Clinical characteristics of diabetic ketoacidosis in users and non-users of SGLT2 inhibitors

AIM

This study investigated the clinical characteristics of diabetic ketoacidosis (DKA) and compared the DKA characteristics between patients treated with and without SGLT2 inhibitors.

METHODS

Data were collected from patients aged ≥ 18 years admitted for DKA at nine centres in Korea between September 2014 and April 2017. The electronic medical records of these subjects were retrospectively reviewed. Based on their history of medications taken before admission, subjects were classified as either users or non-users of SGLT2 inhibitors and their clinical characteristics of DKA were compared.

RESULTS

During the study, the main subtype of DKA episodes (n = 523) was identified as type 2 diabetes (51%). Average hospitalization duration was 11 days, and average intensive care unit (ICU) time was 2.5 days. The in-hospital mortality rate was 3%, but no users of SGLT2 inhibitors died during DKA treatment. In patients taking SGLT2 inhibitors (n = 15), DKA manifested at 124 days, on average, after starting the inhibitors (range: 7-380 days). Also, SGLT2 inhibitors users had significantly lower plasma glucose levels (413 mg/dL) compared with non-users (554 mg/dL), and longer ICU stays (4 vs. 2 days; P = 0.019).

CONCLUSION

In this report of recent data on the clinical features of DKA in Korea, patients using SGLT2 inhibitors needed longer treatment in ICUs compared with non-users and had lower levels of blood glucose, whereas DKA associated with SGLT2 inhibitors was rare.

Variation in 8-ketotrichothecenes and zearalenone production by Fusarium graminearum isolates from corn and barley in Korea

A total of 214 Fusarium graminearum isolates were obtained from corn and barley which were collected from Kangwon province and the southern part of Korea, respectively, and were tested for 8-ketotrichothecenes and zearalenone (ZEA) production on rice grains. The incidences of trichothecene production by 105 isolates of F. graminearum from corn were 59.0% for deoxynivalenol (DON), 37.1% for 15-acetyldeoxynivalenol(15-ADON), 13.3% for 3-acetyldeoxynivalenol (3-ADON), 7.6% for 3,15-diacetyldeoxynivalenol (3,15-DADON), 20.0% for nivalenol (NIV), 6.7% for 4-acetylnivalenol (4-ANIV), and 1.0% for 4,15-diacetylnivalenol (4,15-DANIV). DON chemotypes frequently produced 15-ADON as the major isomer rather than 3-ADON and 9 of the 61 DON chemotypes produced low levels of NIV. On the other hand, the incidences of trichothecene production of 109 isolates by F. graminearum from barley were 24.8% for DON, 72.5% for NIV, 62.4% for 4-ANIV, and 10.1% for 4,15-DANIV. Of these isolates, 78 were NIV chemotypes and only one isolate produced DON and 3-ADON as major toxins. In addition, 26 of the 78 NIV chemotypes produced low levels of DON. ZEA was frequently produced by the trichothecene-producing isolates and the incidences of ZEA were 51.4% and 31.2% for the isolates from corn and barley, respectively. There was a great regional difference in trichothecene production by F. graminearum isolates between corn- and barley-producing areas in Korea.

Serum selenoprotein P levels in patients with type 2 diabetes and prediabetes: implications for insulin resistance, inflammation, and atherosclerosis

CONTEXT AND OBJECTIVE

The dysregulation of hepatokines may be associated with the pathogenesis of insulin resistance and type 2 diabetes. A recent study has suggested that selenoprotein P (SeP), a novel hepatokine, may play a role in the regulation of glucose metabolism and insulin sensitivity. We examined the relationship between circulating SeP levels and clinical parameters associated with insulin resistance in humans.

PARTICIPANTS AND METHODS

We compared serum SeP concentrations in 100 subjects with diverse glucose tolerance statuses. Furthermore, we evaluated the relationship between SeP and cardiometabolic risk factors including insulin resistance, high-sensitivity C-reactive protein, and carotid intima-media thickness.

