Insulin-mediated activation of the L-arginine nitric oxide pathway in man, and its impairment in diabetes

Revisiting the Venoarteriolar Reflex-Further Insights from Upper Limb Dependency in Healthy Subjects

The venoarteriolar reflex (VAR) is described as a vasoconstriction occurring in response to an increase in venous transmural pressure. Its underlying mechanisms are still not clarified, particularly the neural pathway that supposedly evokes this reflex. In addition, recent studies have shown that the postural maneuvers that evoke VAR also produce a decrease in contralateral perfusion, which is also poorly understood. Our study aimed to explore the contralateral response to unilateral upper limb dependency and its underlying mechanisms. Fifteen young, healthy subjects (24.1 ± 5.8 y.o.) participated in this study after giving informed consent. While seated, subjects remained for 7 min with both arms at heart level (baseline), after which a random hand was placed 40 cm below the heart level for 5 min (dependency) before resuming the initial position for another 7 min (recovery). Skin perfusion was assessed bilaterally with photoplethysmography, and electrodermal activity (EDA) was assessed in the contralateral hand. During hand dependency, perfusion decreased significantly in both limbs, although it was more pronounced in the dependent limb, corroborating previous reports that unilateral limb dependency evokes a decrease in contralateral perfusion. Transient EDA peaks were detected in the first seconds of the dependency and recovery phases. These results support the participation of the sympathetic nervous system as a mechanism regulating contralateral perfusion during unilateral limb dependency. This sympathetic activation is probably attributed to the postural changes themselves and is likely not related to the VAR.

Improvement of Vascular Insulin Sensitivity by Ranolazine

Ranolazine (RN) is a drug used in the treatment of chronic coronary ischemia. Different clinical trials have shown that RN behaves as an anti-diabetic drug by lowering blood glucose and glycosylated hemoglobin (HbA1c) levels. However, RN has not been shown to improve insulin (IN) sensitivity. Our study investigates the possible facilitating effects of RN on the actions of IN in the rabbit aorta. IN induced vasodilation of the abdominal aorta in a concentration-dependent manner, and this dilatory effect was due to the phosphorylation of endothelial nitric oxide synthase (eNOS) and the formation of nitric oxide (NO). On the other hand, IN facilitated the vasodilator effects of acetylcholine but not the vasodilation induced by sodium nitroprusside. RN facilitated all the vasodilatory effects of IN. In addition, IN decreased the vasoconstrictor effects of adrenergic nerve stimulation and exogenous noradrenaline. Both effects were in turn facilitated by RN. The joint effect of RN with IN induced a significant increase in the ratio of p-eNOS/eNOS and pAKT/AKT. In conclusion, RN facilitated the vasodilator effects of IN, both direct and induced, on the adrenergic system. Therefore, RN increases vascular sensitivity to IN, thus decreasing tissue resistance to the hormone, a key mechanism in the development of type II diabetes.

Wavelet analysis of laser Doppler microcirculatory signals: Current applications and limitations

Laser Doppler flowmetry (LDF) has long been considered a gold standard for non-invasive assessment of skin microvascular function. Due to the laser Doppler (LD) microcirculatory signal's complex biological and physiological context, using spectral analysis is advisable to extract as many of the signal's properties as feasible. Spectral analysis can be performed using either a classical Fourier transform (FT) technique, which has the disadvantage of not being able to localize a signal in time, or wavelet analysis (WA), which provides both the time and frequency localization of the inspected signal. So far, WA of LD microcirculatory signals has revealed five characteristic frequency intervals, ranging from 0.005 to 2 Hz, each of which being related to a specific physiological influence modulating skin microcirculatory response, providing for a more thorough analysis of the signals measured in healthy and diseased individuals. Even though WA is a valuable tool for analyzing and evaluating LDF-measured microcirculatory signals, limitations remain, resulting in a lack of analytical standardization. As a more accurate assessment of human skin microcirculation may better enhance the prognosis of diseases marked by microvascular dysfunction, searching for improvements to the WA method is crucial from the clinical point of view. Accordingly, we have summarized and discussed WA application and its limitations when evaluating LD microcirculatory signals, and presented insight into possible future improvements. We adopted a novel strategy when presenting the findings of recent studies using WA by focusing on frequency intervals to contrast the findings of the various studies undertaken thus far and highlight their disparities.

