1
|
Sen ZD, Danyeli LV, Woelfer M, Lamers F, Wagner G, Sobanski T, Walter M. Linking atypical depression and insulin resistance-related disorders via low-grade chronic inflammation: Integrating the phenotypic, molecular and neuroanatomical dimensions. Brain Behav Immun 2021; 93:335-352. [PMID: 33359233 DOI: 10.1016/j.bbi.2020.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022] Open
Abstract
Insulin resistance (IR) and related disorders, such as T2DM, increase the risk of major depressive disorder (MDD) and vice versa. Current evidence indicates that psychological stress and overeating can induce chronic low-grade inflammation that can interfere with glutamate metabolism in MDD as well as insulin signaling, particularly in the atypical subtype. Here we first review the interactive role of inflammatory processes in the development of MDD, IR and related metabolic disorders. Next, we describe the role of the anterior cingulate cortex in the pathophysiology of MDD and IR-related disorders. Furthermore, we outline how specific clinical features of atypical depression, such as hyperphagia, are more associated with inflammation and IR-related disorders. Finally, we examine the regional specificity of the effects of inflammation on the brain that show an overlap with the functional and morphometric brain patterns activated in MDD and IR-related disorders.
Collapse
Affiliation(s)
- Zümrüt Duygu Sen
- Department of Psychiatry and Psychotherapy, University Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743 Jena, Germany
| | - Lena Vera Danyeli
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743 Jena, Germany; Clinical Affective Neuroimaging Laboratory (CANLAB), Leipziger Str. 44, Building 65, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology, Brenneckestr. 6, 39118 Magdeburg, Germany
| | - Marie Woelfer
- Clinical Affective Neuroimaging Laboratory (CANLAB), Leipziger Str. 44, Building 65, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology, Brenneckestr. 6, 39118 Magdeburg, Germany
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743 Jena, Germany
| | - Thomas Sobanski
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Thueringen-Kliniken "Georgius Agricola" GmbH, Rainweg 68, 07318 Saalfeld, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743 Jena, Germany; Clinical Affective Neuroimaging Laboratory (CANLAB), Leipziger Str. 44, Building 65, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology, Brenneckestr. 6, 39118 Magdeburg, Germany.
| |
Collapse
|
2
|
Zielinski MR, Systrom DM, Rose NR. Fatigue, Sleep, and Autoimmune and Related Disorders. Front Immunol 2019; 10:1827. [PMID: 31447842 PMCID: PMC6691096 DOI: 10.3389/fimmu.2019.01827] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022] Open
Abstract
Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, chronic fatigue syndrome, and rheumatoid arthritis. Fatigue is multi-faceted and broadly defined, which makes understanding the cause of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases. In general, fatigue is defined by debilitating periods of exhaustion that interfere with normal activities. The severity and duration of fatigue episodes vary, but fatigue can cause difficulty for even simple tasks like climbing stairs or crossing the room. The exact mechanisms of fatigue are not well-understood, perhaps due to its broad definition. Nevertheless, physiological processes known to play a role in fatigue include oxygen/nutrient supply, metabolism, mood, motivation, and sleepiness-all which are affected by inflammation. Additionally, an important contributing element to fatigue is the central nervous system-a region impacted either directly or indirectly in numerous autoimmune and related disorders. This review describes how inflammation and the central nervous system contribute to fatigue and suggests potential mechanisms involved in fatigue that are likely exhibited in autoimmune and related diseases.
