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Chronic Diseases

The thromboxane A2 pathway through its end product thromboxane A2 is implicated in the development and progression of many chronic diseases. There is clear clinical and/or experimental evidence platelet thromboxane A2 release is greatly enhanced in a number of chronic diseases. Frequently in these diseases, the balance between thromboxane A2 and prostacyclin is significantly altered, resulting in excessive vasoconstriction and disorders of hemostasis. Levels of urinary 11-dehydrothromboxane B2 reflect activity of components of the thromboxane A2 pathway resulting in thromboxane A2 generation.

A Japanese cross-sectional multicenter study of biomarkers associated with cardiovascular disease in smokers and non-smokers

“The mean hs-CRP concentration was not significantly different between the two groups of subjects.”

“We found that the 11-DTXB2 concentration was about 24% greater in smokers than in non-smokers, supporting the use of 11-DTXB2 as a potential biomarker for smoking and CVD.”

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The cardiovascular benefits of dark chocolate

"Dark chocolate contains many biologically active components, such as catechins, procyanidins, and theobromine from cocoa, together with added sucrose and lipids.  All of these can directly or indirectly affect the cardiovascular system by multiple mechanisms."

"The effect of chocolate is more convoluted since the sucrose and lipid may transiently and negatively impact on endothelial function, partly through insulin signaling and nitric oxide bioavailability."

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Pentraxin 3 and platelet activation in obese patients after gastric banding

"High-sensitivity CRP decreased by 24 & 29.7% (P<0.0001), whereas CD40L decreased by 64.3 and 58.6% (P=0.002), respectively.  Urinary 11-dehydro-TxB2 decreased from 1,433 to 715 and 564 pg/mg creatinine, respectively, 6 months and 12 months after LAGB (P<0.0001). PTX3 was inversely related to platelet activation markers, 11-dehydro-TxB2 and CD40L.  Moreover, multiple regression analysis on pooled data showed that plasma PTX3 was an independent predictor of urinaty 11-dehydro-TxB2."

“There is an association between inflammation, platelet activation and metabolic dysfunction in obesity, and PTX3 is a key player within these circuits.”

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Citrus flavanoids and human cancers

"Nowadays cancers pose a great threat to the health of human beings.  Based on studies on the flavonoids and other bioactive compounds of citrus fruits in current literature, it was widely suggested that the consumption of citrus fruits is beneficial to the prevention and treatment of human chronic diseases including cancers. In the past decades, the study concerning citrus flavonoids has covered various areas including the type, content and distribution of flavonoids in fruits; their variation between wild and cultivated genotypes; their antioxidant, anti-inflammation, anti-aging, antimicrobial and anticarcinogenic activities."

"Nuclear factor kappa B (NF-κB) transcription factors regulate several important physiologic processes of the cell, e.g., cell growth, and apoptosis. Thus, inhibition of NF-κB activation offers a potential strategy for treatment of different malignancies."

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Mediterranean diet reduces thromboxane A2 production in atrial fibrillation patients

"Platelet activation plays a major role in cardiovascular events.  Mediterranean diet reduces the incidence of stroke and myocardial infarction but it is still unclear if it affects platelet activation.  Aim of the study was to evaluate the effect of Mediterranean diet on the urinary excretion of 11-dehydro-thromboxane (TX) B2, a marker in vivo platelet activation, in patients with atrial fibillation."

"Med diet adherence is inversely associated to urinary excretion of 11-dehydro-TXB2, suggesting that Med-Diet may favorably affect platelet function in AF patients."

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Relation of fish oil supplementation to markers of atherothrombotic risk in patients with cardiovascular disease not receiving lipid-lowering therapy.

"Fish oil supplementation (FOS) is known to have cardiovascular benefits.  However, the effects of FOS on thrombosis are incompletely understood.  We sought to determine if the use of FOS is associated with lower indices of atherothrombotic risk in patients with suspected coronary artery disease."

"Fish oil supplementation (FOS) is known to have cardiovascular benefits. Patients on FOS had lower urinary 11-dehydrothromboxane B2 levels regardless of lipid-lowering therapy."

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The influence of low-grade inflammation on platelets in patients with stable coronary artery disease.

"Inflammation is likely to be involved in all stages of atherosclerosis.  Numerous inflammatory biomarkers are currently being studied, and even subtle increases in inflammatory biomarkers have been associated with increased risk of cardiovascular events in patients with coronary artery disease (CAD).  Low-grade inflammation may influence both platelet production and platelet activation potentially leading to enhanced platelet aggregation."

"Increased levels of hsCRP and IL-6 were independently associated with increased platelet aggregation and urine-11-dehydrothromboxane B2 levels (110). This association may be explained by aspirin-insensitive thromboxane generation derived from cyclooxygenase-2 in non-platelet cells."

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Urinary 11-dehydro-thromboxane B2 is associated with cardiovascular events and mortality in patients with atrial fibrillation

"Patients with nonvalvular atrial fibrillation (AF) show high residual cardiovascular (CV) risk despite oral anticoagulants.  Urinary 11-dehydro-thromboxane B2 (TXB2) is associated with an increased risk of CV events (CVEs), but its predictive value in patients with anticoagulated AF is unknown."

"Urinary 11-dehydro-TxB2 levels are associated with a residual risk of CVEs and CV mortality in patients with AF despite anticoagulant treatment."

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Circulating Prostaglandin Biosynthesis in Colorectal Cancer and Potential Clinical Significance

"Colorectal cancer (CRC) represents the third leading cause of cancer-related death in the United States.  Lack of reliable biomarkers remain a critical issue for early detection of Colorectal cancer.  In this study, we investigated the potential predictive values of circulating prostaglandin biosynthes in CRC risk."

“CRC progression is accompanied by a pronounced elevation of systemic TXA2 biosynthesis.” 

“Measurement of urinary TXA2 metabolites such as 11-dehydro TXB2 might provide the best estimate of systemic TXA2 biosynthesis in vivo”

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The Current and Future Landscape of Urinary Thromboxane Testing to Evaluate Atherothrombotic Risk


"Biomarker testing for efficacy of therapy is an accepted way for clinicians to individualize dosing to genetic and/or environmental factors that may be influencing a treatment regimen.  Aspirin is used by nearly 43 million Americans on a regular basis to reduce risks associated with various artherothrombotic diseases.  Despite its widespread use, many clinicians are unaware of the link between suboptimal response to aspirin therapy and increased risk for inferior clinical outcomes in several disease states, and biomarker testing for efficacy of aspirin therapy is not performed as routinely as efficacy testing in other therapeutic areas.  This article reviews the clinical and laboratory aspects of determining whole-body thromboxane production, particularly as it pertains to efficacy assessment of aspirin responsiveness."

"Aspirin use has been shown to cause a dose-dependent reduction in urinary levels of 11-dehydroTxB2."

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