New insights into mechanisms of endothelial insulin resistance in type 2 diabetes

Insulin resistance in the vasculature is a hallmark of type 2 diabetes (T2D), and blunting of insulin-induced vasodilation is its primary consequence. Individuals with T2D exhibit a marked impairment in insulin-induced dilation in resistance arteries across vascular beds. Importantly, reduced insulin-stimulated vasodilation and blood flow to skeletal muscle limits glucose uptake and contributes to impaired glucose control in T2D. The study of mechanisms responsible for the suppressed vasodilatory effects of insulin has been a growing topic of interest for not only its association with glucose control and extension to T2D but also its relationship with cardiovascular disease development and progression. In this mini-review, we integrate findings from recent studies by our group with the existing literature focused on the mechanisms underlying endothelial insulin resistance in T2D.

The Potential of L-Arginine in Prevention and Treatment of Disturbed Carbohydrate and Lipid Metabolism—A Review

L-arginine, an endogenous amino acid, is a safe substance that can be found in food. The compound is involved in synthesis of various products responsible for regulatory functions in the body. Particularly noteworthy is, among others, nitric oxide, a signaling molecule regulating carbohydrate and lipid metabolism. The increasing experimental and clinical data indicate that L-arginine supplementation may be helpful in managing disturbed metabolism in obesity, regulate arterial blood pressure or alleviate type 2 diabetes symptoms, but the mechanisms underlying these effects have not been sufficiently elucidated. This review aims to present the up-to-date information regarding the current uses and health-promoting potential of L-arginine, its effects on nitric oxide, carbohydrate and lipid metabolisms, based on the results of in vivo, in vitro studies, and clinical human trials. Available literature suggests that L-arginine may have beneficial effects on human health. However, some studies found that higher dietary L-arginine is associated with worsening of an existing disease or may be potential risk factor for development of some diseases. The mechanisms of regulatory effects of L-arginine on carbohydrate and lipid metabolism have not been fully understood and are currently under investigation.

Old and New Biomarkers Associated with Endothelial Dysfunction in Chronic Hyperglycemia

Chronic hyperglycemia and vascular damage are strictly related. Biomarkers of vascular damage have been intensively studied in the recent years in the quest of reliable cardiovascular risk assessment tools able to facilitate risk stratification and early detection of vascular impairment. The present study is a narrative review with the aim of revising the available evidence on current and novel markers of hyperglycemia-induced vascular damage. After a discussion of classic tools used to investigate endothelial dysfunction, we provide an in-depth description of novel circulating biomarkers (chemokines, extracellular vesicles, and epigenetic and metabolomic biomarkers). Appropriate use of a single as well as a cluster of the discussed biomarkers might enable in a near future (a) the prompt identification of targeted and customized treatment strategies and (b) the follow-up of cardiovascular treatment efficacy over time in clinical research and/or in clinical practice.

Oral Glucose Load and Human Cutaneous Microcirculation: An Insight into Flowmotion Assessed by Wavelet Transform

Simple Summary

There is increasing evidence to suggest that microcirculation becomes dysfunctional earlier than large blood vessels or the heart in several diseases. In diabetes mellitus, a disease characterized by chronic hyperglycemia, microvascular impairment is well-established; on the contrary, the effect of acute hyperglycemia in microcirculation remains unclarified. Our aim was to investigate the microvascular effect of an oral glucose load (OGL) using laser Doppler flowmetry (LDF) as a perfusion quantification technique, coupled with wavelet transform (WT) to perform a spectral decomposition of the LDF signal. On two distinct occasions (pre-load and post-load), sixteen healthy subjects drank either a standard glucose solution or water. Perfusion was assessed by LDF and WT while resting and during post-occlusive reactive hyperemia (PORH), evoked by a transient three-min occlusion of the brachial artery, in the forearm and the finger pulp. The OGL affected microcirculation in both sites compared to water, significantly blunting the PORH response in the forearm. The WT revealed significant differences in the cardiac and sympathetic components after OGL between the pre-load and post-load periods. These results suggest that an OGL induces a short-term subtle microvascular impairment, probably involving a modulation of the sympathetic nervous system.