RESULTS

Serum SeP concentrations were significantly higher in patients with type 2 diabetes or prediabetes than those with normal glucose tolerance (all P < 0.01) and decreased in a stepwise manner [1032.4 (495.9-2149.4) vs. 867.3 (516.3-1582.7) vs. 362.0 (252.5-694.5), P = 0.004]. In addition, overweight and obese subjects had significantly increased SeP levels compared with lean subjects (P = 0.002). Spearman's partial correlation analysis adjusted for age and gender showed a significant relationship between SeP and cardiometabolic factors including body mass index, waist circumference, systolic blood pressure, triglycerides, glucose, hemoglobin A1c, aspartate aminotransferase, and insulin resistance. Furthermore, in multiple regression analyses, SeP showed an independent association with carotid intima-media thickness as well as high-sensitivity C-reactive protein, even after adjustment for other confounding factors.

CONCLUSIONS

Circulating SeP concentrations were elevated in patients with glucose metabolism dysregulation and were related to various cardiometabolic parameters including insulin resistance, inflammation, and atherosclerosis.

Combined effect of high-normal blood pressure and low HDL cholesterol on mortality in an elderly Korean population: the South-West Seoul (SWS) study

BACKGROUND

It is unclear whether prehypertension by the seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) criteria (systolic blood pressure (SBP) 120-139 or diastolic blood pressure (DBP) 80-89 mm Hg) or high-normal blood pressure (HNBP) by the European Society of Hypertension and European Society of Cardiology (ESH/ESC) criteria (SBP 130-139 or DBP 85-89 mm Hg) predicts mortality in elderly Koreans. We compared the mortality risk between those with prehypertension and HNBP and evaluated whether the presence of components of metabolic syndrome (MetS) can improve the prediction of mortality in subjects with HNBP.

METHODS

We analyzed all-cause and cardiovascular disease (CVD) mortality according to the JNC-7 and ESH/ESC categories using follow-up data of the South-West Seoul (SWS) Study, a prospective cohort study of 2,376 elderly Koreans, aged >60 years.

RESULTS

During the median follow-up of 7.6 years, 353 deaths occurred from all causes, and 113 of these were attributed to CVD. Prehypertension was nonsignificantly associated with an increased risk of mortality (hazard ratio (HR): 1.06, 95% confidence interval (CI): 0.68-1.64). Subjects with HNBP exhibited a nonsignificantly higher risk of mortality compared with those with optimal blood pressure by the ESH/ESC guideline (HR: 1.35, 95% CI: 0.84-2.18). However, the combination of low high-density lipoprotein (HDL) cholesterol and HNBP showed a twofold higher risk of all-cause mortality (HR: 2.01, 95% CI: 1.11-3.64) independent of other risk factors.

CONCLUSIONS

Although prehypertension was not associated with increased risk of mortality, individuals in the elderly Korean population with HNBP, especially when combined with low HDL cholesterol, showed a significantly increased risk of all-cause mortality.

Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes

OBJECTIVE

The use of a real time continuous glucose monitoring system (RT-CGM) was studied as a behavior modification tool and the effectiveness of a RT-CGM in glucose control for patients with type 2 diabetes was determined.

METHODS

We conducted a prospective, open-label, randomized, controlled clinical trial in 65 patients with poorly controlled type 2 diabetes (8.0</=HbA1c</=10%) over a 3-month period. The intervention group was monitored monthly with a RT-CGM (three days at a time for 3 months) and the control group continued self-monitoring blood glucose (SMBG) at least four times a week for 3 months.

RESULTS

The HbA1c of the RT-CGM group was significantly reduced after 12 weeks compared with the SMBG group (9.1+/-1.0% to 8.0+/-1.2% vs. 8.7+/-0.7% to 8.3+/-1.1%, respectively; P=0.004). In the RT-CGM group, there was a significant reduction in total daily calorie intake, weight, body mass index (BMI), and postprandial glucose level, and a significant increase in total exercise time per week after 3 months.

CONCLUSIONS

We demonstrated that the RT-CGM was useful in modifying a patient's diet and exercise habits and could induce better glycemic control than SMBG for patients with type 2 diabetes.

Serum retinol-binding protein 4 levels are elevated in non-alcoholic fatty liver disease

OBJECTIVE

Retinol-binding protein 4 (RBP4) is a recently identified adipokine that is elevated in the serum in several insulin-resistant states. We investigated the relationship between non-alcoholic fatty liver disease (NAFLD) and serum RBP4 in nondiabetic adults.