Collapse
Affiliation(s)
- Mark R Zielinski
- Veterans Affairs Boston Healthcare System, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - David M Systrom
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Noel R Rose
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
3
|
Rehni AK, Dave KR. Impact of Hypoglycemia on Brain Metabolism During Diabetes. Mol Neurobiol 2018; 55:9075-9088. [PMID: 29637442 PMCID: PMC6179939 DOI: 10.1007/s12035-018-1044-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/27/2018] [Indexed: 12/24/2022]
Abstract
Diabetes is a metabolic disease afflicting millions of people worldwide. A substantial fraction of world's total healthcare expenditure is spent on treating diabetes. Hypoglycemia is a serious consequence of anti-diabetic drug therapy, because it induces metabolic alterations in the brain. Metabolic alterations are one of the central mechanisms mediating hypoglycemia-related functional changes in the brain. Acute, chronic, and/or recurrent hypoglycemia modulate multiple metabolic pathways, and exposure to hypoglycemia increases consumption of alternate respiratory substrates such as ketone bodies, glycogen, and monocarboxylates in the brain. The aim of this review is to discuss hypoglycemia-induced metabolic alterations in the brain in glucose counterregulation, uptake, utilization and metabolism, cellular respiration, amino acid and lipid metabolism, and the significance of other sources of energy. The present review summarizes information on hypoglycemia-induced metabolic changes in the brain of diabetic and non-diabetic subjects and the manner in which they may affect brain function.
Collapse
Affiliation(s)
- Ashish K Rehni
- Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Neurology, University of Miami Miller School of Medicine, 1420 NW 9th Ave, NRB/203E, Miami, FL, 33136, USA
| | - Kunjan R Dave
- Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
- Department of Neurology, University of Miami Miller School of Medicine, 1420 NW 9th Ave, NRB/203E, Miami, FL, 33136, USA.
- Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
| |
Collapse
|
4
|
Volkan-Salanci B, Dagdelen S, Alikasifoglu M, Erbas T, Hayran M, Erbas B. Impact of renin-angiotensin system polymorphisms on renal haemodynamic responsiveness to acute angiotensin-converting enzyme inhibition in type 2 diabetes mellitus. J Renin Angiotensin Aldosterone Syst 2009; 10:41-50. [DOI: 10.1177/1470320309102326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction.The aim of this study was to document the impact of renin-angiotensin system (RAS) polymorphisms on renal haemodynamics and renal hormones in type 2 diabetes mellitus. Materials and methods. Fifty-nine adult patients were studied. Renal haemodynamics were evaluated using 99mTc-MAG3 clearance (MAG3 Cle) using Bubeck's method and captopril renogram. RAS hormones and angiotensin-converting enzyme (ACE) levels were measured before and after captopril.ACE, angiotensin II type 1 receptor and angiotensinogen gene polymorphisms were analysed. Results. Post-captopril MAG3Cle values were significantly lower in patients with microalbuminuria compared to nonproteinuric patients. Statistically significant negative correlation was found between clearance percentage change values and HbA1c levels (r: —0.42, p=0.009). MAG3Cle was relatively lower following captopril administration in DD patients, while a relative increment was observed in I allele carriers (p=0.02).TheAC-CC group had significantly higher mean post-captopril clearance value compared to the AA genotype (480.9±56.1 ml/min/1.73 m2 vs. 428.4±74.8 ml/min/1.73 m2, p=0.022). Conclusions. Our data indicate that the heterogeneity of patients' response to ACE inhibition is, at least partly, genetically determined, and the genetic polymorphisms in RAS might predict the acute responsiveness to ACE inhibitors.