Abstract

Microcirculation in vivo has been assessed using non-invasive technologies such as laser Doppler flowmetry (LDF). In contrast to chronic hyperglycemia, known to induce microvascular dysfunction, the effects of short-term elevations in blood glucose on microcirculation are controversial. We aimed to assess the impact of an oral glucose load (OGL) on the cutaneous microcirculation of healthy subjects, quantified by LDF and coupled with wavelet transform (WT) as an interpretation tool. On two separate occasions, sixteen subjects drank either a glucose solution (75 g in 250 mL water) or water (equal volume). LDF signals were obtained in two anatomical sites (forearm and finger pulp) before and after each load (pre-load and post-load, respectively), in resting conditions and during post-occlusive reactive hyperemia (PORH). The WT allowed decomposition of the LDF signals into their spectral components (cardiac, respiratory, myogenic, sympathetic, endothelial NO-dependent). The OGL blunted the PORH response in the forearm, which was not observed with the water load. Significant differences were found for the cardiac and sympathetic components in the glucose and water groups between the pre-load and post-load periods. These results suggest that an OGL induces a short-term subtle microvascular impairment, probably involving a modulation of the sympathetic nervous system.

Evidence for the Contribution of Gut Microbiota to Age-Related Anabolic Resistance

Globally, people 65 years of age and older are the fastest growing segment of the population. Physiological manifestations of the aging process include undesirable changes in body composition, declines in cardiorespiratory fitness, and reductions in skeletal muscle size and function (i.e., sarcopenia) that are independently associated with mortality. Decrements in muscle protein synthetic responses to anabolic stimuli (i.e., anabolic resistance), such as protein feeding or physical activity, are highly characteristic of the aging skeletal muscle phenotype and play a fundamental role in the development of sarcopenia. A more definitive understanding of the mechanisms underlying this age-associated reduction in anabolic responsiveness will help to guide promyogenic and function promoting therapies. Recent studies have provided evidence in support of a bidirectional gut-muscle axis with implications for aging muscle health. This review will examine how age-related changes in gut microbiota composition may impact anabolic response to protein feeding through adverse changes in protein digestion and amino acid absorption, circulating amino acid availability, anabolic hormone production and responsiveness, and intramuscular anabolic signaling. We conclude by reviewing literature describing lifestyle habits suspected to contribute to age-related changes in the microbiome with the goal of identifying evidence-informed strategies to preserve microbial homeostasis, anabolic sensitivity, and skeletal muscle with advancing age.

Association of Gut Hormones and Microbiota with Vascular Dysfunction in Obesity

In the past few decades, obesity has reached pandemic proportions. Obesity is among the main risk factors for cardiovascular diseases, since chronic fat accumulation leads to dysfunction in vascular endothelium and to a precocious arterial stiffness. So far, not all the mechanisms linking adipose tissue and vascular reactivity have been explained. Recently, novel findings reported interesting pathological link between endothelial dysfunction with gut hormones and gut microbiota and energy homeostasis. These findings suggest an active role of gut secretome in regulating the mediators of vascular function, such as nitric oxide (NO) and endothelin-1 (ET-1) that need to be further investigated. Moreover, a central role of brain has been suggested as a main player in the regulation of the different factors and hormones beyond these complex mechanisms. The aim of the present review is to discuss the state of the art in this field, by focusing on the processes leading to endothelial dysfunction mediated by obesity and metabolic diseases, such as insulin resistance. The role of perivascular adipose tissue (PVAT), gut hormones, gut microbiota dysbiosis, and the CNS function in controlling satiety have been considered. Further understanding the crosstalk between these complex mechanisms will allow us to better design novel strategies for the prevention of obesity and its complications.

