Drug treatment for diabetes in nursing home residents

AIMS

The aim of this study was to describe drug treatment for diabetes in a large sample of nursing home residents and to compare subjects' health outcomes according to the anti-diabetic agents used.

METHODS

The cross-sectional data of 6275 residents [average age 86 years (± 8.2); 73.7% women] from 175 nursing homes in France were analysed. Participants were divided into one of the following four groups: diabetes non-drug treatment, diabetes hypoglycaemic (e.g. insulins, sulphonylurea) treatment, diabetes non-hypoglycaemic (e.g. metformin) treatment and no diabetes. Group comparisons were made on functional ability (activities of daily living score) and on the prevalence of the following variables (yes vs. no): emergency department visits, falls and fractures.

RESULTS

Of the participants, 1076 (17.1%) had diabetes: 222 participants in the non-drug treatment group, 722 in the hypoglycaemic group and 132 in the non-hypoglycaemic group. The remaining 5199 participants made up the group without diabetes. Insulin and metformin were used by 549 and 185 participants, respectively. Activities of daily living scores differed across the four groups, with those in the non-drug treatment group being the most disabled. Adjusted multivariate analyses showed that, compared with the group without diabetes, those in the hypoglycaemic group had a higher probability of emergency department visits (odds ratio 1.26, 95% CI 1.03-1.54) and increased the incidence rate ratios (1.02, 95% CI 1.00-1.04) of disability (activities of daily living score), whereas the non-hypoglycaemic group was not significantly associated with these outcomes.

CONCLUSIONS

The use of hypoglycaemic drugs was associated with poor health outcomes in nursing home residents. Therefore, more attention must be paid to adapting anti-diabetic treatment in this complex population.

Phosphodiesterase-4 inhibition improves corticosteroid insensitivity in pulmonary endothelial cells under oxidative stress

BACKGROUND

Several clinical studies have shown that smoking in asthmatics and chronic obstructive pulmonary disease patients is closely associated with corticosteroid refractoriness. In this work, we have analyzed glucocorticoid insensitivity in human pulmonary artery endothelial cells (HPAECs) under cigarette smoke extract (CSE) exposure as well as the possible additive effects of the combination therapy with a phosphodiesterase (PDE)-4 inhibitor.

METHODS

Interleukin (IL)-8 was measured in cell supernatants by ELISA. Histone deacetylase (HDAC), histone acetylase (HAT), and intracellular cAMP levels were measured by colorimetric assays and enzyme immunoassay, respectively. PDE4 isotypes and glucocorticoid receptor (GR)-α and β expression were measured by real-time RT-PCR.

RESULTS

The PDE4 inhibitor rolipram dose dependently inhibited the IL-8 secretion induced by CSE 5%. In contrast, dexamethasone 1 μM did not show inhibitory effect on IL-8 secretion. Combination of subeffective rolipram concentrations at 10 nM increased the inhibitory effect of dexamethasone to ~45% of inhibition. Cigarette smoke extract 5% inhibited HDAC activity and increased HAT activity generating glucocorticoid insensitivity. Rolipram did not modify the HDAC activity, however partially inhibited the increase in HAT activity at 1 μM. PDE4 isotypes were up-regulated by CSE 5% with the consequent cAMP down-regulation. Dexamethasone reduced all PDE4 isotypes expression and showed additive effects with rolipram enhancing cAMP levels. Furthermore, rolipram enhanced GR-α expression and inhibited the increase in GR-β induced by CSE.

CONCLUSIONS

Combination of rolipram and dexamethasone shows additive properties in HPAECs under glucocorticoid insensitive conditions. These results may be of potential value in future anti-inflammatory therapies using combination of PDE4 inhibitors and glucocorticoids.

Polymorphisms of the IL12B, IL1B, and TNFA genes and susceptibility to asthma

BACKGROUND

Asthma is one of the most common chronic inflammatory diseases in developed countries. Susceptibility to asthma is associated with interaction between multiple genes and environmental factors. Several cytokines play a major role in the pathophysiology of the disease.

