Anti inflammatory effects of pioglitazone and / or simvastatin in high cardiovascular risk patients with elevated high sensitivity C reactive … (2007 Jan)
Anti inflammatory effects of pioglitazone and / or simvastatin in high cardiovascular risk patients with elevated high sensitivity C reactive protein : the piostat study . objectives : The purpose of this study was to test the safety and efficacy of pioglitazone and simvastatin in combination versus each drug individually in non diabetic subjects with cardiovascular disease ( CVD ) and elevated high sensitivity C reactive protein ( hs CRP ) levels . background : Low grade inflammation is a pathogenic factor for atherosclerosis . High sensitivity CRP , matrix metalloproteinase ( MMP ) 9 , and plasminogen activator inhibitor ( PAI ) 1 are markers of inflammation . statins and peroxisome proliferator activated receptor ( PPAR ) gamma agonists lower inflammatory markers and reduce CVD in type 2 diabetes . methods : In a 12 week , prospective , double blind trial , 125 subjects were randomized to simvastatin or pioglitazone plus placebo or a simvastatin / pioglitazone combination . We tested changes in hs CRP by analysis of covariance . A subgroup analysis was performed in patients with and without the metabolic syndrome ( MetS ) . The correlation between changes in hs CRP and homeostasis model assessment ( HOMA ; a measure of insulin resistance ) was calculated with the spearman s rank test . results : At baseline , there were no significant between group differences . At 12 weeks , pioglitazone and simvastatin monotherapies significantly reduced hs CRP ( 3 . 64 / 2 . …

Circulating matrix metalloproteinase 9 is associated with cardiovascular risk factors in a middle aged normal population. (2008 Mar)
circulating matrix metalloproteinase 9 is associated with cardiovascular risk factors in a middle aged normal population . background : elevated levels of circulating matrix metalloproteinase 9 ( MMP 9 ) have been demonstrated in patients with established coronary artery disease ( CAD ) . The aim of this study was to analyse levels of MMP 9 in a population free from symptomatic CAD and investigate their associations with cardiovascular ( CV ) risk factors , including C reactive protein ( CRP ) . methods : A cross sectional study was performed in a population based random sample aged 45 69 ( n 345 , 50 women ) . MMP 9 levels were measured in EDTA plasma using an elisa method . CV risk factors were measured using questionnaires and standard laboratory methods . results : plasma MMP 9 was detectable in all participants , mean 38 . 9 ng / mL ( SD 22 . 1 ng / mL ) . among individuals without reported symptomatic CAD a positive association ( p 0 . 001 ) was seen , for both men and women , of MMP 9 levels regarding total risk load of eight CV risk factors i . e . blood pressure , dyslipidemia , diabetes , obesity , smoking , alcohol intake , physical activity and fruit and vegetable intake . The association was significant also after adjustment for CRP , and was not driven by a single risk factor alone . In regression models adjusted for …

Dietary intake of trans fatty acids and systemic inflammation in women. (2004 Mar)
dietary intake of trans fatty acids and systemic inflammation in women . background : trans fatty acid ( TFA ) intake predicts risks of coronary artery disease and diabetes . systemic inflammation may be involved in the pathogenesis of such conditions ; however , relations between TFA intake and systemic inflammation are not well established . objective : We investigated the relations between TFA intake and inflammatory markers . design : In 823 generally healthy women in the nurses health study I and II , concentrations of soluble tumor necrosis factor alpha receptors 1 and 2 ( sTNF R1 , sTNF R2 ) , interleukin 6 ( IL 6 ) , and C reactive protein ( CRP ) were measured . usual dietary intakes assessed from 2 semiquantitative food frequency questionnaires were averaged for each subject . results : In age adjusted analyses , TFA intake was positively associated with sTNF R1 and sTNF R2 ( P for trend 0 . 001 for each ) : sTNF R1 and sTNF R2 concentrations were 10 ( 108 pg / mL ; 95 CI : 50 , 167 pg / mL ) and 12 ( 258 pg / mL ; 138 , 377 pg / mL ) higher , respectively , in the highest intake quintile than in the lowest . these associations were not appreciably altered by adjustment for body mass index , smoking , physical activity , aspirin and nonsteroidal antiinflammatory drug use , alcohol consumption , and intakes of …

