Keep metformin guidelines intact.
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Acidosis, Lactic↗
Biomedical subjects
B J Goldstein
Publications and source records attributed to B J Goldstein.
Don't be decredentialed without putting up a fight.
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Credentialing↗
Health plans that decredential docs must do it correctly and expect a fight.
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Credentialing↗
Adult olfactory epithelium contains multipotent progenitors that give rise to neurons and non-neural cells.
We have infused replication-incompetent retroviral vectors into the nasal cavity of adult rats 1 day after exposure to the olfactotoxic gas methyl bromide (MeBr) to assess the lineage relationships of cells in the regenerating olfactory epithelium. The vast majority of the retrovirus-labeled clones fall into three broad categories: clones that invariably contain globose basal cells (GBCs) and/or neurons, clones that always include cells in the ducts of Bowman's glands, and clones that are composed of sustentacular cells only. Many of the GBC-related clones contain sustentacular cells and horizontal basal cells as well. Most of the duct-related clones contain gland cells, and some also include sustentacular cells. Thus, the destruction of both neurons and non-neuronal cells that is caused by MeBr activates two distinct types of multipotent cells. The multipotent progenitor that gives rise to neurons and non-neuronal cells is a basal cell, whereas the progenitor that gives rise to duct, gland, and sustentacular cells resides within the ducts, based on the pattern of sparing after lesion and the analysis of early regeneration by using cell type-specific markers. We conclude that the balance between multipotency and selective neuropotency, which is characteristic of globose basal cells in the normal olfactory epithelium, is determined by which cell types have been depleted and need to be replenished rapidly.
Animals↗
Transplantation of multipotent progenitors from the adult olfactory epithelium.
Mammalian olfactory epithelium produces new neurons rapidly throughout adulthood. Here, we demonstrate that precursor cells harvested from the adult olfactory epithelium, when transplanted into the nasal mucosa of host rats exposed previously to an olfactotoxic gas, engraft and participate in neuroepithelial reconstitution. In contrast to their normal neuronal fate in situ, grafted precursors harvested from bulbectomized donors produced non-neuronal cells as well as neurons. These results demonstrate that epithelial precursors activated following olfactory bulbectomy are not irreversibly committed to making neurons. Thus, olfactory progenitors are subject to a form of feedback control in vivo that regulates the types of cells that they produce within a broader-than-neuronal repertoire.
Alkaline Phosphatase↗
Regulation of insulin action by protein tyrosine phosphatases.
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Animals↗
SSRIs in depression: a decade of progress.
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Antidepressive Agents, Second-Generation↗
Selective serotonin reuptake inhibitors in affective disorders--I. Basic pharmacology.
The selective serotonin reuptake inhibitors (SSRIs), citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline, are the result of rational research to find drugs that were as effective as the tricyclic antidepressants but with fewer safety and tolerability problems. The SSRIs selectively and powerfully inhibit serotonin reuptake and result in a potentiation of serotonergic neurotransmission. The property of potent serotonin reuptake appears to give a broad spectrum of therapeutic activity in depression, anxiety, obsessional and impulse control disorders. However, despite the sharing of the same principal mechanism of action, SSRIs are structurally diverse with clear variations in their pharmacodynamic and pharmacokinetic profiles. The potency for serotonin reuptake inhibition varies amongst this group, as does the selectivity for serotonin relative to noradrenaline and dopamine reuptake inhibition. The relative potency of sertraline for dopamine reuptake inhibition differentiates it pharmacologically from other SSRIs. Affinity for neuroreceptors, such as sigma1, muscarinic and 5-HT2c, also differs widely. Furthermore, the inhibition of nitric oxide synthetase by paroxetine, and possibly other SSRIs, may have significant pharmacodynamic effects. Citalopram and fluoxetine are racemic mixtures of different chiral forms that possess varying pharmacokinetic and pharmacological profiles. Fluoxetine has a long acting and pharmacologically active metabolite. There are important clinical differences among the SSRIs in their pharmacokinetic characteristics. These include differences in their half-lives, linear versus non-linear pharmacokinetics, effect of age on their clearance and their potential to inhibit drug metabolising cytochrome P450 (CYP) isoenzymes. These pharmacological and pharmacokinetic differences underly the increasingly apparent important clinical differences amongst the SSRIs.
Antidepressive Agents, Second-Generation↗
Selective serotonin reuptake inhibitors in affective disorders--II. Efficacy and quality of life.
