Insulin sensitivity, insulin secretion, and glucose tolerance versus intima-media thickness in nondiabetic postmenopausal women

To study the association between insulin sensitivity and secretion vs. early manifestations of atherosclerosis, we performed a 5-yr prospective study in 84 nondiabetic, postmenopausal women, aged 58.7 +/- 0.4 yr (mean +/- SD). Insulin sensitivity was measured with the euglycemic, hyperinsulinemic clamp, and insulin secretion was measured as the acute response to iv arginine (5 g). Early atherosclerosis was studied by ultrasonography of the right carotid artery. Mean intima-media thickness (IMT), determined 1 cm proximal to the bifurcation, was 0.81 +/- 0.14 mm at baseline and increased by 0.012 +/- 0.014 mm/yr over the 5 yr (P < 0.001). The maximal IMT, determined in the carotid bifurcation, was 1.42 +/- 0.42 mm at baseline and increased by 0.035 +/- 0.049 mm/yr (P < 0.001). Neither basal IMT nor the increase in mean or maximal IMT correlated to insulin sensitivity or secretion. In contrast, both baseline IMT and the progression in IMT over the 5-yr follow-up (both mean common carotid artery IMT and maximal bifurcation IMT) correlated with systolic blood pressure and low-density lipoprotein cholesterol. We conclude that carotid intima-media thickness is not related to insulin sensitivity or secretion in nondiabetic, postmenopausal women. Instead, the strongest association is seen with systolic blood pressure and low-density lipoprotein cholesterol levels.

Protein composition in different phases obtained by the ultracentrifugation of dough

Ultracentrifugation was used as a non-destructive method to separate dough into liquid, gel, gluten, starch and bottom phases. The protein composition in the different phases was investigated for dough prepared from spring wheat (Triticum aestivum L.). The SDS-PAGE, SE-HPLC and RP-HPLC methods were used for the analysis. The wheat protein composition of the liquid and gel phases consisted of albumins, globulins and traces of gliadins and glutenins. The gluten phase contained proteins extractable with all the extraction buffers used. A similar protein composition was found in the starch and bottom phases, but in considerably lower amounts. Specific LMW glutenin subunits were identified in the gluten phase by RP-HPLC. The albumin composition differed in the gel phase compared to the gluten and bottom phases.  Differences in protein composition due to mixing methods were detected only for the albumin composition in the liquid phases.

Inhibition of dipeptidyl peptidase IV improves metabolic control over a 4-week study period in type 2 diabetes

OBJECTIVE

Glucagon-like peptide-1 (GLP-1) has been proposed as a new treatment modality for type 2 diabetes. To circumvent the drawback of the short half-life of GLP-1, inhibitors of the GLP-1-degrading enzyme dipeptidyl peptidase IV (DPP IV) have been examined. Such inhibitors improve glucose tolerance in insulin-resistant rats and mice. In this study, we examined the 4-week effect of 1-[[[2-[(5-cyanopyridin-2-yl)amino]ethyl]amino]acetyl]-2-cyano-(S)-pyrrolidine (NVP DPP728), a selective, orally active inhibitor of DPP IV, in subjects with diet-controlled type 2 diabetes in a placebo-controlled double-blind multicenter study.

RESEARCH DESIGN AND METHODS

A total of 93 patients (61 men and 32 women), aged 64 +/- 9 years (means +/- SD) and with BMI 27.3 +/- 2.7 kg/m(2), entered the study. Fasting blood glucose was 8.5 +/- 1.5 mmol/l, and HbA(1c) was 7.4 +/- 0.7%. Before and after treatment with NVP DPP728 at 100 mg x 3 (n = 31) or 150 mg x 5 (n = 32) or placebo (n = 30), subjects underwent a 24-h study with standardized meals (total 2,000 kcal).

RESULTS

Compared with placebo, NVP DPP728 at 100 mg t.i.d. reduced fasting glucose by 1.0 mmol/l (mean), prandial glucose excursions by 1.2 mmol/l, and mean 24-h glucose levels by 1.0 mmol/l (all P < 0.001). Similar reductions were seen in the 150-mg b.i.d. treatment group. Mean 24-h insulin was reduced by 26 pmol/l in both groups (P = 0.017 and P = 0.023). Although not an efficacy parameter foreseen in the study protocol, HbA(1c) was reduced to 6.9 +/- 0.7% in the combined active treatment groups (P < 0.001). Laboratory safety and tolerability was good in all groups.

CONCLUSIONS

We conclude that inhibition of DPP IV is a feasible approach to the treatment of type 2 diabetes in the early stage of the disease.

Quantification of insulin secretion in relation to insulin sensitivity in nondiabetic postmenopausal women

To evaluate mechanisms underlying the close association between insulin secretion and insulin sensitivity, insulin sensitivity was evaluated by the euglycemic-hyperinsulinemic clamp technique (M/I(clamp)) and insulin secretion was determined from the 75-g oral glucose tolerance test (OGTT) and from the glucose-dependent arginine-stimulation test in 81 nondiabetic postmenopausal women, all aged 61 years. M/I(clamp) was normally distributed with mean +/- SD of 69.9 +/- 30.5 nmol glucose center.kg(-1).min(-1)/pmol insulin.l(-1). It was found that the several different measures of insulin secretion from the OGTT and the glucose-dependent arginine-stimulation test were all inversely related to M/I(clamp). However, measures determining the direct insulin responses were more markedly potentiated by low M/I(clamp) than were measures determining glucose potentiation of insulin secretion. Moreover, the product of M/I(clamp) times measures of insulin secretion (disposition index [DI]) was inversely related to the 2-h glucose value. Finally, surrogate insulin sensitivity measures quantified from OGTT and the glucose-dependent arginine-stimulation test only weakly correlated to M/I(clamp) (R(2) approx equal to 0.25). Thus, 1) insulin secretion is adaptively increased when insulin sensitivity is low in nondiabetic postmenopausal women; 2) beta-cell exocytotic ability shows more efficient adaptation than beta-cell glucose recognition to low insulin sensitivity; 3) impaired beta-cell adaptation (i.e., low DI) is associated with higher 2-h glucose values during OGTT, although other regulatory mechanisms also exist; and 4) indirect surrogate measures of insulin sensitivity only weakly correlate to insulin sensitivity as determined by the euglycemic-hyperinsulinemic clamp.

Comparison of starch branching enzyme I and II from potato

The in vitro activities of purified potato starch branching enzyme (SBE) I and II expressed in Escherichia coli were compared using several assay methods. With the starch-iodine method, it was found that SBE I was more active than SBE II on an amylose substrate, whereas SBE II was more active than SBE I on an amylopectin substrate. Both enzymes were stimulated by the presence of phosphate. On a substrate consisting of linear dextrins (chain length 8-200 glucose residues), no significant net increase in molecular mass was seen on gel-permeation chromatography after incubation with the enzymes. This indicates intrachain branching of the substrate. After debranching of the products, the majority of dextrins with a degree of polymerization (dp) greater than 60 were absent for SBE I and those with a dp greater than 70 for SBE II. To study the shorter chains, the debranched samples were also analysed by high-performance anion-exchange chromatography. The products of SBE I showed distinct populations at dp 11-12 and dp 29-30, whereas SBE II products had one, broader, population with a peak at dp 13-14. An accumulation of dp 6-7 chains was seen with both isoforms.

Impaired glucose tolerance (IGT) is associated with reduced insulin-induced suppression of glucagon concentrations

AIMS/HYPOTHESIS

We aimed to examine whether impaired glucose tolerance is associated with reduced suppression of glucagon concentrations.

METHODS

Eighty-four non-diabetic women of Caucasian origin and 61 years of age, of whom 48 had normal glucose tolerance (NGT) and 36 had IGT, underwent a 75 g OGTT and a hyperinsulinaemic, euglycaemic clamp with measurement of glucagon, insulin and glucose concentrations.

