rat liver. There was not a significant difference in liver MDA levels between the control groups of young and middle‐aged rats (P > 0.05). However, liver GSH levels, and GPx and TR activities between the control groups of young and middle‐aged rats were significantly different (P < 0.05). Liver MDA level was significantly lower in the taurine group of middle‐aged rats (P < 0.05). Liver GSH levels, and GPx and TR activities were significantly increased in the taurine group of middle‐aged rats when compared to the control group (P < 0.05). Liver MDA level was significantly lower in the taurine group of young rats than the ones in the control group (P < 0.05). Liver TR activity was significantly increased in the taurine group of young rats when compared to the control group (P < 0.05). Liver GPx activity was not statistically different between the taurine and the control groups in young rats (P > 0.05). Liver GSH levels were not different between the young taurine and the control groups (P > 0.05). Immunohistochemical studies exhibited no change in eNOS activity after taurine injection in young rats. However, in middle‐aged rats, taurine lowered the eNOS reactivity to the same level found in young rats. These results suggested that exogenous taurine might play a role in aging by means of its reducing effects on free radical levels in parallel to an increase in the antioxidant capacity.

Neuroprotective effects of gabapentin on spinal cord ischemia-reperfusion injury in rabbits.

OBJECT Extensive research has been focused on neuroprotection after spinal cord trauma to alleviate the effects of secondary injury. This study aims to investigate the neuroprotective effects of gabapentin in an experimental spinal cord ischemia reperfusion injury. METHODS Thirty-two adult male New Zealand white rabbits received spinal cord ischemic injury using the aortic occlusion model. Animals were divided into 4 groups (sham, control, low-dose, and high-dose treatment groups; 8 rabbits in each group). High (200 mg/kg) and low (30 mg/kg) doses of gabapentin were administered to the animals in the treatment groups after spinal cord ischemic injury. Neurological status of the animals, ultrastructural findings in injured tissue samples, and levels of tissue injury markers in these 2 groups were compared with findings in the animals that did not receive the ischemic procedure (sham-operated group) and those that received normal saline after administration of ischemia. RESULTS Regarding levels of tissue injury marker levels after ischemic injury, animals in the gabapentin-treated groups demonstrated better results than animals in the other groups. The ultrastructural findings and caspase-3 activity were similar. The treatment groups demonstrated better results than the other groups. CONCLUSIONS Gabapentin demonstrated significant neuroprotection after early phases of ischemic injury. Further studies with different experimental settings including neurological outcome are required to achieve conclusive results.

Neuroprotective effects of infliximab in experimental spinal cord ischemic injury

Reactive oxygen species (ROS) have been implicated in the pathogenesis of spinal cord injury after both ischemia-reperfusion (I/R) and trauma. This experimental study was designed to investigate the potential effects of infliximab, an anti-tumor necrosis factor-α agent, on I/R injury of the rabbit spinal cord. Eighteen New Zealand white rabbits were divided into three groups, each consisting of six rabbits: sham (no I/R), I/R, and infliximab (I/R + infliximab). Spinal cord ischemia was induced by applying an infrarenal aortic cross clamp for 30 minutes. At 48 hours after ischemia, animals were functionally evaluated using the Tarlov score. Changes in the spinal cord were observed by measuring tissue levels of malondialdehyde (MDA), glutathione (GSH), advanced oxidation protein products (AOPP), and superoxide dismutase (SOD) and by evaluating hematoxylin-eosin-stained sections. At 48 hours after ischemia, the Tarlov scores in the infliximab group were higher than those of the I/R group, MDA and AOPP levels in the I/R group were significantly higher than those in the sham and infliximab groups (p < 0.05), and SOD levels in the infliximab group were significantly higher than those in the I/R and sham groups (p < 0.05). The sham group had higher GSH levels than the infliximab group; however, the difference was not statistically significant (p > 0.05). Histological examination revealed that the infliximab group had significantly less vascular proliferation, edema, and neuron loss than the I/R group. These results indicate that infliximab may protect the spinal cord against injury in a rabbit I/R model.