METHODS

One hundred and fifty-nine nondiabetic, non-alcoholic subjects (95 males and 64 females) participated in this study. Division of subjects into a NAFLD group (n = 73; 45 males and 28 females) or a normal group (n = 86; 50 males and 36 females) was based on the presence of fatty liver disease determined by sonography.

RESULTS

Serum RBP4 levels in the NAFLD group were significantly higher than those in the normal group (62.8 +/- 16.0 mg/l vs. 51.7 +/- 14.6 mg/l, P < 0.0001). Multiple logistic regression analysis revealed that the RBP4 level was an independent factor associated with NAFLD (P = 0.0042). In addition, serum RBP4 levels were positively correlated with serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltranspeptidase (GGT) levels. The significant association between serum RBP4 and GGT levels remained even after adjusting for age, gender, body mass index, the homeostasis model of assessment (HOMA) value and the presence of NAFLD (r = 0.3097, P = 0.0002).

CONCLUSION

Serum RBP4 levels are significantly associated with NAFLD and liver enzymes.

Serum adiponectin, interleukin-10 levels and inflammatory markers in the metabolic syndrome

We examined the association between interleukin-10 (IL-10), adiponectin levels and inflammatory markers such as interleukin-6 (IL-6) and high-sensitive C-reactive protein (hsCRP). Furthermore, the association of these anti-/pro-inflammatory cytokine levels with the metabolic syndrome was investigated. The study subjects were composed of 312 Korean individuals without diabetes. Serum adiponectin level was associated with hsCRP (r=-0.21, P<0.001), IL-6 (r=-0.13, P<0.05) and IL-10 (r=-0.22, P<0.001) levels. Subjects without the metabolic syndrome showed higher adiponectin (17.03 microg/ml versus 13.85 microg/ml, P<0.001) and IL-10 (4.74 pg/ml versus 4.34 pg/ml, P=0.014) levels, and lower serum hsCRP (0.38 microg/ml versus 0.66 microg/ml, P=0.001) and IL-6 (0.94 pg/ml versus 1.32 pg/ml, P=0.009) levels compared to those with the metabolic syndrome. In multiple logistic regression analysis, the metabolic syndrome was associated with sex, age, waist circumference, systolic blood pressure, HDL cholesterol, triglyceride, fasting blood glucose and interleukin-10. Furthermore, serum adiponectin levels are associated with serum hsCRP, IL-6 and IL-10 levels. These results suggest that adiponectin might be associated with the metabolic syndrome through regulation of pro-/anti-inflammatory cytokines.

Aromatase inhibitors (AIs) with or without GnRH agonist as first-line hormone therapy in pre- and post-menopausal Korean women with metastatic breast cancer (MBC): Clinical outcomes in correlation with tumor ER/PR/HER2 status

10732

Background: Clinical outcomes of patients (pts) with MBC by AIs in comprehensive relationship with ER/PR/HER2 status have been scant that the study was performed to analyze their predictive values singly and in combination. Methods: 111 pts who took letrozole or anastrozole as first-line hormonal therapy for MBC were identified from the database at NCC Hospital between Nov. 2001 and Aug. 2005. Pts on AIs concomitantly with or immediately followed by chemotherapy were excluded. AIs/GnRH agonists were used when hormonal levels were not postmenopausal. ER/PR were scored strong, intermediate or weak. HER2+ was IHC 3+ or FISH+. HER2− was IHC 0, 1+ or 2+/FISH−. Clinical benefit (CB) included CR/PR/improving or SD ≥6 months. Results: Median age was 54 years (range, 29–78). Overall 66% achieved CB (CR/PR 18%, improving 26%, and SD ≥ 6mo 22%) with median TTP, 9 mo (range, 1–50, 95% CI, 7–11), and median survival, 41 mo (range, 2–50). Age, AIs with (20) vs. without (91) GnRH agonist, DFI ≤ vs. > 24 mo, adjuvant tamoxifen, or prior metastatic chemotherapy did not affect clinical outcomes. Disease sites (%) were bone (64), LN (52), lung/pleura (41), liver (25), breast (20) and skin (7). Bone only disease had longer TTP (p = 0.004), while liver involvement was associated with short TTP (p = 0.0001)/OS (p = 0.007). ER was 56% strong +, 21% intermediate +, 15% weak +, 5% - and 3% unknown, PR: 24% strong +, 23% intermediate +, 24% weak +, 23% -, and 5% unknown, and HER2: 23% +, 67% -, and 10% unknown. Staining intensity did not affect CB in ER+ tumors. More CB (p = 0.002)/longer TTP (p = 0.003) with strong/intermediate PR+ tumors vs. weak PR+/PR− tumors, and more CB with ER+/PR+ tumors vs. ER+/PR− tumors (P = 0.016) were observed. More CB with HER2− tumors vs. HER2+ tumors (p = 0.001), and with PR+/HER2− tumors vs. the rest (PR−/HER−, PR+/HER+, PR−/HER+) (p = 0.0007) were seen. HER2 positivity was associated with less CB (p = 0.0004)/shorter TTP (p = 0.0157) in ER+/PR+ tumors vs. no influence on CB (p = 0.245)/TTP (p = 0.52) in ER+/PR− tumors. Conclusions: AIs with or without GnRH agonist are effective therapy for pts with MBC, specifically with ER+/PR+/HER2− tumors regardless of ages.

