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Insulin therapy does not diminish beta-cell damage in the neonatal streptozotocin-injected rat.

In recent years it was suggested that in type 2 diabetes mellitus glucose exerts a direct toxic effect: the hyperglycaemic state itself could contribute to the defects in insulin secretion. We studied the effects of insulin treatment on pancreatic insulin content in neonatal Wistar rats made hyperglycaemic with streptozotocin (SZ, 90 mg/kg, injected intraperitoneally at two days of age). Our hypothesis was that normoglycaemia effected by insulin treatment could diminish the beta-cell damage in these animals. Insulin-treated animals received Lente MC insulin (8 mU/g body weight/day) during the first six days after SZ-injection. At four days of age, blood glucose levels (BG) in the fed state were 5.9 +/- 1.0 mmol/l in control animals (n = 14), whereas all untreated SZ-animals (n = 10) showed BG above 11 mmol/l (mean 15.9 +/- 3.4 mmol/l). In all 11 insulin-treated SZ-animals BG was below 10 mmol/l (mean 4.3 +/- 2.7 mmol/l). At 10 days of age plasma insulin levels did not differ between the three groups. However, pancreatic insulin content was 114 +/- 37 ng/mg tissue in the insulin-treated, and 93 +/- 34 ng/mg tissue (p = ns) in the untreated SZ-animals, compared to 516 +/- 257 ng/mg tissue in the controls (p less than 0.001). BG at four days and the pancreatic insulin contents at 10 days were not correlated. We conclude that intraperitoneal streptozotocin injection in neonatal rats produced marked hyperglycaemia and reduction of pancreatic insulin content. Insulin treatment did not result in improved recovery of the insulin stores in the pancreas. Thus, the additive toxic effect of hyperglycaemia on the beta-cells could not be demonstrated.

Animals↗

Reversible phenotypic modulation induced by deprivation of exogenous essential fatty acids.

Essential fatty acid deficiency, produced by deprivation of omega-6 and omega-3 fatty acids, is a condition characterized by renal disease, dermatitis, and infertility. Although many of the biochemical aspects of this disorder have been investigated, little is known about the ultrastructural changes induced by essential fatty acid deficiency. Using a unique fatty acid-deficient cell line (EFD-1), which demonstrates the in vivo fatty acid changes of essential fatty acid deficiency, and the prostaglandin E2-producing mouse fibrosarcoma line from which it was derived (HSDM1C1), we correlated ultrastructural and biochemical changes induced by prolonged deprivation of all exogenous lipids and subsequent repletion of selected essential fatty acids. We found that in cells deprived of all exogenous lipids, there was dilation of rough endoplasmic reticulum and an associated defect in protein secretion; these changes were specifically reversed by arachidonate. There was also an accumulation of secondary lysosomes containing degraded membranes in these cells with an associated increase in phospholipids relative to parent HSDM1C1 cells. Cytoplasmic lipid bodies present in parent cells disappeared, with an associated decrease in triacylglycerol. After just 2 days in lipid-free medium, all these changes were apparent, and prostaglandin E2 production was markedly impaired despite normal amounts of cellular arachidonate. Incubation of EFD-1 cells with arachidonate, the major prostaglandin precursor fatty acid, induced a reversion to the HSDM1C1 phenotype, whereas other fatty acids were totally ineffective. These results indicate changes in fatty acid metabolism in essential fatty acid deficiency are associated with marked alterations in ultrastructure and secretion of protein from cells.

Animals↗

Isolated vitamin E deficiency in the absence of fat malabsorption--familial and sporadic cases: characterization and investigation of causes.

We observed four young adults, including three siblings, with a progressive neurologic disorder that developed over the first two decades. Electrophysiologic studies revealed mildly delayed nerve conduction, decreased amplitudes of sensory action potentials, and sensory delay in the posterior columns. Known causes of similar neurologic disorders were excluded. Although vitamin E deficiency was well documented, intestinal absorption and plasma lipoprotein transport of vitamin E were normal. Incubation studies in vitro failed to identify a plasma factor causing destruction of circulating vitamin E. There was no clinical or laboratory evidence of steatorrhea caused by gastrointestinal, hepatic, or pancreatic disease. Plasma lipoproteins, apolipoprotein B, and adipose tissue fatty acid composition were normal. Oral vitamin E therapy restored serum levels to normal and caused neurologic improvement in two patients. We postulate that an inherited defect in hepatocyte secretion of vitamin E into lipoproteins may account for this disorder, which occurs in sporadic cases as well as in siblings.

