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PubMed2004

Noninvasive diagnosis of the 3243A > G mitochondrial DNA mutation using urinary epithelial cells.

The 3243A > G mutation is one of the most frequently observed mutations of mitochondrial DNA (mtDNA), and is associated with numerous clinical presentations including mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), progressive external ophthalmoplegia (PEO) and diabetes and deafness. The routine diagnosis of the 3243A > G mutation in blood is difficult as mutation levels are known to decrease in this tissue over time, while in some patients it may be absent. We have directly compared the levels of the 3243A > G mutation in skeletal muscle, blood and urinary epithelial cells in 18 patients and observed a striking correlation between the mutation load in postmitotic muscle and urinary epithelium, a mitotic tissue. These data strongly support the use of urinary epithelial cells as the tissue of choice in the noninvasive diagnosis of the 3243A > G mutation.

Blood Cells↗
PubMed1998

Autoimmune IDDM in a sporadic MELAS patient with mitochondrial tRNA(Leu(UUR)) mutation.

We report a 28-year-old young male with MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) presenting with two previous episodes of stroke-like manifestation, lactic acidosis and mitochondrial cardiomyopathy. He was also affected with insulin-dependent diabetes mellitus (IDDM), as diagnosed by the experience of diabetic ketoacidosis (DKA), and dependence on insulin therapy. On admission, the serum lactate level was found to be increased to 5.4 mmol/l, and plasma glucose level to 7.9 mmol/l with haemoglobin A1c 8.4%, while he was using insulin 26-30 units per day. Physical examination revealed a short stature male of height of 150 cm and weight of 49 kg. Mild mental retardation with bilateral sensorineural hearing impairment was observed. After glucagon stimulation, C-peptide levels rose from 0.46 nmol/l to 0.53 nmol/l, indicative of impaired insulin secretion. Anti-glutamate decarboxylase (anti-GAD) antibody was positive. In addition, human leucocyte associated antigen (HLA) typing showed DR3 and DR4, suggesting the strong contribution of autoimmunity to the pathogenesis of IDDM in this patient. Moreover, the result of a treadmill exercise test was positive due to inferior wall myocardial ischaemia. Cardiac catheterization and endomyocardial biopsy disclosed a normal coronary angiogram and confirmed the diagnosis of mitochondrial cardiomyopathy. Molecular genetic analysis of his family revealed a sporadic occurrence of mitochondrial DNA (mtDNA) mutation at base pair (bp) 3243. The degree of heteroplasmy of mtDNA mutation from a total of 19 passages of skin-derived fibroblasts from this patient showed a slightly downward trend. This extremely rare case of sporadic MELAS syndrome with autoimmune IDDM harbouring mtDNA mutation highlights the possible pathogenetic role of mtDNA mutations in autoimmune disease.

Adult↗
PubMed2003

Progression of chronic renal disease.

Risk factors for progression of kidney disease include hypertension, proteinuria, male sex, obesity, diabetes mellitus, hyperlipidemia, smoking, high-protein diets, phosphate retention, and metabolic acidosis. Angiotensin II production upregulates the expression of transforming growth factor-beta1, tumor necrosis factor-alpha, nuclear factor-kappaB, and several adhesion molecules and chemoattractants. In addition to angiotensin, other vasoactive compounds, such as thromboxane A(2), endothelin, and prostaglandins, are upregulated. Treatment with one of several growth factors may ameliorate the progression of kidney disease: insulin-like growth factor-1, hepatocyte growth factor, and bone morphogenetic protein-7.

Angiotensin II↗
PubMed1988

Catechol-o-methyl transferase activity in the human term placenta.

Catechol-O-methyltransferase (COMT) characteristics and activity were studied using radioenzymatic techniques in placentas from normal and high-risk patients at term. The affinity of the catechol estrogen 20-hydroxyestrone (2OHE1), Km = 5 microM, for the enzyme was found to be at least 90-fold higher than that of the catecholamines norepinephrine, epinephrine, and dopamine (450, 490, and 850 microM, respectively). The product formed after incubation of placental cytosol with tritiated 20HE1 was identified as being exclusively (3H) 2-methoxyestrone, by use of high-performance liquid chromatography. Placental COMT activity after normal spontaneous delivery was no different from that obtained after elective cesarean section (270 +/- 20 versus 275 +/- 27, expressed as mean +/- SE activity nanomoles of 2-methoxyestrone formed per hour/mg protein). Placental COMT activity at term in women with hypertension (toxemia [T] or chronic hypertension [CHBP]) was significantly lower than in control subjects (284 +/- 27 versus 183 +/- 26; P less than 0.05). No significant differences in enzyme activity were found between T and CHBP (175 +/- 37 versus 210 +/- 32, P = NS). There were also no differences in COMT activity of diabetic classes A-R (White classification), fetal distress (with or without acidosis), and controls. The possible interference of antihypertensive drugs used by the patients in the study on COMT activity was assessed. Incubations of healthy placental cytosol with hydralazine, methyldopa, and Mg++ in their estimated plasma therapeutic concentrations had no effect on placental COMT activity. The present study suggests that placental COMT activity is low in patients with hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1975

Lactic acidosis associated with phenformin therapy. Evidence that inhibited lactate oxidation is the causative factor.

Using uniformly labeled 14C L-lactate, we have studied the turnover and oxidation of lactic acid in a patient who presented with a mild lactic acidosis while on phenformin medication. As with other cases of lactic acidosis associated with phenformin therapy, this subject had impaired renal function as evidenced by serum creatinine levels of 2 mg./100 ml. and BUNs of 40 mg./100 ml. Comparison of the rate of lactate oxidation relative to the rate of lactate turnover in this subject while on and off phenformin therapy suggests that a prime factor leading to the elevated lactate levels in this situation in impaired peripheral aerobic metabolism. Although lactate oxidation was increased in the presence of phenformin, the control studies clearly demonstrate that aerobic metabolism was not keeping pace with the increased level of anaerobic carbohydrate metabolism brought on by the drug. It is concluded that it is this imbalance in lactate metabolism that is responsible for the lactic acidosis that accompanies phenformin therapy.

Acidosis↗
PubMed1996

Phenformin-associated lactic acidosis due to imported phenformin.

OBJECTIVE: To emphasize the continued incidence of phenformin-associated lactic acidosis. CASE REPORT: We report a case of phenformin-associated lactic acidosis in a Chinese man who received phenformin while in China. Diagnosis was made; the patient was treated appropriately and survived. COMMENTS: Phenformin-associated lactic acidosis may still occur in the U.S.

Acidosis, Lactic↗
PubMed1976

Possible side effects of glucose, fructose, sorbitol and xylitol in man.

It is concluded that there are no specific and dramatic side effects of glucose substitutes, apart from the increase in uric acid synthesis. All other side effects are noticed with glucose as well. The danger of lactic acidosis is not indicated, provided a normal dose of fructose or other carbohydrates is used. With respect to sorbitol and xylitol, lactic acidosis was not considered a serious side effect until now. No facts are known to establish the hepatotoxicity for fructose or for another glucose substitute. The danger of hyperglycemia is smaller with the glucose substitutes as compared to glucose. Therefore, the glucose substitutes are an alternative to glucose under certain conditions.

Acidosis↗
PubMed1985

[Alcohol and metabolic disorders].

Alcohol can cause disturbance in the main metabolic pathways. Alterations of glycoregulation are particularly frequent in chronic alcoholics as well as disorders of lipoprotein. Other biochemical abnormalities affect protein, vitamins and trace elements. But it is often difficult to decide the extent these abnormalities are the result of the direct toxic effect of alcohol or secondary to organ damage.

Acidosis↗