RESULTS

At 2 h after 75 g oral glucose, glucagon concentrations were reduced by 7.1 +/- 1.1 ng/l in NGT vs 8.0 +/- 1.4 ng/l in IGT, (NS). However, the 2 h reductions in glucagon per mmol/l increase in 2 h glucose or per pmol/l increase in 2 h insulin were both impaired in IGT (p = 0.002 and p = 0.043, respectively) because the 2 h increases in glucose and insulin were higher in IGT than in NGT. Furthermore, suppression of glucagon concentrations during a euglycaemic clamp at hyperinsulinaemic concentrations (NGT: 607 +/- 19 pmol/l, IGT: 561 +/- 21 pmol/l) was lower in IGT (13.6 +/- 1.6 ng/l) than in NGT (23.1 +/- 1.2 ng/l; p < 0.001). The suppression of glucagon concentrations during the hyperinsulinaemic, euglycaemic clamp correlated with insulin sensitivity (r = 0.24, p = 0.027) and with the 2 h glucose value during the OGTT (r = -0.52, p < 0.001).

CONCLUSION/INTERPRETATION

Impaired glucose tolerance is associated with reduced insulin-induced suppression of glucagon secretion, which could be caused by A-cell insulin resistance. Inappropriately high glucagon secretion could therefore contribute to the metabolic perturbations in IGT.

Wheelchair seating intervention. Results from a client-centred approach

PURPOSE

The aim of this study was to analyse the effects of wheelchair intervention from a client-centred perspective.

METHOD

Results from 38 consecutive active wheelchair users visiting the wheelchair-seating department at the University Hospital in Linköping, Sweden, were analysed and described. All clients had defined problems related to wheelchair seating. Back pain was estimated before intervention and at follow-up, using a Visual Analogue Scale. The effect of intervention on different aspects of wheelchair functionality, seating and occupational performance was estimated by the clients at follow-up.

RESULTS

Two initial main problem areas were identified among the group; seating discomfort (87%) and back pain (63%). Back pain was significantly reduced at follow-up (p<0.001). Problems initially defined by the clients, e.g. seating discomfort, were affected positively, in 79% of all clients, as estimated by the clients at follow-up. No significant correlation was found between the initial cause of intervention or the highest ranked wheelchair functionality aspect and final acceptance of intervention.

CONCLUSIONS

The results from this study confirm the possibility of reducing, or even eliminating, common secondary problems such as back pain and discomfort, related to wheelchair seating by individually adjusted measures. Further research and development in this field is both necessary and cost-effective.

Semitendinosus muscle in anterior cruciate ligament surgery: Morphology and function

PURPOSE

To evaluate the fate of the hamstring muscles in general and the semitendinosus muscle in particular, after anterior cruciate ligament (ACL) reconstruction with an autologous semitendinosus tendon graft from the ipsilateral side.

TYPE OF STUDY

Prospective consecutive case series investigation.

METHODS

Included were 16 consecutive patients, 14 male and 2 female, with a mean age of 26 years. The inclusion criterion was chronic unilateral ACL insufficiency with no concomitant knee ligament injuries. ACL reconstruction was performed with a quadruple semitendinosus tendon graft using the EndoButton technique (Acufex, Mansfield, MA). Intraoperatively, muscle specimens were taken from the semitendinosus muscle on the harvested side. Follow-up at a minimum of 6 months included clinical examination, isokinetic strength performance, magnetic resonance imaging (MRI) of the thigh and knee, and ultrasound-guided muscle biopsy procurement from the semitendinosus muscle for histochemical and enzymatic analyses.

RESULTS

Of the patients, 75% showed regeneration of their semitendinosus tendons. The neotendons all inserted below the knee joint where they had fused with the gracilis tendon to a conjoined tendon inserting in the pes anserinus. The semitendinosus muscle had a smaller cross-sectional area on the operated side but none showed total atrophy. Less atrophy was present in the patients with a regenerated semitendinosus neotendon compared with those without regeneration (P =.029). In the latter group the semimembranosus muscle seemed to compensate for this with hypertrophy (P =.019). Cross-sectional muscle fiber areas, the relative number of each fiber type and oxidative potential as estimated by citrate synthase activity, showed no significant differences between the operated and nonoperated legs. The isokinetic strength of the hamstrings and quadriceps was significantly lower in the operated leg than in the nonoperated leg.

CONCLUSIONS

With this surgical technique, the semitendinosus muscle can recover and the tendon has, according to the MRI images, a great potential to regenerate after its removal.

The semitendinosus tendon regenerates after resection: a morphologic and MRI analysis in 6 patients after resection for anterior cruciate ligament reconstruction

Recently, the surprising observation has been made, supported by clinical and MRI findings, that the semitendinosus tendon can regenerate after being harvested in its whole length and thickness for anterior cruciate ligament reconstruction. We studied 6 patients with previous anterior cruciate ligament reconstruction, using a quadruple semitendinosus tendon autograft. In 5 of these, physical examination and MRI showed that the tendond had regenerated. In all 6 patients, the findings were documented macroscopically by open surgical exploration and in the 5 regenerated tendons, also morphologically by biopsies. Macroscopically, histologically and immunohistochemically the regenerated tendons closely resembled normal ones with focal scar-like areas. Our present findings and earlier studies show that full length and thickness harvesting of the semitendinosus tendon in most cases result in full-length tendon regeneration with tissue closely resembling the normal tendon.

Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy

OBJECTIVE

To evaluate new echocardiographic modes in the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC).

DESIGN

Prospective observational study.

SETTING

University Hospital.

SUBJECTS

15 patients with ARVC and a control group of 25 healthy subjects.

METHODS

Transthoracic echocardiography included cross sectional measurements of the right ventricular outflow tract, right ventricular inflow tract, and right ventricular body. Wall motion was analysed subjectively. M mode and pulsed tissue Doppler techniques were used for quantitative measurement of tricuspid annular motion at the lateral, septal, posterior, and anterior positions. Doppler assessment of tricuspid flow and systemic venous flow was also performed.

RESULTS

Assessed by M mode, the total amplitude of the tricuspid annular motion was significantly decreased in the lateral, septal, and posterior positions in the patients compared with the controls. The tissue Doppler velocity pattern showed decreased early diastolic peak annular (E(A)) velocity and an accompanying decrease in early (E(A)) to late diastolic (A(A)) velocity ratio in all positions; the systolic annular velocity was significantly decreased only in the lateral position. Four patients had normal right ventricular dimensions and three were judged to have normal right ventricular wall motion. The patient group had also a significantly decreased tricuspid flow E:A ratio.

CONCLUSIONS

Tricuspid annular measurements are valuable, easy to obtain, and allow quantitative assessment of right ventricular function. ARVC patients showed an abnormal velocity pattern that may be an early but non-specific sign of the disease. Normal right ventricular dimensions do not exclude ARVC, and subjective detection of early changes in wall motion may be difficult.

Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy

OBJECTIVE

To evaluate new echocardiographic modes in the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC).

DESIGN

Prospective observational study.

SETTING

University Hospital.

SUBJECTS

15 patients with ARVC and a control group of 25 healthy subjects.

METHODS

Transthoracic echocardiography included cross sectional measurements of the right ventricular outflow tract, right ventricular inflow tract, and right ventricular body. Wall motion was analysed subjectively. M mode and pulsed tissue Doppler techniques were used for quantitative measurement of tricuspid annular motion at the lateral, septal, posterior, and anterior positions. Doppler assessment of tricuspid flow and systemic venous flow was also performed.

RESULTS

Assessed by M mode, the total amplitude of the tricuspid annular motion was significantly decreased in the lateral, septal, and posterior positions in the patients compared with the controls. The tissue Doppler velocity pattern showed decreased early diastolic peak annular (EA) velocity and an accompanying decrease in early (EA) to late diastolic (AA) velocity ratio in all positions; the systolic annular velocity was significantly decreased only in the lateral position. Four patients had normal right ventricular dimensions and three were judged to have normal right ventricular wall motion. The patient group had also a significantly decreased tricuspid flow E:A ratio.

CONCLUSIONS

Tricuspid annular measurements are valuable, easy to obtain, and allow quantitative assessment of right ventricular function. ARVC patients showed an abnormal velocity pattern that may be an early but non-specific sign of the disease. Normal right ventricular dimensions do not exclude ARVC, and subjective detection of early changes in wall motion may be difficult.