Absorption↗

Physiopathological heterogeneity of the duodenal mechanisms that inhibit gastric acid secretion in duodenal ulcer patients.

The effect of duodenal acidification on pentagastrin-stimulated gastric acid secretion was studied in 43 duodenal ulcer patients and in 17 normal controls. Three types of responses were observed: group A, no inhibition of gastric acid secretion occurred in 17 (40%) ulcer patients and in three (18%) controls (p less than 0.05); group B, inhibition of gastric acidity occurred in seven (16%) ulcer patients and in 12 (71%) controls (p less than 0.05), and group C, retarded gastric acid inhibition occurred in 19 (44%) duodenal ulcer patients and in 2 (12%) controls (p less than 0.05). Secretin levels did not increase after duodenal acidification, the higher percentages of failure being observed in groups A and C (p less than 0.05). The pH of the duodenal aspirate was 4.9 +/- 2 and 7.7 +/- 1.4 in ulcer patients and controls, respectively (p less than 0.05), with the low levels being detected in groups A and C (4.7 +/- 2 and 5.3 +/- 2.1) compared to group B (7.3 +/- 1.7; p less than 0.05). The results show that responses of duodenal ulcer patients to duodenal acidification are heterogeneous, and that failure of gastric secretion inhibition and defective intraduodenal acid neutralization are related.

Adult↗

Effects of chronic hemodialysis on thyroid function in chronic renal failure.

Thyroid function was studied in 54 patients undergoing chronic hemodialysis. Serum thyroxine, triiodothyronine and free thyroxine and the free thyroxine index were significantly lower than normal. The levels of both serum thyroxine and the free thyroxine index tended to fall progressively the longer the patients were on hemodialysis. These findings, in association with low serum TSH levels and normal increase in radioactive iodine uptake by the thyroid after TSH injection, suggest that a defect in pituitary secretion of TSH may be responsible. Although some patients experienced symptomatic improvement after treatment with L-thyroxine the efficacy of this form of treatment in patients on chronic hemodialysis has not yet been established.

Adolescent↗

The Somogyi phenomenon. Sacred cow or bull?

Posthypoglycemic hyperglycemia (Somogyi phenomenon) occurs infrequently in insulin-treated diabetic patients. When it occurs it is often in children and adolescents, or patients with a short duration of diabetes. Marked hyperglycemia (greater than 220 mg/dL) after hypoglycemia results from a large meal to relieve the symptoms of hypoglycemia. Posthypoglycemic hyperglycemia correlates with falling plasma insulin levels, rather than increasing concentrations of counterregulatory hormones, whose secretion may be defective. Asymptomatic nocturnal hypoglycemia is common but subsequent fasting hyperglycemia is not necessarily the result of "rebound." More likely, fasting hyperglycemia is due to a falling predawn insulin level. Nocturnal hypoglycemia is dealt with by a readjustment in the timing and dose of insulin. The failure of the Somogyi phenomenon to occur puts insulin-dependent diabetic patients at increased risk to potential lethal consequences of nocturnal hypoglycemia.

Adolescent↗

Spontaneous diabetes mellitus in the New Zealand white rabbit: preliminary morphologic characterization.

Electron microscopic studies on a closed colony of rabbits with an 18.5 per cent incidence of spontaneous onset insulin-dependent diabetes mellitus revealed that the beta-cells of the islets of Langerhans of the diabetic animals were hypergranulated. This finding contrasts with most other animal models of spontaneous diabetes mellitus which show degranulation of the beta-cells. There was no evidence of hyperplasia, insulitis, amyloid, or fibrosis of the islets by either light or electron microscopy. Correlation of our morphologic findings with physiologic data suggests a defect in insulin secretion. Rabbits with normal glucose metabolism showed a normal degree of granulation of their beta-cells. The alpha and delta cells were within normal limits in all animals. No other abnormalities associated with diabetes in humans or other animals were noted except for minimal fusion of the glomerular epithelial foot processes and mineralization of the proximal tubules and Bowman's capsules.

Animals↗

Mechanism of postprandial hyperglycaemia in diabetes mellitus.

Abnormalities of hepatic and extrahepatic tissues combine to produce the postprandial hyperglycaemia characteristic of non-insulin-dependent diabetes mellitus. The altered metabolic responses are primarily due to defects in insulin secretion and action. Other regulators of carbohydrate metabolism also contribute to the altered milieu.

