Ciprofibrate therapy improves endothelial function and reduces postprandial lipemia and oxidative stress in type 2 diabetes mellitus

BACKGROUND

Exaggerated postprandial lipemia (PPL) is a factor in atherogenesis, involving endothelial dysfunction and enhanced oxidative stress. We examined the effect of ciprofibrate therapy on these parameters in type 2 diabetes mellitus.

METHODS AND RESULTS

Twenty patients entered a 3-month, double-blind, placebo-controlled study. Each subject was studied fasting and after a fatty meal, at baseline, and after 3 months of treatment. Glucose and lipid profiles were measured over an 8-hour postprandial period. Endothelial function (flow-mediated endothelium-dependent vasodilatation [FMD]) and oxidative stress (electron paramagnetic resonance spectroscopy) were measured after fasting and 4 hours postprandially. At baseline, both groups exhibited similar PPL and deterioration in endothelial function. After ciprofibrate, fasting and postprandial FMD values were significantly higher (from 3.8+/-1. 8% and 1.8+/-1.3% to 4.8+/-1.1% and 3.4+/-1.1%; P<0.05). This was mirrored by a fall in fasting and postprandial triglycerides (3. 1+/-2.1 and 6.6+/-4.1 mmol/L to 1.5+/-0.8 and 2.8+/-1.3 mmol/L, P<0. 05). Fasting and postprandial HDL cholesterol was also elevated (0. 9+/-0.1 and 0.8+/-0.1 mmol/L and 1.2+/-0.2 and 1.2+/-0.1 mmol/L, P<0. 05). There were no changes in total or LDL cholesterol. Fasting and postprandial triglyceride enrichment of all lipoproteins was attenuated, with cholesterol depletion of VLDL and enrichment of HDL. There were similar postprandial increases in oxidative stress in both groups at baseline, which was significantly attenuated by ciprofibrate (0.3+/-0.6 versus 1.5+/-1.1 U, P<0.05).

CONCLUSIONS

This study demonstrates that fibrate therapy improves fasting and postprandial endothelial function in type 2 diabetes. Attenuation of PPL and the associated oxidative stress, with increased HDL cholesterol levels, may be important.

Support for linkage of autism and specific language impairment to 7q3 from two chromosome rearrangements involving band 7q31

Childhood autism is characterised by impairments in communication and reciprocal social interaction together with restricted/stereotyped interests, which are evident before 3 years of age. Specific developmental disorders of speech and language (SDDSL) are characterised by impairment in the development of expressive and/or receptive language skills which is not associated with intellectual, sensory, physical, or neurological impairment. Family and twin studies indicate a substantial genetic component in the aetiology of both disorders. They also reveal increased rates of SDDSL in relatives of autistic individuals, suggesting that this phenotype can represent one manifestation of the genetic liability for autism. Modelling of the recurrence risk for autism and milder phenotypes, such as SDDSL, suggest that three or four epistatic loci may be aetiologically involved. A recently published linkage study of an exceptional family with an apparently dominantly inherited SDDSL implicated chromosome band 7q31 as the site of the putative susceptibility locus (SPCH1). This region of chromosome 7 also shows strong linkage in multiplex families with autism. We present two individuals (one has autism, the other SDDSL) with different, apparently balanced chromosome rearrangements involving a breakpoint at 7q31.3. Fluorescence in situ hybridisation was used to localise the breakpoints to an approximately 1 cM interval between CFTR and D7S643. Our findings may be of interest and relevance to the genetic aetiology of autism, and helpful in the search for susceptibility loci for SDDSL and autism. Am. J. Med. Genet. (Neuropsychiatr. Genet. ) 96:228-234, 2000.

The fetal and neonatal outcomes of Rhesus D antibody affected pregnancies in Northern Ireland

It has been suggested that routine antenatal prophylactic anti-D should be introduced for prevention of Rhesus D (RhD) haemolytic disease. Before making changes to the current prevention program it is important, therefore, to have up-to-date data on affected infants. Pregnant women with anti-D antibodies between September 1994 and February 1997 were identified by the Northern Ireland Blood Transfusion Service. The records of 124 women and 130 babies were examined. 26% of planned deliveries occurred in hospitals without paediatric cover. Rhesus isoimmunisation affected 78 babies. Fifty-nine infants were admitted to one of seven neonatal units. There were 2 stillbirths and 1 neonatal death. Two infants have severe neurodevelopmental delay. There is still significant morbidity associated with RhD haemolytic disease. Care for RhD affected pregnancies should be centralised to guarantee training opportunities and maintenance of expertise. The current management of these pregnancies should be re-examined before changing the Rhesus prevention program.