A novel anti-angiogenic form of antithrombin with retained proteinase binding ability and heparin affinity

Latent antithrombin, an inactive antithrombin form with low heparin affinity, has previously been shown to efficiently inhibit angiogenesis and tumor growth. We now show that heat treatment similar to that used for preparation of latent antithrombin also transforms antithrombin to another form, which we denote prelatent, with potent anti-angiogenic and anti-tumor activity but with retained proteinase- and heparin-binding properties. The ability of prelatent antithrombin to inhibit angiogenesis is presumably due to a limited conformational change, which may partially resemble that in latent antithrombin. Such a change is evidenced by a different cleavage pattern of prelatent than of native antithrombin by nontarget proteinases. Prelatent antithrombin exerts its anti-angiogenic effect by a similar mechanism as latent antithrombin, i.e. by inhibiting focal adhesion formation and focal adhesion kinase activity, thereby leading to decreased proliferation of endothelial cells. The proteinase inhibitory fractions in commercial antithrombin preparations, which have been heat treated during production, also have anti-angiogenic activity, comparable with that of the prelatent antithrombin form.

Vocal fold vibrations: high-speed imaging, kymography, and acoustic analysis: a preliminary report

OBJECTIVES

To evaluate a new analysis system, High-Speed Tool Box (H. Larsson, custom-made program for image analysis, version 1.1, Department of Logopedics and Phoniatrics, Huddinge University Hospital, Huddinge, Sweden, 1998) for studying vocal fold vibrations using a high-speed camera and to relate findings from these analyses to sound characteristics.

STUDY DESIGN

A Weinberger Speedcam + 500 system (Weinberger AG, Dietikon, Switzerland) was used with a frame rate of 1,904 frames per second. Images were stored and analyzed digitally. Analysis included automatic glottal edge detection and calculation of glottal area variations, as well as kymography. These signals were compared with acoustic waveforms using the Soundswell program (Hitech Development AB, Stockholm, Sweden).

METHODS

The High-Speed Tool Box was applied on two types of high-speed recordings: a diplophonic phonation and a tremor voice. Relations between glottal vibratory patterns and the sound waveform were analyzed.

RESULTS

In the diplophonic phonation, the glottal area waveform, as well as the kymogram, showed a specific pattern of repetitive glottal closures, which was also seen in the acoustic waveform. In the tremor voice, fundamental frequency (F0) fluctuations in the acoustic waveform were reflected in slow variations in amplitude in the glottal area waveform. For studying details of mucosal movements during these kinds of abnormal vibrations, the glottal area waveform was particularly useful.

CONCLUSIONS

Our results suggest that this combined high-speed acoustic-kymographic analysis package is a promising aid for separating and specifying different voice qualities such as diplophonia and voice tremor. Apart from clinical use, this finding should be of help for specification of the terminology of different voice qualities.

Antiangiogenic effects of latent antithrombin through perturbed cell-matrix interactions and apoptosis of endothelial cells

Antithrombin is a plasma protein of the serpin superfamily that may occur as several conformational variants. The native form of antithrombin is a major regulator of blood clotting. In the present study, we have identified the mechanism underlying the antiangiogenic action of a heat-denatured form, denoted latent antithrombin. Fibroblast growth factor (FGF)-induced angiogenesis in the chick embryo and angiogenesis in mouse fibrosarcoma tumors were inhibited by treatment with latent antithrombin at 1 mg/kg/day. Thermolysin-cleaved and native antithrombin were less efficient in these respects. Treatment with latent antithrombin induced apoptosis of cultured endothelial cells and inhibited cell migration toward FGF-2. Under these conditions, FGF-2-stimulated FGF receptor kinase activity was unaffected. However, actin reorganization, activation of focal adhesion kinase, and focal adhesion formation were disturbed by latent antithrombin treatment of FGF-2-stimulated endothelial cells. These data indicate that latent antithrombin induces apoptosis of endothelial cells by disrupting cell-matrix interactions through uncoupling of focal adhesion kinase.

Revision total hip arthroplasty using third-generation cementing technique

A total of 83 consecutive first-revision total hip arthroplasties were performed in 83 patients using pressurized vacuum-mixed cement, a third-generation cementing technique. At a median follow-up of 3.6 years (range, 1.5-6.3 years), the overall failure rates (radiographic loosening, re-revision, or both) were 39% for the femoral components and 30% for the acetabular components. With definite radiographic loosening as an endpoint, the cement-bone interface achieved was the only significant factor to predict stem durability, with an adjusted odds ratio of 1.8 (95% confidence interval, 1.1-3.0). On the acetabular side, bone stock was the only significant factor, with an adjusted odds ratio of 5.3 (95% confidence interval, 4.0-27.7). In this retrospective cohort study, femoral cement pressurization per se did not appear to improve the results over those of other studies using second-generation techniques.

A turnover model of irreversible inhibition of gastric acid secretion by omeprazole in the dog

A turnover model for irreversible inhibition of gastric acid secretion by omeprazole in gastric fistula dogs was developed using data from studies with both short- and long-term measurement periods. In the short-term experiments, after stimulation of acid secretion with histamine, the dogs were infused i.v. with omeprazole and acid secretion was measured for 5 h. Dose and infusion times were varied to produce different concentration-time profiles and schedule dependence in the inhibitory effect of omeprazole was observed. In the long-term experiments, dogs were given single intraduodenal doses, which inhibited the acid secretion for several days. Combining the short-term and long-term data allowed the observation of a biphasic recovery of acid secretion that was described by the turnover model. Second order association rate constants (k(ome)) for the covalent binding of omeprazole to H(+),K(+)-ATPase were estimated to 11 and 3.0 l/micromol/h for the i.v. and intraduodenal experiments, respectively. The apparent turnover rate constant of the enzyme (k(out)) was 0.013 h(-1) and the corresponding half-life of inhibition of acid secretory capacity was 54 h. The potency, calculated as k(out) over k(ome), was 4.3 and 1.2 nM for the intraduodenal and i.v. doses, respectively. Allometric scaling of the model resulted in trustworthy predictions for observations previously done in humans. The model predicted a good correlation between maximal inhibitory effect and exposure (area under the plasma concentration curve). The time dependence in this relation was also predicted by the model.

Prediction of diabetes using ADA or WHO criteria in post-menopausal women: a 10-year follow-up study

AIMS/HYPOTHESIS

To study the risk of women with impaired fasting glucose (IFG) as against impaired glucose tolerance (IGT) developing diabetes.

METHODS

Oral glucose tolerance tests (75 g) were done in 265 women selected at random at baseline (age 55-57 years) and at a 10-year follow-up. Of the women 42 had IFG/NGT (fasting glucose 6.1-6.9 mmol/l, 2-h glucose < 7.8 mmol/l), 66 IGT/ NFG (2-h glucose 7.8-11.0 mmol/l, fasting glucose < 6.1 mmol/1), 30 IGT/IFG and 127 NFG/NGT.

RESULTS

The 10-year progression to diabetes was similar in IGT/NFG (12.1%) and IFG/NGT groups (11.9%, p = 0.97). In IGT/IFG, 20.0% had developed diabetes, which was not significantly higher than in IFG/NGT and IGT/NFG (p = 0.53). In NFG/ NGT at baseline, only 3.9 % had developed diabetes, which was lower than in the other groups (p = 0.023).

CONCLUSION/INTERPRETATION

Fasting and 2-h glucose concentrations are equally good in predicting diabetes development over a 10-year period in Caucasian postmenopausal women. Because IGT is more common than IFG, measuring only fasting glucose concentrations would, however, result in missing a prediabetic stage in a large group of people at risk for diabetes and cardiovascular diseases.

Endostatins derived from collagens XV and XVIII differ in structural and binding properties, tissue distribution and anti-angiogenic activity

Endostatin is a fragment of the C-terminal domain NC1 of collagen XVIII that inhibits angiogenesis and tumor growth. We report the characterization of a collagen XV endostatin analogue and its parent NC1 domain, obtained by recombinant expression in mammalian cells. Both NC1 domains contain a trimerization domain, a hinge region that is more sensitive to proteolysis in collagen XVIII and the endostatin domain. Unlike endostatin-XVIII, endostatin-XV does not bind zinc or heparin, which is explained by the crystal structure of endostatin-XV. The collagen XV and XVIII fragments inhibited chorioallantoic membrane angiogenesis induced by basic fibroblast growth factor (FGF-2) or vascular endothelial growth factor (VEGF), but there are striking differences depending on which cytokine is used and whether free endostatins or NC1 domains are applied. The collagen XV and XVIII fragments showed a similar binding repertoire for extracellular matrix proteins. Differences were found in the immunohistological localization in vessel walls and basement membrane zones. Together, these data indentify endostatin-XV as an angiogenesis inhibitor, which differs from endostatin-XVIII in several important functional details.

