Download biomedica product listCompliance of NT-proBNP test in accredited cardiac marker survey
NT-proBNP ELISA test successfully passed accredited cardiac marker survey: Biomedica participated in an accredited international ring trial program for the cardiac biomarker NT-proBNP. The results demonstrate that the CE-marked NT-proBNP ELISA assay successfully passed the QC circle in the cardiac marker survey.
NT-proBNP ELISA test successfully passed cardiac marker survey
The results comply with strict quality standards confirmed by RfB, an international provider for proficiency testing.
NT-proBNP ELISA assay kit (cat. no. SK-1204)
√ CE-marked – for IVD use in the EU
√ Flexible – can be run in every lab
√ Two controls included
√ Simple 2 step protocol
√ Reliable – full validation
√ Widely cited in more than 100 publications
Developed & manufactured by Biomedica right in the heart of Europe
Biomedica Quality ELISA kits
What is proficiency testing?
Proficiency Testing provides a report that shows how laboratories can compare their own data to data to data from other laboratories around the world.
The testing, carried out in a ring trial program, is performed by an accredited laboratory specialist in proficiency testing. Proficiency testing monitors the performance of individual laboratories for specific tests e.g. cardiac biomarker assays.
LITERATURE
Monitoring of NT-proBNP – predicting risk of cardiovascular events from anti-inflammatory drugs (Non-Steroid Anti-Inflammatory Drugs)
N-terminal pro-B-type natriuretic peptide concentrations predict the risk of cardiovascular adverse events from antiinflammatory drugs: a pilot trial. Brune K, Katus HA, Moecks J, Spanuth E, Jaffe AS, Giannitsis E. Clin Chem. 2008 Jul;54(7):1149-57. doi: 10.1373/clinchem.2007.097428. Epub 2008 May 1. PMID: 18451314.
Safety of Oral Non-Selective Non-Steroidal Anti-Inflammatory Drugs in Osteoarthritis: What Does the Literature Say? Cooper C, Chapurlat R, Al-Daghri N, Herrero-Beaumont G, Bruyère O, Rannou F, Roth R, Uebelhart D, Reginster JY.Drugs Aging. 2019 Apr;36(Suppl 1):15-24. doi: 10.1007/s40266-019-00660-1. PMID: 31073921; PMCID: PMC6509083.
Cardio-renal safety of non-steroidal anti-inflammatory drugs. Radi ZA, Khan KN. J Toxicol Sci. 2019;44(6):373-391. doi: 10.2131/jts.44.373. PMID: 31168026.
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used therapeutic class in clinical medicine. These are sub-divided based on their selectivity for inhibition of cyclooxygenase (COX) isoforms (COX-1 and COX-2) into: (1) non-selective (ns-NSAIDs), and (2) selective NSAIDs (s-NSAIDs) with preferential inhibition of COX-2 isozyme. The safety and pathophysiology of NSAIDs on the renal and cardiovascular systems have continued to evolve over the years following short- and long-term treatment in both preclinical models and humans. This review summarizes major learnings on cardiac and renal complications associated with pharmaceutical inhibition of COX-1 and COX-2 with focus on preclinical to clinical translatability of cardio-renal data.
Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Jüni P.BMJ. 2011 Jan 11;342:c7086. doi: 10.1136/bmj.c7086. PMID: 21224324; PMCID: PMC3019238.
Pathogenic contribution of LRG1 to vascular retinopathies
Globally, 2.2 billion people are estimated to have a vision impairment. Eye diseases are on the rise due to an ageing population and an increase of diabetes. The classical therapy involves the blockage of vascular endothelial growth factor (VEGF). However, a high rate of patient non-response and loss of efficacy over time are major challenges.
Evaluating new treatments with better efficiency are moving forward. One novel therapeutic target is leucine-rich α-2 glycoprotein 1 (LRG1). It is an emerging key player in vascular dysfunction, inflammation, and fibrosis.
LRG1 as a novel therapeutic target in eye disease
The uncontrolled formation of new blood vessels in the eye (ocular angiogenesis) is one of the major causes of eye diseases and blindness.
The blood protein LRG1 plays a central role in the progression of eye diseases and is thus a promising novel therapeutic target.
In searching for mediators of vascular remodeling in the diseased and damaged retina, researchers discovered that leucine-rich α-2 glycoprotein 1 (LRG1) is a novel regulator of TGFß signaling. The study published in Nature in 2013 by Wang X et al., revealed that LRG1 is a novel regulator of angiogenesis that mediates its effect through modulating TGFβ signaling. The researchers showed that LRG1 expression in the retina is predominantly vascular and is increased during neovascular growth. Their study in mice supported the hypothesis that LRG1 is necessary for robust vascular growth and its inhibition has potential as a therapeutic target. Based on their studies, the authors suggested that LRG1 is not only a promising target for controlling pathogenic angiogenesis in eye diseases but could potentially also be used in other diseases such as cancer and atherosclerosis.
WHAT IS LRG1 (leucine-rich α-2 glycoprotein 1)
The mature 38,2 kDa glyocoprotein LRG contains 347 amino acids (Uniprot entry Leucine-rich alpha-2-glycoprotein). It belongs to the family of LRG proteins characterized through leucine-rich repeats in its amino acid sequence. LRG1 (also named LRG) is involved in protein-protein interactions, signal transduction, and development. Studies have shown that LRG plays a role in physiological processes of the nervous system including synapse formation and growth. It is also implied in cell proliferation, in immune responses, in cell migration, in neovascularization, and in apoptosis.
Alternative titles: LRG – OMIM Entry leucine-rich α-2 glycoprotein (LRG)
HOW CAN YOU MEASURE LRG1?
LRG1 can reliably be measured in human serum and plasma with the Biomedica LRG ELISA (cat. no. BI-LRG).
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Sample volume: 5µl
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Assay range: 2-64 ng/ml
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Easy protocol – day test
The validation of the LRG1 ELISA kit has been performed following international quality guidelines. Download the validation data here.
RELATED PUBLICATIONS
LRG1 as a novel therapeutic target in eye disease.
De Rossi G, Da Vitoria Lobo ME, Greenwood J, Moss SE. Eye (Lond). 2022 Feb;36(2):328-340. doi: 10.1038/s41433-021-01807-4. Epub 2022 Jan 5. Erratum in: Eye (Lond). 2022 Feb 28;: PMID: 34987199; PMCID: PMC8807626.
Abstract
Retinal and choroidal diseases are major causes of blindness and visual impairment in the developed world and on the rise due to an ageing population and diabetes epidemic. Standard of care is centred around blockade of vascular endothelial growth factor (VEGF), but despite having halved the number of patients losing sight, a high rate of patient non-response and loss of efficacy over time are key challenges. Dysregulation of vascular homoeostasis, coupled with fibrosis and inflammation, are major culprits driving sight-threatening eye diseases. Improving our knowledge of these pathological processes should inform the development of new drugs to address the current clinical challenges for patients. Leucine-rich α-2 glycoprotein 1 (LRG1) is an emerging key player in vascular dysfunction, inflammation and fibrosis. Under physiological conditions, LRG1 is constitutively expressed by the liver and granulocytes, but little is known about its normal biological function. In pathological scenarios, such as diabetic retinopathy (DR) and neovascular age-related macular degeneration (nvAMD), its expression is ectopically upregulated and it acquires a much better understood pathogenic role. Context-dependent modulation of the transforming growth-factor β (TGFβ) pathway is one of the main activities of LRG1, but additional roles have recently been emerging. This review aims to highlight the clinical and pre-clinical evidence for the pathogenic contribution of LRG1 to vascular retinopathies, as well as extrapolate from other diseases, functions which may be relevant to eye disease. Finally, we will provide a current update on the development of anti-LRG1 therapies for the treatment of nvAMD..
LRG1 promotes angiogenesis by modulating endothelial TGF-β signalling.
Wang X, Abraham S, McKenzie JAG, Jeffs N, Swire M, Tripathi VB, Luhmann UFO, Lange CAK, Zhai Z, Arthur HM, Bainbridge J, Moss SE, Greenwood J.Nature. 2013 Jul 18;499(7458):306-11. doi: 10.1038/nature12345. PMID: 23868260; PMCID: PMC3836402.
High big ET-1 levels are associated with risk of all–cause death in diabetes patients with CAD
Big Endothelin-1 associated with all-cause death in diabetes patients with CAD
A clinical study in 8550 patients investigated the association between the cardio-vascular marker big endothelin-1 (big ET-1) and long-term all-cause death in patients with coronary artery disease (CAD) and impaired glucose metabolism.
Patients were categorized into both glucose status (diabetes mellitus, pre-diabetes mellitus, normalglycemia) and big ET-1 level groups. Primary endpoint was all-cause death. The data indicate that baseline big ET-1 levels were independently associated with the long-term mortality in diabetes patients with CAD.
Read more Big Endothelin-1 associated with all-cause death in diabetes patients with CAD.
What is Big Endothelin-1 (Big ET-1) ?
Big ET-1 is a 38 amino acid peptide and is the precursor of Endothelin-1 (ET-1). ET-1 is a potent vasoconstrictor secreted by endothelial cells. It acts as the counterpart of the vasodilator nitric oxide (NO).
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ET-1 is cleaved from Big ET-1 by the ET converting enzyme -1 (ECE-1).
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Both the precursor Big ET-1 and the shorter 21 aminoacid vasoactive form Endothelin-1 circulate in blood.
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ET-1, the biologically active form, is rapidly cleared and has a short half-life.
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ET-1 and big ET-1 are found in equimolar concentrations in the plasma.
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Thus, the longer half-life of big ET-1, its slower clearance and the findings that increased plasma levels of ET-1 in patients with heart failure are mainly due to an increase in big ET-1 concentrations, offers an analytical window for the measurement of Big ET-1 .
How can you measure Big ET-1?
Big ET-1 can easily be measured using in serum and plasma with only 50µl sample volume.
Biomedica’s Big ET-1 ELISA cat. no. BI-20082H
√ Direct measurement – highly sensitive
√ Full validation package
√ Widely cited +75 publications
check out the customer review on Biocompare
Related publications – Citations Big ET-1 ELISA – Biomedica
The Biomedica Big Endothelin-1 (Big ET-1) ELISA kit was utilized in the following studies:
Xu N, Zhu P, Yao Y, Jiang L, Jia S, Yuan D, Xu J, Wang H, Song Y, Gao L, Gao Z, Song L, Zhao X, Chen J, Yang Y, Xu B, Gao R, Yuan J. Nutr Metab Cardiovasc Dis. 2022 Sep;32(9):2147-2156. doi: 10.1016/j.numecd.2022.06.002. Epub 2022 Jun 11. PMID: 35843800.
Abstract
Background and aims: The present study aimed to examine the association between big endothelin-1 (big ET-1) and long-term all-cause death in patients with coronary artery disease (CAD) and different glucose metabolism status.
Methods and results: We consecutively enrolled 8550 patients from January 2013 to December 2013. Patients were categorized according to both status of glucose metabolism status [Diabetes Mellitus (DM), Pre-Diabetes (Pre-DM), Normoglycemia (NG)] and big ET-1 levels. Primary endpoint was all-cause death. During a median of 5.1-year follow-up periods, 301 all-cause deaths occurred. Elevated big ET-1 was significantly associated with long-term all-cause death (adjusted HR: 2.230, 95%CI 1.629-3.051; p < 0.001). Similarly, patients with DM, but not Pre-DM, had increased risk of all-cause death compared with NG group (p < 0.05). When patients were categorized by both status of glucose metabolism and big ET-1 levels, high big ET-1 were associated with significantly higher risk of all-cause death in Pre-DM (adjusted HR: 2.442, 95% CI 1.039-5.740; p = 0.041) and DM (adjusted HR: 3.162, 95% CI 1.376-7.269; p = 0.007). The Kaplan-Meier curve indicated that DM patients with the highest big ET-1 levels were associated with the greatest risk of all-cause death (p < 0.05).
Conclusions: The present data indicate that baseline big ET-1 levels were independently associated with the long-term all-cause death in DM and Pre-DM patients with CAD undergoing PCI, suggesting that big ET-1 may be a valuable marker in patients with impaired glucose metabolism.
Predictive Value of Plasma Big Endothelin-1 in Adverse Events of Patients With Coronary Artery Restenosis and Diabetes Mellitus: Beyond Traditional and Angiographic Risk Factors. Ma Y, Tian T, Wang T, Wang J, Guan H, Yuan J, Song L, Yang W, Qiao S. Front Cardiovasc Med. 2022 May 26;9:854107. doi: 10.3389/fcvm.2022.854107. PMID: 35694656; PMCID: PMC9177997.
Big Endothelin-1 and long-term all-cause death in patients with coronary artery disease and prediabetes or diabetes after percutaneous coronary intervention . Xu N, Zhu P, Yao Y, Jiang L, Jia S, Yuan D, Xu J, Wang H, Song Y, Gao L, Gao Z, Song L, Zhao X, Chen J, Yang Y, Xu B, Gao R, Yuan J. Nutr Metab Cardiovasc Dis. 2022 Sep;32(9):2147-2156. doi: 10.1016/j.numecd.2022.06.002. Epub 2022 Jun 11. PMID: 35843800.
Plasma concentration of big endothelin-1 and its relation with plasma NT-proBNP and ventricular function in heart failure patients. Rivera M, Cortés R, Portolés M, Valero R, Sancho-Tello MJ, Martínez-Dolz L, Sevilla B, Taléns-Visconti R, Jordán A, Miró V, Pérez-Boscá JL, Marín F, Climent V, García de Burgos F, Payá R, Sogorb F, Bertomeu V, Salvador A. Rev Esp Cardiol. 2005 Mar;58(3):278-84. Spanish. PMID: 15766450.
Plasma big endothelin-1 concentrations in congestive heart failure patients with or without systemic hypertension. Pacher R, Bergler-Klein J, Globits S, Teufelsbauer H, Schuller M, Krauter A, Ogris E, Rödler S, Wutte M, Hartter E. Am J Cardiol. 1993 Jun 1;71(15):1293-9. doi: 10.1016/0002-9149(93)90543-l. PMID: 8498369.
Plasma big endothelin-1 levels at admission and future cardiovascular outcomes: A cohort study in patients with stable coronary artery disease. Zhou BY, Guo YL, Wu NQ, Zhu CG, Gao Y, Qing P, Li XL, Wang Y, Dong Q, Liu G, Xu RX, Cui CJ, Sun J, Li JJ. Int J Cardiol. 2017 Mar 1;230:76-79. doi: 10.1016/j.ijcard.2016.12.082. Epub 2016 Dec 21. PMID: 28038820.
Background: Big endothelin-1 (ET-1) has been proposed as a novel prognostic indicator of acute coronary syndrome, while its predicting role of cardiovascular outcomes in patients with stable coronary artery disease (CAD) is unclear.
Methods and results: A total of 3154 consecutive patients with stable CAD were enrolled and followed up for 24months. The outcomes included all-cause death, non-fatal myocardial infarction, stroke and unplanned revascularization (percutaneous coronary intervention and coronary artery bypass grafting). Baseline big ET-1 was measured using sandwich enzyme immunoassay method. Cox proportional hazard regression analysis and Kaplan-Meier analysis were used to evaluate the prognostic value of big ET-1 on cardiovascular outcomes. One hundred and eighty-nine (5.99%) events occurred during follow-up. Patients were divided into two groups: events group (n=189) and non-events group (n=2965). The results indicated that the events group had higher levels of big ET-1 compared to non-events group. Multivariable Cox proportional hazard regression analysis showed that big ET-1 was positively and statistically correlated with clinical outcomes (Hazard Ratio: 1.656, 95% confidence interval: 1.099-2.496, p=0.016). Additionally, the Kaplan-Meier analysis revealed that patients with higher big ET-1 presented lower event-free survival (p=0.016).
Conclusions: The present study firstly suggests that big ET-1 is an independent risk marker of cardiovascular outcomes in patients with stable CAD. And more studies are needed to confirm our findings.
Superiority of big endothelin-1 and endothelin-1 over natriuretic peptides in predicting survival in severe congestive heart failure: a 7-year follow-up study. Van Beneden R, Gurné O, Selvais PL, Ahn SA, Robert AR, Ketelslegers JM, Pouleur HG, Rousseau MF. J Card Fail. 2004 Dec;10(6):490-5. doi: 10.1016/j.cardfail.2004.04.001. PMID: 15599839.
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Full validation package- assays are optimized for clinical samples
developed & manufactured by Biomedica. Austrian Quality.
IL-6 (Interleukin-6) high sensitivity
VEGF low sample volume – 10µl
ANGIOPOIETIN-2 optimized assay range
All kits include color coded, ready to use prediluted standards and controls.
