الفهرس 
Metabolic syndromeOnly 14 pages are availabe for public view
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Abstract
PEDF is a glycoprotein that belongs to the superfamily of serine protease inhibitors acting like substrates rather than inhibitors of serine proteases. It was first purified from the conditioned media of human retinal pigment epithelial cells as a factor with potent neuronal differentiating activity, it was found that PEDF is a multifunctional secreted protein; it possesses complex neuroprotective, anti- oxidative, anti- inflammatory, anti-thrombogenic, insulin-sensitizing properties, any of which could potentially be exploited as a therapeutic option for the treatment of a variety of disorders.
Insulin resistance is a central feature of the pathophysiology of most obesity-related disorders including type 2 diabetes, and is defined as a subnormal response of tissues to the actions of insulin. Several possible mediators of insulin resistance in obesity, including dysregulation of lipid metabolism and low-grade inflammation .
Metabolic syndrome is defined according to Adult Treatment Panel III (ATP). ATP III identified five components of metabolic syndrome (abdominal obesity, given as waist circumference (>101.6 cm for men ;> 88.9 cm for women), triglycerides (≥130 mg//dl) ,HDL cholesterol (<50 mg /dl for men ;< 40 mg /dl for women), BP (≥ 130 / ≥85 mmHg), and fasting plasma glucose (≥110 mg/dl).
The aim of the work was to study serum levels of PEDF in patient with metabolic syndrome and to clarify the possible correlation with each component and with the accumulation of the number of the components of the syndrome
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Summary and Conclusion
The present study was conducted on 90 subjects subdivided into two groups. Patient group included 70 patients with metabolic syndrome attending the outpatient clinic in Benha University Hospital. And control group, this group included twenty apparently healthy individuals of matched age and sex.
Patients were selected according to:
Hypertension as a systolic blood pressure of ≥ 130 mmHg and/or diastolic blood pressure of ≥ 85 mmHg..
High fasting blood glucose ≥ 110 mg/dL.
Abdominal obesity as waist circumference exceeding 102 cm and 88 cm in men and women, respectively.
Fasting serum triglycerides more than 150 mg/dL.
Fasting serum HDL - cholesterol less than 50 mg/dL for males and less than 40 mg/dl for females.
Metabolic syndrome was diagnosed by the presence of three or more of the previous criteria
Exclusion criteria of the study groups included:
Acute or chronic inflammation ,excluded by:
- Medical history
- C-reactive protein > 10mg/dl.
- Leucocytosis.
- Clinical examination
Diabetic patients treated with oral anti diabetic drugs or insulin.
Liver disease with transaminase level above 5 times the normal upper limit.
Kidney disease with creatinine level above 1.5 mg/dl.
Proteinuria exceeding 0.5 g/L.
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Summary and Conclusion
To all subjects included in the study the following was done:
Full history taking laying stress on diet habits, drug intake, family history of obesity and history and use of tobacco and alcohol.
Anthropometric measurements which included weight in kilograms, height in centimeters, body mass index (kg/ m2) and waist circumference in centimeters.
Clinical Assessment included blood pressure (BP).
Laboratory investigations which included: lipids [total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and triglycerides],fasting serum glucose, creatinine, uric acid, serum PEDF levels were measured with ELISA and highly sensitive CRP serum levels were measured with ELISA.
The results of this work were summarized as the following:
PEDF level is significantly higher in patient group versus control group.
Significant positive elevation of WC, BMI, blood pressure, HS CRP , FBS,TG , LDL-cholesterol and uric acid in patient group versus control group and significant decrease of HDL-cholesterol in patient group versus control group.
Significant positive correlation between PEDF and each of the components of metabolic syndrome as BMI ,WC, LDL-cholesterol and total cholesterol, triglyceride systolic &diastolic blood pressure and the accumulation of the number of these component collectively. whereas, HDL-cholesterol was found to be negatively correlated to PEDF.
Stepwise multiple regression analysis of PEDF with the risk factors of the metabolic syndrome showed that only HDL & cholesterol
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Summary and Conclusion
were significant predictors of PEDF, the remaining factors were not independently related to PEDF, it also shows that PEDF is a significant predictor of the component of metabolic syndrome.
Evaluation of test validity characters using ROC curve defined a moderate diagnostic yield of PEDF with sensitivity 83.6 % and specificity 53.3% at a cut off value 53.5.
In conclusion: Based on the findings of previous studies and the present study it has been demonstrated that serum levels of PEDF are related to metabolic syndrome components such as BMI, WC, total cholesterol, LDL-levels, high blood pressure and the number of these components it also related to HS CRP, thus PEDF may be a potential candidate linking obesity with obesity related metabolic complications and that PEDF may play a potential role as an inflammatory biomarker. Therapeutic strategies to inhibit PEDF action in muscle and liver, or prevent adipocyte PEDF release, may prove a viable approach to ameliorate obesity-induced insulin resistance and its associated pathologies.