[Extremely low SHBG level in consequence of Pro156Leu SHBG polymorphism--case reports of two women with polycystic ovary syndrome]

Presented case reports illustrate clinical manifestations of two women with polycystic ovary syndrome who had extremely low serum SHBG levels (Sex Hormone Binding Globulin) due to homozygote carriership of the rare Pro156Leu SHBG polymorphism.

[Birth weight and genetic risk of type 2 diabetes in Czech population]

INTRODUCTION

Birth weight is associated with type 2 diabetes mellitus and other late-onset metabolic diseases. Reduced birth weight is associated with an increased risk of insulin resistance, type 2 diabetes, and atherosclerosis. Also high birth weight represents risk factor for development of type 2 diabetes later in life. In this study, we investigate whether type 2 diabetes risk-confering alleles and biochemical as well as anthropometrical type 2 diabetes risk markers associate with birth weight in our Czech cohort.

RESULTS

Association between high birth weight and higher BMI in adulthood was found. Low birth weight was associated with higher glycaemia and insulinaemia as well as lower peripheral insulin sensitivity during oGTT. The examination of candidate genes provides evidence that Ngn3 and PPARalpha are involved in final birth weight regulation.

CONCLUSION

According to our results, we suggest that birth weight should be an integral part of medical history record.

[Vertebroplasty and kyphoplasty--treatment of osteoporotic vertebral fractures]

PURPOSE OF THE STUDY The surgical treatment of osteoporotic vertebral body fractures is associated with many complications. Vertebroplasty (VP) and kyphoplasty (KP) are minimally invasive procedures allowing us to strengthen the vertebral body and thus stabilize it. The aim of this non-randomized study is to evaluate a group of patients treated by VP and KP procedures and to discuss related risks. MATERIAL Between September 2005 and October 2007, a total of 32 patients (37 vertebrae) were treated by the VP and KP techniques. Vertebroplasty was used in 21 and kyphoplasty in 11 patients. In this initial group, four patients were excluded from evaluation because of a tumour aetiology of the fracture. The remaining 28 patients who had an osteoporotic vertebral body fracture verified by CT scan findings were followed up and evaluated. METHODS The evaluation was based on modified Oswestry disability index (ODI) and visual analogue scale (VAS) scores recorded at 6 weeks, 3 and 6 months and 1 year postoperatively. Cement leakage detected by X-ray was assessed by means of the classification used by Yeom et al. and, at the same time, the occurrence of adjacent vertebral fracture, if any, was detected by 1 year after surgery. RESULTS Radiographic cement leakage was found in eight patients (21.6%), with clinical manifestation in two (5.4%). One had an incomplete motor lesion due to cement leakage into the spinal column, and the other had pulmonary embolism due to cement leakage into the mediastinum. The whole group showed marked improvement in clinical condition, as assessed by the ODI. When expressed as per cent, the average ODI was 57% pre- and 15.7 % post-operatively. All patients reported pain relief in the affected spine. The average VAS score of 8.1 pre-operatively decreased to an average of 2.6 post-operatively. There were no radiographic findings of adjacent vertebral body fracture. DISCUSSION Vertebroplasty and kyphoplasty are currently used to treat osteoporotic vertebral fracture. Their advantages include an immediate stabilization of the vertebra by cement solidification, possibility of percutaneous application under local anaesthesia, and early patient mobilization without any external fixation. However, when evaluating these techniques, safety of the surgical procedure should be taken into consideration. The most frequent risk is cement leakage. CONCLUSIONS Vertebroplasty and kyphoplasty can, under strict adherence to the operative protocol, be an effective approach to the treatment of osteoporotic vertebral body fracture. It permits early mobilization of the patient without the necessity of external fixation. Key words: vertebroplasty, kyphoplasty, osteoporotic spine fracture, osteoporosis.

[Surgical treatment of spondylodiscitis]

PURPOSE OF THE STUDY

Surgical treatment of spondylodiscitis is associated with many complications and raises a number of issues for discussion. The aim of the study was to evaluate a group of patients who had undergone surgery for inflammation of the spine, and to discuss the optimal operative procedure.