Collapse
Affiliation(s)
- Bilge Volkan-Salanci
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selcuk Dagdelen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Alikasifoglu
- Division of Medical Genetics, Department of Paediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tomris Erbas
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey,
| | - Mutlu Hayran
- Epidemiologist, Research Office, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Belkis Erbas
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey,
| |
Collapse
|
5
|
Heikkilä O, Lundbom N, Timonen M, Groop PH, Heikkinen S, Mäkimattila S. Hyperglycaemia is associated with changes in the regional concentrations of glucose and myo-inositol within the brain. Diabetologia 2009; 52:534-40. [PMID: 19096823 DOI: 10.1007/s00125-008-1242-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 11/30/2008] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to assess the effect of hyperglycaemia on regional concentrations of glucose and other substrates within the brain in non-diabetic individuals and in patients with type 1 diabetes. METHODS The brain metabolites of 17 men with type 1 diabetes and 12 age-matched non-diabetic men (22-43 years old) were studied after an overnight fast (plasma glucose 9.2 +/- 3.0 vs 4.8 +/- 0.5 mmol/l, respectively). N-Acetylaspartate (NAA), creatine, choline, myo-inositol (mI) and glucose in the frontal cortex, frontal white matter and thalamus were quantified with proton magnetic resonance spectroscopy. RESULTS In the non-diabetic participants, the glucose level was 47% higher (p < 0.01) in the frontal cortex than in the frontal white matter. In contrast, this regional variation was not observed in the diabetic participants, in whom the glucose level in the frontal white matter was 64% higher (p < 0.001) and in the frontal cortex 25% higher (p = 0.033) than that of the non-diabetic participants. In the diabetic participants, the glucose level in each of the three regions studied correlated with fasting plasma glucose (r = 0.88-0.67, p < 0.01). In addition, in the diabetic participants, mI was 20% higher (p < 0.001) and NAA 6% lower (p = 0.037) in the frontal white matter, and mI was 8% higher (p = 0.042) in the frontal cortex, than in the non-diabetic participants. CONCLUSIONS/INTERPRETATION In type 1 diabetes, hyperglycaemia is associated with accumulation of glucose and mI in the cortex and in the white matter.
Collapse
Affiliation(s)
- O Heikkilä
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki (C330b), University of Helsinki, P.O. Box 63, 00014, Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
6
|
Tiehuis AM, Vincken KL, van den Berg E, Hendrikse J, Manschot SM, Mali WPTM, Kappelle LJ, Biessels GJ. Cerebral perfusion in relation to cognitive function and type 2 diabetes. Diabetologia 2008; 51:1321-6. [PMID: 18488188 PMCID: PMC2440938 DOI: 10.1007/s00125-008-1041-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 04/04/2008] [Indexed: 11/29/2022]
Abstract
AIM/HYPOTHESIS Underlying mechanisms for decreased cognitive functioning in patients with type 2 diabetes are unclear. In the general population, cerebral hypoperfusion is a risk factor for cognitive dysfunction and dementia. Reduced cerebral perfusion may account for cognitive impairments in diabetic patients relative to controls. METHODS A total of 98 patients with type 2 diabetes and 47 control participants underwent neuropsychological evaluation. Total cerebral blood flow (CBF) was assessed non-invasively by measuring the volume flow in the internal carotid arteries and basilar artery with two-dimensional phase-contrast magnetic resonance angiography. Relative total CBF, a measure of mean total cerebral perfusion, was obtained by expressing total CBF per 100 ml brain parenchyma volume. RESULTS Patients with type 2 diabetes performed worse on neuropsychological tests (p < 0.05). Total CBF per 100 ml brain parenchyma volume did not differ between participants with and without diabetes (difference -2.3 ml min(-1) 100 ml(-1); 95% CI -6.0, 1.3). In the entire group, total CBF per 100 ml brain parenchyma volume was positively associated with cognitive functioning (0.09 SD increase in composite z score per 10 ml min(-1) 100 ml(-1) increase in relative total CBF). This association was not affected by type 2 diabetes. CONCLUSIONS/INTERPRETATION Although total CBF per 100 ml brain parenchyma volume was associated with cognitive functioning, it did not explain cognitive impairments in patients with type 2 diabetes relative to controls.