No significant financial relationships to disclose.

Effects of green tea consumption on inflammation, insulin resistance and pulse wave velocity in type 2 diabetes patients

In this study, we examined the effects of green tea on inflammation and arterial stiffness in type 2 diabetes patients. As results, inflammatory markers, such as hsCRP and IL-6, were unchanged after green tea consumption, and neither were blood glucose, lipid profiles, insulin resistance, or serum adiponectin levels. Furthermore, tea consumption did not improve baPWV. These results suggest that the above-described mechanisms are unlikely to explain the cardiovascular risk reduction by tea consumption observed in epidemiological studies.

Serum osteoprotegerin levels are associated with inflammation and pulse wave velocity

OBJECTIVE

We examined the association between serum osteoprotegerin (OPG) levels, systemic inflammation and arterial stiffness in normal and diabetic patients.

PATIENTS AND MEASUREMENTS

The study subjects comprised 49 newly diagnosed diabetic patients and 72 age- and sex-matched normal glucose controls. Anthropometric parameters, blood pressure, fasting blood glucose (FBG), lipid profiles, serum OPG, high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6) and brachial-ankle pulse wave velocity (baPWV) were measured.

RESULTS

Serum OPG levels (6.1 +/- 1.4 vs. 5.4 +/- 1.3 pmol/l, P = 0.011) and baPWV (1562 +/- 354 vs. 1399 +/- 257 cm/s, P = 0.004) were significantly higher in the diabetic group than in the normal glucose group. Serum OPG levels in normal and diabetic patients correlated significantly with systolic blood pressure (r = 0.20, P = 0.035), FBG (r = 0.30, P = 0.002), right baPWV (r = 0.22, P = 0.021), left baPWV (r = 0.26, P = 0.006), homeostasis model assessment insulin resistance (HOMA-IR) (r = 0.19, P = 0.045), IL-6 (r = 0.32, P = 0.001) and hsCRP (r = 0.21, P = 0.027) after adjusting for age and sex. Multiple regression analysis showed that serum OPG level was significantly associated with age, FBG, IL-6, systolic blood pressure, triglyceride and hsCRP (R(2) = 0.299).

CONCLUSIONS

In summary, serum OPG and baPWV levels are elevated in diabetic patients and serum OPG levels are significantly associated with inflammation and arterial stiffness.

Association among serum ferritin, alanine aminotransferase levels, and metabolic syndrome in Korean postmenopausal women

We examined the relationships among serum ferritin, alanine aminotransferase (ALT) levels, and cardiovascular risk factors of metabolic syndrome in Korean postmenopausal women. We conducted a cross-sectional study of 959 postmenopausal women without an apparent cause of liver disease. Metabolic syndrome was defined as the presence of at least 3 of the following: elevated blood pressure, low high-density lipoprotein cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Serum ferritin and ALT levels were found to be correlated (r=0.374, P<.001) and to be associated with the components of metabolic syndrome. Subjects with metabolic syndrome showed significantly higher serum ferritin (74.7+/- 2.0 vs 59.6+/- 2.0 ng/mL, P<.001) and ALT levels (21.3+/-1.6 vs 18.7+/-1.5 IU/L, P<.001). Moreover, the greater the number of metabolic syndrome components present, the higher were the serum ferritin and ALT levels (P<.001). Multiple regression analysis showed that serum ALT levels are significantly associated with serum ferritin levels, waist circumference, fasting blood glucose, age, and white blood cell count (adjusted R(2)=0.147). Elevated iron stores were positively associated with serum ALT levels and metabolic syndrome in Korean postmenopausal women.