MATERIAL

Between January 2000 and February 2005, a total of 81 patients were treated at our department for pyogenic or tuberculous spondylodiscitis. Of these, 31 (11 women and 20 men) underwent surgery. Patients treated by CT-guided abscess drainage puncture with antibiotic therapy were not included. Indications for surgery included neurological deficit in 20 patients, deformity or mechanic instability in six, and progressing septic condition in three patients.

METHODS

Simple decompression of nerve structures from the posterior approach, combined with drainage, was performed in seven patients, revision surgery from the posterior approach and fusion completed with suction drainage was done in five, anterior radical debridement and stabilization of the anterior column by replacement of the vertebral body was performed in 15 patients, and an anterior procedure completed with posterior instrumentation and fusion was carried out in four patients. The patients were followed up and evaluated at 3, 6 and 12 months post-operatively.

RESULTS

Improvement in neurological deficit by one or more Frankel grades was recorded in 30 % of the patients treated by posterior decompression and suction drainage, and in 83 % of the patients undergoing anterior debridement and stabilization. Further progression of deep infection requiring revision surgery and implant removal occurred in one patient. Clinical outcomes assessed as good or satisfactory were found in 68 % and poor results were in 32 % of the patients.

DISCUSSION

The selection of an optimal surgical procedure in spondylodiscitis depends on the primary localization of infectious lesions. In a typical anterior form of spondylodiscitis, anterior debridement and suction drainage are preferred. Reconstruction of the anterior spinal column in the presence of major destruction, and stabilization of an infected spine still remain challenging issues.

CONCLUSIONS

Radical debridement with deformity correction and segmental stabilization provide an efficient method of treatment for the most frequent anterior forms of pyogenic and tuberculous spondylodiscitis. The use of titan implants does not significantly increase the risk of persistent infection or its recurrence.

Neuromedin beta: P73T polymorphism in overweight and obese subjects

Neuromedin beta (NMB) is a member of the bombesin-like peptide family expressed in brain, gastrointestinal tract, pancreas, adrenals and adipose tissue. The aim of our study was to compare the frequency of P73T polymorphism in overweight and obese patients (37 men: age 50.6+/-11.7 years, BMI 41.1+/-7.8 kg/m(2); 255 women: age 49.0+/-11.9 years, BMI 37.9+/-6.8 kg/m(2)) with that of healthy normal weight subjects (51 men: age 28.2+/-7.1 years, BMI 22.3+/-2.0 kg/m(2); 104 women: age 29.1+/-9.1 years, BMI 21.5+/-1.9 kg/m(2)) and to investigate the polymorphism's influence on anthropometric, nutritional and psychobehavioral parameters in overweight/obese patients both at the baseline examination and at a control visit carried out 2.5 years later, regardless of the patient s compliance with the weight reduction program. No significant differences in the genotype distribution were demonstrated between normal weight and overweight/obese subjects. Male T allele non-carriers compared to T allele carriers had higher energy (p=0.009), protein (p=0.018) and fat (p=0.002) intakes and hunger score (p=0.015) at the beginning of treatment. Male T allele non-carriers had a more favorable response to weight management at the follow-up, as they exhibited a significant reduction in waist circumference, energy intake and depression score as well as a significant increase in dietary restraint. No significant differences between carriers and non-carriers were demonstrated in women at the baseline examination. Both female T allele carriers and non-carriers demonstrated similar significant changes in nutritional parameters and in restraint score at the follow-up. Nevertheless, only female non-carriers showed a significant decrease in the hunger score.

[Regulatory network of transcription factors: their key role in the development and function of pancreas]

Recent molecular biological studies of the pancreatic development have shed new light on the cause of MODY and diabetes mellitus type 2. The identification of transcription factors participating in the regulatory networks cooperating in the development and in adult exocrine and endocrine pancreas enabled the better understanding of the genetic background and subsequent phenotypic features of diabetes.

