Medical Bulletin 09/ April/ 2024

Study finds drug for reducing lipid in patients with hypertriglyceridemia

A study presented at the 2024 American College of Cardiology’s Annual Scientific Session & Expo and published in the New England Journal of Medicine, revealed an experimental treatment that could further lower triglycerides in the blood in patients at high cardiovascular risk.

Hypertriglyceridemia, or high levels of lipids (fats) in the blood, increases the risk of heart attack, stroke and acute pancreatitis. Currently available medications, including statins, fibrates and prescription omega 3 fatty acids, typically lower triglyceride levels by anywhere from below 10% to up to 40%.

In the study, researchers conducted a randomized trial on 154 adults on lipid-lowering therapy with moderate or severe hypertriglyceridemia to receive either 50mg olezarsen, 80mg olezarsen or placebo. Olezarsen is an antisense oligonucleotide that inhibits APOC3, a gene associated with higher levels of triglycerides, by targeting its mRNA. The subcutaneous medication was administered every four weeks, for a period of a year.

The results showed that olezarsen reduced triglyceride levels by 49% at the 50mg dose and 53% at the 80mg dose, compared with placebo. The experimental drug also reduced apolipoprotein B and non-HDL cholesterol, which are important in plaque formation, by 18 to 18.5% and 23% to 25%, respectively.

“These findings indicate that targeting APOC3 mRNA is a promising new pathway for lowering triglycerides and potentially reducing the risk of heart attack and stroke,” said corresponding author Brian Bergmark, MD, of the Division of Cardiovascular Medicine at Brigham and Women’s Hospital.

Reference: Brian A. Bergmark, M.D., Nicholas A. Marston, M.D., M.P.H., Thomas A. Prohaska, M.D., Ph.D., Veronica J. Alexander, Ph.D., André Zimerman, M.D., Ph.D., Filipe A. Moura, M.D., Ph.D., Sabina A. Murphy, M.P.H., Olezarsen for Hypertriglyceridemia in Patients at High Cardiovascular Risk; Journal: the New England Journal of Medicine; DOI: 10.1056/NEJMoa2402309

Does ultra-processed food lead to higher glaucoma risk?

In a recent study published in the journal Nutrients, researchers examined the relationship between ultra-processed food (UPF) intake and glaucoma incidence.

Glaucoma is a leading cause of lifelong blindness globally, defined by the gradual loss of retinal ganglion cells. Elevated intraocular pressure, advanced age, and family history increase glaucoma risk. However, alterable environmental variables like nutrition, exercise, and lifestyle are increasingly associated with its development. Nutrition is gaining scientific interest due to ultra-processed food ingredients heavy in salt, sugar, and fat. Previous research has implied a link between food and glaucoma risk; however, further study is required to apply these findings to clinical care practices.

In the cohort study, researchers investigated whether consuming ultra-processed food increases the incidence of glaucoma among university graduates and included 19,255 participants. The researchers followed the participants for 13 years (mean) through biennial questionnaires to be completed. The baseline questionnaire (Q0) contained data on sociodemographic factors, physical measurements, dietary practices, lifestyle habits, and comorbidities. The researchers sent follow-up study questionnaires in two-year intervals to evaluate changes in diet, lifestyle, and medical conditions and monitored disease incidences.

The results showed that during follow-up, the team noted 230 incidents of glaucoma cases. Individuals with the highest ultra-processed food intake were younger and consumed more ethanol and coffee with a higher calorie intake. After covariate adjustments, individuals having the highest ultra-processed food intake (more than four servings per day) showed a higher glaucoma risk compared to those with the lowest intake (up to one serving per day).

The findings suggested that high intake of ultra-processed foods can cause elevated blood glucose levels, oxidative stress, and inflammation, with sweets having the most contributory role. These processed meals have decreased nutritional density and a higher glycaemic effect, which can lead to oxidative stress and inflammation. Retinal exposure to reactive oxygen species (ROS) increases inflammation and glaucoma risk. High ultra-processed food intake can also cause weight gain, endothelial dysfunction, elevated blood glucose levels, oxidative stress, and inflammation.

Reference: López-Gil, J., et al. Is Ultra-Processed Food Intake Associated with a Higher Risk of Glaucoma? A Prospective Cohort Study including 19,255 Participants from the SUN Project. Journal: Nutrients 2024, 16, 1053. DOI: 10.3390/ nu16071053, https://www.mdpi.com/2072-6643/16/7/1053

Can psycho-biotics elevate mood?

In a recent review study published in the journal Nutrients, researchers investigated the psychobiotic treatment of depression by restoring microbial balance and regulating the microbiome-gut-brain (MGB) axis.

Depression involves a range of biological factors like neurotransmitter imbalance, decreased BDNF, and stress on the HPA axis. The gut-brain axis is key, with intestinal microbes affecting mental health through various pathways. Disruption in this axis, called dysbiosis, can impact neurology, immunity, and gut inflammation. Psycho-biotics, certain probiotics, can enhance mental well-being by fortifying the gut barrier and modulating immune responses. The gut microbiota's role in regulating inflammation is vital in understanding depression's mechanisms.

In the review study, researchers analysed clinical evidence highlighting the psychobiotic features of bacterial strains and found that probiotics such as B.longum help to decrease stress and enhance memory. When coupled with antidepressants, these probiotics can effectively cure TRD. Probiotics such as Lactobacillus casei Shirota and Lactobacillus gasseri enhance general health and lower mood disorders. Multi-strain probiotic medication also boosts general health, alleviates anxiety symptoms, and reduces inflammation. Probiotic milk drinks and fermented soybean seed paste improve cognitive performance in individuals with moderate cognitive impairment and Alzheimer's disease.

The findings of the study highlighted probiotics' involvement in lowering depressive symptoms and their importance in mental health. The gut microbiota is crucial for digestion, food absorption, and psychiatric concerns such as stress reduction and anxiety. With a shift in the emphasis in modern life from infectious disorders to more common mental illnesses such as depression, good dietary habits and optimal intestinal function are critical for mental well-being, with probiotics playing an important role.

Reference: Dziedzic, A.; Maciak, K.; Bliźniewska-Kowalska, K.; Gałecka, M.; Kobierecka, W.; Saluk, J. The Power of Psychobiotics in Depression: A Modern Approach through the Microbiota–Gut–Brain Axis: A literature Review. Nutrients 2024, 16, 1054. DOI: 10.3390/nu16071054, https://www.mdpi.com/2072-6643/16/7/1054