Effect of PPAR-α and -γ agonist on the expression of visfatin, adiponectin, and TNF-α in visceral fat of OLETF rats

A variety of adipocytokines and peptides secreted from adipocytes have been considered to play a crucial role in obesity, insulin resistance, and type 2 diabetes. Recently, visfatin, a new adipocytokine, known as a pre-B cell colony-enhancing factor, has been isolated from visceral fat deposits. It has been shown to activate insulin receptors in a manner different from insulin. To understand the role of adipocytokines in improving insulin sensitivity via activation of the nuclear receptor peroxisome proliferator-activated receptor-alpha (PPAR-alpha) and -gamma (PPAR-gamma), we examined the expression of visfatin, adiponectin, and TNF-alpha in visceral fat depots of Otsuka Long-Evans Tokushima fatty (OLETF) rats from early to advanced diabetic stage (from 28 to 40 weeks of age). Serum glucose and insulin concentrations significantly (P<0.05) decreased in rosiglitazone or fenofibrate-treated OLETF rats compared to untreated OLETF rats. Rosiglitazone significantly increased serum adiponectin concentration from 20 to 40 weeks of age (P<0.05), whereas fenofibrate reduced TNF-alpha concentration. The expression of visfatin and adiponectin mRNA in visceral fat deposits was elevated by rosiglitazone or fenofibrate treatments when compared to untreated OLETF rats (P<0.05), whereas, TNF-alpha mRNA was down-regulated by these drugs (P<0.05). These results suggest that rosiglitazone and fenofibrate may prevent type 2 diabetes by regulating adipocytokines including visfatin, adiponectin, and TNF-alpha.

Relationship between serum adiponectin concentration, pulse wave velocity and nonalcoholic fatty liver disease

OBJECTIVES

We aimed to investigate the relationship between nonalcoholic fatty liver disease (NAFLD), serum adiponectin concentration and brachial-ankle pulse wave velocity (baPWV) as a risk marker for atherosclerosis.

METHODS

A total of 213 nonalcoholic subjects (67 males, 146 females) participated in this study. Division of subjects into the NAFLD group or the normal group was based on the existence of fatty liver detected by sonography.

RESULTS

Serum adiponectin levels in the NAFLD group were significantly lower than those in the normal group. After adjusting for age, body-mass index (BMI) and the homeostasis model of assessment (HOMA), there was a significant negative correlation between NAFLD and serum adiponectin level only in females (r = -0.22, P = 0.008). Multiple logistic regression analysis showed a tendency of inverse correlation between NAFLD and serum adiponectin level in females (P = 0.055). After adjustment for age, BMI and HOMA value, serum adiponectin levels were inversely correlated with serum alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT) levels (r = -0.199 (P = 0.004) and r = -0.282 (P < 0.001)). On the other hand, baPWV in the NAFLD group was also significantly higher than that in the normal group in females (P = 0.005). Individual levels of serum ALT, aspatate aminotransferase (AST), alkaline phosphatase (ALP) and GGT were positively correlated with baPWV after adjusting for age, sex, BMI, HOMA and systolic blood pressure (P < 0.05).

CONCLUSION

Serum adiponectin level and baPWV were significantly associated with NAFLD and various liver enzymes, especially in females.

Relationship between brachial-ankle pulse wave velocity and cardiovascular risk factors of the metabolic syndrome

In this study, we investigated the association between brachial-ankle pulse wave velocity (baPWV), a novel non-invasive means of measuring atherosclerosis, and the cardiovascular risk factors of the metabolic syndrome. The study group comprised of 368 Koreans without history of diabetes or hypertension. Anthropometric parameters, blood pressure, fasting blood glucose (FBG), lipid profiles, ankle-brachial pressure index (ABI), and baPWV were measured in each subject. ABI and baPWV levels were higher in men than in women. ABI and baPWV levels were not correlated with each other. In women, baPWV was closely associated with the cardiovascular risk factors of the metabolic syndrome. Women with the metabolic syndrome showed higher baPWV levels compared to those without the metabolic syndrome (1540 +/- 281 versus 1312 +/- 223, P < 0.001). Multiple regression analysis showed that baPWV was significantly associated with systolic blood pressure, age, sex, waist circumference, and FBG (adjusted R2 = 0.548). The present study shows that baPWV is significantly associated with the features of the metabolic syndrome in Korean women.

