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Genito-Thyroid Index : A Global Systems Approach to the Neutrophil-to-Lymphocyte Ratio According to the Theory of Endobiogeny Applied to Ambulatory Patients with Chronic Heart Failure

par Kamyar M. Hedayat(1), Benjamin M. Schuff(2), Jean-Claude Lapraz(1), Tiffany Barsotti(3), Shahrokh Golshan(4), Suzi Hong(4), Barry H. Greenberg(5), and Paul J. Mills (4,6)

Endobiogeny is a global systems theory rooted in clinical practice. It claims to assess human physiology in a manner that contextualizes upstream and downstream events. The theory of endobiogeny considers the neuroendocrine system as the manager of metabolism, thus, the manager of the global terrain. Biomarkers are considered the downstream metabolic output of tissues that were regulated upstream by neuroendocrine factors. From the theory of endobiogeny, a series of direct and indirect ratios of biomarkers have been developed called the Biology of Functions (BoF). In the BoF, the NLR is referred to as the Genito-thyroid ratio (GT) for reasons discussed below. For the remainder of the article, the NLR will be referred to in both ways : NLR (GT).
We hypothesized that in ambulatory patients with chronic heart failure (CHF), NLR (GT) would be elevated versus control subjects, reflecting the inflammatory terrain of CHF patients. A secondary hypothesis was that the theory of Endobiogeny could contextualize the NLR (GT) values in CHF patients based on currently accepted notions of the CHF terrain.

Article publié dans Journal of Cardiology & Clinical Research
Volume 5 (1), 1091 •Janvier 2017

(1) Systems Biology Research Group, Chicago, USA
(2) National University of Natural Medicine, USA
(3) Heal and Thrive, Encinitas, USA
(4) Department of Psychiatry, University of California San Diego, USA
(5) Department of Medicine, University of California, USA
(6) Department of Family and Preventative Medicine, University of California, USA



Chronic heart failure (CHF) is an inflammatory disorder. Elevated Neutrophil to-Lymphocyte ratio (NLR) is associated with inflammation and increased morbidity and mortality in various disorders including CHF. NLR is a non-specific, quantitative biomarker assessment. It does not allow for a personalized approach to treatment. A global systems approach to biomarker assessment is quantitative and qualitative, contextualizing basic data into larger sets of meaning. Such a system may provide greater meaning to the NLR, increasing its clinical utility in CHF. Endobiogeny is a global systems theory. It claims to be able to model complex physiology through biomarkers, offering context-rich interpretations of data for meaningful clinical applicability. In Endobiogeny, NLR is referred to as the Genito-Thyroid index (GT).


The NLR has never been studied in ambulatory CHF patients. The first aim of this study was to determine if NLR is elevated for ambulatory CHF patients versus controls. The second was to determine if the endobiogenic interpretation of the NLR as the GT index is consistent with current pathophysiologic models.


Methods : A retrospective observational case-controlled study was performed in 93 patients with New York Heart Association class II-III heart failure patients and 104 individuals with no cardiovascular pathology as a control group. Two biomarkers, percent neutrophils and percent lymphocytes, were entered into the Biology of Functions modeling software, from which a direct index was produced to model an aspect of the heart failure terrain. All calculations were performed using SPSS Inc. (version 22.0) and analyzed by univariate or multivariate analysis of covariance.


NLR or, GT index (normal 1.5-2.5) was elevated in CHF patients vs. control (2.81 vs 2.01, p<0.001).


NLR, or, GT index, when elevated reflects a hyperimmune response to an aggression. CHF is associated with elevated immune activity. Ambulatory CHF patients show signs of a hyperimmune response even when clinically stable. The endobiogenic explanation of the NLR is consistent with current pathophysiological models of CHF. Future studies should explore if a certain cutoff value of the GT index is predictive of future deterioration in CHF patients.

Future studies should evaluate other endobiogenic indexes for their clinical relevance in CHF

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