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Campana G, Loizzo S, Fortuna A, Rimondini R, Maroccia Z, Scillitani A, Falchetti A, Spampinato SM, Persani L, Chiodini I. Early post-natal life stress induces permanent adrenocorticotropin-dependent hypercortisolism in male mice. Endocrine 2021; 73:186-195. [PMID: 33630246 DOI: 10.1007/s12020-021-02659-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/10/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE It has been hypothesized that specific early-life stress (ES) procedures on CD-1 male mice produce diabetes-like alterations due to the failure of negative feedback of glucocorticoid hormone in the pituitary. The aim of this study is to investigate the possible mechanism that leads to this pathological model, framing it in a more specific clinical condition. METHODS Metabolic and hypothalamic-pituitary-adrenal-related hormones of stressed mice (SM) have been analyzed immediately after stress procedures (21 postnatal days, PND) and after 70 days of a peaceful (unstressed) period (90 PND). These data have been compared to parameters from age-matched controls (CTR), and mice treated during ES procedures with oligonucleotide antisense for pro-opiomelanocortin (AS-POMC). RESULTS At 21 PND, SM presented an increased secretion of hypothalamic CRH and pituitary POMC-derived peptides, as well as higher plasmatic levels of ACTH and corticosterone vs. CTR. At 90 PND, SM showed hyperglycemia, with suppression of hypothalamic CRH, while pituitary and plasmatic ACTH levels, as well as plasma corticosterone, were constantly higher than in CTR. These values are accompanied by a progressive acceleration in gaining total body weight, which became significant vs. CTR at 90 PND together with a higher pituitary weight. Treatment with AS-POMC prevented all hormonal and metabolic alterations observed in SM, both at 21 and 90 PND. CONCLUSIONS These findings show that these specific ES procedures affect the negative glucocorticoid feedback in the pituitary, but not in the hypothalamus, suggesting a novel model of ACTH-dependent hypercortisolism that can be prevented by silencing the POMC gene.
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Affiliation(s)
- Gabriele Campana
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Stefano Loizzo
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Andrea Fortuna
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Roberto Rimondini
- Department of Medical and Clinical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Zaira Maroccia
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Alfredo Scillitani
- Endocrinology and Diabetology, Ospedale "Casa Sollievo della sofferenza" IRCCS, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Falchetti
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
| | - Santi Mario Spampinato
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
- Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Iacopo Chiodini
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
- Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
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Loizzo A, Spampinato SM, Campana G, Loizzo S. Etiopathogenesis and Pharmacological Prevention of a Type-2 Diabetes Model in Male Mice. J Pharmacol Exp Ther 2018; 364:347-358. [PMID: 29162628 DOI: 10.1124/jpet.117.244707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/15/2017] [Indexed: 12/19/2022] Open
Abstract
We describe a stress-derived type-2 diabetes model in male mice, and formulate new hypotheses on how the model was induced, how diabetes-like alterations were prevented through specific pharmacological treatments, and how its possible neuroendocrine pathogenesis could be hypothesized. Pregnant females arrived in our laboratory on their 14th day of conceptional age. After birth, control mice never showed any apparent behavioral-metabolic-endocrine alterations. However, application of postnatal stress (brief mother deprivation, plus sham injection, daily from birth to weaning), was followed in adult male mice by two series of diabetes-like alterations. Some alterations (e.g., body overweight, immune, neurophysiologic, neurobehavioral alterations) were selectively prevented by opioid antagonist naloxone daily administered during nursing period. The aforementioned alterations plus several others (e.g., hyperglycemia, neuroendocrine alterations) were prevented by administration of specific antisense oligodeoxinucleotide, which modulated synthesis-hyperfunction of proopiomelanocortin-derived corticotropin (ACTH)-corticosterone and endorphins in the pituitary. Surprisingly, together with metabolic alterations, enduring increment of neurophysiologic/neurobehavioral brain performances were observed, accompanied by energy compensative reactions, and brain mitochondria hyperfunction. Thus, increased glycemia/lipidemia appeared to furnish fuel necessary to cope with increased request of energy. Diabetes-like alterations were accompanied by enduring hyperfunction of opioid- and ACTH-corticosterone-endogenous structures in the brain, which were apparently due to failure of negative feedback hormone mechanisms in the pituitary, for the control of the hypothalamus-pituitary-adrenal axis. In conclusion, for the first time we can hypothesize that a diabetes-like syndrome is produced by enduring hyperfunction of two proopiomelanocortin-dependent endogenous systems (brain opioid- and ACTH-corticosterone systems), following failure of pituitary feedback hormonal control, after complex stress procedures.