Collapse
Affiliation(s)
- A M Tiehuis
- Department of Radiology and Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Last D, de Bazelaire C, Alsop DC, Hu K, Abduljalil AM, Cavallerano J, Marquis RP, Novak V. Global and regional effects of type 2 diabetes on brain tissue volumes and cerebral vasoreactivity. Diabetes Care 2007; 30:1193-9. [PMID: 17290035 PMCID: PMC2031924 DOI: 10.2337/dc06-2052] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the regional effects of type 2 diabetes and associated conditions on cerebral tissue volumes and cerebral blood flow (CBF) regulation. RESEARCH DESIGN AND METHODS CBF was examined in 26 diabetic (aged 61.6 +/- 6.6 years) and 25 control (aged 60.4 +/- 8.6 years) subjects using continuous arterial spin labeling (CASL) imaging during baseline, hyperventilation, and CO2 rebreathing. Regional gray and white matter, cerebrospinal fluid (CSF), and white matter hyperintensity (WMH) volumes were measured on a T1-weighted inversion recovery fast-gradient echo and a fluid attenuation inversion recovery magnetic resonance imaging at 3 Tesla. RESULTS The diabetic group had smaller global white (P = 0.006) and gray (P = 0.001) matter and larger CSF (36.3%, P < 0.0001) volumes than the control group. Regional differences were observed for white matter (-13.1%, P = 0.0008) and CSF (36.3%, P < 0.0001) in the frontal region, for CSF (20.9%, P = 0.0002) in the temporal region, and for gray matter (-3.0%, P = 0.04) and CSF (17.6%, P = 0.01) in the parieto-occipital region. Baseline regional CBF (P = 0.006) and CO2 reactivity (P = 0.005) were reduced in the diabetic group. Hypoperfusion in the frontal region was associated with gray matter atrophy (P < 0.0001). Higher A1C was associated with lower CBF (P < 0.0001) and greater CSF (P = 0.002) within the temporal region. CONCLUSIONS Type 2 diabetes is associated with cortical and subcortical atrophy involving several brain regions and with diminished regional cerebral perfusion and vasoreactivity. Uncontrolled diabetes may further contribute to hypoperfusion and atrophy. Diabetic metabolic disturbance and blood flow dysregulation that affects preferentially frontal and temporal regions may have implications for cognition and balance in elderly subjects with diabetes.
Collapse
Affiliation(s)
- David Last
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Cedric de Bazelaire
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - David C. Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kun Hu
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Jerry Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Robert P. Marquis
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Vera Novak
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
8
|
van Harten B, de Leeuw FE, Weinstein HC, Scheltens P, Biessels GJ. Brain imaging in patients with diabetes: a systematic review. Diabetes Care 2006; 29:2539-48. [PMID: 17065699 DOI: 10.2337/dc06-1637] [Citation(s) in RCA: 252] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Barbera van Harten
- Medisch Centrum Leeuwarden, Postbus 888, 8901 BR Leeuwarden, Netherlands.
| | | | | | | | | |
Collapse
|
9
|
Wessels AM, Rombouts SARB, Simsek S, Kuijer JPA, Kostense PJ, Barkhof F, Scheltens P, Snoek FJ, Heine RJ. Microvascular disease in type 1 diabetes alters brain activation: a functional magnetic resonance imaging study. Diabetes 2006; 55:334-40. [PMID: 16443765 DOI: 10.2337/diabetes.55.02.06.db05-0680] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with type 1 diabetes have mild performance deficits on a range of neuropsychological tests compared with nondiabetic control subjects. The mechanisms underlying this cognitive deterioration are still poorly understood, but chronic hyperglycemia is now emerging as a potential determinant, possibly through microvascular changes in the brain. In 24 type 1 diabetic patients, we tested at euglycemia and at acute hypoglycemia whether the presence of proliferative diabetic retinopathy, as a marker of microvascular disease, adversely affects the ability of the brain to respond to standardized hypoglycemia, using functional magnetic resonance imaging with a cognitive task. Patients with retinopathy, compared with patients without, showed less deactivation (hence, an increased response) in the anterior cingulate and the orbital frontal gyrus during hypoglycemia compared with euglycemia (P < 0.05). Task performance and reaction time were not significantly different for either group. We conclude that microvascular damage in the brain of patients with retinopathy caused this increased brain response to compensate for functional loss.