Increased Uric Acid and Life Style Factors Associated with Metabolic Syndrome in Thais

Background

The prevalence of metabolic syndrome (MS) has been continually increasing in developing countries especially in Thailand. Although insulin resistance and central obesity are initially considered as significant risk factors, the other causal factors leading to the development of MS continue to challenge the investigators. The aims of this study were to evaluate the prevalence of MS in Pathum Thani province, Thailand and to investigate the relationship between MS and risk factors.

Methods

This cross-sectional study was performed with 202 Thai volunteers. Anthropometric-biochemical variables and blood pressures in each subject were measured.

Results

Almost one-third (32.7%) of the participants were diagnosed with MS based on the harmonized criteria, and one of the most significant risk factors is the elevated blood pressure. Weight, BMI, waist and hip circumferences, waist-hip ratio, blood pressure, glucose, triglycerides and uric acid were significantly higher in subjects with MS subjects. However, HDL-C levels were significantly lower in subjects with MS, compared to subjects without MS (p<0.001). The results of regression model after adjustment for age and gender showed that the increased serum uric acid level (OR=1.31, 95%CI: =1.04–1.66), cigarette smoking (OR=3.72, 95%CI: =1.51–9.15) and physical activity (OR=0.36, 95%CI: =0.19–0.67) were significantly related to MS.

Conclusions

These findings suggest that the decrease of uric acid level, the promotion of physical activity and smoking cessation may decrease the risk of developing MS among Thais.

Insulin treatment increases brain nitric oxide and oxidative stress, but does not affect memory function in mice

Insulin increases brain nitric oxide (NO) level but the mechanism and the significance of the effect on memory are not fully understood. This study aimed to demonstrate the mechanism of insulin-induced increase in oxidative stress (OS) and its consequences on learning and memory. Twenty four mice were assigned to groups (n = 6) and treated daily for seven days with water (control), insulin, insulin+N^ω-nitro-L-arginine methyl ester hydrochloride (L-NAME) and L-NAME, respectively. Memory was assessed using Y-maze; NO, malondialdehyde (MDA) and glutathione peroxidase (GPx) in brain homogenate were also determined. There was no difference between the groups in the number of entries into the arms and time spent in them, and in number of and percentage alternations performed by the mice, indicating normal memory function of the control and treated mice. NO level in the insulin group was higher compared to the control (p = .018), while those of the other groups were statistically the same compared to the control group. MDA values in the insulin group were higher (p = .001) than those of the control, while those of the other groups were statistically the same compared to those of the control group. GPx activity in the insulin group was lower compared to control (p = .004), while that of the other groups was not significantly different compared to control. It was concluded that insulin treatment increased brain level of NO and OS through increased malondialdehyde level and glutathione peroxidase activity; insulin treatment did not affect long-term visuo-spatial and short-term working memory in the animals. Insulin treatment may have deleterious effects on the brain through increased NO and OS levels.

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta-analysis

This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (-0.41%, 95% CI, -0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (-4.26%, 95% CI, -4.97 to -3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes.

Endothelial Cell Metabolism

Endothelial cells (ECs) are more than inert blood vessel lining material. Instead, they are active players in the formation of new blood vessels (angiogenesis) both in health and (life-threatening) diseases. Recently, a new concept arose by which EC metabolism drives angiogenesis in parallel to well-established angiogenic growth factors (e.g., vascular endothelial growth factor). 6-Phosphofructo-2-kinase/fructose-2,6-bisphosphatase-3-driven glycolysis generates energy to sustain competitive behavior of the ECs at the tip of a growing vessel sprout, whereas carnitine palmitoyltransferase 1a-controlled fatty acid oxidation regulates nucleotide synthesis and proliferation of ECs in the stalk of the sprout. To maintain vascular homeostasis, ECs rely on an intricate metabolic wiring characterized by intracellular compartmentalization, use metabolites for epigenetic regulation of EC subtype differentiation, crosstalk through metabolite release with other cell types, and exhibit EC subtype-specific metabolic traits. Importantly, maladaptation of EC metabolism contributes to vascular disorders, through EC dysfunction or excess angiogenesis, and presents new opportunities for anti-angiogenic strategies. Here we provide a comprehensive overview of established as well as newly uncovered aspects of EC metabolism.