OBJECTIVE

We analyzed the distribution of cytokine gene polymorphisms in a group of patients with asthma and a control group in order to determine the effect of these variants, or their combinations, on the development of clinical phenotypes.

METHODS

We genotyped 22 single-nucleotide polymorphisms (SNPs) corresponding to 13 cytokine genes (IFNG, IL1A, IL1B, IL1R1, IL1RN, IL2, IL4, IL4R, IL6, IL10, IL12B, TGFB1, and TNFA) in 376 individuals (219 asthmatic patients and 157 controls). Genetic association was evaluated using genotype and allele models for different asthma phenotypes. Gene-gene interactions were explored using multifactor dimensionality reduction.

RESULTS

Genotype AC of IL12B-1188 was associated with the presence of asthma. A significant association was detected between 2 SNPs analyzed in TNFA (-308 and -238) and atopic asthma and severe-persistent asthma. The IL1B TT haplotype (3962T and -511T) was also associated with atopy and moderate-persistent asthma.

CONCLUSION

Our data show that the presence of SNPs in IL12B, TNFA, and IL1B was significantly associated with asthma, atopy, and severity of asthma.We also highlight the importance of genetic context, haplotype, and gene-gene interaction analysis in genetic association studies.

Tryptase: genetic and functional considerations

Tryptase is one of the main proteases located in the secretory granules of the mast cells, and is released through degranulation. It is therefore assumed to play an important role in inflammatory and allergic processes. Four genes are known to encode for these enzymes, with different alleles that give rise to different types of tryptases. The term "tryptase" generally refers to β-tryptase, which in vivo is a heterotetramer, possessing a structure of vital importance for enabling drug and substrate access to the active site of the molecule. Tryptase has been reported to possess antagonistic functions, since it plays an important role both in inflammatory phenomena and as a protector against infection. In allergic processes it is associated to bronchial hyperresponsiveness in asthmatic patients, where PAR-2 is of great importance as an airway receptor. Lastly, the genes that encode for tryptase are highly polymorphic and complex. As a result, it is important to establish a relationship between genotype and phenotype in disorders such as asthma, and to identify mutations that are presumably of pharmacological relevance.

Conventional versus Rosemont endoscopic ultrasound criteria for chronic pancreatitis: interobserver agreement in same day back-to-back procedures

BACKGROUND AND STUDY AIMS

Endoscopic ultrasound (EUS) is a commonly used and fairly sensitive method of assessing changes of chronic pancreatitis (CP) when routine noninvasive imaging has not shown overt features of CP. The aim of this study is to evaluate the interobserver agreement (IOA) for the classic (MSC) and the Rosemont (RC) criteria for the diagnosis of chronic pancreatitis on the basis of clinical practice.

PATIENTS AND METHODS

Two experienced endosonographers evaluated on the same day patients referred for EUS in a blinded fashion. Data from the sonographic criteria of both MSC and RC were collected. Agreement was calculated using k statistics.

RESULTS

A total of 69 patients were evaluated. The study population included mainly patients without pancreatic diseases, resulting in a low number of sonographic findings. Agreement for the final diagnosis was moderate for both classification systems of chronic pancreatitis (k = 0.53 for conventional and k = 0.46 for Rosemont).

CONCLUSIONS

The IOA of EUS in the diagnosis of CP is moderate. The concordance values obtained in clinical practice are similar to those obtained in multicenter studies. The RC does not seem to improve the IOA of MSC.

Genetic association study in nasal polyposis

BACKGROUND AND OBJECTIVES

Nasal polyposis (NP) is a chronic inflammatory disease of the upper airways with a variable clinical course and unknown pathogenesis that often coexists with other conditions. Considering the possibility of genetic predisposition, we decided to analyze whether polymorphisms in LTC4S, CYSLTR1, PTGDR, and NOS2A were associated with NP.

