Reciprocal Translation Between Pathophysiology and Practice in Health and Disease

1st Edition - April 1, 2021
Imprint: Academic Press
Authors: Peter B. Soeters, Peter W. de Leeuw
Language: English
Paperback ISBN:
9 7 8 - 0 - 1 2 - 8 2 0 2 0 5 - 0
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 2 0 4 2 2 - 1

Reciprocal Translation Between Pathophysiology and Practice in Health and Disease brings a novel perspective, closing the knowledge gap between normal/abnormal physiology. Chapte… Read more

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Reciprocal Translation Between Pathophysiology and Practice in Health and Disease brings a novel perspective, closing the knowledge gap between normal/abnormal physiology. Chapters describe the basic mechanisms underlying a disease or trauma-related response, describe consequences in practice, and provide insights on how to use information to better understand disease outcomes. Other sections explore how these responses are beneficial and driven by similar hormones and inflammatory immune cell derived modulators. This is a must-have resource for those seeking an authoritative and comprehensive understanding on how to treat the basic mechanisms underlying disease or trauma-related responses.
With contributions from Petronella L.M. Reijven.

Cover image
Title page
Table of Contents
Copyright
Part I: Pathophysiological mechanisms in disease
Chapter 1: Reciprocal translation between pathophysiology and practice in health and disease
Abstract
Chapter 2: General principles of the repair mechanism
Abstract
Introduction
The inflammatory response
Formation of building blocks for repair
Pathophysiological effects after trauma (Table 1)
Evolutionary aspects
Conclusion
Chapter 3: Cardiovascular responses to injury
Abstract
Introduction
Mechanisms of the local vascular response
Role of the local renin-angiotensin system
Role of local adrenergic mechanisms
Regional ischemia-related vascular responses
Role of the autonomic nervous system
Systemic vascular responses to injury
Role of the kidney
Conclusions
Chapter 4: Insulin resistance as an adaptive mechanism
Abstract
Introduction
Insulin resistance and intermediary metabolism
Insulin resistance in pure starvation
Insulin resistance in stress starvation (Fig. 1)
Insulin resistance in pregnancy and growth
Insulin resistance and the response to injury
The possible evolutionary benefit of insulin resistance
Insulin resistance and survival
The downside of insulin resistance: The metabolic syndrome
Conclusion
Chapter 5: Hypercholesterolemia, harm, or benefit?
Abstract
Introduction
Metabolism and transport of cholesterol
Functions of cholesterol
Cholesterol during infections and inflammation
Cholesterol in states of growth
Cholesterol and cardiovascular disease
Conclusion
Chapter 6: Macronutrient metabolism in starvation and stress
Abstract
Introduction
Protein metabolism in starvation and stress
Changes in amino acid metabolism as a consequence of stress (Figs. 3 and 4)
Glutamine metabolism during host response and growth
Pathophysiology and role of the most studied single amino acids in clinical practice (glutamine and arginine)
The significance of arginine in conditions of stress
Nutritional and metabolic consequences
Conclusions
Chapter 7: The role of ectopic adipose tissue: Benefit or deleterious overflow?
Abstract
Introduction
Does overflow of fat exist?
The beneficial role of inflammation and insulin resistance (for details see Chapter 4)
Epicardial adipose tissue (see Fig. 1)
Perinodal adipose tissue
Fat depots in the vicinity of pathological processes
Discussion
Chapter 8: The gut/liver axis, inflammation, and the pathogenesis of metabolic syndrome
Abstract
Introduction
Effect of nutritional lipids
Role of the intestinal microbiota
Intestinal disease and liver abnormalities
Extraintestinal inflammatory events and NAFLD
Lipid storage: An adaptive phenomenon?
Fatty liver as a prelude to MetS
Discussion/conclusions
Chapter 9: Harm and benefit of the inflammatory response
Abstract
Introduction
Natural control mechanisms
Factors interfering with healthy inflammatory responses
Preexisting (chronic) inflammatory activity
Chronic inflammation
The future
Part II: Clinical manifestations of adaptive pathophysiology
Chapter 10: The beneficial role of inflammation and metabolic cycling (Warburg revisited)
Abstract
Introduction
Inflammation drives metabolism for building blocks and survival mechanisms
The role of cycling in intermediary metabolism
Cori, Warburg, and Crabtree in clinical practice
Chapter 11: From hepatic encephalopathy to the quality of food protein and protein requirements: A serendipitous journey
Abstract
Introduction
Postprandial nitrogen accumulation in experimental animals and humans
Protein ingestion and muscle protein synthesis in healthy volunteers
Protein ingestion, the “first pass effect” and muscle protein synthesis
Discussion
Chapter 12: The underlying metabolism of hypoalbuminemia and its clinical effects
Abstract
Introduction
Mechanisms leading to hypoalbuminemia
Inflammation and hypoalbuminemia
Hypoalbuminemia during physiological or pathological growth
Malnutrition and hypoalbuminemia
The potential benefit of albumin escape from the plasma
Hypoalbuminemia and outcome
Conclusion
Chapter 13: Cardiovascular stress syndromes
Abstract
Introduction
Localized trauma and wound healing
Ischemia-related phenomena: The example of renal artery stenosis
Circulatory underfilling
Conclusion
Chapter 14: The benefit of moderate hyperglycemia and hyperlactatemia in critical illness or synthesis of biomass
Abstract
Introduction
Critical illness evokes profound changes in glucose metabolism (Table 1)
Lipid oxidation spares glucose and protein during critical illness
The effect of tight glucose control (see Table 3)
The danger of hypoglycemia
Clinical consequences of low glycemia and limited carbohydrate intake
Hyperlactatemia
Conclusion
Chapter 15: Anemia as an adaptive phenomenon
Abstract
Introduction
Anemia in chronic kidney disease
Anemia of chronic disease
Spurious anemia
Conclusions
Chapter 16: Vitamin D in health and disease
Abstract
Introduction
Activation and transport
Binding of Vit D
Sources of vitamin D
Vitamin D status
Symptoms of vitamin D deficiency
Vitamin D and disease
Severe illness and inflammation
RCTs with positive outcomes (Table 1)
Conclusions
Part III: Implications for treatment
Chapter 17: Decreases of plasma solutes in health and disease: Deficiency or resulting from changing binding proteins and distribution volume?
Abstract
Introduction
General mechanisms changing the concentrations of plasma solutes
Specific changes of plasma solutes (Table 1)
Problems of interpretation
Conclusion
Chapter 18: Comparable metabolism in pregnancy and cancer: A universal role of the Warburg effect
Abstract
Introduction
How does the body tailor its response?
Pathophysiology of tumor growth
Physiology of fetal growth
The Warburg effect in cancer and pregnancy
Conclusion
Chapter 19: Nutritional assessment and the role of preexisting inflammation with a bearing on COVID-19
Abstract
Introduction
The virulence of the invading microorganism
Anecdotal reports of COVID-19
Objective measurements to detect malnourished patients
Nutritional assessment includes assessment of risk
Operationalization of the definition of malnutrition
Nutritional assessment should consist of assessing risk “not to do well.”
Discussion
Chapter 20: The harm afflicted by NSAIDs, statins, and oral antidiabetics by blocking adaptive inflammatory metabolism
Abstract
Introduction
NSAIDs
Statins
Oral antidiabetic drugs (OADs)
Can we promote euglycemia without interfering with the benefit of IR?
Chapter 21: Benefit and concern of ketogenic and vegan diets: A revisit to pathophysiology
Abstract
Introduction
The benefit of ketogenic diets [1]
Concerns about ketogenic diets
The benefit of vegan diets [12]
Concerns about vegan diets
Conclusions regarding the benefit of ketogenic diets
Part IV: Mechanisms providing insight in a few enigmatic syndromes
Chapter 22: Pathophysiology in practice: How to manage gastrointestinal surgery in acute and elective disease conditions
Abstract
Introduction
Preoperative management
Preoperative preparation
Operation
Treatment of metabolic disorders
Conclusions
Chapter 23: The pathophysiology underlying the obesity and plasma cholesterol paradoxes
Abstract
Introduction
The obesity paradox
The cholesterol paradox
Discussion
Chapter 24: The final conclusion: Dogma, bias, and big data
Abstract
Introduction
The results of RCTs and metaanalyses
“We want to dance before we can walk, we want to sing before we can talk” (adapted from ABBA)
Misconceptions
The validity of dogmas
Big data and knowledge of intermediate metabolism
Medical and other curricula
Study design and interpretation
Bias
Index