Selectively desulfated heparin inhibits fibroblast growth factor-induced mitogenicity and angiogenesis

Fibroblast growth factors (FGFs) are known to induce formation of new blood vessels, angiogenesis. We show that FGF-induced angiogenesis can be modulated using selectively desulfated heparin. Chinese hamster ovary cells (CHO677) deficient in heparan sulfate biosynthesis were employed to assess the function of heparin/heparan sulfate in FGF receptor-1 (FGFR-1) signal transduction and biological responses. In the presence of FGF-2, FGFR-1 kinase and subsequent mitogen-activated protein kinase Erk2 activities were augmented in a dose-dependent manner, whereas high concentrations of heparin resulted in decreased activity. The length of the heparin oligomer, minimally an 8/10-mer, was critical for the ability to enhance FGFR-1 kinase activity. The N- and 2-O-sulfate groups of heparin were essential for binding to FGF-2, whereas stimulation of FGFR-1 and Erk2 kinases by FGF-2 also required the presence of 6-O-sulfate groups. Sulfation at 2-O- and 6-O-positions was moreover a prerequisite for binding of heparin to a lysine-rich peptide corresponding to amino acids 160-177 in the extracellular domain of FGFR-1. Selectively 6-O-desulfated heparin, which binds to FGF-2 but fails to bind the receptor, decreased FGF-2-induced proliferation of CHO677 cells, presumably by displacing intact heparin. Furthermore, FGF-2-induced angiogenesis in chick embryos was inhibited by 6-O-desulfated heparin. Thus, formation of a ternary complex of FGF-2, heparin, and FGFR-1 appears critical for the activation of FGFR-1 kinase and downstream signal transduction. Preventing complex formation by modified heparin preparations may allow regulation of FGF-2 functions, such as induction of angiogenesis.

Endostatin-induced tyrosine kinase signaling through the Shb adaptor protein regulates endothelial cell apoptosis

Endostatin, which corresponds to the C-terminal fragment of collagen XVIII, is a potent inhibitor of angiogenesis. Fibroblast growth factor-2 (FGF-2)-induced angiogenesis in the chicken chorioallantoic membrane was inhibited by endostatin, but not by an endostatin mutant R158/270A, lacking heparin-binding ability. Endostatin was internalized by endothelial cells, but not by mouse fibroblasts. Treatment of murine brain endothelial (IBE) cells with endostatin reduced the proportion of cells in S phase, whereas growth-arrested IBE cells in collagen gels treated with endostatin displayed enhanced tubular morphogenesis. IBE cells overexpressing Shb, an adaptor protein implicated in angiostatin-induced apoptosis, displayed elevated apoptosis and decreased tubular morphogenesis in collagen gels in response to endostatin when added together with FGF-2. Induction of apoptosis was dependent on the heparin-binding ability of endostatin and the expression of Shb with a functional Src homology 2 (SH2)-domain. Endostatin treatment for 10 minutes or 24 hours induced tyrosine phosphorylation of Shb and formation of multiprotein complexes. An Shb SH2 domain fusion protein precipitated a 125-kd phosphotyrosyl protein in endostatin-treated cells. The 125-kd component either contained intrinsic tyrosine kinase activity or occurred in complex with a tyrosine kinase. In conclusion, our data show that endostatin induces tyrosine kinase activity and enhanced apoptosis in FGF-treated endothelial cells.

Islet dysfunction in insulin resistance involves impaired insulin secretion and increased glucagon secretion in postmenopausal women with impaired glucose tolerance

OBJECTIVE

To characterize in detail the association between insulin sensitivity and islet function in relation to glucose tolerance in nondiabetic subjects.

RESEARCH DESIGN AND METHODS

The study included 108 postmenopausal women, aged 57-59 years, with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT) and measured glucose tolerance (World Health Organization, 75 g glucose), insulin sensitivity (euglycemic-hyperinsulinemic clamp), and islet function (the 2-5 min insulin responses [AIR] and glucagon [AGR] responses to 5 g intravenous arginine at fasting, 14 and >25 mmol/l glucose levels). The product of insulin sensitivity and secretion was calculated (disposition index [DI]) and used to study the relationship between the two parameters.

RESULTS

Insulin sensitivity and insulin secretion were highly inversely correlated in a hyperbolic manner (r > 0.64, P < 0.001) in women with NGT (n = 71). Women with IGT (n = 37) had reduced insulin sensitivity compared with women with NGT (P = 0.011). The AIRs were not appropriately increased in relation to the reduced insulin sensitivity in the IGT women, demonstrated as reduced DI in IGT compared with NGT (P < 0.001). Further, women with IGT had an increased AGR (P < 0.001) and a reduced glucose inhibition of glucagon secretion (slopeAGR, P = 0.014) compared with women with NGT. In a multivariate regression model including all of the 108 women, 2-h glucose was independently determined by the DI, the AGR, and the slopeAGR (r = 0.63, P < 0.001).

CONCLUSIONS

We have shown that both the individual ability to adapt insulin secretion to the ambient insulin sensitivity and the level of glucagon secretion are important parameters for maintenance of NGT. Therefore, islet dysfunction in IGT involves low insulin and high glucagon secretion, which present potential targets for correcting impaired glycemia.

Measurement of apolipoprotein E (apoE) in cerebrospinal fluid

Apolipoprotein E (apoE) is a protein involved in transport of lipids and has been implicated to play an important role in regeneration after nerve injury. Determination of apoE in cerebrospinal fluid (CSF) thus have a potential interest when studying different forms of brain damage and as a marker of ongoing regenerative processes in the brain. However, previous studies on CSF-ApoE in Alzheimer's disease (AD) have given inconclusive results. Such inconsistent results might be related to confounding factors interfering with sample handling and/or analyses, which have not been fully elucidated. We therefore examined different potential confounding factors for analyses of apoE in CSF and also developed a new enzyme linked immunosorbent assay (ELISA). The hydrophobic character of ApoE resulted in adsorption to different types of test tubes commonly used for collection of CSF at lumbar puncture, resulting in falsely low levels. This makes CSF handling critical, especially if samples are taken in different types of tubes, or is transferred to new tubes. Taking this confounding factors in consideration and analysing patient and control CSF handled in the same way and using the new ELISA, we could confirm our previous finding of reduced levels of ApoE in AD, (3.4 +/- 1.3 mg/l) compared with controls (4.5 +/- 2.7 mg/l) (p = 0.045). Both in the AD and in the control group, higher levels of CSF-ApoE was found in individuals possessing the ApoE4 alleles. Our results support that CSF-ApoE is reduced in AD, and that handling of CSF is a critical factor, which may explain the discrepant results from previous studies. Differences in the amount of patients and controls possessing the ApoE4 allele included might also increase the variance between different studies.

Glucose intolerance is predicted by low insulin secretion and high glucagon secretion: outcome of a prospective study in postmenopausal Caucasian women

AIMS/HYPOTHESIS

To study the pathophysiological importance of changes in insulin sensitivity and islet function over time for alterations in glucose tolerance in a randomly selected large group of non-diabetic women aged 57-59 years over a 3-year period.

METHODS

At baseline and at the 3-year follow-up, glucose tolerance (WHO 75 g oral glucose), insulin sensitivity (euglycaemic, hyperinsulinaemic clamp) and insulin and glucagon secretion (2 to 5-min responses to 5 g i.v. arginine at fasting, 14 and > 25 mmol/l glucose) were measured.

RESULTS

At baseline, women with impaired glucose tolerance (IGT, n = 28) had lower insulin sensitivity (p = 0.048) than normal women (NGT, n = 58). The arginine-induced insulin responses (AIR) were inversely associated with insulin sensitivity (r > or = -0.55, p < 0.001). When related to the 3-year follow-up, the baseline product of AIR at 14 mmol/l glucose times insulin sensitivity, insulin effect index (IE) (r = -0.40, p < 0.001) and the arginine-induced glucagon response at 14 mmol/l glucose (AGR, r = 0.28, p = 0.009) both correlated with follow-up 2-h glucose. In a multiple regression model, baseline 2-h glucose, insulin effect index and arginine-induced glucagon response independently predicted 2-h glucose at follow-up (total r = 0.668, p < 0.001). Furthermore, delta insulin sensitivity (i. e. follow-up minus baseline) correlated with delta insulin secretion (r = -0.30, p = 0.006), whereas delta glucagon secretion correlated with delta2-h glucose (r = 0.30, p = 0.006) over the 3 years. In a multiple regression, alterations in 2-h glucose over the 3 years were independently determined by changes in fasting insulin and glucagon secretion (r = 0.424, p < 0.001).