Diabetes Mellitus, Type 2↗

[The cystic fibrosis gene, its product CFTR protein and its mutations].

Cystic fibrosis (CF) is a fatal genetic disease primarily affecting Caucasians. Its etiology is complex, but it is chiefly a disease of electrolyte transport characterized by defects in fluid secretion by several epithelia. In this review are analyzed the data obtained since the cloning of the CF gene and the characterization of its product, the CF transmembrane conductance regulator (CFTR) protein, which has been shown to act like a cAMP-regulated chloride channel. This protein is a member of a family of ATP-binding proteins that are membrane-spanning, are found in a number of prokaryotic and eucaryotic cells, and have two ATP-binding domains. Unique to this family of proteins, the CFTR possesses an additional highly charged domain (the R domain). The majority of CF chromosomes (70%) have a single Phenylalanine codon deletion at position 508 of the protein (delta F508). A large number of other rare mutations (more than 230) have also been identified. This rapid accumulation of data is essential to genetic diagnosis and will aid in understanding the structure and function of the protein.

Cystic Fibrosis↗

Serotonergic mechanisms in heart failure.

A total of 29 subjects were studied which included 18 heart failure and 11 matched control cases. The underlying heart disease in heart failure cases was mostly chronic rheumatic valvular disease. The diagnosis of heart disease and heart failure was made on the basis of clinical examination, supplemented by electrocardiography, chest skiagram and echo cardiography. The serotonin status was assessed by measuring platelet serotonin uptake, intraplatelet serotonin content and whole blood 5-hydroxytryptamine (5-HT) levels. Blood platelet count was also done. In heart failure cases, platelet count were significantly less, the platelet 5-HT uptake and blood 5-HT levels remain unaltered. These findings indicate that platelet pool of serotonin does not contribute to raised serotonin blood levels in heart failure. The high blood serotonin levels may be due to either clearance defect or enhanced secretion from the gut or both. The altered serotonin kinetics in platelets also indicate a state of platelet activation in heart failure.

Adult↗

[Relationship of the renin-angiotensin-aldosterone system with auricular natriuretic factor in its response to the action of thiazide diuretics and to nifedipine, a sustained-release calcium antagonist].

BACKGROUND: Blood pressure (BP) response to diuretics may be considered as an index of salt-sensitivity. Salt-sensitive patients may have an enhanced response to calcium channel blockers. In this study we correlate the basal values of two of the hormonal systems involved in the control of Na balance comparing them with the antihypertensive effects of a calcium channel blocker and a diuretic, to assess if BP response depends of a particular hormonal pattern by which we could define salt-sensitive patients. METHODS: We studied 21 essential hypertensive patients in a lineal sequence in an open protocol, first treated with slow release nifedipine (Nif-30), 30 mg daily, as a single dose, for 30 days, followed by amiloride+hydrochlorothiazide (HCT+Am), 50 mg and 5 mg, daily, for another month. Plasma renin activity (PRA), plasma aldosterone (PAld) and 24 hours urinary aldosterone (UAld) and atrial natriuretic factor (ANF), were measured at the start and end of the study. The hormonal values on each group were compared and correlated with changes observed in BP at the end of each period of treatment. RESULTS: HCT+Am decreased median arterial pressure (MAP) from 121.4 +/- 11 to 110.4 +/- 8 mmHg and Nif-30 to 108.7 +/- 12.4 mmHg, both p < 0.0004. There were 76% controlling MAP with Nif-30 whereas 48% did so with HCT+Am, p < 0.01, HCT+Am also increased PRA, PAld and decreased ANF, Ca urinary excretion and plasma PTH. Nif-30 did not alter the renin-angiotensin-aldosterone system, nor ANF. PTH remained unchanged. The MAP decrement caused by HCT+Am depended on baseline BP, r = -0.69, p < 0.0005, whereas Nif-30 decreased MAP independent from its baseline values, r = -0.02, NS. PAld showed a reverse correlation with ANF after treatment, r = -0.43, p < 0.05. The decrease of MAP holds a reverse relationship with ANF, both with HCT+Am, r = -0.47, p < 0.02, and with Nif-30, r = -0.45, p < 0.04. CONCLUSIONS: Treatment with Nif-30 was superior to HCT+Am in number of patients controlled, but the decrease in MAP is similar. Since the antihypertensive response to diuretic therapy and to calcium channel-blockers is related to low levels of ANF this fact could indicate some sort of defect of ANF secretion.

Aldosterone↗

[Growth retardation after irradiation of a chordoma of the clivus].