Peter B. Soeters

Peter B. Soeters, MD, PhD is Emeritus Professor of Surgery at Maastricht University and retired in 2006. He has been a licensed surgeon and intensivist and after starting general surgery gradually focused on patients with abdominal catastrophe (inflammatory bowel disease, postoperative or spontaneous abdominal complications) and morbid obesity. He introduced artificial nutrition in 1970 in the Netherlands. In 1984 he established a surgical laboratory, in which interorgan inflammatory metabolism was studied in small and larger animal models and studies in humans were supported. He supervised 35-40 PhD students addressing these issues. Twelve of these PhD students became full professors. He published 280 peer reviewed papers, 65% of them as first or last author (H-index 72) He held several positions in Surgical, Gastroenterological, Hepatological, Nutritional/ Metabolic Societies and scientific journals nationally and internationally, and holds 8 honorary memberships of these societies. He was knighted in the order of the Dutch Lion in 2006.

Affiliations and expertise

Emeritus Professor of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

Peter W. de Leeuw

Peter W. de Leeuw, MD, PhD is emeritus professor of Medicine at the University of Maastricht. His research interest is in cardiovascular medicine. He has published over 480 articles and reviews and served on the editorial board of more than 20 international journals. He also served as Editor-in-Chief of the Netherlands Journal of Medicine, the European Journal of Internal Medicine and the Nederlands Tijdschrift voor Geneeskunde (Dutch Medical Journal). He organized several congresses and symposia and was a steering member on several international trials. He is a member of multiple scientific societies and served in the Council of the International Society of Hypertension. For his scientific work, he received several awards from the High Blood Pressure Research Council of Australia, the European Federation of Internal Medicine and the European Society of Hypertension.

Affiliations and expertise

Emeritus Professor, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

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