Serum adiponectin concentrations predict the developments of type 2 diabetes and the metabolic syndrome in elderly Koreans

OBJECTIVE

To determine whether low serum adiponectin concentrations are able to predict the future developments of type 2 diabetes and the metabolic syndrome using the National Cholesterol Education Programme (NCEP) criteria. We also investigated the stability of adiponectin levels and the relationships between baseline adiponectin levels and changes in the parameters related to the metabolic syndrome over a period of 3 years.

PATIENTS AND MEASUREMENTS

This prospective cohort study included 372 elderly Koreans who participate in the SWS (South-West Seoul) study, which was conducted in 1999 and 2002 in Seoul, Korea. Fasting and postchallenge 2-h plasma glucose, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, lipid profiles and serum adiponectin data obtained in 1999 and 2002 were examined.

RESULTS

The within-person variation between 1999 and 2002 of serum adiponectin was not significant (P = 0.61). Serum adiponectin was closely correlated with the risks factors of cardiovascular disease (CVD), that is negatively with BMI, WHR, blood pressure, triglyceride and blood glucose levels, and positively with high density lipoprotein (HDL)-cholesterol levels. Subjects with the metabolic syndrome showed lower serum adiponectin concentrations than those without the metabolic syndrome (P < 0.0001). Baseline adiponectin levels were found to be correlated with subsequent changes in WHR, low density lipoprotein (LDL)-cholesterol, fasting and postload 2-h glucose over the 3-year period, after adjusting for baseline values. Multiple logistic regression analysis showed that lower baseline serum adiponectin concentrations were significantly associated with the developments of type 2 diabetes and the metabolic syndrome after adjusting for age, sex, obesity, history of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), hypertension and dyslipidaemia.

CONCLUSIONS

Reduced concentrations of adiponectin were found to be independently associated with increased risk of both type 2 diabetes and the metabolic syndrome in elderly Koreans.

The associations between plasma adiponectin, ghrelin levels and cardiovascular risk factors

OBJECTIVE

Ghrelin is a recently discovered peptide, which is produced primarily in the stomach. This orexigenic peptide participates not only in the induction of mealtime hunger but also in long-term body weight regulation and energy homeostasis. Adiponectin is a protein secreted by adipocytes, and has been proposed to mediate obesity-related insulin resistance. Moreover, concentrations of adiponectin are reduced in individuals with obesity, insulin resistance and cardiovascular disease. However, human data are sparse about the direct relationship between adiponectin, ghrelin and cardiovascular risk factors including insulin resistance.

DESIGN

Three hundred and thirty-eight elderly Korean women (mean age+/-s.d., 72.3+/-5.5 years) were included in the present study.

METHODS

Plasma ghrelin and adiponectin levels were measured by RIA. Anthropometric measurements were taken and a 75 g oral glucose tolerance test performed. Fasting insulin and lipid profile were measured and insulin resistance was determined using the homeostasis model assessment insulin resistance index (HOMA-R) and the quantitative insulin sensitivity check index.

RESULTS

Plasma adiponectin levels were negatively correlated with central obesity indices such as waist circumference (r=-0.27, P<0.001) and waist-to-hip ratio (WHR) (r=-0.32, P<0.001), and with insulin resistance indices such as fasting insulin (r=-0.17, P=0.004) and HOMA-R (r=-0.13, P=0.035). Plasma ghrelin levels were negatively correlated with WHR (r=-0.12, P=0.03), but plasma adiponectin and ghrelin levels were not correlated (r=0.03, P=0.66). Multiple regression analysis showed that adiponectin was associated with WHR, fasting insulin and fasting glucose levels. When ghrelin was used as a dependent variable, only WHR remained in the final fitted model.