Phosphoenolpyruvate carboxykinase ( GTP ) gene transcription and hyperglycemia are regulated by glucocorticoids in genetically obese db / db transgenic … (1998 Jan)
phosphoenolpyruvate carboxykinase ( GTP ) gene transcription and hyperglycemia are regulated by glucocorticoids in genetically obese db / db transgenic mice . The molecular mechanisms underlying increased hepatic phosphoenolpyruvate carboxykinase ( pepck ) gene transcription and gluconeogenesis in type II diabetes are largely unknown . To examine the involvement of glucocorticoids and the cis acting insulin response sequence ( IRS , 416 / 407 ) in the genetically obese db / db mouse model , we generated crosses between c57bl / KsJ db / mice and transgenic mice that express 460 or 2000 base pairs of the rat pepck gene promoter containing an intact or mutated IRS , linked to a reporter gene . transgenic mice expressing the intact pepck ( 460 ) CRP ( C reactive protein ) transgene bred to near homozygosity at the db locus were obese , hyperinsulinemic , and developed fasting hyperglycemia ( 389 / 26 mg / 100 ml ) between 4 and 10 weeks of age . levels of CRP reporter gene expression were increased 2 fold despite severe hyperinsulinemia compared with non diabetic non obese transgenic mice . reporter gene expression was also increased 2 fold in transgenic obese diabetic db / db mice bearing a mutation in the IRS , 2000 ( IRS ) hGx , compared with non obese non diabetic transgenic 2000 ( IRS ) hGx mice . treatment of obese diabetic db / db transgenic mice with the glucocorticoid receptor blocker RU 486 decreased plasma glucose by 50 …

Effect of yuquan pill on proinflammatory cytokines in patients with type 2 diabetes mellitus objective : To observe the effect … (2006 Sep)
effect of yuquan pill on proinflammatory cytokines in patients with type 2 diabetes mellitus objective : To observe the effect of yuquan Pill ( YP ) on proinflammatory cytokines in patients with type 2 diabetes mellitus ( DM2 ) . methods : ninety patients with DM2 were randomly divided into the treated group and the control group by the ratio of 2 : 1 . Both groups were treated with glucobay on the base of dietary and exercise therapy for 3 months , with YP , given to the treated group additionally 6 g four times a day . And the changes of proinflammatory cytokines , including C reactive protein ( CRP ) , tumor necrosis factor alpha ( TNF alpha ) and interleukin 6 ( IL 6 ) , etc . were observed . results : The levels of serum CRP , TNF alpha and IL 6 significantly lowered after treatment in both groups ( P 0 . 01 ) , and the improvement in the treated group was superior to that in the control group ( P 0 . 01 ) . conclusion : YP could reduce the levels of the increased proinflammatory cytokines in patients with DM2 .

Inflammatory markers and the risk of coronary heart disease in men and women. (2004 Dec)
inflammatory markers and the risk of coronary heart disease in men and women . background : Few studies have simultaneously investigated the role of soluble tumor necrosis factor alpha ( TNF alpha ) receptors types 1 and 2 ( sTNF R1 and sTNF R2 ) , C reactive protein , and interleukin 6 as predictors of cardiovascular events . The value of these inflammatory markers as independent predictors remains controversial . methods : We examined plasma levels of sTNF R1 , sTNF R2 , interleukin 6 , and C reactive protein as markers of risk for coronary heart disease among women participating in the nurses health study and men participating in the health professionals follow up study in nested case control analyses . among participants who provided a blood sample and who were free of cardiovascular disease at baseline , 239 women and 265 men had a nonfatal myocardial infarction or fatal coronary heart disease during eight years and six years of follow up , respectively . using risk set sampling , we selected controls in a 2 : 1 ratio with matching for age , smoking status , and date of blood sampling . results : after adjustment for matching factors , high levels of interleukin 6 and C reactive protein were significantly related to an increased risk of coronary heart disease in both sexes , whereas high levels of soluble TNF alpha receptors were significant only among women . further adjustment for lipid and nonlipid factors attenuated all …