Inhaled nitric oxide differentiates pulmonary vasospasm from vascular obstruction after surgery for congenital heart disease

OBJECTIVE

To evaluate whether a trial of inhaled nitric oxide (NO) differentiates reversible pulmonary vasoconstriction from fixed anatomic obstruction to pulmonary blood flow after surgery for congenital heart disease in patients at risk for pulmonary hypertension.

DESIGN

Prospective cohort study.

SETTING

Tertiary care children's hospital.

PATIENTS

15 neonate and infants with elevated pulmonary artery or right ventricular pressure or with clinical signs suggestive of high pulmonary vascular resistance in the early postoperative period following repair of congenital heart disease.

INTERVENTION

30-min trial of 40 ppm inhaled NO.

RESULTS

5 patients responded to inhaled NO, 2 patients were weaned from extracorporeal support with NO. Four were maintained on continuous inhaled NO for 3 to 5 days. All the responders survived. Ten patients did not respond to NO. An important anatomic obstruction was found with echocardiography or angiography in all 10 patients. Reintervention was performed in 6/10 (4 stent placement, 1 balloon angioplasty of pulmonary arteries and 1 revision of systemic to pulmonary shunt). Six of the nonresponders died.

CONCLUSION

A trial of inhaled NO after cardiac surgery in neonates and infants may be useful to differentiate reversible pulmonary vasoconstriction from fixed anatomic obstruction and may provide useful information if temporary support with extracorporeal membrane oxygenation is considered. Failure to respond to inhaled NO should prompt further investigations to rule out a residual obstruction.

Effects of fetal spinal cord tissue transplants and cycling exercise on the soleus muscle in spinalized rats

Studies were carried out to determine if an intraspinal transplant (Trpl) of fetal spinal cord tissue or hind limb exercise (Ex) affected the changes in myosin heavy chain (MyHC) composition or myofiber size that occur following a complete transection (Tx) of the lower thoracic spinal cord of the adult rat. In one group of animals, transplants were made acutely, whereas in a second group, daily cycling exercise was initiated 5 days after injury, with animals in both groups being sacrificed 90 days after injury. The soleus muscle is normally composed of myofibers expressing either type I (90%) or type IIa (10%) MyHC. Following a spinal transection, expression of type I MyHC isoform decreased (18% of myofibers), type IIa MyHC expression increased (65% of myofibers), and the majority of myofibers (80%) expressed type IIx MyHC. Most myofibers coexpressed multiple MyHC isoforms. Compared with Tx only, with Ex or with Trpl, there was a decrease in the number of myofibers expressing type I or IIa isoforms but little change in expression of IIx MyHC. Myofibers expressing the IIb isoform appeared in several transplant recipients but not after exercise. Transection resulted in atrophy of type I myofibers to approximately 50% of normal size, whereas myofibers were significantly larger after exercise (74% of control) and in Trpl recipients (77% of control). Type IIa myofibers also were significantly larger in Trpl recipients compared with the Tx only group. Overall, the mean myofiber size was significantly greater after exercise and in Trpl recipients compared with myofibers in Tx only animals. Thus, although neither strategy shifted the MyHC profile towards the control, both interventions influenced the extent of atrophy observed after spinalization. These data suggest that palliative strategies can be developed to modulate some of the changes in hind limb muscles that occur following a spinal cord injury.

Gender differences in knee cartilage volume as measured by magnetic resonance imaging

OBJECTIVE

The aim of this study was to analyze sex differences in knee cartilage volume.

METHODS

Articulate cartilage volumes were determined by processing images acquired in the sagittal plane using T1-weighted fat saturation magnetic resonance on an independent work station. The knees of 28 subjects (17 male, 11 female) who underwent MRI for clinical indications (pain <3 months) but who had a normal X-ray and structurally normal MRI were examined.

RESULTS

Males had significantly larger cartilage volumes than females, with difference in cartilage volume remaining statistically significant after adjusting for age, height, weight and bone volume. The differences for males relative to females were: femoral cartilage volume [4.1 ml 95% CI (2.0, 6.1)]; and patella cartilage volume [1.4 ml (0.2, 2.7)]. Although not statistically significant, the tibial cartilage volume also showed these sex differences. Exploratory analysis indicated an increasing gender difference with increasing age for patellar cartilage volume.

CONCLUSION

Men have significantly larger knee cartilage volume than women, independent of body and bone size. The mechanisms for this will need to be determined.