Since their introduction, the selective serotonin reuptake inhibitors (SSRIs) have become one of the most widely used classes of medication in psychiatry. Their popularity is based on apparent efficacy over a wide range of disorders and a favorable side-effect profile. However, as with any psychotropic medication, considerable data are required to define where a drug works and where it does not. There is now a wealth of evidence demonstrating that SSRIs may differ in their efficacy profiles in certain depressive symptoms, in different subtypes of depression, with respect to their ability to maintain efficacy over time, on broader outcomes such as quality of life, and in the consistency of the usually effective minimum therapeutic dose across the age spectrum and across indications. Although this review includes data on all SSRIs, it focuses on fluoxetine and sertraline, which in addition to being the most widely used SSRIs are also the most widely studied. The relative quantity and quality of data on these two SSRIs means that it is possible to make relatively firm inferences regarding their differential effects on affective symptoms and quality of life.
Cognition Disorders↗
Selective serotonin reuptake inhibitors in the treatment of affective disorders--III. Tolerability, safety and pharmacoeconomics.
The clinical use of tricyclic antidepressants (TCAs) is often complicated by toxicity and safety problems due to their effects on multiple mechanisms of action, many of which are unnecessary for therapeutic effect. The development of the selective serotonin reuptake inhibitors (SSRIs), with their selective mode of action, has resulted in a class of antidepressant drugs possessing an improved side-effect profile, while retaining good clinical efficacy. Their introduction into clinical practice has led to enhanced patient compliance with antidepressant therapy and the ability to maintain treatment over longer periods of time at an adequate therapeutic dose. Although, as a result of their selective action, side-effects associated with SSRI therapy are minimised, distinct variations between individual SSRIs in terms of their tolerability profiles have been observed. The wealth of clinical data now available has revealed differences in their potential to cause psychiatric and neurological side-effects, dermatological reactions, anticholinergic side-effects, changes in body weight, sexual dysfunction, cognitive impairment, discontinuation reactions and drug-drug interactions. Patients who suffer from concomitant depression and physical illness may experience different tolerability profiles, in addition to the greater likelihood that they will be receiving concomitant medications with the potential for pharmacokinetic drug-drug interactions with coadministered SSRI therapy. In addition, the safety margin of SSRIs in overdose may vary within the group. Knowledge of the differences that exist among the SSRIs in respect of tolerability and safety will aid physicians in the selection of the most beneficial treatment strategy for their patients. A successful clinical outcome leads to a reduced economic burden for the patient, their family and the healthcare services. Thus, pharmacoeconomic considerations are also important in choosing antidepressant therapy. The SSRIs, despite relatively higher prescription costs, have been demonstrated to be a more cost-effective option than the TCAs. Furthermore, there is evidence that the emerging clinical differences between SSRIs may translate into significantly different economic outcomes within the group.
Antidepressive Agents, Second-Generation↗
Inhibition of the transmembrane protein tyrosine phosphatase lar by 3S-peptide-I enhances insulin receptor phosphorylation in intact cells.
3S-peptide-I, a tris-sulfotyrosyl dodecapeptide that corresponds to the major autophosphorylation domain within the insulin receptor beta-subunit, selectively enhances insulin signal transduction by specifically inhibiting dephosphorylation of the insulin receptor catalyzed by protein tyrosine phosphatases (PTPases). Because of the potential role of the transmembrane PTPase LAR in the regulation of insulin signaling, we assessed the effect of 3S-peptide-I on recombinant LAR PTPase activity and in McA-RH7777 rat hepatoma cells overexpressing full-length LAR protein (McA4B/LAR). 3S-peptide-I significantly reduced insulin receptor dephosphorylation by recombinant LAR (p < 0.001) while blocking dephosphorylation of the insulin receptor by approximately 72% in semi-permeabilized McA4B/LAR cells (p < 0.001). Increased LAR expression resulted in 40% reduction in ligand-mediated phosphorylation of the insulin receptor compared with null vector control (p < 0.001). However, treatment of intact McA4B/LAR cells with a fatty acid derivative of 3S-peptide-I (50 microM) led to an enhancement of insulin-stimulated receptor phosphorylation by 89% (p < 0.001). As a result, control and McA4B/LAR cells showed comparable steady-state levels of insulin receptor phosphorylation in the presence of insulin. These findings provide evidence that 3S-peptide-I may improve insulin responsiveness in intact cells by inhibiting LAR, an enzyme whose activity has been implicated in the pathogenesis of insulin resistance.
Animals↗
Transgenic mice deficient in the LAR protein-tyrosine phosphatase exhibit profound defects in glucose homeostasis.