Relationship of C reactive protein to adverse cardiovascular events in patients treated by percutaneous coronary intervention for stable angina pectoris. (2005 May)
relationship of C reactive protein to adverse cardiovascular events in patients treated by percutaneous coronary intervention for stable angina pectoris . Low grade inflammation as detected by increased C reactive protein ( CRP ) levels predicts the risk of cardiovascular events . however , there is still controversy over the mid term predictive value of CRP in patients referred for elective percutaneous coronary revascularization ( PCI ) for stable angina pectoris . The aim of this study was to assess the relationship between baseline CRP level and mid term outcome of patients undergoing PCI . Two groups of patients with stable angina pectoris were prospectively studied . group A consisted of 150 consecutive patients with a CRP level or 3 mg / L , and group B consisted of 150 consecutive patients with a CRP level 3 mg / L undergoing PCI at our institution . comparing both groups of patients , the analysis confirmed a significant difference between medians of the CRP levels ( 0 . 5 versus 8 mg / mL ; P 0 . 001 ) . A higher level of CRP in group B was associated with a lower presence of male gender ( P 0 . 05 ) and history of myocardial infarction ( P 0 . 05 ) . On the other hand , in group B there was higher occurrence of smoking ( P 0 . 001 ) , hypertension ( P 0 . 05 ) , hypertriglyceridemia ( P 0 . 001 …

Pentosidine in synovial fluid in osteoarthritis and rheumatoid arthritis : relationship with disease activity in rheumatoid arthritis. (1999 Feb)
pentosidine in synovial fluid in osteoarthritis and rheumatoid arthritis : relationship with disease activity in rheumatoid arthritis . objective : pentosidine is an advanced glycation endproduct formed by glycosylation and oxidation . Our aim was to develop a means to measure pentosidine in synovial fluid ( SF ) , and to compare its concentration in SF in patients with osteoarthritis ( OA ) and rheumatoid arthritis ( RA ) , and to investigate the relationship between its concentration in SF and the disease activity of RA . methods : SF was collected from knee joints in 31 patients with RA and 40 with OA , who had hydrarthrosis . One patient with RA and 7 with OA who had the complication of diabetes mellitus or chronic renal failure made up the DM / CRF group , and the remaining patients made up the RA group ( n 30 ) and the OA group ( n 33 ) . pentosidine was measured by the direct HPLC method with column switching after hydrolysis of SF . results : pentosidine was detected in all SF and was greater in RA ( 83 . 9 / 46 . 0 nmol / l , mean / SD ) than in OA ( 40 . 1 / 19 . 6 nmol / l ) . three DM / CRF patients undergoing hemodialysis had markedly high pentosidine levels ( 482 . 5 / 280 . 8 nmol / l ) . there was a significant correlation between …

Decrease in inflammatory cardiovascular risk markers in hyperlipidemic diabetic patients treated with fenofibrate. (2007 May)
decrease in inflammatory cardiovascular risk markers in hyperlipidemic diabetic patients treated with fenofibrate . The goal was to investigate the effect of micronized fenofibrate , a hypolipidemic drug , on inflammatory markers and proinsulin in patients with type 2 diabetes who had hyperlipidemia . thirty nine patients were treated with micronized fenofibrate ( 200 mg / day for 12 wk ) . erythrocyte sedimentation rate ( ESR ) , fibrinogen , high sensitivity C reactive protein ( hs CRP ) , and proinsulin levels were measured at baseline and after 12 wk of therapy . micronized fenofibrate significantly reduced serum triglyceride , cholesterol , and uric acid levels ( all p 0 . 0001 ) and increased high density lipoprotein ( HDL ) cholesterol ( p 0 . 001 ) and creatinine levels ( p 0 . 0001 ) . micronized fenofibrate also significantly decreased fibrinogen ( 421 / 152 vs 344 / 81 mg / dl , p 0 . 001 ) , hs CRP ( 3 . 3 / 3 . 3 vs 2 . 1 / 1 . 8 mg / L , p 0 . 01 ) , and ESR ( 19 . 1 / 24 . 8 vs 9 . 7 / 8 . 7 mm / hr , p 0 . 01 ) , but did not change proinsulin levels . The correlations among changes of hs CRP , fibrinogen , and ESR were high . although correlation among the decreases in inflammatory markers …

Concentration of the complement activation product , acylation stimulating protein , is related to C reactive protein in patients with … (2001 Mar)
concentration of the complement activation product , acylation stimulating protein , is related to C reactive protein in patients with type 2 diabetes . Type 2 diabetes is characterized by increased acute phase serum proteins . We wanted to study how these proteins are related to complement activation in type 2 diabetes and how improvement of glycemic control affects them or complement activation . A total of 29 type 2 diabetic patients ( age , 55 . 2 / 1 . 8 years , glycosylated hemoglobin HbA ( 1c ) 8 . 9 / 0 . 2 , body mass index BMI 30 . 9 / 0 . 8 kg / m ( 2 ) , duration 5 . 9 / 1 . 3 years ) participated in the study . They were previously treated either with diet alone or in combination with 1 oral antihyperglycemic medication . after a period of at least 4 weeks run in on diet only , the patients were randomized to pioglitazone , glibenclamide , or placebo . blood samples were taken before the treatments and at the end of the 6 month therapy . basal C reactive protein ( CRP ) level was related to acylation stimulating protein ( ASP ) concentration ( r . 55 , P . 01 ) , and many acute phase serum protein concentrations were associated with each other . The treatment reduced HbA ( 1c ) level in the pioglitazone ( from 9 . 1 / 0 …