Citations
Ana-Maria Suciu Andreea, Jacqueline Wallwitz, Berg Gabriela, Maria Laber Anna, Himmler Gottfried. Nephrology Dialysis Transplantation, Volume 34, Issue Supplement_1, June 2019, gfz103.SP339, https://doi.org/10.1093/ndt/gfz103.SP339
Click here to view poster: ERA-EDTA Poster 2019 Human Angiopoietin-2
Abstract
INTRODUCTION: Angiopoietin-2 (Ang-2) is an important regulator of the angiopoietin-1/Tie-2 receptor signaling system on endothelial cells during angiogenesis. Disruption of this signaling leads to the loss of endothelial integrity and renders the endothelium response towards a variety of pro-inflammatory cytokines and growth factors. Thus, Ang-2 might lead to vascular micro-inflammation in patients with CKD (chronic kidney disease). Ang-2 levels increase with CKD stage, are associated with fluid overload and abnormal cardiac structure and predict mortality in patients with CKD stages 4–5. Although Ang-2 levels return toward normal after successful kidney transplantation, Ang-2 remains a putative cardiovascular risk factor in this population.
METHODS: An enzyme-linked immunosorbent assay for the detection of all three angiopoietin-2 isoforms in human serum and plasma was developed. Two high quality antibodies are combined in a sandwich test format: As capturing antibody a recombinant monoclonal antibody is used. A biotin-labeled polyclonal affinity-purified antibody serves for detection of the analyte. High resolution epitope mapping of the antibodies via peptide microarray technology allowed the identification of linear antibody epitopes. Technical performance and accuracy of the assay were assessed according to ICH/EMEA guidelines.
RESULTS: Microarray data illustrate the binding of the polyclonal detection antibody to human angiopoietin-2 spotted on a chip. Altogether, seven linear epitopes located N-terminal/at the center of angiopoietin-2 were detected. Most relevant linear epitopes are epitope e2 in the super clustering region and e6 near the fibrinogen-like domain, displaying a twofold higher fluorescent signal than the remaining epitopes. For the recombinant monoclonal antibody no fluorescence was recorded. This antibody recognizes a structural epitope within the C-terminus of angiopoietin-2, which covers the bioactive receptor-binding site of the protein. We expect to detect all described angiopoietin-2 isoforms, as the receptor-binding site is conserved and the majority of the polyclonal antibody epitopes are present in all isoforms. This assay is in conformance with ICH/EMEA/FDA guidelines. Validation data demonstrate its applicability in nephrological disorders including chronic kidney disease. Here we compare an apparently healthy population to chronic kidney disease samples on haemodialysis and kidney transplant samples.
CONCLUSIONS: This new angiopoietin-2 ELISA enables a quick and accurate quantification of all human angiopoietin-2 isoforms that are bioactive in chronic kidney disease and other nephrological disorders.
RELATED LITERATURE
- Molnar et al. (2014): Circulating angiopoietin-2 levels predict mortality in kidney transplant recipients: a 4-year prospective case–cohort study. Transplant International, 27 (6): 541-52. 2. David et al. (2010): Circulating angiopoietin-2 levels increase with progress of chronic kidney disease. Nephrol. Dial. Transplant, 25: 2571-2579,
- Tsai et al. (2017): The interaction between fluid status and angiopoietin-2 in adverse renal outcomes of chronic kidney disease. PLoS One, 12 (3): e173906.
- Tsai et al. (2016): Angiopoietin-2, Angiopoietin-1 and subclinical cardiovascular disease in Chronic Kidney Disease. Scientific Reports, 6:39400
Circulating DKK-1 levels predict disease outcomes and mirror metabolic adaptations in patients with Covid-19
Individuals with low serum levels of DKK1 (Dickkopf-1) are twice as likely to die from Covid-19 than those with high levels according to new research published by Nikolai Jaschke and colleagues in the Journal of Clinical Endocrinology & Metabolism.
The researchers found that circulating DKK1 levels vary in humans and change as a function of time during SARS-CoV-2 infection. The infection promotes metabolic adaptations that resembles fasting, which are mirrored by circulating DKK1 levels. DKK-1 levels predict disease outcomes in Covid-19 individuals.
The results of the study suggest a potential clinical use of measuring circulating DKK1 as an indicator of disease severity in COVID-19 patients.
Circulating DKK1 levels were measured with the DKK-1 ELISA kit from Biomedica
Biomedica, Vienna, Austria, DKK-1 ELISA, catalog #BI-20413, RRID: AB_2922680
Highlights – DKK-1 ELISA (cat. no. BI-20413)
- Small sample volume – 20µl serum/well
- Reliable –international validation guidelines
- Easy – direct measurement
- Widely cited in +170 publications
Circulating Dickkopf1 parallels metabolic adaptations and predicts disease trajectories in patients with Covid-19. Full text link
Jaschke NP, Funk AM, Jonas S, Riffel RM, Sinha A, Wang A, Pählig S, Hofmann M, Altmann H, Von Bonin S, Koch T, Spieth P, Tausche K, Akgün K, Rauner M, Kronstein-Wiedemann R, Odendahl M, Tonn T, Göbel A, Hofbauer LC, Rachner TD. J Clin Endocrinol Metab. 2022 Sep 8:dgac514. doi: 10.1210/clinem/dgac514. Epub ahead of print. PMID: 36071553; PMCID: PMC9494396.
Abstract
Context and aims: Coronavirus disease 19 (COVID-19) trajectories show high interindividual variability, ranging from asymptomatic manifestations to fatal outcomes, the latter of which may be fueled by immunometabolic maladaptation of the host. Reliable identification of patients who are at risk of severe disease remains challenging. We hypothesized that serum concentrations of Dickkopf1 (DKK1) indicate disease outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals.
Methods: We recruited hospitalized patients with PCR-confirmed SARS-CoV-2 infection and included 80 individuals for whom blood samples from 2 independent time points were available. DKK1 serum concentrations were measured by ELISA in paired samples. Clinical data were extracted from patient charts and correlated with DKK1 levels. Publicly available datasets were screened for changes in cellular DKK1 expression on SARS-CoV-2 infection. Plasma metabolites were profiled by nuclear magnetic resonance spectroscopy in an unbiased fashion and correlated with DKK1 data. Kaplan-Meier and Cox regression analysis were used to investigate the prognostic value of DKK1 levels in the context of COVID-19.
Results: We report that serum levels of DKK1 predict disease outcomes in patients with COVID-19. Circulating DKK1 concentrations are characterized by high interindividual variability and change as a function of time during SARS-CoV-2 infection, which is linked to platelet counts. We further find that the metabolic signature associated with SARS-CoV-2 infection resembles fasting metabolism and is mirrored by circulating DKK1 abundance. Patients with low DKK1 levels are twice as likely to die from COVID-19 than those with high levels, and DKK1 predicts mortality independent of markers of inflammation, renal function, and platelet numbers.
Conclusion: Our study suggests a potential clinical use of circulating DKK1 as a predictor of disease outcomes in patients with COVID-19. These results require validation in additional cohorts.
Decrease of bone biomarker Sclerostin in women with anorexia nervosa during nutrition therapy – indication of reduced bone loss
Anorexia nervosa (AN) is an eating disorder and has one of the highest mortality rates of any mental illness. It affects roughly 2.9 million people and many experience bone loss and increased fracture risk. In a 3-year prospective study, Swedish researchers looked into the long-term effects of nutrition therapy. They investigated bone and mineral metabolism and biomarkers young women with AN. Their results showed that body mass index (BMI) and fat mass was increased. The regulatory bone biomarker Sclerostin decreased during nutrition therapy and further over 3 years, indicating reduced bone loss.
Read more: Bone mass and biomarkers in young women with anorexia nervosa: a prospective 3-year follow-up study.
Biomedica Sclerostin ELISA kit
- The internationally most referenced Sclerostin ELISA with more than 270 citations!
- Rigorously validated according to international quality guidelines
- Low sample volume
Bone mass and biomarkers in young women with anorexia nervosa: a prospective 3-year follow-up study.
Svedlund A, Pettersson C, Tubic B, Ellegård L, Elfvin A, Magnusson P, Swolin-Eide D. J Bone Miner Metab. 2022 Aug 12. doi: 10.1007/s00774-022-01359-x. Epub ahead of print. PMID: 35960382.
Abstract
Introduction: Anorexia nervosa (AN) increases the risk of impaired bone health, low areal bone mineral density (aBMD), and subsequent fractures. This prospective study investigated the long-term effects of bone and mineral metabolism on bone and biomarkers in 22 women with AN.
Materials and methods: Body composition and aBMD were measured by dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography. Total and free 25-hydroxyvitamin D (25OHD), C-terminal collagen cross-links (CTX), osteocalcin, bone-specific alkaline phosphatase (BALP), leptin, sclerostin, and oxidized/non-oxidized parathyroid hormone (PTH) were analyzed before and after 12 weeks of intensive nutrition therapy and again 3 years later. An age-matched comparison group of 17 healthy women was recruited for the 3-year follow-up.
Results: Body mass index (BMI) and fat mass increased from baseline to 3 years in women with AN. Sclerostin decreased during nutrition therapy and further over 3 years, indicating reduced bone loss. CTX was elevated at baseline and after 12 weeks but decreased over 3 years. BALP increased during nutrition therapy and stabilized over 3 years. Free 25OHD was stable during treatment but decreased over 3 years. Non-oxidized PTH was stable during treatment but increased over 3 years. Trabecular volumetric BMD in AN patients decreased during the first 12 weeks and over 3 years despite stable BMI and bone biomarkers implying increased BMD.
Conclusion: Our findings highlight the importance of early detection and organized long-term follow-up of bone health in young women with a history of AN.
Keywords: DXA; Eating disorder; Osteoporosis; Sclerostin; Vitamin D
Related publications
Anorexia nervosa: 30-year outcome.
Dobrescu SR, Dinkler L, Gillberg C, Råstam M, Gillberg C, Wentz E. Br J Psychiatry. 2020 Feb;216(2):97-104. doi: 10.1192/bjp.2019.113. PMID: 31113504; PMCID: PMC7557598.
Abstract
Background: Little is known about the long-term outcome of anorexia nervosa.
Aims: To study the 30-year outcome of adolescent-onset anorexia nervosa.
Method: All 4291 individuals born in 1970 and attending eighth grade in 1985 in Gothenburg, Sweden were screened for anorexia nervosa. A total of 24 individuals (age cohort for anorexia nervosa) were pooled with 27 individuals with anorexia nervosa (identified through community screening) who were born in 1969 and 1971-1974. The 51 individuals with anorexia nervosa and 51 school- and gender-matched controls were followed prospectively and examined at mean ages of 16, 21, 24, 32 and 44. Psychiatric disorders, health-related quality of life and general outcome were assessed.
Results: At the 30-year follow-up 96% of participants agreed to participate. There was no mortality. Of the participants, 19% had an eating disorder diagnosis (6% anorexia nervosa, 2% binge-eating disorder, 11% other specified feeding or eating disorder); 38% had other psychiatric diagnoses; and 64% had full eating disorder symptom recovery, i.e. free of all eating disorder criteria for 6 consecutive months. During the elapsed 30 years, participants had an eating disorder for 10 years, on average, and 23% did not receive psychiatric treatment. Good outcome was predicted by later age at onset among individuals with adolescent-onset anorexia nervosa and premorbid perfectionism.
Conclusions: This long-term follow-up study reflects the course of adolescent-onset anorexia nervosa and has shown a favourable outcome regarding mortality and full symptom recovery. However, one in five had a chronic eating disorder.
Mitchell JE, Peterson CB. N Engl J Med. 2020 Apr 2;382(14):1343-1351. doi: 10.1056/NEJMcp1803175. PMID: 32242359.
Osteoporosis Awareness –
Worldwide around 200 million women have osteoporosis. Osteoporosis is a disease that weakens bone. Bones become fragile and porous. From the outside, the osteoporotic bone is shaped like normal bone. However, the inside of the bone loses density and becomes weak. The risk of fractures become greater with age, due to the loss of minerals like calcium and phosphate. Osteoporosis most often affects bones in the hip, the spine and the wrist. Factors that influence bone health are nutrition, exercise and hormonal factors. Osteoporosis cannot be cured but delayed through early intervention and biomarker research has identified proteins that may help to identify patients at risk.
BIOMEDICA offers ELISA kits to measure Bone Biomarkers in human serum or plasma samples:
Osteoprotegerin (OPG) ELISA , DKK-1 ELISA , Sclerostin ELISA , soluble RANKL ELISA and others…
IL-6 ELISA , VEGF ELISA , Angiopoietin-2 ELISA
How can you prevent Osteoporosis?
Osteoporosis prevention includes a balanced diet, containing sufficient amounts of calcium and vitamin D and regular exercise.
Exercises to protect or reduce your chance of fracture include regular weight-bearing exercise (eg. weight lifting or resistance training) or any kind of activity that carries your own body weight (e.g. walking, running, climbing stairs, dancing).
A healthy and balanced diet with the recommended daily amounts of calcium are important for bone health. Read more about “Good for your bone foods .
Related literature
The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients.
Benedetti MG, Furlini G, Zati A, Letizia Mauro G. Biomed Res Int. 2018. 23;2018:4840531. PMID: 30671455. Link to full text
Abstract
Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewed the current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients. Two types emerged: (1) weight-bearing aerobic exercises, i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) Strength and resistance exercises: these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Other suggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combination of different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving bone mass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of pure reinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistance exercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify. Training with whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they have effect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide good results, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking. Nevertheless, contraindications typical of senility should be taken into account.
Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription.
Daly RM, Dalla Via J, Duckham RL, Fraser SF, Helge EW.Braz J Phys Ther. 2019.23(2):170-180. PMID: 30503353. Full text link
Abstract
Background: Osteoporosis and related fragility fractures are a global public health problem in which pharmaceutical agents targeting bone mineral density (BMD) are the first line of treatment. However, pharmaceuticals have no effect on improving other key fracture risk factors, including low muscle strength, power and functional capacity, all of which are associated with an increased risk for falls and fracture, independent of BMD. Targeted exercise training is the only strategy that can simultaneously improve multiple skeletal and fall-related risk factors, but it must be appropriately prescribed and tailored to the desired outcome(s) and the specified target group.
Objectives: In this review, we provide an overview of the general principles of training and specific loading characteristics underlying current exercise guidelines for the prevention of osteoporosis, and an update on the latest scientific evidence with regard to the type and dose of exercise shown to positively influence bone mass, structure and strength and reduce fracture risk in postmenopausal women.
The bone metabolism mediators RANK (receptor activator of nuclear factor κB), RANKL (receptor activator of nuclear factor κB ligand) and OPG (osteoprotegerin) have been linked to breast cancer tumorgenesis. The dysregulation of RANK signaling is involved in the pathogenesis of BRCA1 associated breast cancer.
Experimental studies have shown that OPG (the decoy receptor for RANKL) protein levels are significantly lower in BRCA1 mutation carriers, inhibiting RANK signaling. Thus, OPG may serve as a potential biomarker of breast cancer risk.
Learn more: Delineating the role of osteoprotegerin as a marker of breast cancer risk among women with a BRCA1 mutation. Park SS et al., 2022.
Osteoprotegerin a potential biomarker of breast cancer risk
OPG can reliably be measured by ELISA analysis with only 20µl of serum or plasma.
The Biomedica OPG ELISA is the most referenced human OPG ELISA.
- Widely cited in more than 240 publications
Delineating the role of osteoprotegerin as a marker of breast cancer risk among women with a BRCA1 mutation.
Park SS, Uzelac A, Kotsopoulos J Hered Cancer Clin Pract. 2022 Apr 13;20(1):14. doi: 10.1186/s13053-022-00223-3. PMID: 35418083; PMCID: PMC9008947. Read full publication
Abstract
Women with a pathogenic germline mutation in the BRCA1 gene face a very high lifetime risk of developing breast cancer, estimated at 72% by age 80. Prophylactic bilateral mastectomy is the only effective way to lower their risk; however, most women with a mutation opt for intensive screening with annual MRI and mammography. Given that the BRCA1 gene was identified over 20 years ago, there is a need to identify a novel non-surgical approach to hereditary breast cancer prevention. Here, we provide a review of the emerging preclinical and epidemiologic evidence implicating the dysregulation of progesterone-mediated receptor activator of nuclear factor κB (RANK) signaling in the pathogenesis of BRCA1-associated breast cancer. Experimental studies have demonstrated that RANK inhibition suppresses Brca1-mammary tumorigenesis, suggesting a potential target for prevention. Data from studies conducted among women with a BRCA1 mutation further support this pathway in BRCA1-associated breast cancer development. Progesterone-containing (but not estrogen-alone) hormone replacement therapy is associated with an increased risk of breast cancer in women with a BRCA1 mutation. Furthermore, BRCA1 mutation carriers have significantly lower levels of circulating osteoprotegerin (OPG), the decoy receptor for RANK-ligand (RANKL) and thus endogenous inhibitor of RANK signaling. OPG levels may be associated with the risk of disease, suggesting a role of this protein as a potential biomarker of breast cancer risk. This may improve upon current risk prediction models, stratifying women at the highest risk of developing the disease, and further identify those who may be targets for anti-RANKL chemoprevention. Collectively, the evidence supports therapeutic inhibition of the RANK pathway for the primary prevention of BRCA1-associated breast cancer, which may generate unique prevention strategies (without prophylactic surgery) and enhance quality of life.