In a seven year old boy a chordoma of the clivus has been treated by X-ray therapy after partial neurochirurgical resection. A recurrence of the tumor is noted 10 years after at the the border of the X-ray field. The final size of the sexually mature boy is -- 4 DS below the mean with a complete defect in GH secretion after arginin and insulin stimulation. TSH secretion insuficiency and high HPr levels are shown by TRH stimulation test. The length of survey in this particular case has allowed the demonstration of severe stunting growth which is in part a consequence of hypothalamo-pituitary axis irradiation.

Child, Preschool↗

Diabetes insipidus.

Diabetes insipidus, characterized by the excretion of copious volumes of unconcentrated urine, results from a deficiency in the action of the antidiuretic hormone arginine vasopressin and can be caused by any of four fundamentally different defects, including impaired secretion (neurohypophyseal diabetes insipidus), impaired renal response (nephrogenic diabetes insipidus), excessive fluid intake (primary polydipsia), or increased metabolism of the hormone (gestational diabetes insipidus). Differentiation between their causes, pathophysiology, and treatment methods is essential for effective management and is best achieved by a combination of hormonal, clinical, and neuroradiologic observations. Understanding of the genetic forms has advanced greatly and may soon lead to improved methods of prevention, diagnosis, and treatment.

Diabetes Insipidus↗

Obesity and insulin resistance in Swedish subjects.

Insulin resistance and secretory defects seem to be present in Swedish obese elderly, NIDDM subjects. A defect in insulin secretion seems to dominate in lean elderly male Swedish subjects with NIDDM. Furthermore, TNF alpha expression and secretion are increased in adipose tissue from obese subjects and correlates with insulin resistance roughly measured as elevated fasting plasma insulin in spite of normal fasting blood glucose.

Adipose Tissue↗

Non-insulin dependent diabetes--the past, present and future.

Diabetes, known since antiquity, has been defined by glycosuria. In 1886, when Minkowski demonstrated that pancreatectomized dogs developed diabetes, the islets of Langerhans became a focus of the search for an active principle culminating in the discovery and the isolation of insulin in 1921 by Banting, Best and Collip. In 1959, the radioimmunoassay of Yalow and Berson solidified the concept of insulin resistance in non-insulin dependent diabetes (NIDDM). In 1971, the insulin receptor was defined as a cell surface protein that initiated the insulin signal transduction cascade. Today, we know that NIDDM accounts for at least 90% of all diabetes worldwide and involves approximately 100 million people. The microvascular complications of NIDDM are the same as for insulin dependent diabetes (IDDM) and are related to the intensity and duration of hyperglycaemia. Further, it is clear from the Diabetes Control and Complications Trial (DCCT) that all microvascular complications can be reduced with intensive control of the blood glucose. Macrovascular disease is also accelerated in NIDDM, including both hypertension and dyslipidemia. The major risk factor for NIDDM are age, obesity, physical inactivity, and genetic background. The earliest features seen in individuals destined to develop NIDDM is insulin resistance, but for hyperglycaemia to ensure there must be a defect in insulin secretion. Thus, insulin resistance defines the prehyperglycaemic phase of NIDDM, but varying degrees of insulin secretory deficiency define the hyperglycaemic phase. Macrovascular risk occurs throughout the lifetime of the individual, whereas microvascular risk ensues with the inception of hyperglycaemia. Tomorrow, we will understand more clearly whether lifestyle changes, such as diet and exercise, or new classes of drugs, can delay or prevent NIDDM. Clinical trials are now beginning to test whether impaired glucose tolerance (IGT) can be delayed or prevented from moving to overt NIDDM. The genetics of NIDDM are under intense study. Mutations in the insulin receptor lead to NIDDM in a small number of patients, and mutations in the glucokinase gene lead to maturity onset diabetes of the young (MODY). Work is now underway to study other candidate genes as well as work on positional cloning techniques to identify diabetes genetic loci. The hormone Leptin has just been discovered and is a major regulator of body weight. In summary, the most important new emphasis on the treatment of NIDDM is the recognition of the importance of hyperglycaemia and our ability to both treat and possibly prevent this metabolic perturbation. This joins the longer-term emphasis on cardiovascular risk reduction from both treatment and prevention of hypertension and dyslipidemia.

Animals↗

[Thyrotropic deficiency].