Protein-tyrosine phosphatases (PTPases) play an integral role in the regulation of cellular insulin action. LAR, a transmembrane PTPase expressed in insulin-sensitive tissues, acts as a negative regulator of insulin signaling in intact cell models. The physiological role of LAR was studied in mice in which LAR expression was eradicated by insertional mutagenesis. In the fasting state, adult male homozygous LAR (-/-) mice had significantly lower plasma levels of insulin and glucose, as well as a reduced rate of hepatic glucose production compared with wild-type controls, suggesting a heightened level of insulin sensitivity. In euglycemic clamp studies, the LAR (-/-) mice exhibited a significant resistance to insulin-stimulated glucose disposal and suppression of hepatic glucose output. Examination of hepatic insulin action demonstrated that the major alteration involved a 47% reduction in insulin-stimulated phosphatidylinositol 3'-kinase (PI 3-kinase) activity in the knockout mice, indicating a post-receptor signaling defect. Taken together with previous work on the cellular effects of LAR, the present results are consistent with a physiological role for LAR in the negative regulation of insulin action, with secondary abnormalities that contribute to the resistance to insulin-stimulated signaling in the knockout mice. Overall, these data provide further evidence for an important role for LAR in the regulation of insulin action and glucose homeostasis in intact animals.
Animals↗
Regulation of the insulin signalling pathway by cellular protein-tyrosine phosphatases.
Protein-tyrosine phosphatases (PTPases) have been implicated in the physiological regulation of the insulin signalling pathway. In cellular and molecular studies, the transmembrane, receptor-type PTPase LAR and the intracellular, non-receptor enzyme PTP1B have been shown to have a direct impact on insulin action in intact cell models. Since insulin signalling can be enhanced by reducing the abundance or activity of specific PTPases, pharmaceutical agents directed at blocking the interaction between individual PTPases and the insulin receptor may have potential clinical relevance to the treatment of insulin-resistant states such as obesity and Type II diabetes mellitus.
Animals↗
Alterations in skeletal muscle protein-tyrosine phosphatase activity and expression in insulin-resistant human obesity and diabetes.
Obese human subjects have increased protein-tyrosine phosphatase (PTPase) activity in adipose tissue that can dephosphorylate and inactivate the insulin receptor kinase. To extend these findings to skeletal muscle, we measured PTPase activity in the skeletal muscle particulate fraction and cytosol from a series of lean controls, insulin-resistant obese (body mass index > 30) nondiabetic subjects, and obese individuals with non-insulin-dependent diabetes. PTPase activities in subcellular fractions from the nondiabetic obese subjects were increased to 140-170% of the level in lean controls (P < 0.05). In contrast, PTPase activity in both fractions from the obese subjects with non-insulin-dependent diabetes was significantly decreased to 39% of the level in controls (P < 0.05). By immunoblot analysis, leukocyte antigen related (LAR) and protein-tyrosine phosphatase 1B had the greatest increase (threefold) in the particulate fraction from obese, nondiabetic subjects, and immunodepletion of this fraction using an affinity-purified antibody directed at the cytoplasmic domain of leukocyte antigen related normalized the PTPase activity when compared to the activity from control subjects. These findings provide further support for negative regulation of insulin action by specific PTPases in the pathogenesis of insulin resistance in human obesity, while other regulatory mechanisms may be operative in the diabetic state.
Adult↗
Functional association between the insulin receptor and the transmembrane protein-tyrosine phosphatase LAR in intact cells.
The receptor-type protein-tyrosine phosphatase LAR (for leukocyte common antigen-related) has been implicated as a physiological regulator of the insulin receptor. To demonstrate a functional interaction between LAR and the insulin receptor, we incubated CHO cells overexpressing the human insulin receptor with an antibody to the extracellular domain of LAR and found a 47% decrease in insulin receptor autophosphorylation and kinase activity. A physical association between LAR and the insulin receptor was then shown by immunoprecipitation of LAR from cell lysates and immunoblotting with antibody to the insulin receptor, or vice versa. Up to 11.8% of the LAR protein in the lysates of CHO cells overexpressing both the insulin receptor and LAR co-immunoprecipitated with the insulin receptor. The LAR/insulin receptor association was related to the level of LAR or insulin receptor overexpression and was increased 6.5-fold by chemical cross-linking and 3.9-fold by treatment with insulin, suggesting that receptor activation influences the affinity of LAR for the insulin receptor. In insulin-stimulated rat liver, LAR was temporally enriched in endosomes with the insulin receptor, and incubation of endosomes with neutralizing LAR antibodies decreased insulin receptor dephosphorylation in situ by 28% (p = 0.01 versus control). These data provide more direct evidence of a role for LAR in the physiological regulation of insulin action at the receptor level.
Animals↗
Improved sensitivity to insulin in obese subjects following weight loss is accompanied by reduced protein-tyrosine phosphatases in adipose tissue.