Related publications
Plasma osteoprotegerin and breast cancer risk in BRCA1 and BRCA2 mutation carriers.
Odén L, Akbari M, Zaman T, Singer CF, Sun P, Narod SA, Salmena L, Kotsopoulos J. Oncotarget. 2016. 27;7(52):86687-86694. doi: 10.18632/oncotarget.13417. PMID: 27893411; PMCID: PMC5349945.
Abstract
Emerging evidence suggests a role of receptor activator of nuclear factor κB (RANK)/RANK ligand (RANKL) signaling in breast cancer development. Lower osteoprotegerin (OPG) levels, the endogenous decoy receptor for RANKL which competes with RANK for binding of RANKL, has been reported among BRCA mutation carriers. Whether low OPG levels contribute to the high breast cancer risk in this population is unknown. OPG concentrations were measured in plasma of 206 cancer-free BRCA mutation carriers using an enzyme-linked immunosorbent assay. Subjects were categorized as high vs. low based on the median of the entire cohort (95 ng/mL) and followed for a new diagnosis of breast cancer. Cumulative incidence by baseline plasma OPG concentration was estimated using Kaplan-Meier survival analysis. Cox proportional hazards models were used to estimate the adjusted hazard ratios for the association between plasma OPG and breast cancer risk. Over a mean follow-up period of 6.5 years (range 0.1-18.8 years), 18 incident breast cancer cases were observed. After ten years of follow-up, the cumulative incidence of breast cancer among women with low OPG was 21%, compared to 9% among women with high OPG (P-log rank = 0.046). After multivariate adjustment, women with high plasma OPG had a significantly decreased risk of developing breast cancer, compared to women with low OPG (HR = 0.25; 95%CI 0.08-0.78; P = 0.02). These data suggest that low OPG levels are associated with an increased risk of BRCA-associated breast cancer. Targeting RANK signalling may represent a plausible, non-surgical prevention option for BRCA mutation carriers.
Human plasma Osteoprotegerin (OPG) was quantified using the Biomedica OPG ELISA – cat. no. BI-20403 .
Breast Cancer – the most common cancer worldwide
Breast cancer (BC) is the most commonly occurring cancer in women and the most common cancer overall. Although it is mostly found in women, it can affect men as well. Breast tissue in men can also become malignant. Though male BCs are rare and occur in 1% of all BCs, men are often diagnosed at a more advanced stage. The delay in seeking medical attention often results in late presentation and poor prognosis.
October is breast cancer month – raising global awareness on risks, the importance of screenings, and the options of treatment.
Related links
Further readings
Wilkinson L et al., Br J Radiol. 2022. PMID: 34905391; PMCID. Full text
Abstract
Breast cancer is now the most commonly diagnosed cancer in the world. The most recent global cancer burden figures estimate that there were 2.26 million incident cases in 2020 and the disease is the leading cause of cancer mortality in women worldwide. The incidence is strongly correlated with human development, with a large rise in cases anticipated in regions of the world that are currently undergoing economic transformation. Survival, however, is far less favourable in less developed regions. There are a multitude of factors behind disparities in the global survival rates, including delays in diagnosis and lack of access to effective treatment. The World Health Organization’s new Global Breast Cancer Initiative was launched this year to address this urgent global health challenge. It aims to improve survival across the world through three pillars: health promotion, timely diagnosis, and comprehensive treatment and supportive care.
Trapani D et al., Cancer Treat Rev. 2022. PMID: 35074727.
Cancer research
Prognostic exploratory biomarkers
Circulating biomarkers have the potential to provide valuable insight into disease progression.
Discover Biomarker ELISA kits for cancer research – developed and manufactured by Biomedica
regulator of tumor biology – expressed by endothelial cells – isoform-specific receptors for VEGF – checkpoint target – association with poor prognosis in BC patients.
extracellular matrix protein – novel therapeutic target – marker of glioma malignancy and potential tumor recurrence – high serum levels associated with a poor survival in BC patients.
glycoprotein – emerging clinical biomarker and therapeutic target in cancer – association with cancer progression and the bone metastases.
contribution to development of bone metastases an –in earlier stages of cancer influence on tumor biology.
Leucine-rich alpha-2-glycoprotein 1 – LRG1 – involved in pathogenic angiogenesis in cancer – wide spread in the microenvironment of numerous tumors – contributes to vascular dysfunction – potential therapeutic target.
ANG2 – ANGPT2 – glycoprotein – drives vessel growth – immune target – involved in resistance to anti-VEGF therapy – possible predictive and prognostic biomarker for immune checkpoint therapy.
important cytokine during breast cancer progression – IL6 triggers activation of STAT2 in breast tumors – soluble factor IL6 could be used for early diagnosis of BC or prevent development of metastasis to the bone.
Vascular growth factor – potent cytokine that induces tumor angiogenesis – subtype VEGFA and VEGF Receptor -2 are therapeutical targets.
Further information on our products can be found on our website
International agency for research on cancer – WHO
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Cancer research for the prevention and early recognition of cancer
Promoting cancer research to beat cancer: prevention and early detection of cancer is essential to control the disease. Understanding the causes of cancer and the ability to detect cancer sooner has a great impact on the survival and the outcome of patients.
Subsequently, early detection strategies and progress in diagnostic procedures will help to develop treatments to control the disease.
Promoting cancer research:
Exploring new biomarkers may help to identify the disease early.
Biomedica offers a range of novel biomarker ELISA kits for your cancer research.
Novel research biomarkers for cancer research include: Periostin, Neuropilin-1, Semaphorin 4D
A range of cytokine ELISA kits complete the panel: Interleukin-6, VEGF, Angiopoietin-2 .
See our comprehensive “Oncology Biomarker Brochure “ for more information or contact us directly info@bmgrp.com .
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RELATED LITERATURE:
Promoting Cancer Early Diagnosis – https://www.who.int
“Early diagnosis of cancer focuses on detecting symptomatic patients as early as possible so they have the best chance for successful treatment. When cancer care is delayed or inaccessible there is a lower chance of survival, greater problems associated with treatment and higher costs of care. Early diagnosis improves cancer outcomes by providing care at the earliest possible stage and is therefore an important public health strategy in all settings…” Read more
Pelosi E, Castelli G, Testa U.Ann Ist Super Sanita. 2019 Oct-Dec;55(4):371-379. doi: 10.4415/ANN_19_04_11. PMID: 31850865.
Abstract
The burden of cancer is increasing worldwide, with a continuous rise of the annual total cases. Although mortality rates due to cancer are declining in developed countries, the total number of cancer deaths continues to rise due to the increase in the number of aged people. Three main causes of cancer have been described, represented by environmental factors, hereditary factors and random factors related to defects originated during cell replication. The frequency of cancers is very different for the various tissues and there is great debate on the extent of the specific contribution of environmental factors and random factors (due to “bad luck”) to cancer development. However, there is consensus that about 50% of all cases of cancer are related to environment and are preventable. Although a part of cancers is related to intrinsic mechanisms non preventable of genetic instability, it is evident that implementation of primary and secondary prevention measures is the only affordable strategy to meet from a medical and economic point of view the tremendous pressure created on healthcare structures by the increased cancer burden. It is time to bypass the paradox of disease prevention: celebrated in principle, resisted in practice.
Ovarian Cancer Biomarkers: Moving Forward in Early Detection
Bonifácio VDB. Adv Exp Med Biol. 2020;1219:355-363. doi: 10.1007/978-3-030-34025-4_18. PMID: 32130708.
Abstract
Ovarian cancer is a silent cancer which rate survival mainly relays in early stage detection. The discovery of reliable ovarian cancer biomarkers plays a crucial role in the disease management and strongly impact in patient’s prognosis and survival. Although having many limitations CA125 is a classical ovarian cancer biomarker, but current research using proteomic or metabolomic methodologies struggles to find alternative biomarkers, using non-invasive our relatively non-invasive sources such as urine, serum, plasma, tissue, ascites or exosomes. Metabolism and metabolites are key players in cancer biology and its importance in biomarkers discovery cannot be neglected. In this chapter we overview the state of art and the challenges facing the use and discovery of biomarkers and focus on ovarian cancer early detection.
Keywords: Cancer biomarkers; Early detection; Metabolomics; Ovarian cancer; Proteomics; Urine biomarkers.
Back to school – sports training has positive outcomes
Strength training for children and adolescents enhances bone health
Strength training for children and adolescents is becoming more important as part of sport training and after-school fitness programs. Consequently, health problems due to inactivity, sedentary lifestyle and being overweight have resulted in increased interest in strength and resistance training (1). Today there is ample evidence that youth resistance training is safe and effective and improves motor skills, reduces fat mass, and enhances bone health. In addition, various performance markers such as muscle strength, power and overall health also improve (2-5). In adults, weight-bearing impact exercise such as jumping or hopping in addition to strength training can improve bone health. Among these, resistance training is the most promising intervention to maintain or increase bone mass and density (5, 6).
Subsequently, measuring serum bone related biomarkers can be helpful in understanding normal and pathological processes that reflect bone cell activities in the skeleton.
Check out Biomedica´s high quality bone marker ELISA kits: Sclerostin, RANKL, OPG, DKK-1, FGF23 (C-terminal), FGF23 intact and other
RELIABLE MANUFACTURING ENSURES CONSISTENT RESULTS
√ The internationally most referenced Sclerostin ELISA!
√ Extensively validated according to international quality guidelines
√ Only 20µl sample / well – low sample volume
References on strength training for children and adoloscents
- Resistance Training for Children and Adolescents.
Stricker PR, Faigenbaum AD, McCambridge TM; COUNCIL ON SPORTS MEDICINE AND FITNESS Pediatrics. 2020. 145(6):e20201011. doi: 10.1542/peds.2020-1011. - Performance – and health-related benefits of youth resistance training – Leistungs- und gesundheitsbezogene Wirkungen von Krafttraining mit Heranwachsenden.
H.Chaabene H et al., 2020. Sports Orthopaedics and Traumatology; 36: 231-240. - Strength training for children and adolescents: benefits and risks.
Barbieri D, Zaccagni L. Coll Antropol. 2013. 37 Suppl 2:219-25. PMID: 23914510. - Strength training for children and adolescents.
Faigenbaum A. 2000. Clinics in Sports Medicine; 593-619. - Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis.
Beck BR, Daly RM, Singh MA, Taaffe DR. J Sci Med Sport. 2017;20:438–445. - Effects of Resistance Exercise on Bone Health.
Hong AR, Kim SW. Endocrinol Metab (Seoul). 2018. 33(4):435-444. doi: 10.3803/EnM.2018.33.4.435. PMID: 30513557; PMCID: PMC6279907.
RELATED LITERATURE
Youth Resistance Training: The Good, the Bad, and the Ugly-The Year That Was 2017.
Faigenbaum AD. Pediatr Exerc Sci. 2018. 1;30(1):19-24. doi: 10.1123/pes.2017-0290. PMID: 29424264.
Abstract
The good news is that a growing body of evidence recognizes resistance training as foundational to long-term physical development. Original research and reviews published in 2017 conclude that early exposure to developmentally appropriate resistance training can improve markers of health, increase muscular fitness, enhance physical literacy, and reduce the risk of injury in young athletes. Although the papers discussed in the commentary add to our understanding of the pleiotropic benefits of youth resistance training, they also raise concerns. As measures of muscular strength and power have been found to track from childhood to adulthood, the bad news is that youth with low levels of muscular fitness tend to become weak adults who are at increased risk for functional limitations and adverse health outcomes. Furthermore, global participation in youth resistance training is falling far short of public health recommendations, and these ugly trends will likely impact the health and well-being of future generations. A change in current attitudes and common practices is urgently needed to educate parents, practitioners, and clinicians about the potential benefits of resistance training for all children and adolescents, not only young athletes.
Leister KR, Cilhoroz BT, Rosenberg J, Brown EC, Kim JY Diabetes Metab Syndr. 2022. 16(6):102530. doi: 10.1016/j.dsx.2022.102530. PMID: 35709585.
Watch this on how kids can get stronger muscles: “Top 10 Kids Exercises To Get Stronger Muscles”
Strength training for children and adolescents enhances bone health
FGF23 is a cardiovascular toxin in CKD
Chronic kidney disease (CKD) is a serious health problem that involves gradual loss of kidney function. The major cause of death in CKD patients is cardiovascular disease is triggered by the cardiovascular toxins fibroblast growth factor (FGF23) and phosphate.
Declining kidney function leads to elevated serum phosphate levels which are regulated by the phophaturic hormone FGF23 in CKD patients. In later stages of chronic kidney disease, access FGF23 and phosphate levels lead to increased cardiovascular disease and mortality. Ongoing experimental studies are identifying novel therapeutic strategies in order to prevent toxicity of FGF23 and hyperphosphatemia in CKD patients.
FGF23 is a cardiovascular toxin in chronic kidney disease
FGF23 and Phosphate-Cardiovascular Toxins in CKD.
Vogt I, Haffner D, Leifheit-Nestler M. Toxins (Basel). 2019 Nov 6;11(11):647. doi: 10.3390/toxins11110647. PMID: 31698866; PMCID: PMC6891626.
Biomedica offers ready to use FGF23 (C-terminal) and FGF23 intact ELISA kits
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FGF23 and Phosphate-Cardiovascular Toxins in CKD full text link
Abstract
Elevated levels of fibroblast growth factor 23 (FGF23) and phosphate are highly associated with increased cardiovascular disease and mortality in patients suffering from chronic kidney disease (CKD). As the kidney function declines, serum phosphate levels rise and subsequently induce the secretion of the phosphaturic hormone FGF23. In early stages of CKD, FGF23 prevents the increase of serum phosphate levels and thereby attenuates phosphate-induced vascular calcification, whereas in end-stage kidney disease, FGF23 fails to maintain phosphate homeostasis. Both hyperphosphatemia and elevated FGF23 levels promote the development of hypertension, vascular calcification, and left ventricular hypertrophy by distinct mechanisms. Therefore, FGF23 and phosphate are considered promising therapeutic targets to improve the cardiovascular outcome in CKD patients. Previous therapeutic strategies are based on dietary and pharmacological reduction of serum phosphate, and consequently FGF23 levels. However, clinical trials proving the effects on the cardiovascular outcome are lacking. Recent publications provide evidence for new promising therapeutic interventions, such as magnesium supplementation and direct targeting of phosphate and FGF receptors to prevent toxicity of FGF23 and hyperphosphatemia in CKD patients.
RELATED PUBLICATIONS
Fibroblast Growth Factor-23-A Potential Uremic Toxin.
Kuczera P, Adamczak M, Wiecek A Toxins (Basel). 2016 Dec 8;8(12):369. doi: 10.3390/toxins8120369. PMID: 27941640; PMCID: PMC5198563.
Abstract
Fibroblast growth factor-23 (FGF23) is a circulating member of the FGF family produced mainly by the osteocytes and osteoblasts that can act as a hormone. The main action of FGF23 is to lower phosphatemia via the reduction of urinary phosphate reabsorption and the decrease of 1,25(OH)₂-D generation in the kidney. In the course of chronic kidney disease (CKD), plasma FGF23 concentration rises early, most probably to compensate the inability of the deteriorating kidneys to excrete an adequate amount of phosphate. However, this comes at the cost of FGF23-related target organ toxicity. Results of clinical studies suggest that elevated plasma FGF23 concentration is independently associated with the increased risk of CKD progression, occurrence of cardio-vascular complications, and mortality in different stages of CKD. FGF23 also contributes to cardiomyocyte hypertrophy, vascular calcification, and endothelial dysfunction. The impact of FGF23 on heart muscle is not dependent on Klotho, but rather on the PLCγ-calcineurin-NFAT (nuclear factor of activated T-cells) pathway. Among the factors increasing plasma FGF23 concentration, active vitamin D analogues play a significant role. Additionally, inflammation and iron deficiency can contribute to the increase of plasma FGF23. Among the factors decreasing plasma FGF23, dietary phosphate restriction, some intestinal phosphate binders, cinacalcet (and other calcimimetics), and nicotinamide can be enumerated. Anti-FGF23 antibodies have also recently been developed to inhibit the action of FGF23 in target organs. Still, the best way to normalize plasma FGF23 in maintenance hemodialysis patients is restoring kidney function by successful kidney transplantation.
Zhao SJ, Wang ZX, Chen L, Wang FX, Kong LD. Ann Palliat Med. 2022 Apr;11(4):1264-1277. doi: 10.21037/apm-21-1943. Epub 2021 Nov 2. PMID: 34775773.
Courbon G, Martinez-Calle M, David V. Curr Opin Nephrol Hypertens. 2020 Jul;29(4):359-366. doi: 10.1097/MNH.0000000000000614. PMID: 32452919; PMCID: PMC7769207.