CONCLUSION/INTERPRETATION

Low insulin secretion, when judged in relation to insulin sensitivity, and high glucagon secretion, determine glucose tolerance over time in the individual subject. These processes are therefore potential targets for prevention of deterioration in glucose tolerance.

Open MR imaging of the unstable shoulder in the apprehension test position: description and evaluation of an alternative MR examination position

The aim of this study was to describe and evaluate an alternative MR assessment procedure for analysis of unstable shoulders. Twelve patients with unilateral recurrent anterior shoulder dislocation had both shoulders examined. Magnetic resonance imaging was performed with an open-MR system in the apprehension position with the shoulder in 90 degrees of abduction and maximum tolerable external rotation. Contrast enhancement was achieved with intravenous gadolinium. Correlations were made to the findings at operation. In 10 of 12 unstable shoulders the inferior glenohumeral ligament labral complex (IGHLLC) was detached from the glenoid as seen on MR and later verified during surgery. In one shoulder MR was unable to show a capsulolabral detachment that was verified at surgery, whereas in one shoulder both MR and surgical assessment revealed no soft tissue detachment (accuracy 92 %). A Hill-Sachs lesion was visualized and verified in all unstable shoulders, whereas the stable controls revealed normal IGHLLC and no Hill-Sachs lesion. Open-MRI evaluation of the shoulder in the apprehension test position may become a useful tool for the evaluation of anterior shoulder instability.

Structural basis and potential role of heparin/heparan sulfate binding to the angiogenesis inhibitor endostatin

Recombinant mouse endostatin produced by mammalian cells was shown to bind to heparin with a K(d) of 0.3 microM, suggesting that this interaction may play a role in its anti-angiogenic activity. Alanine mutagenesis demonstrated that a major site of four clustered arginines (positions 155, 158, 184 and 270) and a second site (R193, R194) are essential for binding. The same epitopes also participate in endostatin binding to heparan sulfate and sulfatides but not in its binding to the extracellular protein ligands fibulin-1 and fibulin-2. Analyses with various heparin fragments demonstrated a minimum size (12mer) for efficient binding to endostatin and a crucial role of 2-O- and 6-O-sulfation. Furthermore, a substantial proportion (10-50%) of heparan sulfate chains obtained from various tissues showed a distinct binding to endostatin, indicating its potential to interact with extracellular and/or membrane-bound proteoglycans. Angiogenesis induced by basic fibroblast growth factor-2 (FGF-2), but not by vascular endothelial growth factor (VEGF), in a chick chorioallantoic membrane assay could be inhibited by endostatin in a dose-dependent manner. The mutational block of heparin binding decreased endostatin inhibition to low levels but elimination of zinc binding had no effect.

Fibroblast growth factor receptor-1-mediated endothelial cell proliferation is dependent on the Src homology (SH) 2/SH3 domain-containing adaptor protein Crk

Stimulation of fibroblast growth factor receptor-1 (FGFR-1) expressed on endothelial cells leads to cellular migration and proliferation. We have examined the role of the Src homology (SH) 2/SH3 domain-containing adaptor protein Crk in these processes. Transient tyrosine phosphorylation of Crk in fibroblast growth factor-2-stimulated endothelial cells was dependent on the juxtamembrane tyrosine residue 463 in FGFR-1, and a Crk SH2 domain precipitated FGFR-1 via phosphorylated Tyr-463, indicating direct complex formation between Crk and FGFR-1. Furthermore, Crk SH2 and SH3 domains formed ligand-independent complexes with Shc, C3G, and the Crk-associated substrate (Cas). Tyrosine phosphorylation of C3G and Cas increased as a consequence of growth factor treatment. We examined the role of Crk in FGFR-1-mediated cellular responses by use of cells expressing chimeric platelet-derived growth factor receptor-alpha/FGFR-1 (alphaR/FR) wild type and mutant Y463F receptors. The kinase activity of alphaR/FR Y463F was intact, but both Crk and the adaptor FRS-2 were no longer tyrosine-phosphorylated in the mutant cells. Both wild type and mutant receptor cells migrated efficiently, whereas cells expressing the mutant alphaR/FR Y463F failed to proliferate and Erk2 and Jun kinase activities were suppressed in these cells. In wild type alphaR/FR cells transiently expressing an SH2 domain mutant of Crk, Erk and Jun kinase activities as well as DNA synthesis were attenuated. Our data indicate that Crk participates in signaling complexes downstream of FGFR-1, which propagate mitogenic signals.

Semitendinosus tendon regeneration after harvesting for ACL reconstruction. A prospective MRI study

Utilisation of the semitendinosus and gracilis tendons in reconstruction of the anterior cruciate ligament (ACL) has become more common during the last few years. In recent studies a regeneration potential in the harvested tendons has been observed. In this study, 11 consecutive patients who underwent ACL reconstruction with a quadruple semitendinosus graft were examined 6-12 months postoperatively by MRI. Another two patients were examined within 2 weeks after surgery. The median age of the patients was 24 years and there were 8 males and 3 females. The right knee was involved in six patients and the left knee in five. A low-field 0.2 Tesla Siemens open MRI was used for examinations and T1 and T2 weighted transaxial sequences over the thigh and the knee joint were performed. In some instances, additional sagittal sequences were used. ROI analysis of the pixel value of the signal and area determinations on transaxial sequences was performed for both the involved and the healthy side. In 8 of the 11 patients examined 6-12 months postoperatively, a regeneration of the semitendinosus tendon with normal anatomical topographies to the level of the tibial plateau was found. Three of these eight patients were analysed more distally and fusion of the semitendinosus and gracilis tendons was found approximately 30 mm below the joint line before they inserted as a "conjoined tendon" into the pes anserinus. At the mid-thigh level, the semitendinosus muscle had a smaller area and a higher signal than that on the normal side. However, this difference was smaller in the patients showing normal distal tendon regeneration. This study indicates that the semitendinosus tendon has a strong potential for regeneration and that the muscle atrophy seems to be less in the patients with a more normalised distal insertion of the tendon in the pes anserinus.

Insulin resistant subjects lack islet adaptation to short-term dexamethasone-induced reduction in insulin sensitivity

AIMS/HYPOTHESIS

To establish whether islet compensation to deterioration of insulin action depends on inherent insulin sensitivity.

METHODS

We examined insulin and glucagon secretion after i.v. arginine (5 g) at fasting, 14 and greater than 25 mmol/l glucose concentrations before and after lowering of insulin sensitivity by oral dexamethasone (3 mg twice daily for 2 1/2 days) in 10 women with normal glucose tolerance, aged 58 or 59 years. Five women had high insulin sensitivity as shown by euglycaemic, hyperinsulinaemic clamp (99 +/- 12 nmol glucose.kg body weight-1.min-1/pmol insulin.l-1; means +/- SD) whereas five women had low insulin sensitivity (34 +/- 15 nmol glucose.kg body weight-1.min-1/pmol insulin.l-1).

RESULTS

Dexamethasone reduced insulin sensitivity in both groups. Fasting insulin concentration increased by dexamethasone in high insulin sensitivity (72 +/- 10 vs 49 +/- 9 pmol/l, p = 0.043) but not in low insulin sensitivity (148 +/- 63 vs 145 +/- 78 pmol/l) whereas the fasting glucose concentration increased in low insulin sensitivity (6.5 +/- 0.8 vs 5.8 +/- 0.6 mmol/l, p = 0.043) but not in high insulin sensitivity (5.3 +/- 0.8 vs 5.3 +/- 0.6 mmol/l). Fasting glucagon concentration was not changed. Plasma insulin concentrations after raising glucose to 14 and more than 25 mmol/l and the insulin response to arginine at more than 25 mmol/l glucose were increased by dexamethasone in high insulin sensitivity (p < 0.05) but not changed by dexamethasone in low insulin sensitivity. Furthermore, in high but not in low insulin sensitivity, dexamethasone reduced the glucagon response to arginine (p = 0.043).