Central hypothyroidism (thyrotropic deficiency) is due to a defect in TSH secretion by thyrotrophs (or alternatively to an altered bioactivity of TSH). Central hypothyroidism is rare and is often associated with other pituitary deficiencies as it is generally encountered in case of hypothalamo-pituitary tumoral process. Clinical symptoms are milder than those of primary thyroid failure. Diagnosis is based on free T4 measurement whose level is decreased while TSH concentration is normal or minimally increased, reflecting an alteration in the bioactivity of TSH. Replacement therapy is monitored by T4 level measurement: the objective is to obtain normal T4 levels. TSH concentration must not be taken into account for the adjustment of the thyroxine doses.

Humans↗

Induction of a cAMP-stimulated chloride secretion in regenerating poorly differentiated airway epithelial cells by adenovirus-mediated CFTR gene transfer.

In cystic fibrosis (CF), the airway epithelium is in the process of injury and regeneration. In the context of the CF gene therapy, we previously reported that regenerating poorly differentiated (PD) cells of human airway epithelium represent preferential cell targets for recombinant adenoviral gene vectors. To define whether PD non-CF and CF epithelial cells possess a functional cystic fibrosis transmembrane conductance regulator protein (CFTR) chloride channel, we analyzed the CFTR expression and the regulation of chloride secretion under cyclic (c)AMP stimulation in these regenerating PD epithelial cells of non-CF and CF airway tissue. Moreover, we studied the effects of CFTR gene transfer mediated by a replication-defective adenovirus containing the wild-type CFTR gene (AdCFTR) on CFTR expression and on cAMP-stimulated chloride secretion. Distribution of the CFTR protein was evaluated in regenerating PD airway cells by light fluorescence microscopy and scanning laser confocal microscopy. The cAMP-mediated regulation of cell membrane chloride secretion was investigated using the whole-cell patch clamp and SPQ (6-methoxy-N-[3-sulfopropyl]quinolinium) techniques. Compared with the absence of CFTR expression and cAMP-regulated chloride secretion in nontransduced regenerating PD cells of either non-CF or CF origin, transduction with AdCFTR induces a CFTR expression and a cAMP-regulated stimulation of the cell membrane chloride secretion in the regenerating PD cells. These results suggest that, out of the context of CF, remodeled and poorly differentiated airway epithelium may present abnormalities in ion transport. Moreover, our data suggest that, in the context of CF gene therapy, adenoviral vectors can be efficient in correcting, at least partially, the chloride secretion defect in the remodeled CF airway epithelium.

Adenoviridae↗

Effect of hormone replacement therapy on insulin secretion and insulin sensitivity in postmenopausal diabetic women.

The aim of the present study was to evaluate the effect of three different combinations of hormone replacement therapy (HRT) on insulin secretion, peripheral insulin sensitivity, serum lipid levels and parameters of oxidative stress. Seven type II diabetic women of mean age 55.4 +/- 4.7 years, who had been menopausal for an average of 5 years, were enrolled in the study. Phases of insulin secretion--first (FPIS) and second (SPIS)--and the area under the curve (AUC) for insulin secretion were studied during an intravenous glucose tolerance test (IVGTT). Insulin sensitivity was determined using the manual euglycemic-hyperinsulinemic clamp technique. Three different HRT combinations were applied consecutively for 3-month periods: estradiol valerate plus cyproterone acetate (Climen); transdermal 17 beta-estradiol (System TTS 50) plus dydrogesterone (Duphaston) 10 mg daily for 10 days a month; oral 17 beta-estradiol plus dydrogesterone (Femoston) for 14 days a month. A group of nine women with normal glucose tolerance (according to World Health Organization criteria during a 75-g oral glucose tolerance test (OGTT)), of mean age 50.1 +/- 8.2 years and mean body mass index 24.60 +/- 2.01 kg/m2, were also studied, and served as a control group. Insulin secretion improved significantly after Climen: FPIS increased by 16% and SPIS by 44%. Insulin sensitivity increased by 50% after Systen TTS 50 + Duphaston; fasting hyperinsulinemia was normalized and total antioxidant capacity of the serum (TAOCS) was significantly raised (p < 0.01). Femoston led to an increase in insulin sensitivity (by 23%) and in TAOCS (p < 0.05), while fasting hyperinsulinemia remained unchanged. HRT should be prescribed in type II diabetic postmenopausal women because of its favorable effect on existing pathophysiological defects. Cyproterone acetate should be preferred in cases with a predominant beta-cell insulin secretion defect, while dydrogesterone in combination with a transdermal estrogen should be recommended in cases with leading insulin resistance.

Administration, Cutaneous↗