METHODS

The study population comprised 486 Caucasian individuals. Polyposis and aspirin intolerance were diagnosed following the recommendations of the European Position Paper on Rhinosinusitis and Nasal Polyps. Genotypes were determined using polymerase chain reaction amplification and direct sequencing.

RESULTS

The -444A > C LTC4S polymorphism was significantly associated with NP and atopy (P = .033) and with NP and atopic asthma, (P =.012). In addition, a significant association was found when the (CCTTT) repetition of the NOS2A gene was present more than 14 times in patients with NP and asthma (P = .034), in patients with polyposis and intolerance to nonsteroidal anti-inflammatory drugs (P = .009), and in patients with the aspirin triad (P = .005). The PTGDR diplotype CCCT/CCCC (-613CC, -549CC, -441CC and -197TC) was more frequent in patients with NP (P = .043), NP with asthma (P = .013), and the aspirin triad (P = .041).

CONCLUSIONS

NP was associated with specific polymorphisms only when it occurred with related phenotypes. Our results suggest that this genetic background plays a more relevant role in the development of the associated clinical features of nasal polyposis than in simple polyposis.

PTGDR gene in asthma: a functional, genetic, and epigenetic study

BACKGROUND

Asthma affects more than 300 million individuals in the world. Several studies have demonstrated the importance of the genetic component. The aim of this study is to develop a holistic approach, including genetic, epigenetic, and expression analysis to study the Prostaglandin D2 receptor gene (PTGDR) in asthmatic patients.

METHODS

In this study, 637 Caucasian individuals were included. Genetic variants were characterized by sequencing, and haplotype and diplotype combinations were established. Electrophoretic mobility shift assays (EMSAs) were performed with different promoter variants. An epigenetic analysis of PTGDR was for the first time developed by MassArray assays, and gene expression was determined by real-time polymerase chain reaction.

RESULTS

The -197T > C (Fisher's P = 0.028) and -613C > T (Fisher's P < 0.001) polymorphisms were found to be significantly associated with allergic asthma and allergy to pollen and mites, respectively. In addition, several haplotype and diplotype combinations were associated with different allergy and asthma phenotypes. The presence of the -613C > T SNP determined variations in the EMSAs. Moreover, consistent differences in the methylation and expression patterns were observed between asthmatic patients and controls determining a 2.34-fold increase of PTGDR gene expression in asthmatic patients.

CONCLUSIONS

Genetic combinations described have functional implications in the PTGDR promoter activity by changing the transcription factors affinity that will help characterize different risk groups. The differences observed in the transcription factors affinity and in the methylation pattern bring insight into different transcription regulation in these patients. To the best of our knowledge, this is the first work in which the implication of genetic and epigenetic factors of PTGDR has been characterized pointing to putative therapeutic targets.

Pre–release training of juvenile little owls Athene noctua to avoid predation

Anti–predator training of juvenile little owls was tested in a sample of recovered owls raised in captivity in Brinzal Owl Rescue Center (Madrid, Spain). Mortality caused by predators has been described previously in released individuals. Nine little owls were conditioned during their development to a naturalized goshawk and a large live rat, whose presence was paired to the owl’s alarm call. All nine owls and seven non–trained individuals were then released during the late summer and autumn and radio–tracked for six weeks to test their survival. In total 71.4% of the trained owls survived while only the 33.3% of the untrained group were alive at the end of week six. The only cause of death that was detected was predation. Antipredator training, therefore, seems to be beneficial in maximizing survival after the release of juvenile little owls.