Microalbuminuria and C reactive protein : similar messengers of cardiovascular risk ? C reactive protein ( CRP ) and urinary … (2005 Sep)
microalbuminuria and C reactive protein : similar messengers of cardiovascular risk ? C reactive protein ( CRP ) and urinary albumin excretion are both determinants of cardiovascular risk . The first is closely related to systemic and vascular low grade inflammation , the latter is considered to be a marker of endothelial dysfunction . because of these properties , one might presume them to be closely interrelated . In this article , we review the available evidence concerning the relationships of CRP and urinary albumin excretion , with each other and with other cardiovascular risk markers and factors . should they be considered as dependent or independent risk markers , and which risk markers might be present in the cardiovascular risk estimation formula of the near future ? The reasons that this formula might or should include CRP and urinary albumin excretion , rather than diabetes mellitus and the metabolic syndrome , are discussed .

Utility of inflammatory markers in the management of coronary artery disease. (2003 Jul)
utility of inflammatory markers in the management of coronary artery disease . certain markers of systemic inflammation are powerful predictors of cardiovascular events . fibrinogen , C reactive protein ( CRP ) , and cytokines are among the inflammatory markers associated with various cardiovascular end points . fibrinogen and CRP both have been associated with coronary artery disease ( CAD ) mortality in patients with stable angina . High sensitivity CRP ( hs CRP ) and fibrinogen also have prognostic value in patients with unstable angina . In addition to prognostic implications , several cardiovascular risk factors ( eg , smoking , obesity , diabetes ) are associated with high levels of fibrinogen and hs CRP . benefits from aspirin are more likely in patients whose hs CRP levels are very high . Some fibrates decrease fibrinogen levels and hs CRP . statin therapy either reduces the CAD risk associated with system inflammation or lowers circulating levels of hs CRP .

Anti inflammatory effects of short term pioglitazone therapy in men with advanced diabetic nephropathy. (2006 Feb)
Anti inflammatory effects of short term pioglitazone therapy in men with advanced diabetic nephropathy . patients with diabetic nephropathy have a high rate of cardiovascular events and mortality . nontraditional cardiovascular risk factors such as oxidative stress and inflammation are thought to be particularly important in mediating these events . studies suggest that thiazolidinediones ( TZDs ) can reduce the level of nontraditional cardiovascular risk in people with or without diabetes mellitus . whether this benefit occurs in patients with diabetic nephropathy is unknown . I hypothesized that the TZD pioglitazone will mitigate oxidative stress and inflammation compared with glipizide in patients with overt diabetic nephropathy . markers of oxidative stress ( plasma and urine albumin carbonyl and total protein carbonyls and malondialdehyde ) , inflammation white blood cell ( WBC ) count , C reactive protein ( CRP ) , plasma IL 6 , TNF alpha , and plaque stability matrix metalloproteinase 9 ( MMP 9 ) were measured in frozen samples obtained from patients with overt diabetic nephropathy participating in a randomized , open label , blinded end point , 16 wk trial with glipizide ( n 22 ) or pioglitazone ( n 22 ) . pioglitazone therapy in men with advanced diabetic nephropathy reduced WBC count by 1 , 125 / mul ( P 0 . 001 ) , CRP by 41 ( P 0 . 042 ) , IL 6 by 38 ( P 0 . 009 ) , and MMP 9 by 29 ( P …

C reactive protein on admission as a predictor of in hospital death in the elderly with acute myocardial infarction. (2000 Mar)
C reactive protein on admission as a predictor of in hospital death in the elderly with acute myocardial infarction . background : The mean age of patients with acute myocardial infarction is increasing and the associated in hospital mortality is exponentially age related . inflammation markers have been related to cardiovascular short and long term prognosis . The aim of this study was to evaluate the short term prognostic value of C reactive protein ( CRP ) levels on admission in the oldest segment of the patients with acute myocardial infarction . methods : CRP was prospectively measured on admission by immunonephelometry in 205 consecutive old women ( mean age 82 / 5 years ) with definite acute myocardial infarction ; values were then related to in hospital mortality and the causes of death . results : CRP levels ranged from 0 . 1 to 31 . 9 mg / dl and were raised in 71 of the patients . It showed no significant correlation with baseline clinical variables such as age , history of diabetes or hypertension or prior myocardial infarction , infarct location , and time from symptom onset to admission . The overall in hospital mortality rate was 25 and rose from 15 among patients in the lower three quartiles of CRP levels ( cut point 6 . 4 mg / dl ) to 55 among those in the upper quartile ( p 0 . 001 ) . By univariate logistic regression , the odds ratio for …