Collapse
Affiliation(s)
- Alette M Wessels
- Department of Medical Psychology, Vrije University (VU) Medical Center, Amsterdam, Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Salem MAK, Matta LF, Tantawy AAG, Hussein M, Gad GI. Single photon emission tomography (SPECT) study of regional cerebral blood flow in normoalbuminuric children and adolescents with type 1 diabetes. Pediatr Diabetes 2002; 3:155-62. [PMID: 15016156 DOI: 10.1034/j.1399-5448.2002.30306.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Cerebral damage in diabetes can be related to chronic hyperglycemia and recurrent severe hypoglycemia as well as due to the associated vasculopathy. The pattern of regional cerebral blood flow using cerebral single photon emission tomography (SPECT) was evaluated in normoalbuminuric type 1 diabetic children and adolescents and its relation to the metabolic control and cognitive functions. Thirty-one type 1 diabetics aged 10-18 yr (mean 14.7 +/- 3.4) were included, 16 males and 15 females, divided into four groups: group I (n = 8) with history of recurrent severe hypoglycemia (> or = 3); group II (n = 8) with history of severe diabetic ketoacidosis (> or = 3); group III (n = 7) with recurrent minor hypoglycemia (> or = 3/week); and group IV (n = 8) with controlled diabetes. The control group (V) comprised seven healthy children, aged 10-18 yr (mean 14.2 +/- 3.1). SPECT was done using technetium-99m hexamethyl propylene amine oxime. There was significant brain hypoperfusion in diabetics compared with controls, mainly in the basal ganglia (p < 0.01) and frontal regions (p < 0.01), with less changes in parietal and temporal regions. These changes were not related to the age, sex, diabetes duration, mean blood glucose or HbA1C. Basal ganglia hypoperfusion was significant in groups I (p < 0.01) and II (p < 0.01) compared with controlled diabetics. There was no correlation between cerebral SPECT changes and cognitive scores in type 1 diabetics. CONCLUSION Subclinical alterations in cerebral blood flow (hypoperfusion) are present in children and adolescents with type 1 diabetes mainly affecting the basal ganglia and frontal regions, usually not associated with measurable alterations of the cognitive functions
Collapse
Affiliation(s)
- Mona A K Salem
- Department of Pediatrics, Ain Shams University, Cairo, Egypt.
| | | | | | | | | |
Collapse
|
11
|
Ergün EL, Cağlar M, Erdem Y, Usalan C, Uğur O, Duranay M. Tc-99m DTPA acetylsalicylic acid (aspirin) renography in the detection of renovascular hypertension. Clin Nucl Med 2000; 25:682-90. [PMID: 10983754 DOI: 10.1097/00003072-200009000-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Prostaglandins play important roles in renal physiology and in the development of renovascular hypertension. In a recent study, inhibition of renal prostaglandin synthesis was found to be useful for detecting renovascular hypertension using renal scintigraphy. In the current study, the authors evaluated the role of aspirin (an inhibitor of prostaglandin synthesis) and compared it with Tc-99m DTPA captopril renal scintigraphy (CS). MATERIALS AND METHODS Twenty-five patients were examined with Tc-99m DTPA in a three-step manner: a baseline study, CS, and aspirin scintigraphy (AS). Each scintigraphic study was interpreted visually and according to the renogram curve patterns. Semiquantitative parameters (Tmax, renal indices [%], 20-minute/max count ratio, glomerular filtration rate) were also calculated. Plasma renin activity was determined for each study. The blood pressures of all patients were measured during AS. All patients had a contrast-enhanced angiogram that was used as the reference test. RESULTS Three groups of patients were observed based on the scintigraphic and angiographic results. In each group, no difference was observed in blood pressure after aspirin administration. In group 1, seven patients had normal angiographic and scintigraphic results. In group 2, eight patients had angiographically confirmed renal artery stenosis (RAS). In 6 patients (mean, 47% RAS), both AS and CS were negative for RVH. In the remaining two patients with RAS (mean, 83% stenosis), the kidneys were atrophic on the stenotic side, and thus the kidneys did not respond to the interventions. No difference was observed in plasma renin activity in groups 1 and 2. Group 3 included 10 patients who had angiographically confirmed RAS (mean, 86%). In 9 patients, both CS and AS were positive for RVH. In the remaining one patient, scintigraphic results were falsely negative. Statistical analyses performed for semiquantitative parameters did not reveal any significant difference in this group, although there was a tendency toward prolonged Tmax values after captopril and aspirin administration. In four cases, unexpected elevation of plasma renin activity was observed in group 3. CONCLUSIONS These data indicate that AS with Tc-99m DTPA is an alternative for CS. It has the advantage of having no effect on blood pressure and does not require that angiotensin-converting enzyme inhibitors be discontinued. Although in this study 9 of 10 patients had correct diagnoses of RAS, further studies, especially using tubular agents with the calculation of parenchymal transit time, might provide valuable information in this patient group. An ongoing study is being performed in the authors' institute.