Human Skeletal Muscle Protein Metabolism Responses to Amino Acid Nutrition

Healthy individuals maintain remarkably constant skeletal muscle mass across much of adult life, suggesting the existence of robust homeostatic mechanisms. Muscle exists in dynamic equilibrium whereby the influx of amino acids (AAs) and the resulting increases in muscle protein synthesis (MPS) associated with the intake of dietary proteins cancel out the efflux of AAs from muscle protein breakdown that occurs between meals. Dysregulated proteostasis is evident with aging, especially beyond the sixth decade of life. Women and men aged 75 y lose muscle mass at a rate of ∼0.7% and 1%/y, respectively (sarcopenia), and lose strength 2- to 5-fold faster (dynapenia) as muscle "quality" decreases. Factors contributing to the disruption of an otherwise robust proteostatic system represent targets for potential therapies that promote healthy aging. Understanding age-related impairments in anabolic responses to AAs and identifying strategies to mitigate these factors constitute major areas of interest. Numerous studies have aimed to identify 1) the influence of distinct protein sources on absorption kinetics and muscle anabolism, 2) the latency and time course of MPS responses to protein/AAs, 3) the impacts of protein/AA intake on muscle microvascular recruitment, and 4) the role of certain AAs (e.g., leucine) as signaling molecules, which are able to trigger anabolic pathways in tissues. This review aims to discuss these 4 issues listed, to provide historical and modern perspectives of AAs as modulators of human skeletal muscle protein metabolism, to describe how advances in stable isotope/mass spectrometric approaches and instrumentation have underpinned these advances, and to highlight relevant differences between young adults and older individuals. Whenever possible, observations are based on human studies, with additional consideration of relevant nonhuman studies.

Augmented endothelial l-arginine transport ameliorates pressure-overload-induced cardiac hypertrophy

NEW FINDINGS

What is the central question of this study? What is the potential role of endothelial NO production via overexpression of the l-arginine transporter, CAT1, as a mitigator of cardiac hypertrophy? What is the main finding and its importance? Augmentation of endothelium-specific l-arginine transport via CAT1 can attenuate pressure-overload-dependent cardiac hypertrophy and fibrosis. Our findings support the conclusion that interventions that improve endothelial l-arginine transport may provide therapeutic utility in the setting of myocardial hypertrophy. Such modifications may be introduced by exercise training or locally delivered gene therapy, but further experimental and clinical studies are required. Endothelial dysfunction has been postulated to play a central role in the development of cardiac hypertrophy, probably as a result of reduced NO bioavailability. We tested the hypothesis that increased endothelial NO production, mediated by increased l-arginine transport, could attenuate pressure-overload-induced cardiac hypertrophy. Echocardiography and blood pressure measurements were performed 15 weeks after transverse aortic constriction (TAC) in wild-type (WT) mice (n = 12) and in mice with endothelium-specific overexpression of the l-arginine transporter, CAT1 (CAT+; n = 12). Transverse aortic constriction induced greater increases in heart weight to body weight ratio in WT (by 47%) than CAT+ mice (by 25%) compared with the respective controls (P ≤ 0.05). Likewise, the increase in left ventricular wall thickness induced by TAC was significantly attenuated in CAT+ mice (P = 0.05). Cardiac collagen type I mRNA expression was greater in WT mice with TAC (by 22%; P = 0.03), but not in CAT+ mice with TAC, compared with the respective controls. Transverse aortic constriction also induced lesser increases in β-myosin heavy chain mRNA expression in CAT+ mice compared with WT (P ≤ 0.05). Left ventricular systolic pressure after TAC was 36 and 39% greater in WT and CAT+ mice, respectively, compared with the respective controls (P ≤ 0.001). Transverse aortic constriction had little effect on left ventricular end-diastolic pressure in both genotypes. Taken together, these data indicate that augmenting endothelial function by overexpression of l-arginine transport can attenuate pressure-overload-induced cardiac hypertrophy.