[Genetic background of mitochondrial diabetes]

Diabetes mellitus type 2 represents a heterogenous disease characterized by impaired glucose homeostasis. The disorder clusters in families suggesting genetic disposition, however the mechanism underlying is unknown. Many studies show more frequent maternal transmission of diabetes in the families. One of huge range of explanation is exclusively maternal transmission of mitochondria. Mitochondria are power organelles which produce ATP molecules by oxidation-reduction reactions via the respiratory chain. They contain their own genome which codes subunits of the respiratory chain and proteosynthetic apparatus for proteins encoded by this genome. Pathogenic mutations of mitochondrial DNA can affect the activity of the respiratory chain and result in various phenotypes. Mitochondrial diabetes is commonly associated with neuromuscular disorders and often presents with nonautoimmune beta cell failure. Although mitochondrial mutations are associated with diabetes, their low frequency does not explain reported more frequent maternal transmission of diabetes mellitus type 2.

[Study of the genetic causes of polygeneticallv determined endocrinopathies--patience can bring success]

Complex endocrinopathies, such as diabetes mellitus, obesity, polycystic ovary syndrome and osteoporosis belong to the most common diseases but their pathogenesis is still not fully explained. Environmental fadors along with genetic factors contribute to their occurrence and development. The study of genetic background is based on different strategies, mostly on linkage analysis and candidate gene approach. The common forms of these endocrinopathies do not seem to be the result of a defect of one or several major genes but the search for complex gene-gene, gene-environment interactions is needed. The article gives a short review of the recent knowledge together with our own experience in the field of study of the genetic background of polygenic diseases.

Screening of six risk exons of the RET proto-oncogene in families with medullary thyroid carcinoma in the Czech Republic

Medullary thyroid carcinoma (MTC) occurs as a sporadic form (75%) or as an autosomal dominant inherited familial disorder (25%) called familial MTC (FMTC) or as multiple endocrine neoplasia type 2 (MEN2) syndromes. Germ-line mutations in the rearranged during transfection (RET) proto-oncogene in exons 10, 11, 13, 14, 15 and 16 are known to be a cause of most of the familial forms. In this paper we report molecular genetic testing of 106 families with MTC (358 tested persons) from the Czech Republic in which we directly sequenced these six exons of the RET proto-oncogene. We detected germ-line mutations in 100% of MEN2B families (4/4 families), 90% of MEN2A families (9/10), 40% of FMTC families (4/10) and 7% of apparently sporadic MTC (6/82). Eleven different germ-line mutations were revealed. MEN2B was associated with mutation Met918 Thr in exon 16. In one MEN2B family beside this mutation the Tyr791 Phe was also found, which has not yet been reported. MEN2A was restricted to different mutations in exon 11 (codon 634). In FMTC and 'sporadic' MTC families the mutations in exons 10, 11, 13 and 14 were detected. The genotype/phenotype correlations are given. Genetic testing revealed germ-line mutations in 23 index patients, 24 family members and excluded them in 53 relatives.

Mutations and intronic variants in the HNF-1 beta gene in a group of German and Czech Caucasians with type 2 diabetes mellitus and progressive diabetic nephropathy

Mutations in the hepatocyte nuclear factor - 1 beta (HNF-1 beta) gene cause maturity onset diabetes of the young type 5 (MODY 5). A clinical feature of the resulting phenotype besides impaired glucose tolerance is a variety of renal abnormalities, ranging from renal cysts to end-stage renal failure. Using a candidate gene approach we investigated the prevalence of mutations in the HNF-1 beta gene in a group of 63 patients from two different European populations (33 Germans, 30 Czechs) with type 2 diabetes mellitus and diabetic nephropathy diagnosed by increased albuminuria (39 patients) or end-stage renal failure (24 patients). No mutations were found in any of the 9 exons or in a minimal promoter region. Three intronic variants (single nucleotide polymorphisms - SNPs) were detected. The frequencies of these variants showed no difference between the two studied populations and were comparable to data reported from healthy subjects. No association between SNPs or formed haplotypes and any clinical parameters (like age of disease onset, BMI and severity of renal failure) was found. The results confirm that the genetic variations in the HNF-1 beta gene would be a very uncommon cause of progressive nephropathy in patients with type 2 diabetes mellitus.