Collapse
Affiliation(s)
- E L Ergün
- Department of Nuclear Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Woolfson RG, Neild GH. The true clinical significance of renography in nephro-urology. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1997; 24:557-70. [PMID: 9142738 DOI: 10.1007/bf01267689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Isotopic renography is a non-invasive technique used routinely by the clinician to provide information about kidney structure and function. Whilst there is no doubt of its value in the accurate measurement of glomerular filtration rate and in the detection of parenchymal abnormalities, its role in the diagnosis of renovascular disease (especially in patients with renal insufficiency), the exclusion of obstruction and the evaluation of the patient with either acute renal failure or renal transplant dysfunction remains unproven. In part, this reflects a failure to standardise protocols and rigorously evaluate diagnostic techniques. Recent developments in ultrasound, computerised X-ray tomography and nuclear magnetic resonance now present the clinician with rival techniques and emphasise the need for the clinical development of isotopic renography.
Collapse
Affiliation(s)
- R G Woolfson
- Department of Nephrology, Institute of Urology and Nephrology, Middlesex Hospital, London W1N 8AA, UK
| | | |
Collapse
|
14
|
Keymeulen B, de Metz K, Cluydts R, Bossuyt A, Somers G. Technetium-99m hexamethylpropylene amine oxime single-photon emission tomography of regional cerebral blood flow in insulin-dependent diabetes. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1996; 23:163-8. [PMID: 8925851 DOI: 10.1007/bf01731840] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The study was performed to investigate subclinical abnormalities in regional cerebral blood flow (rCBF) in patients with insulin-dependent diabetes mellitus (IDDM) and to correlate them with patients characteristics. After intravenous injection of technetium-99m hexamethylpropylene amine oxime (HMPAO), tracer uptake of the prefrontal, frontal and parieto-occipital zones was measured with a triple-head single-photon emission tomography (SPET) camera system in 35 IDDM patients outside an episode of hypoglycaemia. Tracer uptake values in 16 age- and sex-matched healthy volunteers served as reference values. Compared with healthy subjects, increased tracer uptake of both prefrontal regions and the left frontal region could be shown in diabetes. Tracer uptake was negatively correlated with the duration of diabetes in all investigated regions. In diabetic patients with a disease duration of more than 5 years (n=26), stepwise regression analysis revealed a significant positive correlation between their HbA1c levels and tracer uptake. Long-term diabetic patients with reduced (pre)frontal tracer uptake (n=8) had lower HbA1c levels than those without (8.4%+/-0.2% vs 9.3%+/-0.3%, P<0.05) and tended to have more frequently a history of hypoglycaemic coma (6/8 vs 6/18, P=0.06). It can be concluded that duration of diabetes contributes to subclinical changes in basal rCBF in IDDM as detected with HMPAO SPET of the brain. The positive correlation between the presence of regional hypoperfusion and lower HbA1c levels in long-term diabetic patients may be interpreted in the light of a presumed higher incidence of hypoglycaemia as metabolic control improves.
Collapse
Affiliation(s)
- B Keymeulen
- Department of Internal Medicine, Academic Hospital VUB, Laarbeeklaan 101, B-1090 Brussels, Belgium
| | | | | | | | | |
Collapse
|