CONCLUSION

Fasting plasma adiponectin and ghrelin levels were found to be associated with central obesity or insulin resistance. However, plasma adiponectin and ghrelin concentrations were not associated with each other in elderly Korean women.

Comparison of serum concentrations of C-reactive protein, TNF-alpha, and interleukin 6 between elderly Korean women with normal and impaired glucose tolerance

This study was performed to compare concentrations of pro-inflammatory cytokines, such as interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) as well as acute-phase protein, such as C-reactive protein (CRP) between subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT). The purpose of this study was to verify whether the pro-inflammatory cytokine-induced acute-phase response is a pathogenic mechanism in type 2 diabetes in elderly Korean women. A total of 1737 elderly subjects aged over 60 years participated in a population based study in Seoul, Korea (SWS Study 1999). Amongst them, a total of 232 non-smoking and non-diabetic female subjects aged 60-89 years was randomly selected and compared with each other. Higher serum high-sensitivity CRP (hs-CRP) concentrations were shown in subjects with IGT than those with normal glucose tolerance (median 1.2 versus 0.9, P < 0.05). Moreover, a relationship between serum hs-CRP concentrations and many components of the metabolic syndrome were detected. Serum pro-inflammatory cytokine IL-6 or TNF-alpha concentrations, however, were neither increased in subjects with IGT nor closely correlated with the components of the metabolic syndrome. In multiple regression analysis with stepwise selection method using hs-CRP as a dependent variable, it was found that white blood cell (WBC) counts, body mass index (BMI), fasting insulin, post-load 2h glucose, hematocrit and LDL cholesterol were significant independent variables. Our study confirms that increased acute-phase reaction is associated with impaired glucose tolerance and the metabolic syndrome in elderly Korean women. However, the hypothesis that pro-inflammatory cytokine-induced systemic inflammation is an early metabolic defect prior to onset of type 2 diabetes, is not supported in our study of elderly Korean women.

Characterization of four clustered and coregulated genes associated with fumonisin biosynthesis in Fusarium verticillioides

Fumonisins are mycotoxins that cause several fatal animal diseases, including cancer in rats and mice. These toxins are produced by several Fusarium species, including the maize pathogen Fusarium verticillioides, and can accumulate in maize infected with the fungus. We have identified four F. verticillioides genes (FUM6, FUM7, FUM8, and FUM9) adjacent to FUM5, a previously identified polyketide synthase gene that is required for fumonisin biosynthesis. Gene disruption analysis revealed that FUM6 and FUM8 are required for fumonisin production and Northern blot analysis revealed that expression of all four recently identified genes is correlated with fumonisin production. Nucleotide sequence analysis indicated that the predicted FUM6 translation product is most similar to cytochrome P450 monooxygenase-P450 reductase fusion proteins and the predicted products of FUM7, FUM8, and FUM9 are most similar to type III alcohol dehydrogenases, class-II alpha-aminotransferases, and dioxygenases, respectively. Together, these data are consistent with FUM5 through FUM9 being part of a fumonisin biosynthetic gene cluster in F. verticillioides.

Co-occurrence of Fusarium mycotoxins in mouldy and healthy corn from Korea

A total of 71 samples consisting of 36 mouldy and 35 visibly healthy corn were collected from Kangwon province of Korea and analysed for 8-ketotrichothecenes, zearalenone (ZEA), and fumonisins, including fumonisin B1 (FB1), fumonisin B2 (FB2), and fumonisin B3 (FB3). Five 8-ketotrichothecenes, namely deoxynivalenol (DON), 15-acetyldeoxynivalenol (15-ADON), 3-acetyldeoxynivalenol (3-ADON), nivalenol (NIV), and 4-acetylnivalenol (4-ANIV), ZEA, FB1, FB2, and FB3 were detected in corn samples. DON, 15-ADON, 3-ADON, NIV, 4-ANIV, ZEA, FB1, FB2, and FB3 were detected in mouldy corn with mean values of 4.0, 0.9, 0.2, 1.7, 0.4, 0.6, 23.2, 7.5, and 6.3 micrograms/g, respectively. Visibly healthy corn samples were contaminated with lower levels of 8-ketotrichothecenes, ZEA, and fumonisins than mouldy corn samples. However, 5 of 35 healthy corn samples analysed were contaminated with fumonisins at high levels up to 12.5 micrograms/g for FB1, 5.4 micrograms/g for FB2, and 0.5 microgram/g for FB3. This is the first report on the simultaneous occurrence of trichothecenes, ZEA, and fumonisins in corn from Korea.