Leucine-rich alpha-2 glycoprotein – an inflammation marker
LRG – a biomarker of fetal infection: Infections during pregnancy could harm the pregnant mother and the developing baby and remain a substantial clinical problem. Findings suggest that certain biomarkers have diagnostic value when maternal infection is suspected. Researchers from Japan recently identified the inflammatory protein leucine-rich alpha-2 glycoprotein (LRG) as a biomarker of fetal infection. Read more: Evaluation of leucine-rich alpha-2 glycoprotein as a biomarker of fetal infection.
LRG can reliably be measured by ELISA assay in serum, plasma, urine or cell culture supernatants.
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Check out the LRG ELISA assay validation data
RELATED PUBLICATIONS
Evaluation of leucine-rich alpha-2 glycoprotein as a biomarker of fetal infection.
Kajimoto E, Endo M, Fujimoto M, Matsuzaki S, Fujii M, Yagi K, Kakigano A, Mimura K, Tomimatsu T, Serada S, Takeuchi M, Yoshino K, Ueda Y, Kimura T, Naka T.
PLoS One. 2020, 19;15(11):e0242076. doi: 10.1371/journal.pone.0242076. PMID: 33211747; PMCID: PMC7676652. PubMed
Abstract
This study aimed to determine the association between umbilical cord leucine-rich alpha-2 glycoprotein (LRG) and fetal infection and investigate the underlying mechanism of LRG elevation in fetuses. We retrospectively reviewed the medical records of patients who delivered at Osaka University Hospital between 2012 and 2017 and selected those with histologically confirmed chorioamnionitis (CAM), which is a common pregnancy complication that may cause neonatal infection. The participants were divided into two groups: CAM with fetal infection (CAM-f[+] group, n = 14) and CAM without fetal infection (CAM-f[-] group, n = 31). Fetal infection was defined by the histological evidence of funisitis. We also selected 50 cases without clinical signs of CAM to serve as the control. LRG concentrations in sera obtained from the umbilical cord were unaffected by gestational age at delivery, neonatal birth weight, nor the presence of noninfectious obstetric complications (all, p > 0.05). Meanwhile, the LRG levels (median, Interquartile range [IQR]) were significantly higher in the CAM-f(+) group (10.37 [5.21-13.7] μg/ml) than in the CAM-f(-) (3.61 [2.71-4.65] μg/ml) or control group (3.39 [2.81-3.93] μg/ml; p < 0.01). The area under the receiver operating characteristic (ROC) curve of LRG for recognizing fetal infection was 0.92 (optimal cutoff, 5.08 μg/ml; sensitivity, 86%; specificity, 88%). In a mouse CAM model established by lipopolysaccharide administration, the fetal LRG protein in sera and LRG mRNA in the liver were significantly higher than those in phosphate-buffered saline (PBS)-administered control mice (p < 0.01). In vitro experiments using a fetal liver-derived cell line (WRL68) showed that the expression of LRG mRNA was significantly increased after interleukin (IL)-6, IL-1β, and tumor necrosis factor- alpha (TNF-α) stimulation (p < 0.01); the induction was considerably stronger following IL-6 and TNF-α stimulation (p < 0.01). In conclusion, LRG is an effective biomarker of fetal infection, and fetal hepatocytes stimulated with inflammatory cytokines may be the primary source of LRG production in utero.
Recognising the burden of maternal infection worldwide.
Seale AC. Lancet Glob Health. 2020. 8(5):e615-e616. doi: 10.1016/S2214-109X(20)30126-1. PMID: 32353299.
Oben AG, Johnson BM, Tita ATN, Andrews WW, Hibberd PL, Subramaniam A, Sinkey RG. Int J Gynaecol Obstet. 2022.157(1):42-50. doi: 10.1002/ijgo.13747. PMID: 33999419.
An update on COVID-19 and pregnancy.
Jamieson DJ, Rasmussen SA. Am J Obstet Gynecol. 2022. 226(2):177-186. doi: 10.1016/j.ajog.2021.08.054. PMID: 34534497; PMCID: PMC8438995.
Developed & manufactured by Biomedica – Biomarkers for Cancer Research
The identification and validation of biomarkers in cancer is essential to improve our understanding of the disease. The emergence of novel cancer biomarkers continues to grow as scientists strive to find promising novel therapeutic targets and new prognostic and predictive markers to fight the disease.
Discover Biomedica Biomarker Assays for Cancer Research – we offer a range of unique biomarker ELISAs for your research.
Advantages of Biomedica ELISA kits
• RELIABLE – full validation package
• CONVENIENT – assay range optimized for clinical samples
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• LOW sample volumes
• TRUSTED – widely cited
High specificity – known target binding sites through mapping data
The unique specificity of the proprietary antibodies used in the Biomedica ELISA kits ensure that the assays only measure the analyte of interest.
Discover Biomedica´s Biomarker ELISA kits for cancer research
Neuropilin-1, Periostin, Semaphorin 4D, Osteoprotegerin, RANKL, LRG1, IL-6, VEGF, Angiopoietin-2 and other
Biomarkers for Cancer Research – Learn more about the markers
The transmembrane protein Neuropilin-1 (NRP1) regulates tumor biology and has been identified as a checkpoint target (1). High tissue NRP-1 levels are associated with a poor prognosis in breast cancer patients. In a recent study (2), German researchers have shown that circulating soluble NRP1 serum levels are an independent marker for poor prognosis in early breast cancer. Soluble Neuropilin-1 was quantified in serum with the highly specific NRP1 ELISA from Biomedica. Therapeutic areas of NRP1.
The secreted extracellular matrix protein Periostin has evolved as a novel therapeutic target and is a robust marker of glioma malignancy and potential tumor recurrence. It has also been implicated in the pathogenesis of breast cancer as high serum levels of periostin are associated with a poor survival in breast cancer patients (3). Periostin was quantified in serum with the well characterized Biomedica Periostin ELISA that has been published (4). Therapeutic areas of Periostin.
Semaphorin 4D (Sema4D) is a glycoprotein that is emerging as clinical biomarker and as therapeutic target in cancer. It has been associated with cancer progression and the occurrence of bone metastases (5, 6). Therapeutic areas of Sema4D.
Leucine-rich alpha-2-glycoprotein 1 (LRG1) is a protein that is an important factor involved in pathogenic angiogenesis in cancer. It is abundantly present in the microenvironment of many tumors contributing to vascular dysfunction and thus serving as a potential therapeutic target (7). Therapeutic areas of LRG 1.
The RANKL/RANK/OPG system contributes to the development of bone metastases and influences tumor biology in earlier stages of cancer (9). Dysregulation has been widely documented in the context of metastatic bone disease (10). The Biomedica OPG and RANKL ELISA kits have been widely used in the respective studies.
Literature
1. Neuropilin-1: a checkpoint target with unique implications for cancer immunology and immunotherapy. Chuckran CA et al., J Immunother Cancer. 2020. 8(2):e000967.
2. Soluble Neuropilin-1 is an independent marker of poor prognosis in early breast cancer. Rachner TD et al., J Cancer Res Clin Oncol. 2021. 147(8):2233-2238.
3. High serum levels of periostin are associated with a poor survival in breast cancer. Rachner TD et al., 2020. 180(2):515-524.
4. Characterization of a sandwich ELISA for the quantification of all human periostin isoforms. Gadermaier E J Clin Lab Anal. 2018. 32(2):e22252.
5. Plasma levels of Semaphorin 4D are decreased by adjuvant tamoxifen but not aromatase inhibitor therapy in breast cancer patients. Göbel A J Bone Oncol. 2019. 4;16:100237.
6. Semaphorins as emerging clinical biomarkers and therapeutic targets in cancer. Mastrantonio R et al., Theranostics. 202. 15;11(7):3262-3277.
7. Leucine-rich alpha-2-glycoprotein 1 (LRG1) as a novel ADC target. Javaid F et al., RSC Chem Biol. 2021. 31;2(4):1206-1220.
8. RANKL/RANK/OPG system beyond bone remodeling: involvement in breast cancer and clinical perspectives. Infante M J Exp Clin Cancer Res. 2019. 8;38(1):12.
9. Serum receptor activator of nuclear factor κB ligand (RANKL) levels predict biochemical recurrence in patients undergoing radical prostatectomy. Todenhöfer T, BJU Int. 2014. 113(1):152-9.
10. Prognostic Value of RANKL/OPG Serum Levels and Disseminated Tumor Cells in Nonmetastatic Breast Cancer. Rachner TD et al., Clin Cancer Res. 2019. 15;25(4):1369-1378.
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Report on novel prostate tumor cell targets
The Biomedica EZ4U – Cell Proliferation & Cytotoxicity Kit was cited in a high tier journal studying novel prostate tumor endothelial cell targets. The study highlights CXCR4/CXCL12 interaction as a potential novel target to interfere with tumor angiogenesis:
EZ4U Cell Proliferation & Cytotoxicity Assay
- Use of non-radioactive & non-toxic substances
- Easy one-step procedure on living cells
- Cited in more than 225 publications
More information can be found in our brochure: EZ4U – cat. no. BI-5000
Comprehensive characterization of the prostate tumor microenvironment identifies CXCR4/CXCL12 crosstalk as a novel antiangiogenic therapeutic target in prostate cancer.
Heidegger I, Fotakis G, Offermann A, Goveia J, Daum S, Salcher S, Noureen A, Timmer-Bosscha H, Schäfer G, Walenkamp A, Perner S, Beatovic A, Moisse M, Plattner C, Krogsdam A, Haybaeck J, Sopper S, Thaler S, Keller MA, Klocker H, Trajanoski Z, Wolf D, Pircher A. Mol Cancer. 2022 Jun 18;21(1):132. doi: 10.1186/s12943-022-01597-7. PMID: 35717322; PMCID: PMC9206324. Full text
Abstract
Background: Crosstalk between neoplastic and stromal cells fosters prostate cancer (PCa) progression and dissemination. Insight in cell-to-cell communication networks provides new therapeutic avenues to mold processes that contribute to PCa tumor microenvironment (TME) alterations. Here we performed a detailed characterization of PCa tumor endothelial cells (TEC) to delineate intercellular crosstalk between TEC and the PCa TME.
Methods: TEC isolated from 67 fresh radical prostatectomy (RP) specimens underwent multi-omic ex vivo characterization as well as orthogonal validation of both TEC functions and key markers by immunohistochemistry (IHC) and immunofluorescence (IF). To identify cell-cell interaction targets in TEC, we performed single-cell RNA sequencing (scRNA-seq) in four PCa patients who underwent a RP to catalogue cellular TME composition. Targets were cross-validated using IHC, publicly available datasets, cell culture experiments as well as a PCa xenograft mouse model.
Results: Compared to adjacent normal endothelial cells (NEC) bulk RNA-seq analysis revealed upregulation of genes associated with tumor vasculature, collagen modification and extracellular matrix remodeling in TEC. PTGIR, PLAC9, CXCL12 and VDR were identified as TEC markers and confirmed by IF and IHC in an independent patient cohort. By scRNA-seq we identified 27 cell (sub)types, including endothelial cells (EC) with arterial, venous and immature signatures, as well as angiogenic tip EC. A focused molecular analysis revealed that arterial TEC displayed highest CXCL12 mRNA expression levels when compared to all other TME cell (sub)populations and showed a negative prognostic role. Receptor-ligand interaction analysis predicted interactions between arterial TEC derived CXCL12 and its cognate receptor CXCR4 on angiogenic tip EC. CXCL12 was in vitro and in vivo validated as actionable TEC target by highlighting the vessel number- and density- reducing activity of the CXCR4-inhibitor AMD3100 in murine PCa as well as by inhibition of TEC proliferation and migration in vitro.
Conclusions: Overall, our comprehensive analysis identified novel PCa TEC targets and highlights CXCR4/CXCL12 interaction as a potential novel target to interfere with tumor angiogenesis in PCa.
Procedure of the EZ4U colorimetric test
The cell proliferation Assay kit EZ4U is non-toxic and non-radioactive that is based on the reduction of tetrazolium salt to colored formazan in living cells. Thus, the assay discriminates between living and dead cells since the process requires functional mitochondria. The assay is very easy to perform – add EZ4U reagent directly to the cells cultured, incubate and detect absorbance of the supernatant by a reader. The assay has been applied in numerous cells as reported in more than 225 publications e.g.
Fasting improves therapeutic response in hepatocellular carcinoma through p53-dependent metabolic synergism. Krstic J et al., Sci Adv. 2022. 21;8(3):eabh2635.
“Cell viability was analyzed using EZ4U assay (Biomedica Immunoassays) according to the manufacturer’s instructions. Briefly, at the end of treatment, the medium was replaced with fresh GM (200 μl per well) and 20 μl per well of EZ4U working solution. After 2 hours of incubation at 37°C, the absorbance was measured at 492 nm with a reference wavelength of 620 nm (Spark 10M multimode microplate reader).”
Syndecan-4 Is a Key Facilitator of the SARS-CoV-2 Delta Variant’s Superior Transmission. Hudák A et al., Int J Mol Sci. 2022. 12;23(2):796.
“Cell Viability Measurements: The effect of the applied spike proteins on cell viability was assessed with the EZ4U cell proliferation assay (Biomedica Gmbh, Vienna, Austria, cat. no. BI-5000), according to the instructions of the manufacturer. Absorbance was measured with a BioTek Cytation 3 multimode microplate reader.”
Method
- Water-soluble tetrazolium compound penetrates cell membrane
- In mitochondria reduction takes place and results in intense colored formazan which is water-soluble
- The reagent Formazan is secreted into culture medium and measured with an ELISA reader at 450 nm or 492 nm
Protocol
- Sample type – culture medium
- Sample size – 200 µl / test
- Detection limit – depends on respective cell line. Some xamples are shown in the product insert
- Incubation time – between 2-5 hours
What does the EZ4U kit include?
The reagents supplied per kit are sufficient for testing 10 x 96 well microtiter plates and contain:
- Substrate – lyophilized 10 vials
- Activator solution – ready to use 1 x 30 ml
Examples of cell types used in the EZ4U assay
– Endothelial cells (primary isolated from biopsies or cell-lines)
– Peripheral blood mononuclear cells (PBMCsec)
– HeLa (human cervical cancer) and HEK293A (human embryonic kidney) cell lines
– Human aortic smooth muscle cells (HAoSMCs)
– Huh7 (human liver carcinoma, CLS Cell Lines)
– Colon carcinoma cell models SW480
– CLC CTC cell lines (BHGc7, BHGc10, BHGc16, BHGc26 and UHGc5)
– CRC cell line HT29, DLD-1, HCT116,primary CRC cell line CG08
– HepG2 and Huh6 clone 5 cell lines
– Primary human skin cells – keratinocytes and fibroblasts
– Bovine mammary epithelial cells (MAC-T)
– Human primary chondrocytes
– HL-60 leukemia cells
– A172 and T98G glioblastoma cells
– Clonal preosteoblastic cell line MC3T3-E1-derived from newborn mouse calvaria
– Osteocyte-like MLO-Y4 cell line
– Preosteoclastic, macrophage-like RAW 264.7 cell line
– Primary HUVECs – human vascular endothelial cells
– MCF-7, T47D and MDA-MB-231 breast cancer cell lines
and many more..
Baseline Ang-2 plasma levels are an independent prognostic biomarker in refractory metastatic colorectal cancer
Chemorefractory is a term that is used to describe a cancer that does not respond to chemotherapy. Currently, no biomarkers are available to predict the efficacy of chemotherapy in chemorefractory metastatic colorectal cancer. Researchers from Italy have shown that circulating biomarker levels of Angiopoietin-2 (ANG2) increases early and predicts outcome with regorafenib but not with trifluridine/tipiracil treatment. Thus, baseline Ang-2 plasma levels are an independent prognostic biomarker in chemorefractory metastatic colorectal cancer. Read more: Early modulation of Angiopoietin-2 plasma levels predicts benefit from regorafenib in patients with metastatic colorectal cancer
Easy measurement of Angiopoietin-2 (ANG-2) in blood samples with only 20µl sample volume.
Check out the Biomedica ANGIOPOIETIN-2 (ANG2) ELISA kit
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Related publications
Antoniotti C, Marmorino F, Boccaccino A, Martini S, Antista M, Rossini D, Zuco V, Prisciandaro M, Conca V, Zucchelli G, Borelli B, Cosentino P, Germani MM, Bosco MF, Carullo M, Vetere G, Moretto R, Giordano M, Masi G, Pietrantonio F, Zaffaroni N, Cremolini C. Eur J Cancer. 2022. 165:116-124. doi: 10.1016/j.ejca.2022.01.025. PMID: 35231767.