Cardiovascular Action of Insulin in Health and Disease: Endothelial L-Arginine Transport and Cardiac Voltage-Dependent Potassium Channels

Impairment of insulin signaling on diabetes mellitus has been related to cardiovascular dysfunction, heart failure, and sudden death. In human endothelium, cationic amino acid transporter 1 (hCAT-1) is related to the synthesis of nitric oxide (NO) and insulin has a vascular effect in endothelial cells through a signaling pathway that involves increases in hCAT-1 expression and L-arginine transport. This mechanism is disrupted in diabetes, a phenomenon potentiated by excessive accumulation of reactive oxygen species (ROS), which contribute to lower availability of NO and endothelial dysfunction. On the other hand, electrical remodeling in cardiomyocytes is considered a key factor in heart failure progression associated to diabetes mellitus. This generates a challenge to understand the specific role of insulin and the pathways involved in cardiac function. Studies on isolated mammalian cardiomyocytes have shown prolongated action potential in ventricular repolarization phase that produces a long QT interval, which is well explained by attenuation in the repolarizing potassium currents in cardiac ventricles. Impaired insulin signaling causes specific changes in these currents, such a decrease amplitude of the transient outward K(+) (Ito) and the ultra-rapid delayed rectifier (IKur) currents where, together, a reduction of mRNA and protein expression levels of α-subunits (Ito, fast; Kv 4.2 and IKs; Kv 1.5) or β-subunits (KChIP2 and MiRP) of K(+) channels involved in these currents in a MAPK mediated pathway process have been described. These results support the hypothesis that lack of insulin signaling can produce an abnormal repolarization in cardiomyocytes. Furthermore, the arrhythmogenic potential due to reduced Ito current can contribute to an increase in the incidence of sudden death in heart failure. This review aims to show, based on pathophysiological models, the regulatory function that would have insulin in vascular system and in cardiac electrophysiology.

Skeletal muscle homeostasis and plasticity in youth and ageing: impact of nutrition and exercise

Skeletal muscles comprise a substantial portion of whole body mass and are integral for locomotion and metabolic health. Increasing age is associated with declines in both muscle mass and function (e.g. strength‐related performance, power) with declines in muscle function quantitatively outweighing those in muscle volume. The mechanisms behind these declines are multi‐faceted involving both intrinsic age‐related metabolic dysregulation and environmental influences such as nutritional and physical activity. Ageing is associated with a degree of ‘anabolic resistance’ to these key environmental inputs, which likely accelerates the intrinsic processes driving ageing. On this basis, strategies to sensitize and/or promote anabolic responses to nutrition and physical activity are likely to be imperative in alleviating the progression and trajectory of sarcopenia. Both resistance‐ and aerobic‐type exercises are likely to confer functional and health benefits in older age, and a clutch of research suggests that enhancement of anabolic responsiveness to exercise and/or nutrition may be achieved by optimizing modifications of muscle‐loading paradigms (workload, volume, blood flow restriction) or nutritional support (e.g. essential amino acid/leucine) patterns. Nonetheless, more work is needed in which a more holistic view in ageing studies is taken into account. This should include improved characterization of older study recruits, that is physical activity/nutritional behaviours, to limit confounding variables influencing whether findings are attributable to age, or other environmental influences. Nonetheless, on balance, ageing is associated with declines in muscle mass and function and a partially related decline in aerobic capacity. There is also good evidence that metabolic flexibility is impaired in older age.