Homocysteine and C reactive protein concentrations in serum of diabetic patients increased homocysteine and C reactive protein ( CRP ) … (2004 Apr)
homocysteine and C reactive protein concentrations in serum of diabetic patients increased homocysteine and C reactive protein ( CRP ) concentration is associated with increased coronary risk . The aim of the study was to assess the potential relationships between homocysteine and CRP levels and lipid coronary risk factors in men and women with diabetes . We examined 117 persons , 64 men and 53 women . Mean age of examined men was 62 . 0 / 8 . 1 yrs , mean diabetes duration 12 . 1 / 7 . 4 yrs , BMI 29 . 7 / 3 . 7 kg / m2 ; in women 60 . 6 / 8 . 1 yrs , 12 . 1 / 6 . 3 yrs and 31 . 8 4 . 9 kg / m2 respectively . serum homocysteine and creatinine values were significantly higher in men than in women ( 15 . 3 / 4 . 7 vs 13 . 3 / 3 . 9 mumol / l and 93 . 6 / 19 . 8 vs 74 . 4 vs 17 . 2 mumol / l respectively ) , while HDL cholesterol , fibrinogen and CRP levels were significantly higher in women than in men ( 1 . 28 / 0 . 5 vs 1 . 13 / 0 . 25 mmol / l ; 3 . 53 / 0 . 5 vs 3 . 26 / 0 . 8 g / l and 4 . 7 / …

Is serum C reactive protein concentration correlated with hba1c and insulin resistance in Type 2 diabetic men with or without … (2005 May)
Is serum C reactive protein concentration correlated with hba1c and insulin resistance in Type 2 diabetic men with or without coronary heart disease ? background AND AIMS : C reactive protein ( CRP ) is an inflammatory marker that predicts coronary heart disease ( CHD ) risk . diabetes mellitus ( DM ) counts as a CHD risk equivalent . We aimed to compare serum high sensitivity CRP ( hs CRP ) levels in Type 2 diabetic ( T2DM ) men without CHD , non diabetic CHD patients and T2DM patients with CHD . subjects AND methods : Four groups were formed ; group 1 DM ( ) , CHD ( ) , no . 25 , group 2 DM ( ) , CHD ( ) no . 25 , group 3 DM ( ) , CHD ( ) , no . 25 , and group 4 ( controls , no . 30 ) . serum hs CRP , insulin , glucose , total , HDL , LDL and VLDL cholesterol , triglyceride levels and homeostasis model assessment for insulin resistance ( HOMA IR ) index were determined . results : Mean hs CRP level of group 1 ( 0 . 6 / 0 . 29 ) was not different statistically from group 2 ( 1 . 44 / 0 . 97 ) . Mean hs CRP levels were higher in men with CHD , whether they were diabetic ( group 3 ; 3 . 83 / 2 . 01 …

Glycohaemoglobin as a determinant of increased fibrinogen concentrations and low grade inflammation in apparently healthy nondiabetic individuals. (2008 Jan)
glycohaemoglobin as a determinant of increased fibrinogen concentrations and low grade inflammation in apparently healthy nondiabetic individuals . objective : To determine the potential role of glycohaemoglobin as a possible determinant of increased fibrinogen concentrations and low grade inflammation in a group of apparently healthy , nondiabetic individuals not expressing clinically overt atherothrombosis . design AND MAIN outcome measures : We performed a cross sectional analysis of the concentrations of glycohaemoglobin alongside the concentrations of quantitative fibrinogen and high sensitivity C reactive protein ( hs CRP ) . In all , 1511 males and 757 apparently healthy females , without diabetes mellitus or clinically evident atherothrombotic disease , were enrolled in the study during their routine annual health check up . results : glycohaemoglobin entered the linear regression models as a significant determinant of quantitative fibrinogen in both genders and of hs CRP in men . We found this to be true even following the inclusion of multiple variables known to influence the intensity of low grade inflammation , such as age , gender , waist circumference , body mass index , blood pressure , medications , hormone therapy , glucose levels ( normal or impaired fasting glucose ) , smoking habits , family history of coronary artery disease , lipid profile as well as alcohol consumption and sports intensity . We found glycohaemoglobin to be a significant determinant of fibrinogen concentrations in apparently healthy nondiabetic individuals not yet presenting with evident atherothrombosis . conclusions : This observation supports the …