Abstract
Background: No biomarkers are currently available to predict the efficacy of trifluridine/tipiracil (FTD/TPI) in chemorefractory metastatic colorectal cancer. The multicohort REGOLAND study aims at exploring and validating circulating markers potentially able to predict benefit from regorafenib in this setting. Material and methods: In the retrospective ‘regorafenib exploratory cohort’, including 105 patients treated with regorafenib, baseline (d1) plasma levels of angiogenesis-related biomarkers and their early modulation after 15 days (d15) of treatment were investigated for correlation with clinical outcome. Based on a pre-specified statistical hypothesis, main retrospective findings were prospectively challenged in the ‘regorafenib validation cohort’, including 100 patients treated with regorafenib. Prospectively validated putative biomarkers were then assessed in the control ‘FTD/TPI cohort’, including 93 patients treated with FTD/TPI. Results: In the ‘regorafenib exploratory cohort’, the early (d15) increase of Angiopoietin-2 (Ang-2) was associated with longer progression-free survival (HR:0.57 [95%CI:0.38-0.88], P = 0.004) and a trend towards longer OS (HR:0.74 [95%CI:0.48-1.14], P = 0.165), than the early decrease. Similar results were prospectively confirmed in the ‘regorafenib validation cohort’ (HR for progression-free survival:0.72 [95%CI:0.48-1.08], P = 0.095; HR for OS:0.77 [95%CI:0.51-1.16], P = 0.204). No predictive impact was shown for the early modulation of Ang-2 in the ‘FTD/TPI cohort’. High baseline Ang-2 levels predict poor prognosis in all the investigated cohorts, independently of other clinical prognostic variables. Conclusions: The early modulation of circulating Ang-2 predicts the efficacy of regorafenib. Baseline Ang-2 plasma levels are an independent prognostic biomarker in chemorefractory metastatic colorectal cancer.
Angiopoietin-2 as a Prognostic Factor in Patients with Incurable Stage IV Colorectal Cancer.
Munakata S, Ueyama T, Ishihara H, Komiyama H, Tsukamoto R, Kawai M, Takahashi M, Kojima Y, Tomiki Y, Sakamoto K. J Gastrointest Cancer. 2021.52(1):237-242. PMID: 32166589.
UK study suggests protective effect of Vitamin D supplementation on bone metabolism
Vitamin D plays an important role in bone mineralization. It helps the body to effectively absorb calcium which is essential to good bone health. The most common way for the body to produce vitamin D is through sunlight. As we get older the natural production of vitamin D decreases. Thus, elderly people either need to take vitamin D supplements or focus on eating foods that contain vitamin D. In a recent study, UK researchers investigated the effect of vitamin D supplementation in older people for 12 months. They looked into changes in markers of bone metabolism, bone mineral density, and bone mineral content . The results suggest a protective effect of supplementation on bone metabolism. Read more: Vitamin D Supplementation for 12 Months in Older Adults Alters Regulators of Bone Metabolism but Does Not Change Wnt Signaling Pathway Markers.
Biomedica offers a wide range of high quality ELISA Kits for bone markers.
The following Wnt signaling and regulatory bone markers were measured in this study:
Sclerostin, OPG, RANKL, DKK-1, FGF23 intact, FGF23 (C-terminal)
Related publications
Vitamin D Supplementation for 12 Months in Older Adults Alters Regulators of Bone Metabolism but Does Not Change Wnt Signaling Pathway Markers.
Christodoulou M, Aspray TJ, Piec I, Washbourne C, Tang JC, Fraser WD, Schoenmakers I; VDOP Trial Group. JBMR Plus. 2022 Mar 24;6(5):e10619. doi: 10.1002/jbm4.10619. PMID: 35509637; PMCID: PMC9059470.
Abstract
Vitamin D status and supplementation regulates bone metabolism and may modulate Wnt signaling. We studied the response of hormonal regulators of bone metabolism, markers of Wnt signaling and bone turnover and bone mineral density (BMD) and bone mineral content (BMC) in a randomized vitamin D intervention trial (12,000 IU, 24,000 IU, 48,000 IU/mo for 1 year; men and women aged >70 years; n = 379; ISRCTN35648481). Associations with total and free 25(OH)D concentrations were analyzed by linear regression. Baseline vitamin D status was (mean ± SD) 25(OH)D: 40.0 ± 20.1 nmol/L. Supplementation dose-dependently increased total and free 25(OH)D concentrations and decreased plasma phosphate and parathyroid hormone (PTH) (all p < 0.05). The procollagen 1 intact N-terminal (PINP)/C-terminal telopeptide (CTX) ratio, C-terminal fibroblast growth factor-23 (cFGF23), and intact FGF23 (iFGF23) significantly increased with no between-group differences, whereas Klotho was unchanged. 1,25(OH)2D and PINP significantly increased in the 24 IU and 48,000 IU groups. Sclerostin (SOST), osteoprotegerin (OPG), receptor activator of NF-κB ligand (RANKL), BMD, BMC, and CTX remained unchanged. Subgroup analyses with baseline 25(OH)D <25 nmol/L (n = 94) provided similar results. Baseline total and free 25(OH)D concentrations were positively associated with 1,25(OH)2D, 24,25(OH)2D (p < 0.001), vitamin D binding protein (DBP) (p < 0.05), BMD, and BMC (p < 0.05). Associations with PTH (p <0.001), cFGF23 (p < 0.01), and BAP (p < 0.05) were negative. After supplementation, total and free 25(OH)D concentrations remained positively associated only with 24,25(OH)2D (p < 0.001) and DBP (p < 0.001) and negatively with estimated glomerular filtration rate (eGFR) (p < 0.01). PTH and SOST were significantly associated only with free 25(OH)D. There were no significant relationships with BMD and BMC after supplementation. The decrease in PTH and increase in PINP/CTX ratio suggest a protective effect of supplementation on bone metabolism, although no significant effect on BMD or pronounced changes in regulators of Wnt signaling were found. The increase in FGF23 warrants caution because of its negative association with skeletal and cardiovascular health. Associations of total and free 25(OH)D with biomarkers were similar and known positive associations between vitamin D status and BMD were confirmed. The change in associations after supplementation might suggest a threshold effect. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
The role of vitamin D in maintaining bone health in older people.
Hill TR, Aspray TJ. Ther Adv Musculoskelet Dis. 2017 Apr;9(4):89-95. doi: 10.1177/1759720X17692502. Epub 2017 Feb 14. PMID: 28382112; PMCID: PMC5367643.
Abstract
This review summarises aspects of vitamin D metabolism, the consequences of vitamin D deficiency, and the impact of vitamin D supplementation on musculoskeletal health in older age. With age, changes in vitamin D exposure, cutaneous vitamin D synthesis and behavioural factors (including physical activity, diet and sun exposure) are compounded by changes in calcium and vitamin D pathophysiology with altered calcium absorption, decreased 25-OH vitamin D [25(OH)D] hydroxylation, lower renal fractional calcium reabsorption and a rise in parathyroid hormone. Hypovitaminosis D is common and associated with a risk of osteomalacia, particularly in older adults, where rates of vitamin D deficiency range from 10-66%, depending on the threshold of circulating 25(OH)D used, population studied and season. The relationship between vitamin D status and osteoporosis is less clear. While circulating 25(OH)D has a linear relationship with bone mineral density (BMD) in some epidemiological studies, this is not consistent across all racial groups. The results of randomized controlled trials of vitamin D supplementation on BMD are also inconsistent, and some studies may be less relevant to the older population, as, for example, half of participants in the most robust meta-analysis were aged under 60 years. The impact on BMD of treating vitamin D deficiency (and osteomalacia) is also rarely considered in such intervention studies. When considering osteoporosis, fracture risk is our main concern, but vitamin D therapy has no consistent fracture-prevention effect, except in studies where calcium is coprescribed (particularly in frail populations living in care homes). As a J-shaped effect on falls and fracture risk is becoming evident with vitamin D interventions, we should target those at greatest risk who may benefit from vitamin D supplementation to decrease falls and fractures, although the optimum dose is still unclear.
The health effects of vitamin D supplementation: evidence from human studies.
Bouillon R, Manousaki D, Rosen C, Trajanoska K, Rivadeneira F, Richards JB. Nat Rev Endocrinol. 2022 Feb;18(2):96-110. doi: 10.1038/s41574-021-00593-z. Epub 2021 Nov 23. PMID: 34815552; PMCID: PMC8609267.
Abstract
Vitamin D supplementation can prevent and cure nutritional rickets in infants and children. Preclinical and observational data suggest that the vitamin D endocrine system has a wide spectrum of skeletal and extra-skeletal activities. There is consensus that severe vitamin D deficiency (serum 25-hydroxyvitamin D (25OHD) concentration <30 nmol/l) should be corrected, whereas most guidelines recommend serum 25OHD concentrations of >50 nmol/l for optimal bone health in older adults. However, the causal link between vitamin D and many extra-skeletal outcomes remains unclear. The VITAL, ViDA and D2d randomized clinical trials (combined number of participants >30,000) indicated that vitamin D supplementation of vitamin D-replete adults (baseline serum 25OHD >50 nmol/l) does not prevent cancer, cardiovascular events, falls or progression to type 2 diabetes mellitus. Post hoc analysis has suggested some extra-skeletal benefits for individuals with vitamin D deficiency. Over 60 Mendelian randomization studies, designed to minimize bias from confounding, have evaluated the consequences of lifelong genetically lowered serum 25OHD concentrations on various outcomes and most studies have found null effects. Four Mendelian randomization studies found an increased risk of multiple sclerosis in individuals with genetically lowered serum 25OHD concentrations. In conclusion, supplementation of vitamin D-replete individuals does not provide demonstrable health benefits. This conclusion does not contradict older guidelines that severe vitamin D deficiency should be prevented or corrected.
Vitamin D: Production, Metabolism and Mechanisms of Action.
Bikle DD. 2021. Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905172.
Excerpt
Vitamin D production in the skin under the influence of sunlight (UVB) is maximized at levels of sunlight exposure that do not burn the skin. Further metabolism of vitamin D to its major circulating form (25(OH)D) and hormonal form (1,25(OH)2D) takes place in the liver and kidney, respectively, but also in other tissues where the 1,25(OH)2D produced serves a paracrine/autocrine function: examples include the skin, cells of the immune system, parathyroid gland, intestinal epithelium, prostate, and breast. Parathyroid hormone, FGF23, calcium and phosphate are the major regulators of the renal 1-hydroxylase (CYP27B1, the enzyme producing 1,25(OH)2D); regulation of the extra renal 1-hydroxylase differs from that in the kidney and involves cytokines. The major enzyme that catabolizes 25(OH)D and 1,25(OH)2D is the 24-hydroxylase; like the 1-hydroxylase it is tightly controlled in the kidney in a manner opposite to that of the 1-hydroxylase, but like the 1-hydroxylase it is widespread in other tissues where its regulation is different from that of the kidney. Vitamin D and its metabolites are carried in the blood bound to vitamin D binding protein (DBP) and albumin–for most tissues it is the free (i.e., unbound) metabolite that enters the cell; however, DBP bound metabolites can enter some cells such as the kidney and parathyroid gland through a megalin/cubilin mechanism. Most but not all actions of 1,25(OH)2D are mediated by the vitamin D receptor (VDR). VDR is a transcription factor that partners with other transcription factors such as retinoid X receptor that when bound to 1,25(OH)2D regulates gene transcription either positively or negatively depending on other cofactors to which it binds or interacts. The VDR is found in most cells, not just those involved with bone and mineral homeostasis (i.e., bone, gut, kidney) resulting in wide spread actions of 1,25(OH)2D on most physiologic and pathologic processes. Animal studies indicate that vitamin D has beneficial effects on various cancers, blood pressure, heart disease, immunologic disorders, but these non-skeletal effects have been difficult to prove in humans in randomized controlled trials. Analogs of 1,25(OH)2D are being developed to achieve specificity for non-skeletal target tissues such as the parathyroid gland and cancers to avoid the hypercalcemia resulting from 1,25(OH)2D itself. The level of vitamin D intake and achieved serum levels of 25(OH)D that are optimal and safe for skeletal health and the non-skeletal actions remain controversial, but are likely between an intake of 800-2000IU vitamin D in the diet and 20-50ng/ml 25(OH)D in the blood.
Sleeve gastrectomy might improve the “natriuretic handicap” of severely obese individuals
NT-proBNP serum levels increase with surgical weight loss interventions: Natriuretic peptides, including BNP hormone (B-type natriuretic peptide) and its amino-terminal counterpart NT-proBNP play a crucial role in the regulation of cardiovascular and energy homeostasis. They decrease blood pressure and increase the degradation of lipids and energy expenditure in fat tissue. Furthermore, both hormones are used as biomarkers in clinical practice in the diagnosis of heart failure.
Several studies have demonstrated that obesity is associated with low circulating levels of NT-proBNP concentrations, a condition known as “natriuretic handicap” * . In the following publication, researchers have investigated the impact of two surgical weight loss interventions on NT-proBNP serum concentrations in obese individuals without clinical signs of heart failure. Their data support the idea that the “natriuretic handicap * ” of obese individuals can be improved with surgically-induced weight loss, especially sleeve gastrectomy.
Effect of various weight loss interventions on serum NT-proBNP concentration in severe obese subjects without clinical manifest heart failure. Hollstein T et al. 2021.
*condition of decreased BNP levels in obese patients has been termed “the natriuretic handicap ” ( B-type natriuretic peptide and obesity in heart failure: a mysterious but important association in clinical practice. Reinmann M and P Meyer. 2020.)
⇒ NT-proBNP serum concentrations were measured with the Biomedica NT-proBNP ELISA (cat.no. SK-1204)
NT-proBNP serum levels increase with surgical weight loss interventions –
Kit highlights
√ CE-marked – for IVD use in the EU
√ Flexible – can be run in every lab
√ Two controls included
√ Simple 2 step protocol
√ Reliable – full validation
√ Widely cited
Developed & manufactured by Biomedica – right in the heart of Europe
Hollstein T, Schlicht K, Krause L, Hagen S, Rohmann N, Schulte DM, Türk K, Beckmann A, Ahrens M, Franke A, Schreiber S, Becker T, Beckmann J, Laudes M. Sci Rep. 2021. 12;11(1):10096. doi: 10.1038/s41598-021-89426-7. PMID: 33980890; PMCID: PMC8115663.
Abstract
The B-type natriuretic peptide (BNP) hormone plays a crucial role in the regulation of cardiovascular and energy homeostasis. Obesity is associated with low circulating levels of BNP, a condition known as “natriuretic handicap.” Recent evidences suggest an altered expression of BNP receptors-both the signaling natriuretic peptide receptors (NPR)-A and the clearance NPR-C receptor-in adipose tissue (AT) as one of the putative causes of natriuretic handicap.
The current study aims at clarifying the molecular mechanisms behind the natriuretic handicap, focusing on NPR modulation in the AT of obese and control subjects.
The study enrolled 34 obese and 20 control subjects undergoing bariatric or abdominal surgery, respectively. The main clinical and biochemical parameters, including circulating BNP, were assessed. In visceral (VAT) and subcutaneous AT (SAT) samples, collected during surgery, the adipocytes and stromal vascular fraction (SVF) expression of NPR-A and NPR-C and the SVF secretion of interleukin 6 (IL-6) were determined. Both VAT and SAT from obese patients expressed a lower NPR-A/NPR-C ratio in adipocytes and the SVF secreted a higher level of IL-6, compared with the controls. Moreover, NPR-A/NPR-C ratio expressed by VAT and SAT adipocytes negatively correlated with body mass index, insulin, the Homeostasis Model Assessment of Insulin resistance, and IL-6 secreted by SVF, and the expression of the clearance receptor NPR-C, in both the VAT and SAT adipocytes, showed a negative correlation with circulating BNP.
Overall, insulin resistance/hyperinsulinemia and AT inflammation (ie, high level of IL-6) are the major determinants of the lower NPR-A/NPR-C ratio in adipocytes, thus contributing to the natriuretic handicap in obese subjects.
RELATED PUBLICATIONS
Gentili A et al., . Transl Res. 2017. 186:52-61. doi: 10.1016/j.trsl.2017.06.001. PMID: 28651075.
Abstract
The B-type natriuretic peptide (BNP) hormone plays a crucial role in the regulation of cardiovascular and energy homeostasis. Obesity is associated with low circulating levels of BNP, a condition known as “natriuretic handicap.” Recent evidences suggest an altered expression of BNP receptors-both the signaling natriuretic peptide receptors (NPR)-A and the clearance NPR-C receptor-in adipose tissue (AT) as one of the putative causes of natriuretic handicap.
The current study aims at clarifying the molecular mechanisms behind the natriuretic handicap, focusing on NPR modulation in the AT of obese and control subjects.
The study enrolled 34 obese and 20 control subjects undergoing bariatric or abdominal surgery, respectively. The main clinical and biochemical parameters, including circulating BNP, were assessed. In visceral (VAT) and subcutaneous AT (SAT) samples, collected during surgery, the adipocytes and stromal vascular fraction (SVF) expression of NPR-A and NPR-C and the SVF secretion of interleukin 6 (IL-6) were determined. Both VAT and SAT from obese patients expressed a lower NPR-A/NPR-C ratio in adipocytes and the SVF secreted a higher level of IL-6, compared with the controls. Moreover, NPR-A/NPR-C ratio expressed by VAT and SAT adipocytes negatively correlated with body mass index, insulin, the Homeostasis Model Assessment of Insulin resistance, and IL-6 secreted by SVF, and the expression of the clearance receptor NPR-C, in both the VAT and SAT adipocytes, showed a negative correlation with circulating BNP.