Natural occurrence of the C series of fumonisins in moldy corn

We analyzed 44 moldy corn samples for the B and C series of fumonisins by high-performance liquid chromatography. Of the 44 samples, 32 (73%) were contaminated with both the B and C series of fumonisins and 6 were contaminated with only the B series of fumonisins. The incidence of fumonisin C1 in moldy corn was 71%; the incidence was 11% for fumonisin C3 and 43% for fumonisin C4. Their mean levels ranged from 500 to 1,900 ng/g. This is the first report on the natural occurrence of the C series of fumonisins and fumonisin B4 in moldy corn.

N-Acetyl derivatives of type C fumonisins produced by fusarium oxysporum

Four new fumonisins, an isomer of fumonisin C1 (iso-FC1) (1) and three N-acetyl derivatives of hydroxylated fumonisin C1 (OH-FC1) (2), fumonisin C1 (FC1) (3), and iso-FC1 (4) were isolated from wheat cultures of Fusarium oxysporum. One of the hydroxy groups of compound 1 is at C-3 instead of C-4 for FC1. Compounds 2-4 are similar in structure to OH-FC1, FC1, and iso-FC1, respectively, except for the presence of an acetyl group at the amine of C-1.

A hemorrhagic factor (Apicidin) produced by toxic Fusarium isolates from soybean seeds

Fifty-two isolates of Fusarium species were obtained from soybean seeds from various parts of Korea and identified as Fusarium oxysporum, F. moniliforme, F. semitectum, F. solani, F. graminearum, or F. lateritium. These isolates were grown on autoclaved wheat grains and examined for toxicity in a rat-feeding test. Nine cultures were toxic to rats. One of these, a culture of Fusarium sp. strain KCTC 16677, produced apicidin, an antiprotozoal agent that caused toxic effects in rats (including body weight loss; hemorrhage in the stomach, intestines, and bladder; and finally death) when rats were fed diets supplemented with 0.05 and 0.1% apicidin. The toxin was toxic to brine shrimp (the 50% lethal concentration was 40 microg/ml) and was weakly cytotoxic to human and mouse tumor cell lines.

Phytotoxicity and cytotoxicity of the fumonisin C and P series of mycotoxins from Fusarium spp. fungi

Fumonisin C (FC) and P (FP) are two recently identified series of sphingosine-analog mycotoxins, for which biological activities have not previously been reported. FC1, FC2 and OH-FC1 (1 microM) exhibited strong phytotoxicity comparable to the standard FB1 in duckweed (Lemna pausicotata L.) cultures, whereas FC3 and FC4 were moderately phytotoxic. Conversely, FP1 exhibited weak phytotoxicity only at higher concentrations (> or =10 microM). These mycotoxins exhibited a similar pattern of cytotoxicity with FB1-sensitive cultured mammalian cell lines, H4TG and MDCK.

Natural occurrence of trichothecenes and zearalenone in Korean and imported beers

In order to survey the natural occurrence of Fusarium mycotoxins including deoxynivalenol (DON), nivalenol (NIV), and zearalenone (ZEN) in beers consumed in Korea, a total of 54 extracts of Korean and imported beers were derivatized with heptafluorobutyric anhydride and analysed by gas chromatography-mass spectrometry with selected ion monitoring mode. DON was detected in 14 samples (26%) and NIV was detected in 43 samples (80%). ZEN was not detected in any of the samples tested. The incidence of DON was 19% for Korean beers and 50% for imported beers, whereas the incidence of NIV was 85% for Korean beers and 58% for imported beers. This is the first report that the beers consumed in Korea are contaminated with DON and NIV.

Isolation and characterization of two new type C fumonisins produced by Fusarium oxysporum

Two new fumonisins, hydroxylated fumonisin C1 (1) and fumonisin C3 (3), were isolated from wheat cultures of Fusarium oxysporum together with known fumonisin C1 (2) and C4 (4). Compound 1 is structurally similar to 2 except for the presence of an additional hydroxy group at C-3. Compound 3 is similar in structure to fumonisin B3 except that the C-1 terminal methyl group is missing.