Insulin resistance in adipose tissue in human obesity is associated with increased protein-tyrosine phosphatase (PTPase) activity and elevated levels of the PTPases leukocyte common antigen-related PTPase (LAR) and PTP1B. To determine whether the improved insulin sensitivity associated with weight loss in obese subjects is accompanied by reversible changes in PTPases, we obtained subcutaneous adipose tissue from seven obese subjects (mean body mass index [BMI], 40.4 kg/m2) before and after a loss of 10% of body weight and again after a 4-week maintenance period. Weight loss was accompanied by an 18.5% decrease in overall adipose tissue PTPase activity (P = .015) that was further reduced to 22.3% of the control value (P = .005) at the end of the maintenance period. By immunoblot analysis, the abundance of LAR was decreased by 21% (P = .04) and abundance of PTP1B was decreased by 40% (P < .004) after the initial weight loss, and the decreases persisted during the maintenance period. Enhanced insulin sensitivity following weight loss, evident from a 26% decrease in fasting insulin levels (P < .05), was also closely correlated with the reduction in the abundance of both LAR (R2 = .80, P < .01) and PTP1B (R2 = .64, P = .03). These results support the hypothesis that LAR and PTP1B may be reversibly involved in the pathogenesis of insulin resistance, and may be therapeutic targets in insulin-resistant states.
Adipocytes↗
Dexamethasone, OB gene, and leptin in humans; effect of exogenous hyperinsulinemia.
This study was undertaken to investigate temporal association between dexamethasone administration, OB gene expression, and leptin response in humans in the presence and absence of exogenous hyperinsulinemia. Six healthy males (age 24.5 +/- 1.0 yr, body mass index 26.4 +/- 1.0, body fat 16.2 +/- 1.8%) received 10 mg oral dexamethasone in five divided doses twice (protocols A and B) 1-2 weeks apart beginning at 0800 h on day 1 and ending at 0700 h on day 2. The dexamethasone administration was combined with two subcutaneous abdominal fat biopsies performed at 0800 h before and after dexamethasone administration (protocol A), or 4-h isoglycemic hyperinsulinemic (300 mU/m2 BSA/min, protocol B) clamp carried out between 0900 and 1300 h on day 2. OB gene expression (protocol A) did not change. In both protocols on day 2, the 0800 h leptin levels nearly doubled (P < 0.001), whereas 1300 h levels nearly quadrupled (P < 0.001). The elevation in leptin persisted until 0800 h of day 3 (24 h after last dexamethasone dose) with its subsequent rapid normalization. The short-term isoglycemic hyperinsulinemia (protocol B) had no additional effect on the postdexamethasone leptin response. We summarize that: 1) 24-h administration of dexamethasone has a marked stimulatory effect on circulating leptin levels but not on OB gene expression in the subcutaneous abdominal fat. 2) The effect is sustained for the next 24 h. 3) Short-term hyperinsulinemia has no additional effect. We conclude that dexamethasone is a powerful stimulator of leptin production in vivo through a mechanism that appears to be independent of OB gene transcription in the human subcutaneous abdominal fat.
Adipose Tissue↗
Effect of tumor necrosis factor-alpha on the phosphorylation of tyrosine kinase receptors is associated with dynamic alterations in specific protein-tyrosine phosphatases.
Tumor necrosis factor-alpha (TNF-alpha) can modulate the signalling capacity of tyrosine kinase receptors; in particular, TNF-alpha has been shown to mediate the insulin resistance associated with animal models of obesity and noninsulin-dependent diabetes mellitus. In order to determine whether the effects of TNF-alpha might involve alterations in the expression of specific protein-tyrosine phosphatases (PTPases) that have been implicated in the regulation of growth factor receptor signalling, KRC-7 rat hepatoma cells were treated with TNF-alpha, and changes in overall tissue PTPase activity and the abundance of three major hepatic PTPases (LAR, PTP1B, and SH-PTP2) were measured in addition to effects of TNF-alpha on ligand-stimulated autophosphorylation of insulin and epidermal growth factor (EGF) receptors and insulin-stimulated insulin receptor substrate-1 (IRS-1) phosphorylation. TNF-alpha caused a dose-dependent decrease in insulin-stimulated IRS-1 phosphorylation and EGF-stimulated receptor autophosphorylation to 47-50% of control. Overall PTPase activity in the cytosol fraction did not change with TNF-alpha treatment, and PTPase activity in the particulate fraction was decreased by 55-66%, demonstrating that increases in total cellular PTPase activity did not account for the observed alterations in receptor signalling. However, immunoblot analysis showed that TNF-alpha treatment resulted in a 2.5-fold increase in the abundance of SH-PTP2, a 49% decrease in the transmembrane PTPase LAR, and no evident change in the expression of PTP1B. These data suggest that at least part of the TNF-alpha effect on pathways of reversible tyrosine phosphorylation may be exerted through the dynamic modulation of the expression of specific PTPases. Since SH-PTP2 has been shown to interact directly with both the EGF receptor and IRS-1, increased abundance of this PTPase, may mediate the TNF-alpha effect to inhibit signalling through these proteins. Furthermore, decreased abundance of the LAR PTPase, which has been implicated in the regulation of insulin receptor phosphorylation, may account for the less marked effect of TNF-alpha on the autophosphorylation state of the insulin receptor while postreceptor actions of insulin are inhibited.
Animals↗