Overall, insulin resistance/hyperinsulinemia and AT inflammation (ie, high level of IL-6) are the major determinants of the lower NPR-A/NPR-C ratio in adipocytes, thus contributing to the natriuretic handicap in obese subjects.
Parcha V, Patel N, Kalra R, Suri SS, Arora G, Wang TJ, Arora P. J Am Heart Assoc. 2021 Apr 6;10(7):e018689. doi: 10.1161/JAHA.120.018689. PMID: 33754794; PMCID: PMC8174357.
Abstract
Background Obese patients have lower NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels.
The prognostic implications of achieving NT-proBNP levels ≤1000 pg/mL in obese patients with heart failure (HF) receiving biomarker-guided therapy are not completely known.
We evaluated the prognostic implications of obesity and having NT-proBNP levels (≤1000 pg/mL) in the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in HF) trial participants. Methods and Results The risk of adverse cardiovascular events (HF hospitalization or cardiovascular mortality) was assessed using multivariable-adjusted Cox proportional hazard models based on having NT-proBNP ≤1000 pg/mL (taken as a time-varying covariate), stratified by obesity status. The study outcome was also assessed on the basis of the body mass index at baseline. The predictive ability of NT-proBNP for adverse cardiovascular events was assessed using the likelihood ratio test. Compared with nonobese patients, obese patients were mostly younger, Black race, and more likely to be women. NT-proBNP levels were 59.0% (95% CI, 39.5%-83.5%) lower among obese individuals. The risk of adverse cardiovascular events was lower in obese (hazard ratio [HR], 0.48; 95% CI, 0.29-0.59) and nonobese (HR, 0.32; 95% CI, 0.19-0.57) patients with HF who had NT-proBNP levels ≤1000 pg/mL, compared with those who did not. There was no interaction between obesity and having NT-proBNP ≤1000 pg/mL on the study outcome (P>0.10). Obese patients had a greater risk of developing adverse cardiovascular events (HR, 1.39; 95% CI, 1.01-1.90) compared with nonobese patients. NT-proBNP was the strongest predictor of adverse cardiovascular event risk in both obese and nonobese patients.
Conclusions On-treatment NT-proBNP level ≤1000 pg/mL has favorable prognostic implications, irrespective of obesity status. NT-proBNP levels were the strongest predictor of cardiovascular events in both obese and nonobese individuals in this trial.
Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01685840.
BIOMEDICA Quality CYTOKINE KITS for affordable & efficient research
My name is Lan Chi. I am part of the Biomedica assay quality management team. All our ELISA kits undergo a stringent quality control process. This ensures reliable and consistent results. We are located right in the heart of Europe. I am happy to introduce our new human Cytokine ELISA Kits – developed & manufactured by Biomedica
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Biomedica ´s ELISA assay kits are validated according to international quality guidelines (ICH, EMEA, FDA). You can find the assay validation data on the respective product pages of our website.
DILUTION LINEARITY (PARALLELISM): CONSISTENT RECOVERY IN DILUTED SAMPLES
Our validation data include the following experiments: e.g. parallelism (dilution of samples containing elevated endogenous levels of the protein of interest) and dilution linearity (dilution of samples containing levels of endogenous and recombinant protein of interest).
WITHIN-RUN AND IN-BETWEEN RUN PRECISION: PRECISE & REPRODUCIBLE RESULTS WITHIN AND ACROSS LOTS
Our lab team also validates our assays for precision and accuracy. The precision of our assays is determined by measuring samples of known concentrations a number of times with one kit lot (within-run precision) and with two different kit lots (in-between run precision).
Finally, we check the stability of the analyte in the respective sample matrix.
STABILITY – Sample stability and stability of kit components
We take measures to ensure the stability of all component substances that are included in the kits. Accordingly, the stability of all assay components is tested during kit development. Furthermore, we expose real samples to several freeze-thaw cycles and also leave samples at room temperature for at least 24 hours. Hence, with these experiments we are able to determine sample stability after temperature stress.
Related information:
Our Biomedica human Angiopoietin-2 ELISA (cat.no. BI-ANG2) has been cited in the following publication:
Chu C et al., Nephrol Dial Transplant. 2022 ; 23;37(7):1348-1356.
Particularly, a detailed description of Biomedica´s Angiopoietin-2 ELISA is shown in the following poster .
Check out the validation data of our human IL-6 ELISA
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We can measure any kind of selected biomarker by ELISA.
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Testicular Cancer – RANKL inhibition suppresses tumor growth: Testicular cancer is the most commonly diagnosed malignancy in young males. A new study features the use of the Biomedica RANKL ELISA investigating the effects of RANKL (receptor activator of nuclear factor- κB ligand) inhibition in patients with testicular cancer. Despite its high cure rate, patients suffer from serious adverse effects to chemotherapy. Investigating alternative treatments, the scientists demonstrated that the RANKL inhibitor Denosumamb, used to treat osteoporosis, has tumor suppressive properties. As RANKL signaling was recently identified in the testis regulating male reproductive function, an open question remains if RANKL is responsible for the malignant transformation to invasive tumors.
Testicular Cancer – RANKL inhibition suppresses tumor growth
Andreassen CH, Lorenzen M, Nielsen JE, Kafai Yahyavi S, Toft BG, Ingerslev LR, Clemmensen C, Rasmussen LJ, Bokemeyer C, Juul A, Jørgensen A, Blomberg Jensen M. Br J Cancer. 2022 Apr 13. doi: 10.1038/s41416-022-01810-w. Epub ahead of print. PMID: 35418213.
Abstract
Background: Testicular germ cell tumours (TGCTs) have a high sensitivity to chemotherapy and a high cure rate, although with serious adverse effects. In the search for tumour suppressive drugs, the RANKL inhibitor Denosumab, used to treat osteoporosis, came up as a candidate since RANKL signalling was recently identified in the testis.
Methods: Expression of RANKL, RANK and OPG, and the effects of RANKL inhibition were investigated in human TGCTs, TGCT-derived cell-lines, and TGCT-xenograft models. Serum RANKL was measured in TGCT-patients.
Results: RANKL, RANK, and OPG were expressed in germ cell neoplasia in situ (GCNIS), TGCTs, and TGCT-derived cell lines. RANKL-inhibition reduced proliferation of seminoma-derived TCam-2 cells, but had no effect on embryonal carcinoma-derived NTera2 cells. Pretreatment with Denosumab did not augment the effect of cisplatin in vitro. However, inhibition of RANKL in vivo reduced tumour growth exclusively in the TCam-2-xenograft model and Denosumab-treatment decreased proliferation in human GCNIS cultures. In TGCT-patients serum RANKL had no prognostic value.
Conclusions: This study shows that the RANKL signalling system is expressed in GCNIS and seminoma where RANKL inhibition suppresses tumour growth in vitro and in vivo. Future studies are needed to determine whether RANKL is important for the malignant transformation or transition from GCNIS to invasive tumours.
FREE soluble RANKL HS ELISA | BI-20462
Biomedica offers an ELISA assay kit for the reliable detection of free soluble uncomplexed RANKL in human serum samples: free soluble RANKL ELISA (cat. no. BI-20462)
Widely cited in clinical studies – 290+ publications
• Reliable – fully validated according to international guidelines
• High sensitivity – measurable concentrations in healthy subjects
• HIGH quality guaranteed – developed & produced by Biomedica
Related products
Osteoprotegerin (OPG) ELISA , DKK-1 ELISA , Sclerostin ELISA ,
IL-6 ELISA , VEGF ELISA , Angiopoietin-2 ELISA
Related publications
RANKL regulates male reproductive function.
Blomberg Jensen M, Andreassen CH, Jørgensen A, Nielsen JE, Juel Mortensen L, Boisen IM, et al. Nat Commun. 2021;12:1–15. doi: 10.1038/s41467-021-22734-8. PMID: 33893301; PMCID: PMC8065035.
Abstract
Infertile men have few treatment options. Here, we demonstrate that the transmembrane receptor activator of NF-kB ligand (RANKL) signaling system is active in mouse and human testis. RANKL is highly expressed in Sertoli cells and signals through RANK, expressed in most germ cells, whereas the RANKL-inhibitor osteoprotegerin (OPG) is expressed in germ and peritubular cells. OPG treatment increases wild-type mouse sperm counts, and mice with global or Sertoli-specific genetic suppression of Rankl have increased male fertility and sperm counts. Moreover, RANKL levels in seminal fluid are high and distinguishes normal from infertile men with higher specificity than total sperm count. In infertile men, one dose of Denosumab decreases RANKL seminal fluid concentration and increases serum Inhibin-B and anti-Müllerian-hormone levels, but semen quality only in a subgroup. This translational study suggests that RANKL is a regulator of male reproductive function, however, predictive biomarkers for treatment-outcome requires further investigation in placebo-controlled studies.
The RANK-RANKL axis: an opportunity for drug repurposing in cancer?
Peters S, Clézardin P, Márquez-Rodas I, Niepel D, Gedye C. Clin Transl Oncol. 2019;21:977–91. doi: 10.1007/s12094-018-02023-5. Epub 2019 Jan 17. PMID: 30656607.
Abstract
Drug repurposing offers advantages over traditional drug development in terms of cost, speed and improved patient outcomes. The receptor activator of nuclear factor kappa B (RANK) ligand (RANKL) inhibitor denosumab is approved for the prevention of skeletal-related events in patients with advanced malignancies involving bone, including solid tumours and multiple myeloma. Following improved understanding of the role of RANK/RANKL in cancer biology, denosumab has already been repurposed as a treatment for giant cell tumour of bone. Here, we review the role of RANK/RANKL in tumourigenesis, including effects on tumour initiation, progression and metastasis and consider the impact of RANK/RANKL on tumour immunology and immune evasion. Finally, we look briefly at ongoing trials and future opportunities for therapeutic synergy when combining denosumab with anti-cancer agents such as immune checkpoint inhibitors.
Juel Mortensen L, Lorenzen M, Jørgensen N, Andersson A-M, Nielsen JE, Petersen LI, et al.Bone. 2019;123:103–14. doi: 10.1016/j.bone.2019.03.022. Epub 2019 Mar 23. PMID: 30914274.
International Trends in the Incidence of Testicular Cancer: Lessons from 35 Years and 41 Countries.
Gurney JK, Florio AA, Znaor A, Ferlay J, Laversanne M, Sarfati D, Bray F, McGlynn KA. Eur Urol. 2019 Nov;76(5):615-623. doi: 10.1016/j.eururo.2019.07.002. Epub 2019 Jul 17. PMID: 31324498; PMCID: PMC8653517.
Development of a 3D-printed testicular cancer model for testicular examination education.
Power RJ, Hearn J, Gillis CJ, Harvey D, French C, Organ M. Can Urol Assoc J. 2021 Apr;15(4):E221-E226. doi: 10.5489/cuaj.6675. PMID: 33007179; PMCID: PMC8021429.
How to do a Testicular Self Exam . Testicular Cancer Society
Circulating Angiopoietin-2 (ANG2) increases with PAP sleep apnea treatment: Obstructive sleep apnea (OSA), the most common sleep-related breathing disorder, is becoming increasingly prevalent worldwide due to widespread obesity. It causes a person to repeatedly stop and start breathing during sleep. Positive airway pressure (PAP) is a well-established treatment for OSA patients, using a machine to pump air under pressure into the airway of the lungs. Though effective, the therapy causes large increases in lung volumes during the night that are potentially deleterious. A recent study investigated the impact of PAP therapy on various biomarkers related to alveolar epithelial and endothelial injury. The researchers have shown that Angiopoietin-2 (ANG-2), a marker of endothelial injury and cardiovascular disease risk, increases with continuous positive airway pressure therapy . This finding raises concern for a possible adverse impact of PAP therapy on the vascular endothelium.
Circulating-angiopoietin-2-ang2-increases-with-pap-sleep-apnea-treatment: Effect of positive airway pressure therapy of obstructive sleep apnea on circulating Angiopoietin-2.
Gottlieb DJ, Lederer DJ, Kim JS, Tracy RP, Gao S, Redline S, Jelic S. Sleep Med. 2022 May 16;96:119-121. doi: 10.1016/j.sleep.2022.05.007. Epub ahead of print. PMID: 35636149.
Abstract
Background: Obstructive sleep apnea (OSA) has been identified as a possible contributor to interstitial lung disease. While positive airway pressure (PAP) is effective therapy for OSA, it causes large increases in lung volumes during the night that are potentially deleterious, analogous to ventilator-induced lung injury, although this has not been previously studied. The goal of this study was to assess the impact of PAP therapy on four biomarkers of alveolar epithelial and endothelial injury and extracellular matrix remodeling in patients with OSA.
Methods: In 82 patients with moderate to severe OSA who were adherent to PAP therapy, surfactant protein D, osteopontin, angiopoietin-2, and matrix metalloprotease-7 were measured by ELISA in serum samples collected before and 3- to 6-months after initiation of PAP therapy.
Results: An increase in angiopoietin-2 level of 0.28 ng/mL following PAP therapy was observed (p = 0.007). This finding was replicated in an independent sample of OSA patients. No significant change was detected in surfactant protein D, osteopontin, or matrix metalloprotease-7.
Conclusions: This finding raises concern for a possible adverse impact of PAP therapy on vascular endothelium.
Keywords: Angiopoietin-2; Lung injury; Obstructive sleep apnea; Positive airway pressure.
Human Angiopoietin-2 ELISA Kit | BI-ANG2
Angiopoietin-2 can easily be measured with an ELISA assay in serum and plasma samples with only 20 µl of sample volume! The kit incorporates ready to use standards and controls. The assay range is optimized for clinical samples- no sample dilution required!
Features & Benefits of the Biomedica human Angipoietin-2 ELISA
√ Immediate results: no sample dilution required
√ Full validation package – the assay is optimized for clinical samples
√ Kit includes ready to use standards and controls
√ HIGH QUALITY GUARANTEED
Find out more: Angiopoietin-2 ELISA
Circulating-angiopoietin-2 increases-with-pap-sleep-apnea-treatment
Related publications:
Increased Level of Angiopoietin Like Proteins 4 and 8 in People With Sleep Apnea.
Al-Terki A, Abu-Farha M, AlKhairi I, Cherian PT, Sriraman D, Shyamsundar A, Ali S, Almulla F, Tuomilehto J, Abubaker JA. Front Endocrinol (Lausanne). 2018 Nov 13;9:651. doi: 10.3389/fendo.2018.00651. PMID: 30524367; PMCID: PMC6262344.
Abstract
Objective: Obstructive sleep apnea (OSA) is a sleep disorder caused by the complete or partial obstruction of the upper airways. The worldwide prevalence of OSA is increasing due to its close association with obesity epidemic and multiple health complications, such as hypertension, cardiovascular disease, and Type 2 diabetes. Angiopoietin-like protein (ANGPTL)-4 and ANGPTL8 (betatrophin) have been suggested to play a role in the development of these diseases through their role in regulating the metabolism of plasma lipid molecules. This study was designed to evaluate ANGPTL4 and 8 levels in an OSA group and a control group to clarify the effect of OSA on ANGPTL4 and 8 levels. Methods: In total, 74 subjects were enrolled in this study, including 22 age- and body mass index (BMI)-matched controls with the Apnea Hypopnea Index (AHI) score of <5 events/h and 52 subjects with an AHI score of >5 events/h. Sleep apnea was assessed using a portable sleep test. ANGPTL4 and 8 levels were measured in plasma samples using enzyme-linked immunosorbent assay. Results: Mean AHI score (2.5 ± 1.6) in the control group was significantly lower than that in the OSA group (22.9 ± 17.9; p < 0.0001). Leptin, interleukin-(IL) 6, insulin, and HOMA-IR values were higher in the OSA group than in the control group. ANGPTL8 level was higher in the OSA group (1130.0 ± 108.61 pg/mL) than in the control group (809.39 ± 108.78 pg/mL; p = 0.041). Similarly, ANGPTL4 was higher in the OSA group (179.26 ± 12.89 ng/mL) than in the control group (142.63 ±7.99 ng/mL; p = 0.018). Conclusion: Our findings demonstrate that ANGPTL4 and 8 levels were increased in subjects with OSA, suggesting that the upregulation of these lipid metabolism regulators might play a role in lipid dysregulation observed in people with OSA.
Gao S, Emin M, Thoma T, Pastellas K, Castagna F, Shah R, Jimenez A, Patel N, Wei Y, Jelic S. Sleep. 2021 Apr 9;44(4):zsaa286. doi: 10.1093/sleep/zsaa286. PMID: 33351148; PMCID: PMC8033461.
Abstract
Study objective: Obstructive sleep apnea (OSA) is highly prevalent and triples vascular thromboembolic risk. Intermittent hypoxia (IH) during transient cessation of breathing in OSA impairs endothelial protection against complement. Complement activation stimulates the endothelial release of a pro-thrombotic von Willebrand factor (vWF). We investigated whether increased complement activity in OSA promotes the endothelial release of vWF and pro-inflammatory angiopoietin-2. We further investigated whether improving complement protection with statins reverses these changes.