A novel leucocyte-depleting filter for use in continuous venovenous haemofiltration: preliminary in vitro studies

Multiple organ failure (MOF) secondary to circulatory shock, sepsis, or trauma was first described over 20 years ago. Despite much research effort and clinical trials of biological response modifiers, MOF continues to be the leading cause of death in both medical and surgical intensive care units (ICU). MOF is associated with widespread cellular and humoral systemic inflammatory responses which, in turn, are linked with inadequate tissue perfusion to vital organs and the inappropriate accumulation of activated neutrophils, resulting in microcirculatory injury. Much evidence suggests that such activated neutrophils cause vascular damage by adhering to the endothelium and releasing a variety of highly reactive and toxic moieties; these may subsequently produce endothelial injury and compromised organ function. We reasoned that a clinical device designed to remove such cells in a controlled fashion from the circulation of patients with MOF by means of using a continuous venovenous circuit might be beneficial. We report the leucocyte depletion performance of a novel filter medium as a first step towards the production of a clinical device, and show specific depletion of phagocytes relative to other formed elements in the blood.

PDE4 inhibitors: new xanthine analogues

Novel xanthine analogues are described which are selective PDE4 inhibitors with improved therapeutic potential over theophylline.

Short normal children and environmental disadvantage: a longitudinal study of growth and cognitive development from 4 to 11 years

The aim of this investigation was to follow up a sample of exceptionally short but medically healthy children, and a normal comparison group, previously studied at 4 years of age. They lived in an inner-city area which was, on objective criteria, seriously disadvantaged in socioeconomic terms. When first seen at 4 years, cases were significantly impaired in cognitive abilities relative to comparisons, although firstborns were much less severely affected. Of the original 46 cases, 45 were assessed again at 11 years. Most continued to live in the same geographical area. Case children remained exceptionally short, even when parental stature was taken into account, although a degree of catch-up had occurred. One third had special educational needs, and a similar proportion had been referred for speech therapy. Verbal and nonverbal cognitive skills of both case and comparison children had, on the whole, changed little and group differences persisted. In conclusion, short normal children from socioeconomically disadvantaged backgrounds are at high risk of educational failure at elementary school.

Differential expression of a senescence-enhanced metallothionein gene in Arabidopsis in response to isolates of Peronospora parasitica and Pseudomonas syringae

The metallothionein gene, LSC54, shows increased expression during leaf senescence in Brassica napus and Arabidopsis thaliana. A number of abiotic and biotic stresses have been shown to induce senescence-like symptoms in plants and, to investigate this further, the promoter of the LSC54 gene was cloned and fused to the GUS gene and transformed into Arabidopsis. The promoter was highly induced during leaf senescence and also in response to wounding; histochemical analysis indicated that this induction was localised to a few cells close to the wound site. The transgenic Arabidopsis tissue was infected with compatible and incompatible isolates of both the fungal biotroph, Peronospora parasitica and the bacterial necrotroph, Pseudomonas syringae. Incompatible isolates induced rapid cell death (the hypersensitive response) at the site of infection and, with both pathogens, early, localised expression of the GUS gene was observed. In contrast, relatively slow induction of the GUS gene was seen in the compatible interaction and this was correlated with the appearance of senescence-like symptoms in the biotrophic interaction and cell death by necrosis that occurred in response to the necrotrophic pathogen. These results suggest that there are common steps in the signalling pathways that lead to cell death in the hypersensitive response, pathogen induced necrosis and senescence.

Effect of K+ATP channel inhibition on total and regional vascular resistance in guinea pig pregnancy

Decreased vascular resistance and vasoconstrictor response during pregnancy enables an increase in cardiac output and regional blood flow to the uterine circulation. We sought to determine whether inhibition of vascular smooth muscle ATP-sensitive potassium (K+ATP) channel activity during pregnancy increased systemic and/or regional vascular resistance and resistance response to ANG II. A total of 32 catheterized, awake, pregnant or nonpregnant guinea pigs were treated with either the K+ATP channel inhibitor glibenclamide (3.5 mg/kg) or vehicle (DMSO) (n = 8/group). In nonpregnant and pregnant animals, glibenclamide raised blood pressure and systemic, uterine, and coronary vascular resistance, diminishing cardiac output and organ blood flow. Glibenclamide produced a greater rise in coronary vascular resistance in the pregnant than nonpregnant groups and increased renal and cerebral vascular resistance in the pregnant animals only. ANG II infusion raised blood pressure and systemic and renal vascular resistance and lowered cardiac output and renal blood flow in vehicle-treated animals. Glibenclamide augmented ANG II-induced systemic vasoconstriction in the nonpregnant and pregnant groups and the rise in uteroplacental vascular resistance in the pregnant animals. We concluded that K+ATP channel activity likely modulates systemic, uterine, and coronary vascular resistance and opposes ANG II-induced systemic vasoconstriction in nonpregnant and pregnant guinea pigs. Pregnancy augments K+ATP channel activity in the uterine, coronary, renal, and cerebral vascular beds and the uteroplacental circulation during ANG II infusion. Thus increased K+ATP channel activity appears to influence regional control of vascular resistance during guinea pig pregnancy but cannot account for the characteristic decrease in systemic vascular resistance and ANG II-induced systemic vasoconstrictor response.