Physical exercise for the prevention and treatment of type 2 diabetes

The prevalence of type 2 diabetes is rapidly increasing worldwide, yet its primary prevention and treatment are still a challenge. The objectives of this review are to assess the effects of exercise on the prevention of type 2 diabetes in high-risk individuals and on glycaemic control in type 2 diabetic patients. Considering the available reports, there is unequivocal and strong evidence that physical exercise can prevent or delay progression to type 2 diabetes in subjects with impaired glucose tolerance. Also, lifestyle interventions, including diet and physical exercise, can result in a reduction of around 50% in diabetes incidence that persists even after the individual lifestyle counselling has stopped. In addition, short-term randomized studies have confirmed that physical training based on endurance and/or resistance exercises can also improve blood glucose control in type 2 diabetics with a mean glycated haemoglobin decrease of 0.6%. Thus, physical exercise should be part of any therapeutic strategy to slow the development of type 2 diabetes in high-risk individuals and to improve glucose control in type 2 diabetes.

Signaling and biological effects of glucagon-like peptide 1 on the differentiation of mesenchymal stem cells from human bone marrow

Glucagon-like peptide 1 (GLP-1) functions as an incretin hormone with antidiabetogenic properties. However, the role of GLP-1 in human bone marrow-derived mesenchymal stem cells (hMSCs), if any, remains unknown. The effects of GLP-1 on hMSCs were tested with regard to cell proliferation, cytoprotection, and cell differentiation into adipocytes. The signaling pathways involved in these processes were also analyzed. Cells were characterized with biochemical and morphological approaches before and after being induced to differentiate into adipocytes. PCNA protein levels were used as a proliferation index, whereas cell apoptosis was studied by deprivation of fetal bovine serum. Isolated hMSCs expressed stem cell markers as well as mRNA and GLP-1 receptor protein. GLP-1 increased the proliferation of hMSCs, which decreased when they were induced to differentiate into adipocytes. This process produced biochemical and morphological changes in cells expressing PPARgamma, C/EBPbeta, AP2, and LPL in a time-dependent pattern. Notably, GLP-1 significantly reduced the expression of PPARgamma, C/EBPbeta, and LPL. These effects were exerted at least through the MEK and PKC signaling pathways. In addition, GLP-1 significantly reduced cell apoptosis. Our data indicate that, in hMSCs, GLP-1 promotes cellular proliferation and cytoprotection and prevents cell differentiation into adipocytes. These latter findings underscore the potential therapeutic role of GLP-1 in preventing the adipocyte hyperplasia associated with obesity and, additionally, could bolster the maintenance of hMSC stores by promoting the proliferation and cytoprotection of undifferentiated hMSC.

Diabetes is associated with a slower rate of cognitive decline in Alzheimer disease

BACKGROUND

Previous epidemiologic studies indicate that diabetes mellitus (DM) is associated with cognitive decline and an increased risk of developing Alzheimer disease (AD) in people who do not have dementia. However, little is known about the effect of DM on the rate of cognitive decline in established AD. Our objective was to determine whether DM influences the rate of cognitive decline in patients with AD.

METHODS

A total of 608 patients with a probable diagnosis of AD and a Mini-Mental State Examination (MMSE) score between 10 and 26 were enrolled in a prospective multicenter study. Participants were followed up to 52 (mean 26) months. DM was assessed at baseline (history of DM or antidiabetic medication use). Cognitive function was assessed twice yearly with the MMSE.

RESULTS

Sixty-three participants (10.4%) had DM at baseline. In a mixed model adjusted for sex, age, educational level, dementia severity, cholinesterase inhibitor use, and vascular factors (hypertension, atrial fibrillation, coronary heart disease, and hypercholesterolemia), there were no differences between the groups in MMSE baseline scores (-0.75, p = 0.20), but cognitive decline was slower in the group with DM (0.38, p = 0.01).

CONCLUSIONS

In a cohort of community-dwelling patients with Alzheimer disease (AD), the presence of diabetes mellitus (DM) was associated with a lower rate of cognitive decline. Future studies will need to address the potential impact of DM in the cerebral aging process and to assess the neuropathologic variations in patients with AD with DM.