Antioxidant Enzymes and Diabetic Retinopathy

Abstract:  The aim of this study was to discuss the serum copper (Cu), zinc (Zn), nitric oxide (NO), glutathione (GSH), advanced oxidation protein products (AOPP) levels, and superoxide dismutase (SOD) activities with diabetic retinopathy severity. Twenty‐five patients with proliferative diabetic retinopathy (PDR group 1), 25 patients with nonproliferative diabetic retinopathy (NPDR group 2), and 25 nondiabetic controls (control group) were included in the study. Patients who had macrovascular complications of diabetes (coronary arterial disease, periferic vascular disease) were excluded. The major finding of our study was that we did not observe any differences between group 1 and 2, which we aimed to discuss the severity of diabetic retinopathy. As the levels of SOD and Zn were not different between the groups, statistically significant differences were observed for GSH, NO, and Cu levels when compared to control group. AOPP levels were statistically increased in group 1 compared to control group. It can be suggested that hyperglycemia in DM is associated with accelerated nonenzymatic glycation and oxidative stress.

The evaluation of the oxidative stress parameters in nondiabetic and diabetic senile cataract patients.

The aim of the present study was to evaluate the copper (Cu), zinc (Zn), malondialdehyde (MDA), glutathione (GSH), and advanced oxidation protein products (AOPP) levels and superoxide dismutase (SOD) activities in diabetic senile cataract. Ten patients with diabetic senile cataract and ten patients with nondiabetic senile cataract (control group) were included in this study. AOPP, MDA, and GSH levels and SOD activity were measured by a spectrophotometric method. Serum, lens Cu, and Zn levels were measured by an atomic absorption spectrophotometric method. Both the lens and serum Zn and Cu levels between the two groups were not significantly different (p > 0.05). GSH, AOPP, and MDA levels and the SOD activities in the diabetic senile cataract group were significantly increased as compared to the control group (p < 0.05). Oxidative stress is one of the major factors which may lead to the early cataract formation. Oxidative events are of great importance in diabetic complications and, particularly in the lens, may have a role in the pathogenesis of cataract associated with diabetes mellitus as exhibited in this study.

Effects of curcumin on acute spinal cord ischemia-reperfusion injury in rabbits. Laboratory investigation.

OBJECT The object of this study was to conduct a prospective, randomized, laboratory investigation of the neuroprotective effects of curcumin functionally, biochemically, and histologically in an experimental acute spinal cord ischemia-reperfusion injury on rabbits. METHODS Eighteen rabbits were randomly assigned to 1 of 3 groups: the sham group, the ischemia-reperfusion group, or the curcumin group. Spinal cord ischemia was induced by applying an infrarenal aortic cross-clamp for 30 minutes. At 48 hours after ischemia, neurological function was evaluated with modified Tarlov criteria. Biochemical changes in the spinal cord and plasma were observed by measuring levels of malondialdehyde (MDA), advanced oxidation protein products (AOPP), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), nitrite/nitrate, and tumor necrosis factor-α (TNF-α). Histological changes were examined with H & E staining. Immunohistochemical staining with antibodies against caspase-3 was performed to evaluate cell apoptosis after ischemia. RESULTS In the curcumin group, neurological outcome scores were statistically significantly better compared with the ischemia-reperfusion group. In the ischemia-reperfusion group, MDA, AOPP, and nitrite/nitrate levels were significantly elevated in the spinal cord tissue and the plasma by the induction of ischemia-reperfusion. The curcumin treatment significantly prevented the ischemia-reperfusion-induced elevation of nitrite/nitrate and TNF-α. In addition, the spinal cord tissue and the plasma SOD, GSH, and CAT levels were found to be preserved in the curcumin group and not statistically different from those of the sham group. Histological evaluation of the tissues also demonstrated a decrease in axonal damage, neuronal degeneration, and glial cell infiltration after curcumin administration. CONCLUSIONS Although further studies including different dose regimens and time intervals are required, curcumin could attenuate a spinal cord ischemia-reperfusion injury in rabbits via reducing oxidative products and proinflammatory cytokines, as well as increasing activities of antioxidant enzymes and preventing apoptotic cell death.