High sensitivity C reactive protein is predictive of medium term cardiac outcome in high risk asian patients presenting with chest … (2004 Aug)
High sensitivity C reactive protein is predictive of medium term cardiac outcome in high risk asian patients presenting with chest pain syndrome without myocardial infarction . introduction : High sensitivity C reactive protein ( hs CRP ) has been shown to be predictive of cardiac events but data among asians is comparatively few . We evaluated the role of hs CRP in the prediction of adverse cardiac outcome in a cohort of high risk patients presenting with chest pain syndrome without myocardial infarction ( MI ) . materials AND methods : three hundred and forty seven patients were prospectively recruited over an 18 month period and patients with MI as documented by serial electrocardiogram abnormalities , and creatinine kinase or troponin elevation were excluded . Mean follow up duration was 901 / 306 days . kaplan meier and Cox proportional hazards modelling were used to evaluate outcome and determine association with predictor variables . results : The composite primary endpoint of cardiac mortality , non fatal MI , cardiac failure or coronary revascularisation procedure ( coronary artery bypass grafting or angioplasty ) unrelated to the index admission was reached in 37 patients . history of previous MI ( P 0 . 002 ) , presence of at least 1 coronary artery with or 50 stenosis ( P 0 . 028 ) and elevated hs CRP levels were associated with an adverse cardiac outcome ( P 0 . 001 for CRP in the upper quartile , and 0 . 002 for …

Acute phase inflammatory response to periodontal disease in the US population. (2000 Mar)
acute phase inflammatory response to periodontal disease in the US population . moderate elevation of serum C reactive protein ( CRP ) is a risk factor for cardiovascular disease among apparently healthy individuals , although factors that create this inflammatory response in the absence of systemic illness have not been clarified . This study aimed to : ( 1 ) evaluate associations among periodontal disease , established risk factors for elevated CRP , and CRP levels within the US population ; and ( 2 ) determine whether total tooth loss is associated with reduced CRP . Data were obtained from the third national health and nutrition examination survey . A random sample of the US population was interviewed in their homes and examined at mobile examination centers . CRP was quantified from peripheral blood samples and analyzed as a continuous variable and as the prevalence of elevated CRP ( or 10 mg / L ) . Some 12 , 949 people aged 18 years who had periodontal examinations and an additional 1 , 817 edentulous people aged 18 years were included in the analysis . dentate people with extensive periodontal disease ( 10 of sites with periodontal pockets 4 mm ) had an increase of approximately one third in mean CRP and a doubling in prevalence of elevated CRP compared with periodontally healthy people . raised CRP levels among people with extensive periodontal disease persisted in multivariate analyses ( P 0 . 01 ) , with established risk factors for …

The inflammatory C reactive protein is increased in both liver and adipose tissue in severely obese patients independently from metabolic … (2006 Aug)
The inflammatory C reactive protein is increased in both liver and adipose tissue in severely obese patients independently from metabolic syndrome , Type 2 diabetes , and NASH . objective : C reactive protein ( CRP ) , a nonspecific marker of inflammation that is moderately elevated in obesity , metabolic syndrome ( MS ) , and type 2 diabetes , has been proposed as a surrogate marker of nonalcoholic steatohepatitis ( NASH ) . Its clinical usefulness in the diagnosis of NASH was evaluated in severely obese patients without or with MS , diabetes , and NASH and the potential roles of the liver and of the adipose tissue in CRP production were characterized . methods : severely obese patients without NASH ( without MS N 13 , with MS N 11 , or with MS and diabetes N 7 ) and with NASH ( without N 8 or with N 7 MS ) were studied . For each patient , liver and adipose tissue biopsies were collected during a bariatric surgery and were used to determine the CRP gene expression by real time PCR . The role of interleukin 6 ( IL6 ) and lipopolysaccharide in CRP expression was also evaluated in subcutaneous adipose tissue obtained during cosmetic abdominoplasty . results : plasma CRP levels were elevated in severely obese patients independently from the presence or absence of MS , diabetes , or NASH . CRP gene expression was not only increased in livers but also in adipose …