Methods: Using endothelial cells (ECs) and blood collected from OSA patients (n = 109) and controls (n = 67), we assessed whether altered cellular localization of complement inhibitor CD59 in OSA modulates exocytosis of Weibel-Palade bodies (WPB), secretory granules that store vWF and angiopoietin-2. These interactions were also assessed in vitro in ECs exposed to normoxia or IH with or without recombinant complement C9 and with or without atorvastatin.
Results: Circulating levels of angiopoietin-2 were greater in OSA than controls and levels of vWF cleavage products correlated with OSA severity. In cultured ECs, IH enhanced complement-stimulated angiopoietin-2 and vWF release by reducing EC surface and increasing intracellular expression of complement inhibitor CD59. Intracellular CD59 co-localized with WPB in OSA. IH increased binding of intracellular CD59 to syntaxin-3, which dissociated syntaxin-3 from voltage-sensitive calcium channel Cav1.2, and activated WPB exocytosis in a calcium-dependent manner. Atorvastatin reversed IH-enhanced endothelial release of vWF and angiopoietin-2.
Conclusions: IH promotes the complement-mediated release of vWF and angiopoietin-2, which may contribute to pro-thrombotic and pro-inflammatory conditions in OSA. Statin reversed these effects, suggesting a potential approach to reduce cardiovascular risk in OSA.
Globally, about 1 in 6 deaths is related to cancer. Advances in cancer research have improved the prevention, the detection, and the treatment of cancer. Understanding on how cancers starts, grows and spreads is important for cancer treatment. Biomarkers play a critical role at all stages of the disease and serve as therapeutic targets (1).
Biomarkers in Cancer Research
NEUROPILIN-1 is a checkpoint target
The biomarker Neuropilin-1 (NRP1) has gained renewed attention as it is implicated in promoting tumor progression. It acts as a co-receptor to VEGF (Vascular Endothelial Growth Factor) and induces angiogenesis, the process of the formation of new blood-vessels (2). NRP-1 is expressed in a variety of cancers including lung, prostate, pancreas or colon carcinoma. In metastatic melanoma, NRP-1 plays a crucial role in melanoma aggressiveness and evidence supports its use as a target for therapies (3) .
More recently, Neuropilin-1 has been identified as a checkpoint target with unique implications for cancer immunology and immunotherapy (4). This review discusses the increasing literature on Neuropilin-1 mediated immune modulation providing a rationale to categorize NRP1 as a key checkpoint in the tumor microenvironment (TME) as well as a promising immunotherapeutic target.
Did you know: Neuropilin-1 can easily be detected in serum, plasma and in cell culture supernatants using a conventional ELISA kit?
The assay is fully validated for clinical use in human samples but also works in non-human samples. Only 10µl sample is required.
For more information contact us at BIOMEDICA
Neuropilin-1 (NRP1) ELISA assay highlights:
-Highly specific using epitope mapped antibodies
-Detects free and ligand-bound soluble NRP1
-10 µl sample/well
Literature:
- Biomarkers and Its Application in Cancer Research. Jiancheng Hu and Qiang You. Biomark Applic 2017: 103. DOI: 10.29011/BMAP-103. 100103.
- VEGF binding to NRP1 is essential for VEGF stimulation of endothelial cell migration, complex formation between NRP1 and VEGFR2, and signaling via FAK Tyr407 phosphorylation. Herzog B, Pellet-Many C, Britton G, Hartzoulakis B, Zachary IC. Mol Biol Cell. 2011 :;22(15):2766-76. doi: 10.1091/mbc.E09-12-1061. PMID: 21653826.
- Neuropilin-1 as Therapeutic Target for Malignant Melanoma. Graziani G, Lacal PM. Front Oncol. 2015;5:125. Published 2015 Jun 3. doi:10.3389/fonc.2015.00125.
- Neuropilin-1: a checkpoint target with unique implications for cancer immunology and immunotherapy. Chuckran CA, Liu C, Bruno TC, Workman CJ, Vignali DA. J Immunother Cancer. 2020 Jul;8(2):e000967. doi: 10.1136/jitc-2020-000967. PMID: 32675311; PMCID: PMC7368550:
Neuropilin-1: a checkpoint target with unique implications for cancer immunology and immunotherapy
Abstract
Checkpoint blockade immunotherapy established a new paradigm in cancer treatment: for certain patients curative treatment requires immune reinvigoration. Despite this monumental advance, only 20%-30% of patients achieve an objective response to standard of care immunotherapy, necessitating the consideration of alternative targets. Optimal strategies will not only stimulate CD8+ T cells, but concomitantly modulate immunosuppressive cells in the tumor microenvironment (TME), most notably regulatory T cells (Treg cells). In this context, the immunoregulatory receptor Neuropilin-1 (NRP1) is garnering renewed attention as it reinforces intratumoral Treg cell function amidst inflammation in the TME. Loss of NRP1 on Treg cells in mouse models restores antitumor immunity without sacrificing peripheral tolerance. Enrichment of NRP1+ Treg cells is observed in patients across multiple malignancies with cancer, both intratumorally and in peripheral sites. Thus, targeting NRP1 may safely undermine intratumoral Treg cell fitness, permitting enhanced inflammatory responses with existing immunotherapies. Furthermore, NRP1 has been recently found to modulate tumor-specific CD8+ T cell responses. Emerging data suggest that NRP1 restricts CD8+ T cell reinvigoration in response to checkpoint inhibitors, and more importantly, acts as a barrier to the long-term durability of CD8+ T cell-mediated tumor immunosurveillance. These novel and distinct regulatory mechanisms present an exciting therapeutic opportunity. This review will discuss the growing literature on NRP1-mediated immune modulation which provides a strong rationale for categorizing NRP1 as both a key checkpoint in the TME as well as an immunotherapeutic target with promise either alone or in combination with current standard of care therapeutic regimens.
Keywords: immunomodulation; immunotherapy; tumor microenvironment.
Check out our biomarker ELISA kits for cancer research
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-Neuropilin-1 – BI-20409
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-Periostin – BI-20433
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-Angiopoietin-2 – BI-ANG2
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I am proud to introduce our new human Cytokine ELISA Kits – developed & manufactured by Biomedica.
IL-6 (Interleukin-6) high sensitivity – detectable levels
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ANGIOPOIETIN-2 optimized assay range – no predilution
All kits include color coded, ready to use prediluted standards and controls.
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Citations:
The Biomedica human Angiopoietin-2 ELISA (cat.no. BI-ANG2) is described in Nephrology Dialysis Transplantation, Volume 34, Issue Supplement_1, June 2019, gfz103.SP339:
Ana-Maria Suciu Andreea, Jacqueline Wallwitz, Berg Gabriela, Maria Laber Anna, Himmler Gottfried
INTRODUCTION: Angiopoietin-2 (Ang-2) is an important regulator of the angiopoietin-1/Tie-2 receptor signaling system on endothelial cells during angiogenesis. Disruption of this signaling leads to the loss of endothelial integrity and renders the endothelium response towards a variety of pro-inflammatory cytokines and growth factors. Thus, Ang-2 might lead to vascular micro-inflammation in patients with CKD (chronic kidney disease). Ang-2 levels increase with CKD stage, are associated with fluid overload and abnormal cardiac structure and predict mortality in patients with CKD stages 4–5. Although Ang-2 levels return toward normal after successful kidney transplantation, Ang-2 remains a putative cardiovascular risk factor in this population.
METHODS: An enzyme-linked immunosorbent assay for the detection of all three angiopoietin-2 isoforms in human serum and plasma was developed. Two high quality antibodies are combined in a sandwich test format: As capturing antibody a recombinant monoclonal antibody is used. A biotin-labeled polyclonal affinity-purified antibody serves for detection of the analyte. High resolution epitope mapping of the antibodies via peptide microarray technology allowed the identification of linear antibody epitopes. Technical performance and accuracy of the assay were assessed according to ICH/EMEA guidelines.
RESULTS: Microarray data illustrate the binding of the polyclonal detection antibody to human angiopoietin-2 spotted on a chip. Altogether, seven linear epitopes located N-terminal/at the center of angiopoietin-2 were detected. Most relevant linear epitopes are epitope e2 in the super clustering region and e6 near the fibrinogen-like domain, displaying a twofold higher fluorescent signal than the remaining epitopes. For the recombinant monoclonal antibody no fluorescence was recorded. This antibody recognizes a structural epitope within the C-terminus of angiopoietin-2, which covers the bioactive receptor-binding site of the protein. We expect to detect all described angiopoietin-2 isoforms, as the receptor-binding site is conserved and the majority of the polyclonal antibody epitopes are present in all isoforms. This assay is in conformance with ICH/EMEA/FDA guidelines. Validation data demonstrate its applicability in nephrological disorders including chronic kidney disease. Here we compare an apparently healthy population to chronic kidney disease samples on haemodialysis and kidney transplant samples.
CONCLUSIONS: This new angiopoietin-2 ELISA enables a quick and accurate quantification of all human angiopoietin-2 isoforms that are bioactive in chronic kidney disease and other nephrological disorders.
The Angiopoietin-2 (ANG2) ELISA assay has been fully validated according to international quality guidelines (ICH, EMEA, FDA) and is in line with the required quality specifications (data are shown in the validation file). Assay performance characteristics as accuracy, dilution linearity and parallelism, precision, detection limit and sensitivity, sample stability, specificity including characterization of the angiopoietin-2 antibodies, epitope-mapping were performed.
The Biomedica human VEGF (Vascular Endothelial Growth Factor) ELISA (cat.no. BI-VEGF) is described in the following publication:
NOVEL VEGF-A ELISA ALLOWS SENSITIVE QUANTIFICATION OF HUMAN TOTAL BIOACTIVE VEGF-A.
Osteologie 2020; 29(01): 72. DOI: 10.1055/s-0039-3402888. G Berg, Andreea Ana-Maria Suciu, E Gadermaier, J Wallwitz, G Himmler
Introduction Vascular endothelial growth factor A (VEGF-A), a prominent member of growth factors that regulate angiogenesis and development of normal vasculature, plays an important role in bone development and remodeling. Studies have shown that ossification requires vascularization a priori and that most VEGF in the bone comes from osteoblastic cells. Upon secretion from osteoblasts, VEGF activates endothelial cell migration/proliferation and vessel permeability. Moreover, it regulates osteoclastic differentiation and migration in bone repair. Thus, VEGF represents a relevant therapeutic target. The sensitive measurement of low amounts of circulating VEGF-A found in control cohorts of apparently healthy individuals proves to be difficult. Hence, there is a need for a high-sensitivity assay that reliably measures low VEGF-A concentrations.
Methods We developed a high-sensitivity sandwich ELISA for the detection of human total bioactive VEGF-A using high quality, well-characterized recombinant monoclonal and polyclonal anti-human VEGF-A antibodies. The linear epitopes of the polyclonal detection antibody were mapped with microarray technology. Analyte stability was determined and in accordance with ICH and EMEA guidelines, assay parameters like specificity, dilution linearity, and spike recovery were assessed.
Results We demonstrate that bioactive human VEGF-A can reliably be measured in plasma preparations. In contrast, serum VEGF levels are clearly increased in some samples. This indicates that serum preparation might have an influence on the VEGF amount measured as VEGF can be released from platelets during sample manipulation. Most importantly, we show that samples of apparently healthy individuals are measurable over background. The assay covers a calibration range between 0 and 2000 pg/ml and assay characteristics as well as analyte stability meet the international standards of acceptance. The recombinant capture antibody recognizes a structural epitope in the conserved receptor binding-site of VEGF-A, and thus, specifically binds to all bioactive isoforms of VEGF-A. The polyclonal detection antibody recognizes linear epitopes in the first 120 amino acids of the VEGF-A molecule.
Discussion Our novel VEGF-A ELISA provides a reliable and accurate tool for the quantitative determination of all biologically active VEGF-A isoforms with high sensitivity.
Keywords Angiogenesis, Bone Formation, Growth Factors, Bone Repair, Vascular Endothelial Growth Factor
Of note: The VEGF ELISA assay has been validated according to the guidelines of ICH, EMEA, and FDA. The VEGF assay validation data show that they correspond to the international quality specifications. Various experiments including parallelism and dilution linearity as well as accuracy, precision, analysis of the stability of samples, and the characterization of antibodies utilized in the VEGF ELISA assay e.g. epitope-mapping, were performed.
The Biomedica EZ4U cell proliferation & cytotoxicity assay was highlighted in a study demonstrating that fasting improved the therapeutic response in liver cancer. As certain therapies are severely limited by resistance, the results may drive clinical studies aimed at improving therapy response. The results have been published by Jelena Krstic and colleagues in Science Advances in January 2022: Fasting improves therapeutic response in hepatocellular carcinoma through p53-dependent metabolic synergism.
EZ4U Cell Proliferation & Cytotoxicity Assay Highlights
√ Non-Radioactive & Non-Toxic
√ Reliable & Sensitive
√ Convenient single-step incubation for use on living cells
√ Widely cited +195 publications
Check out the EZ4U Brochure link
Krstic J, Reinisch I, Schindlmaier K, Galhuber M, Riahi Z, Berger N, Kupper N, Moyschewitz E, Auer M, Michenthaler H, Nössing C, Depaoli MR, Ramadani-Muja J, Usluer S, Stryeck S, Pichler M, Rinner B, Deutsch AJA, Reinisch A, Madl T, Chiozzi RZ, Heck AJR, Huch M, Malli R, Prokesch A. Sci Adv. 2022 Jan 21;8(3):eabh2635. doi: 10.1126/sciadv.abh2635. Epub 2022 Jan 21. PMID: 35061544; PMCID: PMC8782451.
Abstract
Cancer cells voraciously consume nutrients to support their growth, exposing metabolic vulnerabilities that can be therapeutically exploited. Here, we show in hepatocellular carcinoma (HCC) cells, xenografts, and patient-derived organoids that fasting improves sorafenib efficacy and acts synergistically to sensitize sorafenib-resistant HCC. Mechanistically, sorafenib acts noncanonically as an inhibitor of mitochondrial respiration, causing resistant cells to depend on glycolysis for survival. Fasting, through reduction in glucose and impeded AKT/mTOR signaling, prevents this Warburg shift. Regulating glucose transporter and proapoptotic protein expression, p53 is necessary and sufficient for the sorafenib-sensitizing effect of fasting. p53 is also crucial for fasting-mediated improvement of sorafenib efficacy in an orthotopic HCC mouse model. Together, our data suggest fasting and sorafenib as rational combination therapy for HCC with intact p53 signaling. As HCC therapy is currently severely limited by resistance, these results should instigate clinical studies aimed at improving therapy response in advanced-stage HCC.
The experimental set up is outlined in the “Material and Methods” section in the publication: Cell viability of HepG2 cells was analyzed using EZ4U assay (Biomedica Immunoassays).
How does the EZ4U cell proliferation assay work?
The EZ4U assay kit is a simple non-radioactive two to five-hour test that employs tetrazolium salts. These are non-toxic and are reduced to colored formazan. The assay discriminates between living and dead cells as the reduction process requires functional mitochondria that are inactivated within a few minutes after cell death. The assay procedure is identical to the 3H incorporation assays and does not require any change in the test protocol, thus offering the benefit of utilizing a non-radioactive substance.
Of note is the possibility to re-cultivate the cells after determining the cell number. The EZ4U assay has been cited in over 195 publications. Product code: BI-5000.
Method:
√ Water-soluble tetrazolium compound penetrates cell membrane
√ In mitochondria reduction to intense coloured formazan which is also water-soluble
√ Formazan is secreted into culture medium
√ Measured by ELISA reader (450 nm or 492 nm)
Kit specifications:
√ Substrate, lyophilised 10 vials
√ Activator solution, ready to use 1 x 30 ml
√ Sufficient reagents for 10 x 96 tests microtiterplates
√ Sample type: culture medium
√ Sample size: 200 µl / test
√ Detection limit: depending on cell lines. Examples are shown in the product insert
√ Incubation time: 2h – 5h
The EZ4U assay was also highlighted in a recent study:
Syndecan-4 Is a Key Facilitator of the SARS-CoV-2 Delta Variant’s Superior Transmission.
Hudák A, Veres G, Letoha A, Szilák L, Letoha T. Int J Mol Sci. 2022 Jan 12;23(2):796. PMID: 35054983.