CONCLUSION/INTERPRETATION

The results show that adaptation in islets function to dexamethasone-induced short-term reduction in insulin sensitivity is lacking in subjects with low inherent insulin sensitivity.

Muscle fiber characteristics in postmenopausal women with normal or impaired glucose tolerance

OBJECTIVE

Muscle fiber characteristics are altered in type 2 diabetes. We studied whether these alterations also exist in impaired glucose tolerance (IGT) and whether they are determinants of insulin sensitivity and glucose tolerance in postmenopausal women.

RESEARCH DESIGN AND METHODS

Percutaneous muscle biopsies from the vastus lateralis muscle were obtained from 77 postmenopausal women aged 57-59 years: 50 women with normal glucose tolerance (NGT) and 27 with IGT. The IGT group had a reduced insulin sensitivity compared with the NGT group (euglycemic-hyperinsulinemic clamp) (P = 0.003).

RESULTS

The groups did not differ in muscle fiber composition, as judged by the percentage of type I, IIa, or IIx fibers. In contrast, the IGT group had increased size of the IIa (mean +/-SD 3,776+/-987 vs. 3,078+/-862 microm2, P = 0.002) and IIx fibers (2,730+/-1,037 vs. 2,253+/-672 microm2, P = 0.017). There was a trend for the capillary diffusion areas (the muscle area supplied by each capillary) to be larger in the IGT group for the IIa (1,132+/-286 vs. 1,013+/-240 microm2, P = 0.061) and IIx fibers (1,020+/-246 vs. 906+/-240 microm2, P = 0.058). In the entire group, insulin sensitivity correlated with the size of the type IIa fibers (r = -0.28, P = 0.013), but not with the percentages of muscle fiber types. In a multiple regression, insulin sensitivity was determined by body fat content and HDL cholesterol level, while the size of the IIa fibers was not included in the model. Glucose tolerance was independently predicted by the number of capillaries/type I fiber, as well as by insulin sensitivity and triglyceride levels.

CONCLUSIONS

We conclude that although muscle fiber composition is not altered, women with IGT have larger type IIa and IIx muscle fibers and a trend for increased capillary diffusion areas for these fibers, compared with women with NGT. In the entire group, insulin sensitivity was determined mainly by body fat content, while muscle fiber capillarization may be of importance for glucose tolerance.

Relative hyperproinsulinemia as a sign of islet dysfunction in women with impaired glucose tolerance

Proinsulin release is increased relative to insulin secretion in subjects with type 2 diabetes, indicative of islet dysfunction. However, it has not been conclusively shown whether there is an increased relative proinsulin release in subjects with impaired glucose tolerance (IGT), i.e. whether it precedes the development of diabetes. We therefore determined the proinsulin to insulin ratios in the fasting state and after acute stimulation of insulin secretion in 23 postmenopausal women, aged 61-62 yr (mean +/- SD, 61.7 +/- 0.5 yr). Ten women had normal glucose tolerance (NGT), and 13 had IGT. The groups were matched for insulin sensitivity and did not differ in body mass index. Proinsulin and insulin secretion were measured after arginine stimulation (5 g, i.v.) at three glucose levels (fasting, 14 mmol/L, and >25 mmol/L), and the acute insulin (AIR(arg)) and proinsulin responses (APIR(arg)) were calculated as the mean 2-5 min postload increase. At fasting glucose, levels of insulin, proinsulin, or the proinsulin/insulin ratio (13.6 +/- 5.0% vs. 11.1 +/- 2.7%; P = NS) did not differ between NGT and IGT. Although the AIR(arg) values were decreased in the IGT group at all glucose levels (P < 0.05), the absolute proinsulin levels and the APIRs(arg) were similar between IGT and NGT women. Therefore, the IGT women had higher proinsulin/insulin ratios at 14 mmol/L (10.7 +/- 4.4% vs. 6.4 +/- 1.8%; P = 0.006) and more than 25 mmol/L glucose (11.4 +/- 5.2% vs. 6.7 +/- 2.1%; P = 0.007). The IGT group had increased APIR(arg)/AIR(arg) at fasting (2.2 +/- 1.4% vs. 1.3 +/- 0.6%; P = 0.047) and more than 25 mmol/L glucose (3.5 +/- 1.6% vs. 2.3 +/- 0.7%; P = 0.037). We conclude that women with IGT exhibit increased relative proinsulin secretion, suggesting a defect in the intracellular proinsulin processing before diabetes develops.

Habitual dietary intake versus glucose tolerance, insulin sensitivity and insulin secretion in postmenopausal women

OBJECTIVE

The major aim was to study the relation between habitual dietary intake and glucose tolerance, insulin sensitivity and insulin secretion in postmenopausal women. Dietary intake was also compared between women with normal (NGT) or impaired glucose tolerance (IGT).

DESIGN

Habitual dietary intake was studied using a modified diet history method, from which the energy, carbohydrate, fat and protein intake was calculated. Glucose tolerance was determined as the 2 h glucose value after a 75 g oral glucose tolerance test. Insulin sensitivity was studied with a euglycemic, hyperinsulinaemic clamp, whilst insulin secretion was measured as the acute (2-5 min) response to iv arginine (5 g) at fasting, 14 and >25 mmol L(-1) glucose.

SETTING

Clinical research unit at the University Hospital in Malmo, Sweden. Subjects. A total of 74 women (mean+/-SD age 58.7+/-0.4 years).

RESULTS

In the entire group, the 2 h glucose level correlated with polyunsaturated fat intake (PUFA, r = 0.41, P < 0.001), and negatively with carbohydrate intake (r = -0.23, P = 0.05). The relation between 2 h glucose and PUFA was independent of body fat content and insulin sensitivity in a multivariate model. Insulin sensitivity correlated with energy intake (r = 0.31, P = 0.007) and PUFA (r = -0.27. P = 0.022). However, these correlations were not significant after adjustment for body fat content in a multivariate model. There were no correlations between insulin secretory variables and habitual dietary intake. Of the 74 women, 60 had NGT and 14 had IGT. The NGT and IGT groups did not differ in intakes of total energy, carbohydrate or protein. The IGT women had higher intake of PUFA (P = 0.003), whilst the total, saturated and monounsaturated fat intake did not differ between the groups.

CONCLUSION

Dietary parameters are not independently associated with insulin sensitivity or insulin secretion in postmenopausal women. Furthermore, dietary habits are largely similar in women with NGT and IGT, although subtle differences cannot be excluded due to the small study size. Therefore, habitual intake of total carbohydrate or total fat seems not to be the major determinant of glucose tolerance in nondiabetic Caucasian postmenopausal women.

Implementation of a respiratory drive monitor on a Servo Ventilator

OBJECTIVE

To design and evaluate a clinical monitor of respiratory drive (P0.1) and other respiratory variables in a simple way, using a commercial ventilator.

METHODS

Nine healthy males were studied as they were breathing spontaneously in a Servo 900C Ventilator, at rest and during light exercise (50 W). The ventilator was slightly modified to improve its mechanical performance during spontaneous breathing, and was used as a measuring instrument. All the relevant information was retrieved, calculated and monitored by a PC. Respiratory drive was assessed as occlusion pressures from the inspiratory airway pressure signal. The equipment was compared with a two-way non-rebreathing laboratory system. Furthermore, negative and positive inspiratory pressures were applied from the ventilator, to study respiratory responses to mechanical loads.

RESULTS

At rest, the ventilator introduced a minor influence on inspiratory time and P0.1, but not in ventilation, tidal volume, expiratory duration and respiratory frequency. During exercise, the influence was more evident. This effect could also be noticed in the coefficients of variation. The responses to mechanical loads were easily recorded and can be used as a simple test of central load-compensating mechanisms. CONCLUSIONS. The ventilator, with limitations, may be an alternative to conventional techniques, especially in clinical studies of the central inspiratory activity with and without respiratory loading.