Pseudoexfoliation syndrome and trace elements

Abstract:  To investigate the role of zinc and copper in the development of pseudoexfoliation (PSX) syndrome, 34 cataract patients with PSX syndrome and 27 cataract patients without PSX syndrome were included in the study and groups were matched for age and gender. During the cataract surgery, lenses were obtained intraoperatively, frozen under liquid nitrogen, and kept at −70°C until processing. Zinc and copper concentrations were measured by atomic absorption spectrophotometric method after the homogenization (acid hydrolysis) of dried lenses. The mean concentration of zinc in the lens from patients with PSX (20.33 ± 8.76 μg/g tissue; range 11.04–42.94 μg/g tissue) was significantly lower than that measured in the lens of patients without PSX (28.88 ± 15.32 μg/g tissue; range 12.02–64.32 μg/g tissue) (P < 0.05). The mean concentration of copper in the lens from patients with PSX (29.51 ± 10.05 μg/g tissue; range 12.69–59.71 μg/g tissue) and in the lens of patients without PSX (39.72 ± 25.64 μg/g tissue; range 12.38–92.14 μg/g tissue) was not statistically different. The decreased content of zinc could increase oxidative stress. The results support the role of oxidative stress in the development of PSX in cataract patients.

The role of the cytokines in the pathogenesis of pseudoexfoliation syndrome.

AIM To examine the mechanism of the development of pseudoexfoliation (PSX) syndrome via both cytokine formation and endothelial vasorelaxing and growth factors that will provide us new therapeutic insights for the treatment. METHODS This is a cross sectional study included two groups; Group 1: control patients with nuclear cataract (n=20, aged 51-80 years). Group 2: PSX patients with nuclear cataract (n=18, aged 50-90 years). Patients with other ophthalmic problems and systemic diseases were excluded. Vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and interleukin-1β (IL-1β) and nitrotyrosine levels were determined through serum samples by Enzyme-linked immunosorbent assay (ELISA) method. Nitrite-nitrate levels were measured with photometric endpoint determination. RESULTS There were no significant differences between the groups in terms of age, VEGF, IL-1β, nitrite-nitrate and nitrotyrosine. The significant results were the mean IL-6 levels that were higher in PSX group 2 (37.68±29.52 pg/mL) compared to that in control group 1 (15.32±10.08 pg/mL) (P<0.001). CONCLUSION Several interacting and extending biochemical pathways may lead to the promotion of VEGF and IL-6 expressions. IL-6 which is the only altered marker in our study may indirectly cause an increase of vascular permeability and neovascularization. We suggest inflammation as a factor that can be involved in etiopathogenesis of PSX.

Fluorometric determination of acid proteinase activity in Candida albicans strains from diabetic patients with vulvovaginal candidiasis.

Vulvovaginal candidiasis is one of the most frequent disorders in obstetrics and gynaecology. Approximately three‐quarters of all adult women experience at least one episode of vulvovaginal candidiasis during their life span. Diabetes mellitus (DM) increases the rate of vaginal colonisation and infection with Candida species. The secreted acid proteinase might be especially relevant in the pathogenesis of vulvovaginal candidiasis. The aim of this study was to determine the acid proteinase activity in the samples of Candida albicans from diabetic patients with vulvovaginal candidiasis by a fluorometric method. Vaginal swabs were taken from 33 women (aged between 22 and 57 years) having symptoms of vaginitis. Patients were divided into three groups: control group, controlled diabetic group and uncontrolled diabetic group. The proteinase activity in the culture supernatants was determined by a modified fluorometric method. Acid proteinase activities were significantly increased in the uncontrolled diabetic group in comparison with both the control group and the controlled diabetic group (P < 0.05). Acid proteinase may play an important role in C. albicans pathogenesis in diabetic patients. Improving glucose control may reduce the risk of Candida colonisation and potentially symptomatic infection, among women with diabetes and hence may be useful even for weaker enzyme activity measurements.