Pharmacological enhancement of leg and muscle microvascular blood flow does not augment anabolic responses in skeletal muscle of young men under fed conditions

Skeletal muscle anabolism associated with postprandial plasma aminoacidemia and insulinemia is contingent upon amino acids (AA) and insulin crossing the microcirculation-myocyte interface. In this study, we hypothesized that increasing muscle microvascular blood volume (flow) would enhance fed-state anabolic responses in muscle protein turnover. We studied 10 young men (23.2 ± 2.1 yr) under postabsorptive and fed [iv Glamin (∼10 g AA), glucose ∼7.5 mmol/l] conditions. Methacholine was infused into the femoral artery of one leg to determine, via bilateral comparison, the effects of feeding alone vs. feeding plus pharmacological vasodilation. We measured leg blood flow (LBF; femoral artery) by Doppler ultrasound, muscle microvascular blood volume (MBV) by contrast-enhanced ultrasound (CEUS), muscle protein synthesis (MPS) and breakdown (MPB; a-v balance modeling), and net protein balance (NPB) using [1,2-(13)C2]leucine and [(2)H5]phenylalanine tracers via gas chromatography-mass spectrometry (GC-MS). Indexes of anabolic signaling/endothelial activation (e.g., Akt/mTORC1/NOS) were assessed using immunoblotting techniques. Under fed conditions, LBF (+12 ± 5%, P < 0.05), MBV (+25 ± 10%, P < 0.05), and MPS (+129 ± 33%, P < 0.05) increased. Infusion of methacholine further enhanced LBF (+126 ± 12%, P < 0.05) and MBV (+79 ± 30%, P < 0.05). Despite these radically different blood flow conditions, neither increases in MPS in response to feeding (0.04 ± 0.004 vs. 0.08 ± 0.01%/h, P < 0.05) nor improvements in NPB (-4.4 ± 2.4 vs. 16.4 ± 5.7 nmol Phe·100 ml leg(-1)·min(-1), P < 0.05) were affected by methacholine infusion (MPS 0.07 ± 0.01%/h; NPB 24.0 ± 7.7 nmol Phe·100 ml leg(-1)·min(-1)), whereas MPB was unaltered by either feeding or infusion of methacholine. Thus, enhancing LBF/MBV above that occurring naturally with feeding alone does not improve muscle anabolism.

The influence of retinal blood flow on open-angle glaucoma in patients with and without diabetes

PURPOSE

To evaluate the impact of retinal blood flow on optic nerve head (ONH) morphology in patients with open-angle glaucoma (OAG) with and without diabetes mellitus (DM).

METHODS

A total of 66 patients with OAG (14 with DM, 52 without DM) were assessed at baseline and 3-year follow-up for retinal capillary blood flow using confocal scanning laser Doppler and ocular structure using Heidelberg retinal tomography and optical coherence tomography.

RESULTS

Change in retinal tissue with zero blood flow in the superior and inferior retina was found to have a strong correlation with ONH changes in diabetic patients (r≥0.90, p≤0.03); however, no relation was found in the nondiabetic cohort. There were also significant changes in inferior mean flow that strongly correlated with changes in cup area (r = 0.97, p = 0.0029), cup/disc area ratio (r = 0.96, p = 0.0070), linear cup/disc ratio (r = 0.93, p = 0.0172), rim area (r = -0.97, p = 0.0036), and rim volume (r = -0.95, p = 0.0084) in diabetic patients only, while changes in the superior mean flow were only significantly associated with cup area (r = -0.30, p = 0.0498), cup volume (r = -0.36, p = 0.0178), and rim volume (r = 0.35, p = 0.0193) in nondiabetic patients.

CONCLUSIONS

In this cohort of patients with OAG, changes in retinal capillary blood flow correlated more strongly with changes in ONH morphology in patients with DM than in those without DM. These data suggest that changes in retinal blood flow may play a larger role in glaucomatous ONH progression in patients with OAG with DM.