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Affiliation(s)
- Alberto Loizzo
- National Center for Global Health, Istituto Superiore di Sanità, Roma, Italy (A.L., S.L.); and Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy (S.M.S., G.C.)
| | - Santi M Spampinato
- National Center for Global Health, Istituto Superiore di Sanità, Roma, Italy (A.L., S.L.); and Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy (S.M.S., G.C.)
| | - Gabriele Campana
- National Center for Global Health, Istituto Superiore di Sanità, Roma, Italy (A.L., S.L.); and Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy (S.M.S., G.C.)
| | - Stefano Loizzo
- National Center for Global Health, Istituto Superiore di Sanità, Roma, Italy (A.L., S.L.); and Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy (S.M.S., G.C.)
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Loizzo A, Spampinato SM, Fortuna A, Vella S, Fabi F, Del Basso P, Campana G, Loizzo S. Antisense versus proopiomelanocortin mRNA reduces vascular risk in a murine model of type-2 diabetes following stress exposure in early post-natal life. Peptides 2015; 64:34-9. [PMID: 25554217 DOI: 10.1016/j.peptides.2014.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/20/2014] [Accepted: 12/20/2014] [Indexed: 12/19/2022]
Abstract
Mechanisms of vascular complications in type-2 diabetes patients and animal models are matter of debate. We previously demonstrated that a double-stress model applied to male mice during nursing period produces enduring hyperfunction of endogenous opioid and adrenocorticotropin (ACTH)-corticosteroid systems, accompanied by type-2 diabetes-like alterations in adult animals. Administration of the opioid receptor antagonist naloxone, or of an antisense oligodeoxynucleotide versus proopiomelanocortin mRNA, capable to block the pro-opiomelanocortin-derived peptides β-endorphin and ACTH, selectively prevent these alterations. Here, we investigated alterations produced by our stress model on aorta endothelium-dependent relaxation and contractile responses. Mice, stressed during nursing period, showed in the adulthood hormonal and metabolic type-2 diabetes-like alterations, including hyperglycemia, increased body weight and increased plasma ACTH and corticosterone levels. Ex vivo isolated aorta rings, gathered from stressed mice, were less sensitive to noradrenaline-induced contractions versus controls. This effect was blocked by nitric-oxide synthase-inhibitor l-N(G)-nitroarginine added to bath organ solution. Aorta rings relaxation caused by acetylcholine was enhanced in stressed mice versus controls, but following treatment with the nitric-oxide donor sodium nitroprusside, concentration-relaxation curves in aorta from stressed groups were similar to controls. Therefore, vascular response alterations to physiologic-pharmacologic stimuli were apparently due to nitric-oxide hyperfunction-dependent mechanisms. Aorta functional alterations, and plasma stress hormones enhancement, were prevented in mice stressed and treated with antisense oligodeoxinucleotide, addressed to reduce ACTH- and corticosteroid-mediated hyperfunction. This study demonstrates the key role of ACTH-corticosteroid axis hyperfunction for the triggering of vascular conditions in male adult rodents following postnatal stress in a type-2 diabetes model.
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Affiliation(s)
- Alberto Loizzo
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, via Regina Elena 299, 00161 Roma, Italy
| | - Santi M Spampinato
- Department of Pharmacy and Biotechnology, University of Bologna, via Irnerio 48, 40126 Bologna, Italy
| | - Andrea Fortuna
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, via Regina Elena 299, 00161 Roma, Italy
| | - Stefano Vella
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, via Regina Elena 299, 00161 Roma, Italy
| | - Fulvia Fabi
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, via Regina Elena 299, 00161 Roma, Italy
| | - Paola Del Basso
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, via Regina Elena 299, 00161 Roma, Italy
| | - Gabriele Campana
- Department of Pharmacy and Biotechnology, University of Bologna, via Irnerio 48, 40126 Bologna, Italy
| | - Stefano Loizzo
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, via Regina Elena 299, 00161 Roma, Italy.
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Loizzo A, Spampinato SM, Campana G, Vella S, Fortuna A, Costa L, Capasso A, Monteleone P, Renzi P, Loizzo S. Enhanced brain performance in mice following postnatal stress. J Endocrinol 2012; 215:413-24. [PMID: 23045190 DOI: 10.1530/joe-12-0369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The double postnatal stress model (brief maternal separation plus sham injection daily applied from birth to weaning) induces metabolic alterations similar to type 2 diabetes in young-adult male mice. We verify whether 1) the stress also induces brain metabolic-functional alterations connected to diabetes and 2) different alterations are modulated selectively by two stress-damaged endogenous systems (opioid- and/or ACTH-corticosteroid-linked). Here, diabetes-like metabolic plus neurophysiologic-neurometabolic parameters are studied in adult mice following postnatal stress and drug treatment. Surprisingly, together with 'classic' diabetes-like alterations, the stress model induces in young-adult mice significantly enhanced brain neurometabolic-neurophysiologic performances, consisting of decreased latency to flash-visual evoked potentials (- ~8%); increased level (+ ~40%) and reduced latency (- ~30%) of NAD(P)H autofluorescence postsynaptic signals following electric stimuli; enhanced passive avoidance learning (+ ~135% latency); and enhanced brain-derived neurotrophic factor level (+ ~70%). Postnatal treatment with the opioid receptor antagonist naloxone prevents some alterations, moreover the treatment with antisense (AS; AS vs proopiomelanocortin mRNA) draws all parameters to control levels, thus showing that some alterations are bound to endogenous opioid-system hyper-functioning, while others depend on ACTH-corticosterone system hyper-functioning. Our stress model induces diabetes-like metabolic alterations coupled to enhanced brain neurometabolic-neurophysiologic performances. Taken all together, these findings are compatible with an 'enduring acute-stress' reaction, which puts mice in favorable survival situations vs controls. However, prolonged hormonal-metabolic imbalances are expected to also produce diabetes-like complications at later ages in stressed mice.