Evidence for leptin regulation of food intake in humans

The adipocyte hormone leptin regulates body weight in mice by decreasing food intake and increasing energy expenditure. Whether leptin is of physiological importance for these processes in humans is, however, not clear. We therefore studied the relation between leptin and habitual food intake in 64 healthy postmenopausal women. Dietary habits were assessed with a modified diet history method. Body fat content was measured using bioelectrical impedance. In the 64 women, aged 58.6+/-0.4 yr (mean+/-SD), serum leptin was 19.3+/-12.7 ng/mL, body mass index was 25.0+/-3.5 kg/m2, body fat content was 31.6+/-4.3%, fasting glucose was 4.6+/-0.5 mmol/L, and fasting insulin was 56+/-21 pmol/L. Leptin levels were negatively correlated to total energy intake (r=-0.34; P=0.006), carbohydrate intake (r=-0.36; P=0.004), and total (r=-0.27; P=0.034) as well as saturated fat intake (r=-0.31; P=0.014). Leptin was correlated to the absolute, but not to the percent, intake of these nutrients. When normalized for body fat content, the correlations remained significant. Our results suggest that plasma leptin is involved in the physiological regulation of food intake in humans, and that leptin is related to the quantity rather than the quality of habitual food intake.

Smoking habits and circulating leptin in postmenopausal non-obese women

This study examined whether smoking habits affect the correlation between serum leptin levels and body mass index (BMI) in 101 postmenopausal Caucasian non-obese women, all aged 57-59years. Mean serum leptin level in the entire group was 19.8 +/- 12.3 ng/ml (mean +/- s.d.) and mean BMI was 25.3 +/- 3.5 kg/m2. These parameters correlated significantly to each other (r = 0.70, p < 0.001). Between those who have smoked regularly for more than 2 years (n = 26) and those who are ex-smokers or have never smoked (n = 75), serum leptin levels or BMI did not differ and the correlation between serum leptin and BMI was identical. This suggests that smoking habits do not influence circulating leptin in Caucasian postmenopausal non-obese women.

Evidence for leptin regulation of food intake in humans

The adipocyte hormone leptin regulates body weight in mice by decreasing food intake and increasing energy expenditure. Whether leptin is of physiological importance for these processes in humans is, however, not clear. We therefore studied the relation between leptin and habitual food intake in 64 healthy postmenopausal women. Dietary habits were assessed with a modified diet history method. Body fat content was measured using bioelectrical impedance. In the 64 women, aged 58.6+/-0.4 yr (mean+/-SD), serum leptin was 19.3+/-12.7 ng/mL, body mass index was 25.0+/-3.5 kg/m2, body fat content was 31.6+/-4.3%, fasting glucose was 4.6+/-0.5 mmol/L, and fasting insulin was 56+/-21 pmol/L. Leptin levels were negatively correlated to total energy intake (r=-0.34; P=0.006), carbohydrate intake (r=-0.36; P=0.004), and total (r=-0.27; P=0.034) as well as saturated fat intake (r=-0.31; P=0.014). Leptin was correlated to the absolute, but not to the percent, intake of these nutrients. When normalized for body fat content, the correlations remained significant. Our results suggest that plasma leptin is involved in the physiological regulation of food intake in humans, and that leptin is related to the quantity rather than the quality of habitual food intake.

How should blood rheology be measured in macroglobulinaemia?

Blood and plasma viscosity were measured in 13 patients with monoclonal macroglobulinaemia. Blood viscosity was measured at natural hematocrit and after adjustment to 45%. Studies were performed at three different temperatures, +24 degrees C, +32 degrees C and +37 degrees C. Plasma viscosity was measured in a rotational viscometer and in a capillary tube at the above-mentioned temperatures. Blood viscosity was to some extent related to the patients' symptoms, whereas a correlation between blood and plasma viscosity became less pronounced with decreasing shear rates, indicating that plasma viscosity is not a perfect indicator of blood viscosity in macroglobulinaemia. It was shown that red cell concentration, besides the concentration of monoclonal immunoglobulins (= paraproteins (PP)), is an important determinant of blood viscosity. The correlation between red cell concentration and viscosity became stronger with decreasing shear rate. Whole blood viscosity at low shear rates seems to be the best indicator of rheological symptoms in patients with macroglobulinaemia. It is concluded that blood rheology in patients with macroglobulinaemia is best studied at +32 degrees C to +37 degrees C in whole blood and at low shear rates.

Indirect MR arthrography of anterior shoulder instability in the ABER and the apprehension test positions: a prospective comparative study of two different shoulder positions during MRI using intravenous gadodiamide contrast for enhancement of the joint fluid

OBJECTIVE

The value of MRI for the evaluation of anterior shoulder instability can be enhanced by shoulder positions that stress the stabilising structures. The ABER position is one that has been described in combination with intra-articular gadopentetate dimeglumine arthrography. We believe that MRI in the Apprehension test position with 90 degrees abduction and maximal tolerable external rotation provides maximum tension on the anterior stabilising structures and with this technique it is sufficient to use indirect gadodiamide arthrography following intravenous injection of the contrast medium. The purpose of this study was to make a prospective comparative evaluation of the ABER and Apprehension test positions when using indirect arthrography with intravenous gadodiamide administration in shoulders with anterior instability.

DESIGN AND PATIENTS

Sixteen patients with persistent anterior instability after recurrent shoulder dislocations were examined in an open MRI unit (0.2 T) following 0.1 mmol/kg of intravenous gadodiamide. Oblique axial T1-weighted imaging was used for analysis. Operative findings were used for correlation.

RESULTS

Both the ABER and the Apprehension test position were useful techniques in detecting capsulolabral pathology and Hill-Sachs lesions. The Apprehension test position produced significantly better gadodiamide-enhanced joint fluid in the region of pathology in both the capsulolabral lesion and the Hill-Sachs lesion. It also visualised the size of the Hill-Sachs lesion significantly better than did the ABER position.

CONCLUSION

MRI examination of anterior shoulder instability in the Apprehension test position was more beneficial than examination in the ABER position in visualising capsulolabral and Hill-Sachs lesions when using indirect arthrography.

Glucose-dependent arginine stimulation test for characterization of islet function: studies on reproducibility and priming effect of arginine

Quantitative determination of insulin secretion is of importance both clinically and in research. The optimal method has not been established, although several different methods have been used. We determined the reproducibility of islet function parameters obtained by the glucose-dependent arginine stimulation test, and also studied the priming effect of arginine on subsequent acute insulin responses. The test measures the acute insulin (AIR) and glucagon (AGR) responses to i.v. arginine (5 g injected over 45 s) at fasting glucose and glucose concentrations clamped at 14 and above 25 mmol/l, as well as the glucose potentiation of insulin secretion (slopeAIR) and the glucose inhibition of glucagon secretion (slopeAGR). When the test was performed twice in seven healthy women (mean +/- SD age 58.7 +/- 0.5 years, BMI 27.6 +/- 5.5 kg/m2), the AIRs to arginine had a within-subject coefficient of variation (CV) of 18.6% at fasting glucose, 18.7% at 14 mmol/l glucose and 16.3% at above 25 mmol/l glucose. The CVs for AGR were 11.6, 14.9 and 8.9%, respectively. The CV of the slopeAIR was 24% and of the slopeAGR 17.2%. The arginine priming study was performed in six healthy women (age 63.7 +/- 0.3 years, BMI 28.0 +/- 6.9 kg/m2). Saline or arginine (5 g) was injected at fasting glucose, followed by arginine (5 g) at 14 mmol/l glucose. There was no difference between the acute insulin or glucagon responses to arginine at 14 mmol/l glucose in the two conditions, suggesting that there is no priming effect of arginine on the subsequent acute insulin or glucagon responses. Therefore, this method is a good tool to determine insulin secretion as, apart from its good reproducibility, it also provides several important parameters of islet function.

Reduced number of circulating monocytes after institution of insulin therapy--relevance for development of atherosclerosis in diabetics?

Twelve patients with Type II diabetes mellitus, insufficiently controlled with oral hypoglycemic agents, were studied before, after 2 months, and after 4 months on insulin therapy. For comparison the same variables were also studied in 10 healthy subjects. From the start, in the diabetic group, the authors found alterations in the hemorheologic parameters indicated by increased values for whole blood viscosity, plasma viscosity, red cell transit time (RCTT), and decreased values for white cell initial relative filtration rate (IrFR). In hematologic parameters they found increased values for mean corpuscular volume (MCV), leukocyte count, counts of neutrophils and monocytes, and a decreased count of lymphocytes. They also found increased values in the lipid parameters P-triglycerides and Apo B/Apo A-I ratio, risk factors of coronary atherosclerosis. After 4 months of insulin treatment whole blood and plasma viscosity were still increased, but there was a partial improvement of lipoprotein abnormalities. Red and white cell filterability, however, tended to normalize. These results indicate that changes in blood cell filterability do not necessarily influence in vitro measurements of blood viscosity. The change in RCTT during the insulin treatment was associated with a decreased MCV and the change in white cell IrFR with a decrease in the number of monocytes. This change of white cell filterability during insulin therapy, probably due to a reduced number of monocytes, may be of interest in the study of atherosclerosis and circulatory disease in diabetics.