Abstract
Emerging SARS-CoV-2 variants pose threats to vaccination campaigns against COVID-19. Being more transmissible than the original virus, the SARS-CoV-2 B.1.617 lineage, named the Delta variant, swept through the world in 2021. The mutations in the Delta’s spike protein shift the protein towards a net positive electrostatic potential. To understand the key molecular drivers of the Delta infection, we investigate the cellular uptake of the Delta spike protein and Delta spike-bearing SARS-CoV-2 pseudoviruses. Specific in vitro modification of ACE2 and syndecan expression enabled us to demonstrate that syndecan-4, the syndecan isoform abundant in the lung, enhances the transmission of the Delta variant by attaching its mutated spike glycoprotein and facilitating its cellular entry. Compared to the wild-type spike, the Delta one shows a higher affinity towards heparan sulfate proteoglycans than towards ACE2. In addition to attachment to the polyanionic heparan sulfate chains, the Delta spike’s molecular interactions with syndecan-4 also involve syndecan-4’s cell-binding domain that mediates cell-to-cell adhesion. Regardless of the complexity of these interactions, exogenously added heparin blocks Delta’s cellular entry as efficiently as syndecan-4 knockdown. Therefore, a profound understanding of the molecular mechanisms underlying Delta infections enables the development of molecularly targeted yet simple strategies to reduce the Delta variant’s spread.
The experimental set up is outlined in the “Material and Methods” section in the publication: Cellular viability of 293T and 293T-ACE2 cells was measured with EZ4U assay.
Discover Biomedica Biomarker ELISA Kits for Biomarkers in Bone-Kidney-Heart diseases.
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Biomarker Assays
√ Natriuretic Peptides NT-proBNP, NT-proANP (for human and rat samples), NT-proCNP
√ Endothelins Big Endothelin-1
√ Wnt inhibitors Sclerostin, Dickkopf-1 (DKK-1)
√ Bone metabilism Osteoprotegerin (OPG), soluble free RANKL (sRANKL)
√ Nephrology & transplant Fibroblast growth factor 23 (FGF23 c-terminal and FGF23 intact),
Endostatin, Angiopoietin-2 (human, mouse and rat) , Neuropilin-1,
Vanin-1 urine (human, mouse and rat), anti-C4d antibody
RELATED CITATIONS
Big Endothelin-1 (BigET-1)
Plasma Big Endothelin-1 Level Predicted 5-Year Major Adverse Cardiovascular Events in Patients With Coronary Artery Ectasia. Cai Z, Wang H, Yuan S, Yin D, Song W, Dou K.Front Cardiovasc Med. 2021 Nov 29;8:768431. doi: 10.3389/fcvm.2021.768431. PMID: 34912865; PMCID: PMC8667227.
Abstract
Background: Coronary artery ectasia (CAE) is found in about 1% of coronary angiography and is associated with poor clinical outcomes. The prognostic value of plasma big Endothelin-1 (ET-1) in CAE remains unknown. Methods: Patients with angiographically confirmed CAE from 2009 to 2015, who had big ET-1 data available were included. The primary outcome was 5-year major adverse cardiovascular events (MACE), defined as a component of cardiovascular death and non-fatal myocardial infarction (MI). Patients were divided into high or low big ET-1 groups using a cut-off value of 0.58 pmol/L, according to the receiver operating characteristic curve. Kaplan-Meier method, propensity score method, and Cox regression were used to assess the clinical outcomes in the 2 groups. Results: A total of 992 patients were included, with 260 in the high big ET-1 group and 732 in the low big ET-1 group. At 5-year follow-up, 57 MACEs were observed. Kaplan-Meier analysis and univariable Cox regression showed that patients with high big ET-1 levels were at increased risk of MACE (9.87 vs. 4.50%; HR 2.23, 95% CI 1.32-3.78, P = 0.003), cardiovascular death (4.01 vs. 1.69%; HR 2.37, 95% CI 1.02-5.48, P = 0.044), and non-fatal MI (6.09 vs. 2.84%; HR 2.17, 95% CI 1.11-4.24, P = 0.023). A higher risk of MACE in the high big ET-1 group was consistent in the propensity score matched cohort and propensity score weighted analysis. In multivariable analysis, a high plasma big ET-1 level was still an independent predictor of MACE (HR 1.82, 95% CI 1.02-3.25, P = 0.043). A combination of high plasma big ET-1 concentrate and diffuse dilation, when used to predict 5-year MACE risk, yielded a C-statistic of 0.67 (95% CI 0.59-0.74). Conclusion: Among patients with CAE, high plasma big ET-1 level was associated with increased risk of MACE, a finding that could improve risk stratification.
Intracerebral hemorrhage (ICH) is caused by bleeding within the brain. Very few circulating biomarkers are known to be associated with the risk of ICH. Fibroblast growth factor 23 (FGF23) is a bone-derived protein hormone associated with mortality in patients with heart failure. A recent nested case–control study showed that FGF23 is associated with risk of intracerebral hemorrhage: Fibroblast growth factor 23 is associated with risk of intracerebral hemorrhage. Svensson EH, Söderholm M. Eur J Neurol. 2022 Jan;29(1):114-120. doi: 10.1111/ene.15060. PMID: 34379844.
Abstract
Background and purpose: Fibroblast growth factor 23 (FGF23) is an osteogenic hormone associated with chronic kidney disease and is an emerging risk factor for several cardiovascular diseases. The association of FGF23 with stroke is unclear. The aim of this study was to investigate the association of FGF23 with incident intracerebral hemorrhage (ICH).
Methods: This was a nested case-control study of 220 ICH cases and 244 age- and sex-matched controls from the population-based Malmö Diet and Cancer Study (n = 28,449). Incident ICH cases were ascertained using national registers and classified by bleeding location. Logistic regression was used to study the association of plasma levels of FGF23 with incident ICH, adjusting for potential ICH risk factors. Subgroup analyses were performed for lobar and non-lobar ICH, fatal ICH, ICH with large volume and ICH with poor functional outcome, respectively.
Results: Higher FGF23 levels at baseline were significantly associated with incident ICH. After multivariable adjustment, the odds ratio for the association with all ICH was 1.84 (95% confidence interval [CI] 1.25-2.71, p = 0.002) per doubling of FGF23 concentration. For lobar and non-lobar ICH, odds ratios were 1.73 (95% CI 1.04-2.87, p = 0.035) and 2.13 (95% CI 1.32-3.45, p = 0.002), respectively. FGF23 was also significantly associated with fatal ICH, ICH with large volume and ICH with poor functional outcome.
Conclusions: Higher FGF23 was associated with incident ICH in this nested case-control study. Further studies are required to explore whether the association is causal.
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Related publications
Plasma FGF23 and the risk of stroke: the Northern Manhattan Study (NOMAS).
Wright CB, Dong C, Stark M, Silverberg S, Rundek T, Elkind MS, Sacco RL, Mendez A, Wolf M. Neurology 2014. 13;82(19):1700-6. PMID: 24706015.
Abstract
Objective: To examine fibroblast growth factor 23 (FGF23) as a risk factor for incident stroke in a racially/ethnically diverse population-based urban cohort.
Methods: Stroke-free Northern Manhattan Study participants with FGF23 measurements (n = 2,525) were followed for a mean of 12 (±5) years to detect incident strokes. We used Cox proportional hazards models to estimate the association of baseline FGF23 with incident total, ischemic, and hemorrhagic stroke.
Results: Median FGF23 was 57 relative units (RU)/mL (interquartile range = 44-81 RU/mL). Each unit increase of natural log-transformed FGF23 conferred a 40% greater overall stroke risk after adjusting for estimated glomerular filtration rate and sociodemographic and vascular risk factors (hazard ratio = 1.4, 95% confidence interval 1.1-1.6, p = 0.004). Penalized spline analysis revealed a linear association with overall stroke risk at ≥90 RU/mL FGF23, compared with <90 RU/mL (hazard ratio = 1.5, 95% confidence interval = 1.2-2.1, p = 0.004). Greater FGF23 conferred a doubling of intracerebral hemorrhage (ICH) risk but no significant increased risk of ischemic stroke. The associations of elevated FGF23 levels with greater risks of overall stroke and ICH events were independent of phosphate and parathyroid hormone levels and were similar among participants without chronic kidney disease.
Conclusions: Elevated FGF23 was a risk factor for overall stroke and ICH events, in particular in a racially and ethnically diverse urban community, independent of chronic kidney disease.
Fibroblast growth factor 23 and risk of incident stroke in community-living adults.
Panwar B, Jenny NS, Howard VJ, Wadley VG, Muntner P, Kissela BM, Judd SE, Gutiérrez OM. Stroke. 2015. 46(2):322-8. doi: 10.1161/STROKEAHA.114.007489. PMID: 25563643.
Abstract
Background and purpose: Fibroblast growth factor 23 (FGF23) is a hormone that regulates phosphorus and vitamin D metabolism. Elevated FGF23 concentrations are associated with excess risk of cardiovascular disease. Associations of FGF23 with stroke outcomes are less clear.
Methods: Using a case-cohort study design, we examined the association of baseline plasma FGF23 concentrations with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults aged ≥45 years. FGF23 was measured in 615 participants who developed incident stroke (cases) and in 936 participants randomly selected from the REGARDS cohort (comparison subcohort).
Results: In multivariable-adjusted models, higher calcium and phosphorus concentrations, lower estimated glomerular filtration rate and higher urine albumin excretion were independently associated with higher FGF23. There was no statistically significant association of FGF23 with risk of all-cause stroke in Cox models adjusted for demographic factors and established stroke risk factors (hazard ratio comparing fourth with first quartile 1.19; 95% confidence interval, 0.78-1.82). In prespecified models stratified by stroke subtypes, there was a graded association of FGF23 with risk of cardioembolic stroke in fully adjusted models (quartile 1, reference; quartile 2 hazard ratio, 1.48; 95% confidence interval, 0.63-3.47; quartile 3 hazard ratio, 1.99; 95% confidence interval, 0.89-4.44; quartile 4 hazard ratio, 2.52; 95% confidence interval, 1.08-5.91). There were no statistically significant associations of FGF23 with other ischemic stroke subtypes or with hemorrhagic strokes.
Conclusions: Higher FGF23 concentrations were associated with higher risk of cardioembolic but not with other stroke subtypes in community-dwelling adults. Additional studies should delineate reasons for these findings.
Diabetes, high blood pressure and obesity are risk factors for chronic kidney disease (CKD). Roughly 10% of the population worldwide is affected. As the function of the kidneys decline, bone fracture risk increases. Bone fragility is associated with kidney function. Sclerostin is a key molecule in bone metabolism. A novel antibody, blocking the actions of Sclerostin, has become available for treating severe osteoporosis. Whether Sclerostin inhibition is useful in the clinical setting of CKD is discussed in the following review:
Cardiovascular Safety of Anti-Sclerostin Therapy in Chronic Kidney Disease.
Cejka D. Metabolites. 2021 Nov 10;11(11):770. doi: 10.3390/metabo11110770. PMID: 34822428; PMCID: PMC8624769.
Abstract
The significance of sclerostin for bone and cardiovascular health in patients with chronic kidney disease (CKD) is complex and incompletely understood. Experimental evidence suggests that anti-sclerostin therapy shows diminished efficacy on bone in the setting of CKD. Limited clinical evidence suggests that the osteoanabolic and anti-resorptive activity is attenuated, but hypocalcemia is more prevalent in patients with advanced CKD (eGFR < 30 mL/min) treated with anti-sclerostin (romosozumab) therapy as compared to patients without kidney disease. Furthermore, sclerostin is prominently expressed in uremic arteries. Whether the inhibition of sclerostin has adverse effects on cardiovascular health in CKD is currently unknown. This review summarizes the current understanding of the physiology and pathophysiology of sclerostin in CKD, with a focus on the cardiovascular safety of anti-sclerostin therapy in patients with or without CKD.
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Related publications
Bone Fragility Fractures in CKD Patients.
Pimentel A, Ureña-Torres P, Bover J, Luis Fernandez-Martín J, Cohen-Solal M. Calcif Tissue Int. 2021 Apr;108(4):539-550. doi: 10.1007/s00223-020-00779-z. Epub 2020 Nov 21. PMID: 33219822; PMCID: PMC8052229.
Abstract
Chronic kidney diseases (CKD) are associated with mineral and bone diseases (MBD), including pain, bone loss, and fractures. Bone fragility related to CKD includes the risk factors observed in osteoporosis in addition to those related to CKD, resulting in a higher risk of mortality related to fractures. Unawareness of such complications led to a poor management of fractures and a lack of preventive approaches. The current guidelines of the Kidney Disease Improving Global Outcomes (KDIGO) recommend the assessment of bone mineral density if results will impact treatment decision. In addition to bone density, circulating biomarkers of mineral, serum bone turnover markers, and imaging techniques are currently available to evaluate the fracture risk. The purpose of this review is to provide an overview of the epidemiology and pathogenesis of CKD-associated bone loss. The contribution of the current tools and other techniques in development are discussed. We here propose a current view of how to better predict bone fragility and the therapeutic options in CKD.
Sclerostin in chronic kidney disease-mineral bone disorder think first before you block it!
Brandenburg VM, Verhulst A, Babler A, D’Haese PC, Evenepoel P, Kaesler N. Nephrol Dial Transplant. 2019 Mar 1;34(3):408-414. doi: 10.1093/ndt/gfy129. PMID: 29846712.
Abstract
Canonical Wnt signalling activity is a major player in physiological and adaptive bone metabolism. Wnt signalling is regulated by soluble inhibitors, with sclerostin being the most widely studied. Sclerostin’s main origin is the osteocyte and its major function is blockade of osteoblast differentiation and function. Therefore, sclerostin is a potent inhibitor of bone formation and mineralization. Consequently, blocking sclerostin via human monoclonal antibodies (such as romosozumab) represents a promising perspective for the treatment of (postmenopausal) osteoporosis. However, sclerostin’s physiology and the effects of sclerostin monoclonal antibody treatment are not limited to the skeleton. Specifically, the potential roles of sclerostin in chronic kidney disease (CKD) and associated pathologies covered by the term chronic kidney disease and mineral bone disorder (CKD-MBD), which also includes accelerated cardiovascular calcification, warrant specific attention. CKD-MBD is a complex disease condition in which sclerostin antibodies may interfere at different levels and influence the multiform interplay of hyperparathyroidism, renal osteodystrophy and vascular calcification, but the clinical sequelae remain obscure. The present review summarizes the potential effects of sclerostin blockade in CKD-MBD. We will address and summarize the urgent research targets that are being identified and that need to be addressed before a valid risk-benefit ratio can be established in the clinical setting of CKD.
Sclerostin: a new biomarker of CKD-MBD.
Figurek A, Rroji M, Spasovski G. Int Urol Nephrol. 2020 Jan;52(1):107-113. doi: 10.1007/s11255-019-02290-3. Epub 2019 Oct 14. PMID: 31612420.
Abstract
The causes of the increased cardiovascular risk associated with kidney diseases partly reside in the chronic kidney disease-mineral bone disorder (CKD-MBD) syndrome. Three cardiovascular risk factors [hyperphosphatemia, vascular calcification, and elevated fibroblast growth factor 23 (FGF23)] levels have been discovered within the CKD-MBD over the last decades. In addition, sclerostin is recently presented as a new bone and vascular disease biomarker. This 22-kDa glycoprotein, secreted mainly by osteocytes, is a soluble inhibitor of the canonical Wnt pathway that has a pivotal role in bone biology and turnover. CKD patients are reported with higher levels of sclerostin, and levels decrease during dialysis. Sclerostin is associated with vascular calcification and CV risk in CKD, although data are still controversial. The question whether serum sclerostin has protective or deleterious role in CKD-MBD pathophysiology, and therefore in cardiovascular risk and overall mortality, is still open and needs to be answered. The standardization of assays and the establishment of a clear cut-off values when sclerostin starts to switch from physiological to pathophysiological role have to be another important step. Further research is needed also to define its relationship with other CKD-MBD biomarkers for future diagnostic and therapeutic strategies.
Serum sclerostin in vascular calcification and clinical outcome in chronic kidney disease.
Zeng C, Guo C, Cai J, Tang C, Dong Z. Diab Vasc Dis Res. 2018 Mar;15(2):99-105. doi: 10.1177/1479164117742316. Epub 2017 Nov 23. PMID: 29168393.
Abstract
Sclerostin, a potent soluble inhibitor of the Wnt signalling pathway, is known to inhibit bone formation by suppressing osteocytes differentiation and function. Patients with chronic kidney disease have high levels of serum sclerostin. Sclerostin has been implicated in the pathogenesis of vascular calcification, which may promote the cardiovascular events of morbidity and mortality in chronic kidney disease patients. However, the role of sclerostin in vascular calcification and clinical prognosis in chronic kidney disease remains elusive. While some studies suggested a positive correlation between serum sclerostin and vascular calcification or clinical outcome, other studies showed no or even negative correlation between them. Small sample size, heterogeneity in enrolled patients, discrepancy in anatomical structure examined and differences in the applied assays may be responsible for the discrepant results. Nonetheless, anti-sclerostin antibodies may be a new therapeutic approach to increase bone mass and strength in chronic kidney disease. This review aims to have a better understanding of the relationship of serum sclerostin with vascular calcification and clinical outcome in chronic kidney disease patients, and propose the application of anti-sclerostin therapy in chronic kidney disease.
Related products
Bioactive Sclerostin ELISA kit – cat.no. BI-20472