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Affiliation(s)
- Alberto Loizzo
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanita', via Regina Elena 299, 00161 Rome, Italy
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Loizzo S, Campana G, Vella S, Fortuna A, Galietta G, Guarino I, Costa L, Capasso A, Renzi P, Frajese GV, Franconi F, Loizzo A, Spampinato S. Post-natal stress-induced endocrine and metabolic alterations in mice at adulthood involve different pro-opiomelanocortin-derived peptides. Peptides 2010; 31:2123-9. [PMID: 20727932 DOI: 10.1016/j.peptides.2010.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 08/01/2010] [Accepted: 08/01/2010] [Indexed: 11/26/2022]
Abstract
In previous investigations we added a physical stress (mild pain) to the "classical" post-natal psychological stress in male mice, and we found that this combination produced a series of dysmetabolic signs very similar to mild human type-2 diabetes. Here, for the first time we demonstrate that within this diabetes model at least two groups of signs depend on the unbalance of two different endogenous systems. Newborn male mice were daily exposed to stressful procedures for 21 days (brief mother separation plus sham injection). Other groups underwent the same procedure, and also received naloxone (Na) to block μ-δ endogenous receptors, or a phosphorothioate antisense oligonucleotide (AS) directed against pro-opiomelanocortin (POMC)-mRNA [to block adrenocorticotropin (ACTH)- and POMC-derived opioid peptides]. Adult mice which received only post-natal stress increased body weight (+7.5%), abdominal overweight (+74%), fasting glycemia (+43%), plasma corticosterone (+110%), plasma (+169%) and pituitary (+153%) ACTH levels. Conversely, hypothalamic ACTH and corticotropin-releasing hormone (CRH) were reduced (-70% and -75%, respectively). Neonatal AS administration reverted all parameters to control values. Neonatal naloxone had little or no influence on glucose, corticosterone, ACTH, CRH levels, whereas it prevented body overweight and abdominal overweight. We conclude that, within this type-2 diabetes model in male mice at least two endocrino-neurohumoral systems are damaged, one concerning the opioid system, and the other concerning HPA hormones. The use of the two drugs was of primary importance to demonstrate this statement, and to demonstrate that these two groups of signs could be defined as "separate entities" following our complex post-natal stress model.
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Affiliation(s)
- Stefano Loizzo
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Roma, Italy.
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6
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Loizzo S, Vella S, Loizzo A, Fortuna A, Di Biase A, Salvati S, Frajese GV, Agrapart V, Ramirez Morales R, Spampinato S, Campana G, Capasso A, Galietta G, Guarino I, Carta S, Carru C, Zinellu A, Ghirlanda G, Seghieri G, Renzi P, Franconi F. Sexual dimorphic evolution of metabolic programming in non-genetic non-alimentary mild metabolic syndrome model in mice depends on feed-back mechanisms integrity for pro-opiomelanocortin-derived endogenous substances. Peptides 2010; 31:1598-605. [PMID: 20493223 DOI: 10.1016/j.peptides.2010.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 05/12/2010] [Accepted: 05/12/2010] [Indexed: 01/05/2023]
Abstract
Previously, we showed that our post-natal handling model induces pro-opiomelanocortin-derived (POMC) endogenous systems alterations in male mice at weaning. These alterations last up to adult age, and are at the basis of adult hormonal and metabolic conditions similar to mild metabolic syndrome/type-2 diabetes. Here, we evaluate how sex influences post-natal programming in these metabolic conditions. Subjects are adult control (non-handled) female (NHF) and male (NHM) CD-1 mice; adult post-natal handled female (HF) and male (HM) mice. Handling consists of daily maternal separation (10 min) plus sham injection, from birth to weaning (21 days). In adult handled males (90-days old) we find not only POMC-derived hormones alterations (enhanced basal plasma corticosterone (+91%) and ACTH (+109%)) but also overweight (+5.4%), fasting hyperglycemia (+40%), hypertriglyceridemia (+21%), enhanced brain mRNA expression of hydroxysteroid(11-beta)dehydrogenase type-1 (HSD11B1) (+49%), and decreased mRNA-HSD11B2 (-39%). Conversely, uric acid, creatinine, HDL(C), total cholesterol, glucose and insulin incremental area under-the-curve are not affected. In females, post-natal handling does not produce both hormonal and dysmetabolic diabetes-like changes; but handling enhances n3- and n6-poly-unsaturated, and decreases saturated fatty acids content in erythrocyte membrane composition in HF versus NHF. In conclusion, for the first time we show that female sex in mice exerts effective protection against the hypothalamus-pituitary-adrenal homeostasis disruption induced by our post-natal handling model on POMC cleavage products; endocrine disruption is in turn responsible for altered metabolic programming in male mice. The role of sex hormones is still to be elucidated.