Molecular cloning and characterization of starch-branching enzyme II from potato

Full-length cDNA for starch branching enzyme (SBE) II of potato was isolated and sequenced. In potato, similarly to most other investigated plants, the SBE-II isoform differs from SBE-I by having an acidic amino-terminal extension and a shorter carboxyterminus. Two forms of SBE-II, migrating as 98 and 95 kDa proteins in 6% SDS-polyacrylamide gels, were associated to tuber starch. The latter form was 16 amino acids shorter in the amino terminus. Transcript of SBE-II was present in leaf tissue, whereas significant expression was not seen in tubers. On the other hand, a significant amount of SBE-I transcript was detected in tuber tissue but not in leaves.

Structure-activity relationship of 2-[[(2-pyridyl)methyl]thio]-1H- benzimidazoles as anti Helicobacter pylori agents in vitro and evaluation of their in vivo efficacy

A relationship between the structure of 21 2-[[(2-pyridyl)methyl]thio]-1H-benzimidazoles (6) and their anti Helicobacter pylori activity expressed as minimum bactericidal concentration (MBC) values is described. Observed MBCs ranged from 256 to 1 microg/mL. The structure-activity relationship (SAR) showed that larger and more lipophilic compounds, especially compounds with such substituents in the 4-position of the pyridyl moiety, generally had lower MBC values. Four new compounds that were predicted to be potent by the established SAR model were synthesized and tested. One such compound, i.e., 2-[[(4-[(cyclopropylmethyl)oxy]-3-methyl-2-pyridyl)methyl]thio]-1H-be nzimidazole (18), was tested for in vivo efficacy in a mouse Helicobacter felismodel (125 micromol/kg bid given orally for 4 days, n = 4). Unfortunately, antibacterial activity could not be clearly demonstrated in this model. Instead a potent acid secretion inhibition was observed. This finding was attributed to the methylthio compound being oxidized to the corresponding methyl sulfinyl derivative, i.e., a proton pump inhibitor, in vivo. Although the antibacterial activity had the potential of decreasing H. felis cell counts in vivo the proton pump inhibitory effect became dominant and actually promoted H. felis cell growth. Hence, we conclude that the antibacterial utility of the 2-[[(2-pyridyl)methyl]thio]-1H-benzimidazoles (6) as a compound class is compromised by their propensity to become proton pump inhibitors upon metabolic oxidation in vivo.

Joint fluid enhancement at MRI of the glenohumeral joint with intravenous injection of gadodiamide in standard and triple dose: a prospective comparative study of stable and unstable shoulders

OBJECTIVE

To investigate the joint fluid enhancement at MRI of unstable and stable glenohumeral joints after intravenous administration of different doses of gadodiamide.

DESIGN AND PATIENTS

Fourteen patients with unilateral anterior shoulder instability and six healthy controls had both shoulders examined on two occasions using either a standard dose (0.1 mmol/kg) or a triple dose (0.3 mmol/kg) of gadodiamide in an open MRI magnet (0.2 T).

RESULTS AND CONCLUSIONS

The joint fluid enhancement in the unstable shoulders was on average 134% following the lower dose and 182% for the triple dose, whereas corresponding values in the stable shoulder in the same individuals were 69% and 142%, and (65% and 159%) in the healthy controls. Enhancement of the joint fluid was higher after the triple dose than after the standard dose in both the unstable shoulders (P < 0.0001) and the controls (P < 0.0005). Compared with the stable controls enhancement in the unstable shoulders was higher for the lower dose (P < 0.0001) while there was no significant difference between the groups following the higher dose. The improved enhancement following the higher dose was especially evident in stable shoulders, while the lower dose was found satisfactory for unstable shoulders.

Histological indications of a progressive snorers disease in an upper airway muscle

The etiology of upper airway collapsibility in patients with snoring and obstructive sleep apnea (OSA) remains unclear. Local muscular abnormalities, including neurogenic lesions, could be a contributory factor. The aim of this study was to histologically evaluate the hypothesis of a progressive snorers disease. Biopsies of palatopharyngeal muscle were obtained from 21 patients with habitual snoring and different degrees of upper airway obstruction (10 patients with OSA) and 10 nonsnoring control subjects. Morphological abnormalities, including neurogenic signs (e.g., type grouping), were blindly quantified. The degree of abnormality was significantly increased in patients compared with control subjects. The individual score of abnormalities was significantly correlated to the percentage periodic obstructive breathing but not to oxygen desaturation index. Analyses of the individual fiber-size spectra demonstrated a significantly increased number of hypertrophied and/or atrophied fibers in patients compared with controls. The subjects were also divided into three groups according to their type of nocturnal breathing, i.e., nonsnorers, patients with < 20%, and patients with > or = 45% obstructive breathing. These groups correlated significantly with the degree of abnormality and pathological fiber-size spectra. In conclusion, these results support the hypothesis of a progressive local neurogenic lesion, caused by the trauma of snoring, as a possible contributory factor to upper airway collapsibility.

Gastrin release and gastric acid secretion in the rat infected with either Helicobacter felis or Helicobacter heilmannii

Helicobacter pylori infection in humans has been shown to be associated with changes in gastric physiology, including exaggerated basal and meal-stimulated gastrin levels. This has been suggested to be due to the direct effects of the bacterium through inflammation and its urease enzyme. The gastric bacteria Helicobacter felis and Helicobacter heilmannii colonize the antrum of rats in large numbers and induce no significant inflammatory response. Thus, the direct effect of Helicobacter infection on gastric physiology, independent of gastritis, could be studied. Basal, freely fed and stimulated acid and gastrin levels were recorded from animals infected with H. felis, H. heilmannii or uninfected controls over a 30 week period. No significant difference was found between freely fed gastrin over 7 weeks or fasting gastrin over 24 weeks or basal and stimulated acid over 30 weeks between all three groups. Triple therapy did not alter gastrin or acid output. The antrum of all Helicobacter-infected rats was well colonized; triple therapy cleared H. felis but not H. heilmannii. Very little inflammation was seen in control or Helicobacter-infected animals. In conclusion, Helicobacter-induced effects on gastric physiology are unlikely to be due to direct bacterial effects, but are best explained by other factors (i.e. inflammatory damage).

Leptin--a regulator of islet function?: its plasma levels correlate with glucagon and insulin secretion in healthy women

It has previously been demonstrated that plasma leptin correlates to body fat content. It has also been demonstrated that in subjects with normal glucose tolerance, circulating leptin correlates to circulating insulin and to insulin secretion and that these relations are independent of body fat. However, whether leptin also covaries with other islet hormones is not known. We therefore studied the relation between plasma levels of leptin and glucagon secretion and circulating pancreatic polypeptide (PP) in healthy humans. Arginine was injected intravenously (5 g) at fasting and at 14 and 28 mmol/L, glucose in 71 postmenopausal women with normal glucose tolerance. In a multivariate analysis controlling for the influence of the body mass index, we found that circulating leptin correlated significantly to fasting insulin (r = .38, P = .002), and to circulating insulin at 14 mmol/L glucose levels (r = .29, P = .0019) and 28 mmol/L glucose (r = .32, P = .009), as well as to the insulin response to arginine at all three glucose levels (r > .30, P < .013). Circulating leptin, independently of the body mass index, also correlated to fasting glucagon (r = .31, P = .012) and to the glucagon response to arginine at all three glucose levels (r > .28, P < .038). In contrast, circulating leptin did not correlate to plasma glucagon at 14 or 28 mmol/L glucose or to plasma levels of PP. We conclude that circulating leptin correlates to the secretory capacity of both glucagon and insulin but not to the reduction of plasma glucagon during hyperglycemia or to PP in a large group of postmenopausal women. This suggests that islet function is related to circulating leptin in humans.