Glucokinase and glucokinase regulatory proteins are functionally coexpressed before birth in the rat brain

Our previous description of functional glucokinase (GK) isoforms and their interactions with glucokinase regulatory protein (GKRP) in adult rat and human brains suggested that both participate in glucose sensing in the central nervous system. To determine whether both proteins are coexpressed and active before birth or during early post-natal life, we characterised these molecules in the brains of foetal and post-natal pup rats. We found GK and GKRP mRNAs that were similar to those previously reported in the adult rat brain. Likewise, GK and GKRP gene expression gave rise to proteins of 52 and 69 kDa, respectively. Immunohistochemistry experiments showed the colocalisation of both GK and GKRP proteins in the same brain cells of 21-day-old rat foetuses. Furthermore, coprecipitation of GK and GKRP in the presence of fructose 6-phosphate suggests interactions between both proteins. The presence of GK phosphorylating activity was detected in different brain areas of 21-day-old foetuses with a contribution to the total glucose-phosphorylating activity of between 17.2 +/- 1.7% and 12.4 +/- 3.7%, with the hypothalamus being the region of maximum activity. The hypothalamic GK activity in 21-day-old foetuses has a high apparent K(m) for glucose and no product inhibition by glucose 6-phosphate. Our findings indicate that both proteins may be functionally active before birth and that they can act within a glucose sensor system involved in controlling food intake.

Analysis of 927T > C CYSLTR1 and -444A > C LTC4S polymorphisms in children with asthma

INTRODUCTION

The cysteinyl leukotrienes (Cys-LTs) are potent inflammatory mediators in asthma. It has been suggested that the different response of patients to Cys-LTs inhibitors could be due to the presence of polymorphisms in the genes implicated in this pathway.

METHODS

In this study, polymorphisms 927T > C CYSLTR1 and -444A > C LTC4S were analysed in a Spanish population of 188 individuals (109 asthmatic children and 79 controls). Standardised history, skin prick tests and lung function measurements were performed in all patients. Genotypes were determined by sequencing after PCR amplification.

RESULTS

Differences were observed in 927T > C CYSLTR1, regarding the severity of asthma in males. A greater presence of allele C in the population with persistent asthma versus the control group (Fisher's p-value = 0.001; Monte Carlo p-value = 0.003; OR: 12.35; 95 %CI: 2.18-70.00) was observed. Differences were also detected in the combined study of both polymorphisms, among controls and asthmatic patients (Monte Carlo p-value = 0.0002). In the group of males with asthma, an increase of AC variant (-444A LTC4S and 927C CYSLTR1) and a reduction in the AT genetic combination were detected.

CONCLUSIONS

The combined study of polymorphisms in genes of the leukotriene pathway could explain the differences observed in the studies reported on polymorphism -444A < C LTC4S individually analysed.

Multiple endocrine neoplasia type 2a and germ line C634G RET mutation diagnosed in an 80-year-old patient

An 80-year-old man presented with progressive fatigue. Blood tests showed that serum calcium was increased (2.93 mmol/l, normal range 2.20-2.55 mmol/l) and serum concentration of intact parathyroid hormone (iPTH) inappropriately high (198 pg/ml, normal range 15-85 pg/ml). Neck ultrasonography and Tc-MIBI scintigraphy revealed a right parathyroid adenoma and a multinodular goiter. Serum calcitonin was significantly increased (220 pg/ml, normal range<10 pg/ml). Concomitantly, a chest-abdominal computed tomography was performed and revealed a 22 mm right adrenal incidentaloma. The urinary catecholamines and metabolites were two-fold above the upper limit of normal. After right adrenalectomy which confirmed the diagnosis of pheochromocytoma, the patient underwent total thyroidectomy with dissection of the central lymph node compartment and right parathyroidectomy. On histopathologic examination, both thyroid lobes presented 13 foci of MTC without lymph node metastasis and the parathyroid gland presented a benign adenoma without hyperplasia. The patient underwent screening and genetic testing revealing a germ line C634 G RET mutation. The diagnosis of Men2a at the age of 80 years and the absence of lymph node metastasis of the multiple MTC in a carrier of C634G mutation were unusual and argued for the possible role of genetic modifier(s) in this MEN 2a patient.