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MESH Headings
- 11-beta-Hydroxysteroid Dehydrogenase Type 1/genetics
- 11-beta-Hydroxysteroid Dehydrogenase Type 1/metabolism
- 11-beta-Hydroxysteroid Dehydrogenase Type 2/genetics
- 11-beta-Hydroxysteroid Dehydrogenase Type 2/metabolism
- Adrenocorticotropic Hormone/blood
- Animals
- Animals, Newborn
- Brain/metabolism
- Corticosterone/blood
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/metabolism
- Feedback, Physiological
- Female
- Gene Expression Regulation, Enzymologic
- Handling, Psychological
- Hypothalamo-Hypophyseal System/metabolism
- Hypothalamo-Hypophyseal System/physiopathology
- Lipid Metabolism/physiology
- Male
- Metabolic Syndrome/blood
- Metabolic Syndrome/etiology
- Metabolic Syndrome/metabolism
- Metabolic Syndrome/physiopathology
- Mice
- Pain Threshold/physiology
- Pituitary-Adrenal System/metabolism
- Pituitary-Adrenal System/physiopathology
- Pro-Opiomelanocortin/metabolism
- RNA, Messenger/metabolism
- Random Allocation
- Sex Characteristics
- Stress, Psychological/complications
- Stress, Psychological/physiopathology
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Affiliation(s)
- Stefano Loizzo
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, via Regina Elena 299, 00161 Roma, Italy.
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Are the available experimental models of type 2 diabetes appropriate for a gender perspective? Pharmacol Res 2007; 57:6-18. [PMID: 18221886 DOI: 10.1016/j.phrs.2007.11.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 11/20/2007] [Accepted: 11/21/2007] [Indexed: 01/01/2023]
Abstract
Several experimental models have so far been developed to improve our knowledge of the pathogenetic mechanisms of type 2 diabetes mellitus (T2D), to determine the possible pharmacological targets of this disease and to better evaluate diabetes-associated complications, e.g. the cardiovascular disease. In particular, the study of T2D gained the attention of several groups working with different animal species: rodents, cats or pigs, as well as other non-human primate species. Each of these species provided useful and different clues. However, T2D has to be considered as a gender-associated disease: sex differences play in fact a key role in the onset as well as in the progression of the disease and a higher mortality for cardiovascular diseases is detected in diabetic women with respect to men. The results obtained from all the available animal models appear to only partially address this issue so that the search for more precise information in this respect appears to be mandatory. In this review we summarize these concepts and literature in the field and propose a reappraisal of the various animal models for a study of T2D that would take into consideration a gender perspective.
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Abstract
This paper is the 29th consecutive installment of the annual review of research concerning the endogenous opioid system, now spanning 30 years of research. It summarizes papers published during 2006 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurological disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY 11367, United States.
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Loizzo A, Carta S, Bennardini F, Coinu R, Loizzo S, Guarino I, Seghieri G, Ghirlanda G, Franconi F. Neonatal taurine administration modifies metabolic programming in male mice. Early Hum Dev 2007; 83:693-6. [PMID: 17493776 DOI: 10.1016/j.earlhumdev.2007.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 03/23/2007] [Accepted: 03/24/2007] [Indexed: 01/21/2023]
Abstract
The semi-essential amino-acid taurine is involved in glucose homeostasis either in adults or in parental life. Taurine is currently used in neonatal life because it is added to milk formula for babies, and to parental solution for prematures. Here, it has been examined whether taurine administration in lactation modifies adult glucose metabolism. Neonatally taurine-treated mice (50 mg/kg body weight/day, for the first 21 days of life) as adults have lower basal glucose and iAUC after glucose loading curves in comparison with vehicle-treated mice, whereas iAUC following insulin loading curves, plasma lipids and malondialdehyde (MDA), an index of lipid peroxidation were not significantly changed. Thus, in rodents, neonatally administered taurine produces enduring effects in a way that could be advantageous for the control of glucose homoeostasis.
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