Catalyzed dehalogenation of Delor 103 by sodium hydridoaluminate

The complete dechlorination of PCB liquid Delor 103 (42.6% Cl) to biphenyl has been effected in toluene with sodium dihydridobis(2-methoxyethoxo)aluminate (SDMA) in the presence of catalytic amounts of Ni(II) and Co(II) 2,4-pentanedionates at elevated temperatures. Changes in PCB congeners distribution during dechlorination were monitored by GC(ECD) and GC/MS, and the scheme of their transformation was proposed on the basis of site selectivity observed. A kinetic analysis of the reaction is presented.

[Mutation in the beta3-adrenergic receptor gene (Trp64Arg) does not influence insulin resistence, energy metabolism, fat distribution and lipid spectrum in young people. Pilot study]

A missence mutation Trp64Arg in the beta3-adrenergic receptor gene is associated with obesity, insulin resistance, a lower metabolic rate and the earlier onset of NIDDM but the published results are controversial. We investigated the effect of this mutation on insulin resistance (euglycemic hyperinsulinemic clamp), on fat mass and fat distribution (anthropometry, bioimpedance, CT) and resting metabolic rate (indirect calorimetry), lipid spectrum and other metabolic disturbances in Czech juveniles recruited from juvenile hypertensives (H, n = 68) and controls (C, n = 81). The frequency of this mutation (determined by digestion of 210 bp PCR product with MvaI) was double in H than in C (14.7%, vs. 7.4%) and the carriers of Arg64 allele had sig. higher fasting glucose (H: p = 0.002. C: p = 0.025). Four Trp64/Arg64 and six Trp64/Trp64 men (age 23 +/- 4.2, vs. 22.5 +/- 1.9 y, BMI 26 +/- 5.5, vs. 22.9 +/- 5.1 kg/m2) took part in a detailed pilot study. But no signif. differences (Horn's method) in fasting glucose (4.6 +/- 0.6, vs. 4.9 +/- 0.4 mmol/l), in parameters of insulin resistance (M-value150-180 min. 9.1 +/- 1.1, vs. 8.9 +/- 1.5 mg glucose/kg.min(-1)), resting metabolic rate/lean body mass (RMR/kg LBM: 78.6 +/- 4.6, vs. 85.6 +/- 23.2 kJ/kg), lipid spectrum and other screened parameters were found. The lowest resting metabolic rate (RMR/kg LBM 55.4; 62.6 kJ/kg) was found in brothers (both C, Trp64/Trp64) who highly differ in body constitution (BMI 19.0 resp. 32.4 kg/m2). We suppose that in this case the energy metabolism is probably determined by other genetic loci and does not correlate with body fat mass.

CONCLUSION

Our pilot study does not confirm the influence of Trp64Arg mutation in heterozygous carriers on insulin resistance, energy metabolism and lipid spectrum.

[Ret proto-oncogene mutation found in the Czech population and its predictive value for offspring of patients with medullary carcinoma of the thyroid gland]

The authors completed a total of 23 pedigrees with the clinical diagnosis of medullary thyroid carcinoma (5 MEN 2A pedigrees, 11 FMTC pedigrees and 7 MTC pedigrees). Using the method of polymerase chain reaction (PCR), it was possible to define the rate of the most frequent mutations in exons 10, 11 and 16 of Ret-protooncogene present in the Czech population. The most frequent hereditary mutation found in MEN 2A and FMTC groups is substitution of thymine for cytosine in position 2095 of the transmembranous domain of the Ret-tyrosine kinase gene. Another six types of known mutations were tested.

[Non-insulin-dependent diabetes mellitus--strategies and problems in genetic research]

Non-insulin dependent diabetes mellitus (NIDDM) is at present one of the most serious and widespread diseases with a mass incidence and its treatment is very costly. In the genesis and development of the disease genetic factors participate along with environmental factors. Genetic research of NIDDM is difficult, as ensues from the very essence of this heterogeneous disease. Research concentrates on the identification of specific genetic determinants which influence the predisposition of the individual to glucose intolerance which, if revealed, would make more effective prevention and treatment possible. Intensive research is focused on different candidate genes. Although some "minority" genes were identified, the primary diabetogen was not revealed so far and partial positive results must be confirmed on a larger population sample. The article reviews the contemporary state of genetic research of the disease.