Second World Congress on the Insulin Resistance Syndrome: hypertension, cardiovascular disease, and treatment approaches

Effects of Lactobacillus on Mice with Diabetes Induced by High-Fat Diet with Streptozotocin (STZ)

This study aimed to evaluate and compare the effects of heat-killed and live Lactobacillus on mice with diabetes induced by high-fat diet with streptozotocin (STZ). Results based on body weight and liver pathological changes, oral glucose tolerance test, and related serum index (AST (aspartate aminotransferase), ALT (alanine aminotransferase), MDA (malondialdehyde), TNF-α (tumor necrosis factor α), INS (insulin), and GC (glucagon) and gene expression of IL-1β (Interleukin 1β), IRS-1(Insulin receptor substrate 1), GLUT-4 (glucose transporter type 4), PPARγ (peroxisome proliferators-activated receptor γ), and SREBP-1c (sterol-regulatory element-binding protein-1c) levels indicated that Lactobacillus fermentum (LF) and Lactobacillus plantarum (LP) could increase the average weight, alleviate the degree of damage in the liver, and improve the glucose tolerance of mice with diabetes. LF and LP also participated in the downregulation of AST, ALT, MDA, TNF-α, INS, and GC in serum, as well as the inhibition of IL-1β, TNF-α, IRS-1, GLUT-4, PPARγ, and SREBP-1c expression. These regulating effects were remarkable, and the regulating effect of the live group was significantly better than that of the heat-killed group. This study suggested that LF and LP can significantly alleviate liver damage and hepatic insulin resistance in mice with diabetes and that the acting mechanisms of LF and LP were related to cellular components and their activities.

Therapeutic interventions for hypertension in metabolic syndrome: a comprehensive approach

Hypertension is a major component of the metabolic syndrome and a major cardiovascular risk factor. Both disorders are rapidly increasing in frequency, with hypertension affecting nearly 60 million Americans and over 1 billion people worldwide, and metabolic syndrome affecting 44% of the US population above the age of 60 years. Sedentary lifestyle, together with obesity and aging of the population, are the major contributing factors for this growing epidemic. Hypertension in metabolic syndrome possesses unique pathophysiological aspects that have considerable implications on therapy of this disease. In this article, we review the pathophysiology and provide a rationale for the current therapeutic options in light of the most recent clinical trials in the field.

Arterial stiffness predicts risk for long-term recurrence in patients with type 2 diabetes admitted for acute coronary event

OBJECTIVES

to investigate the predictive value of arterial stiffness (AS) estimation for long-term recurrences in patients with type 2 diabetes (DM2) following acute coronary event.

PATIENTS AND METHODS

prospective observational study involving 119 DM2 patients without history of coronary heart disease admitted with ST-segment elevation myocardial infarction (STEMI). Medical history, anthropometrics, smoking, HbA1c, lipid profile, troponine-I levels, and left ventricular ejection fraction (LVEF) were recorded. Carotid-femoral pulse wave velocity (cf-PWV) was measured 1 month after discharge. Patients were followed up for 36 months or to reach an end-point: cardiovascular death, acute coronary event, angioplasty or hospitalization for acute heart failure. To facilitate analysis, patients were divided into two groups according to cf-PWV, using the accepted cut-off value of 12m/s.

RESULTS

overall, 34 patients had a recurrence. In Kaplan-Meier analysis patients with cf-PWV>12m/s had mean time-to-event 353±43 days compared to 505±115 days for patients with cf-PWV≤12m/s, log rank=0.0252. In multivariate analysis factors independently associated with recurrence were age (66.53±6.87 vs. 61.54±10.77 years, p=0.015), LVEF (41.66±8.21 vs. 47.58±8.11%, p=0.001) and cf-PWV (13.94±2.91 vs. 12.35±2.77m/s, p=0.008).

CONCLUSIONS

AS estimation in patients with DM2 after STEMI discriminate patients at higher risk for 3-year recurrence, and maybe valuable for distinguishing patients likely to require a more rigorous therapeutic intervention.

Urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels in patients with nonalcoholic fatty liver disease

Background/Aims

Nonalcoholic fatty liver disease (NAFLD), one of the most common forms of chronic liver disease, is closely associated with obesity and insulin resistance (IR). Adipokines secreted by adipose tissue have recently been implicated in initiating and perpetuating the chronic inflammatory state observed in obesity and NAFLD. Recent studies suggest neutrophil gelatinase-associated lipocalin (NGAL) plays a key role in the pathogenesis of IR. The aims of this study were to determine urinary NGAL levels in patients with ultrasonography proven NAFLD and to correlate these levels with the metabolic profile and fibrosis grade in this population.

Methodology

Our cohort consisted of 65 consecutive patients undergoing abdominal ultrasonography for clinical suspicion of NAFLD. Patients were subsequently divided into two groups: no steatosis (n=20) and steatosis (n=45). The stage of fibrosis was measured using a four-point scale. Urinary NGAL was measured by a specific microparticle enzyme immunoassay. The degree of insulin resistance was determined by the homeostatic model assessment (HOMA). Glucose, insulin, lipid profile, and transaminases were also measured.

Results

Urinary NGAL levels correlated with body mass index, HOMA, fasting glucose, and insulin levels in patients with steatosis. Moreover, uNGAL levels were higher in patients with steatosis compared to those with no steatosis (49.8 ng/mL and 22.7 ng/mL, respectively) with a statistically significant difference (p<0.001). A stepwise increase in uNGAL levels from patients without fibrosis (21.7 ng/mL) to patients with cirrhosis (47.4 ng/mL) was noted (p<0.001).

Conclusions

Our study demonstrates that in adult patients with NAFLD, uNGAL levels correlate with BMI, insulin resistance, and lipid profiles, and identifies a novel association between uNGAL levels and hepatocellular injury in these patients.

Peroxisome proliferator-activated receptor-alpha (PPARalpha): at the crossroads of obesity, diabetes and cardiovascular disease

Cardiovascular disease is the leading cause of morbidity and mortality world-wide. The burden of disease is also increasing as a result of the global epidemics of diabetes and obesity. Peroxisome proliferator-activated receptor alpha (PPARalpha), a member of this nuclear receptor family, has emerged as an important player in this scenario, with evidence supporting a central co-ordinated role in the regulation of fatty acid oxidation, lipid and lipoprotein metabolism and inflammatory and vascular responses, all of which would be predicted to reduce atherosclerotic risk. Additionally, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study has indicated the possibility of preventive effects in diabetes-related microvascular complications, although the mechanisms of these effects warrant further study. The multimodal pharmacological profile of PPARalpha has prompted development of selective PPAR modulators (SPPARMs) to maximise therapeutic potential. It is anticipated that PPARalpha will continue to have important clinical application in addressing the major challenge of cardiometabolic risk associated with type 2 diabetes, obesity and metabolic syndrome.

Serum retinol-binding protein 4 levels in patients with nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD), one of the most common forms of chronic liver disease, is closely associated with obesity and insulin resistance (IR). Recent studies suggest serum retinol-binding protein 4 (RBP4) plays a key role in the pathogenesis of IR. The aims of this study were to determine serum RBP4 levels in patients with biopsy proven NAFLD, and to correlate these levels with the metabolic profile and histologic features in this population.

METHODS

Our cohort consisted of 51 consecutive patients undergoing liver biopsy for clinical suspicion of NAFLD. Patients were subsequently divided into 3 groups: simple steatosis (n=16), borderline nonalcoholic steatohepatitis (NASH) (n=2) and NASH (n=33). The stage of fibrosis was measured using a 4-point scale. RBP4 was measured in triplicates by a specific enzyme-linked immunosorbent assay. The degree of insulin resistance was determined by the homeostatic model assessment.

RESULTS

Serum RBP4 levels did not correlate with body mass index, homeostatic model assessment, fasting glucose, or insulin levels in patients with simple steatosis and NASH. Moreover, RBP4 levels were lower in patients with NASH compared with those with simple steatosis (21.3 and 26.8 mg/L, respectively) although the difference did not reach statistical significance (P=0.21). A stepwise decrease in RBP4 levels from patients without fibrosis (27.9 mg/L) to patients with cirrhosis (14.1 mg/L) was noted (P=0.03).

CONCLUSIONS

Our study demonstrates that in adult patients with NAFLD, serum RBP4 levels do not correlate with body mass index or insulin resistance and identifies a novel association between serum RBP4 levels and hepatocellular injury in these patients.