Antioxidant activity and sensory analysis of murtilla (

An oil model system was used to analyze the antioxidant activity of Chilean fruit extracts and to determine their odor sensory effect. Hydroalcoholic extracts from wild and 14-4 genotype murtilla (Ugni molinae Turcz.) fruit were assessed by the Response Surface Methodology. The optimal conditions for producing high total phenolic-content extracts were 49.5% (v/v) ethanol at 30 ºC, which yielded 18.39 and 26.14 mg GAE·g-1 dry matter, respectively. The optimized extracts were added to a lipid model system and evaluated via the Schaal Oven Test. After 96 hours, 150 and 200 mg·kg-1 oil of the wild and 14-4 genotype extracts, respectively, showed an antioxidant capacity similar to TBHQ (200 mg·kg-1 oil) in terms of peroxide values and odor. Thus, murtilla fruit extracts are a natural source of antioxidants for protecting lipidic foods, such as soybean oil.

Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus

DIRECT (Diabetes Incidence after Renal Transplantation: Neoral C(2) Monitoring Versus Tacrolimus) was a 6-month, open-label, randomized, multicenter study which used American Diabetes Association/World Health Organization criteria to define glucose abnormalities. De novo renal transplant patients were randomized to cyclosporine microemulsion (CsA-ME, using C(2) monitoring) or tacrolimus, with mycophenolic acid, steroids and basiliximab. The intent-to-treat population comprised 682 patients (336 CsA-ME, 346 tacrolimus): 567 were nondiabetic at baseline. Demographics, diabetes risk factors and steroid doses were similar between treatment groups. The primary safety endpoint, new-onset diabetes after transplant (NODAT) or impaired fasting glucose (IFG) at 6 months, occurred in 73 CsA-ME patients (26.0%) and 96 tacrolimus patients (33.6%, p = 0.046). The primary efficacy endpoint, biopsy-proven acute rejection, graft loss or death at 6 months, occurred in 43 CsA-ME patients (12.8%) and 34 tacrolimus patients (9.8%, p = 0.211). Mean glomerular filtration rate (Cockcroft-Gault) was 63.6 +/- 20.7 mL/min/1.73 m(2) in the CsA-ME cohort and 65.9 +/- 23.1 mL/min/1.73 m(2) with tacrolimus (p = 0.285); mean serum creatinine was 139 +/- 58 and 133 +/- 57 mumol/L, respectively (p = 0.005). Blood pressure was similar between treatment groups at month 6, but total cholesterol, LDL-cholesterol and triglyceride levels were significantly higher with CsA than with tacrolimus (total cholesterol:HDL remained unchanged). The profile and incidence of adverse events were similar between treatments. The incidence of NODAT or IFG at 6 months post-transplant is significantly lower with CsA-ME than with tacrolimus without a significant difference in short-term outcome.

Qualität der Leichennierenentnahme in Deutschland

BACKGROUND

Organ damage during organ procurement is believed to be an increasing problem among transplant centres. However, only very few published data are available. The purpose of our study was to examine the quality of kidney procurement in Germany.

METHODS

We retrospectively analyzed all allograft renal transplants performed at our centre from 1996 to 2005. All kidneys were retrieved in Germany and allocated by Eurotransplant.

RESULTS

From a total of 486 cadaveric kidneys, 103 (21.2%) were not correctly retrieved. Nevertheless, none of the organs had to be rejected. In 18 (3.7%), a technically insufficient organ retrieval was associated with a considerable extension of the surgical procedure or complications.

CONCLUSIONS

Technically insufficient kidney procurement rarely results in clinical consequences. However, surgeons performing organ retrieval should be better trained. Whether adequate technical proficiency is achieved with ten supervised cases, as requested by the German Medical Association, remains to be determined. In our opinion, a further interdisciplinary course that trains surgeons in more refined techniques of organ procurement is desirable.

Lipoprotein(a) stimulates growth of human mesangial cells and induces activation of phospholipase C via pertussis toxin-sensitive G proteins

BACKGROUND

Renal disease is commonly associated with hyperlipidemia and correlates with glomerular accumulation of atherogenic lipoproteins, for example, lipoprotein(a) [Lp(a)], and mesangial hypercellularity. Specific binding of Lp(a) to mesangial cells and induction of c-myc and c-fos expression has been demonstrated. Therefore, in this study, we investigated a possible growth stimulatory effect and mode of action of Lp(a) in human mesangial cells.

METHODS

Lp(a) was purified from the regenerate fluid of a dextran sulfate column-based low-density lipoprotein apheresis system. Human mesangial cells were isolated by a sequential sieving technique from patients undergoing tumor nephrectomy. DNA synthesis was measured by [3H]-thymidine incorporation. The intracellular calcium concentration ([Ca2+]i) was determined by Fura 2-fluorescence, and inositol 1,4,5-trisphosphate (1,4,5-IP3) concentration was measured by a radioreceptor assay.

RESULTS

The data show that Lp(a) bound to the cells with a Kd of 17.0 micrograms/ml and increased DNA synthesis and cell proliferation. Lp(a) caused a rapid increase in 1,4,5-IP3 and [Ca2+]i via a pertussis toxin-sensitive mechanism. The phospholipase C (PLC) inhibitor U73122 abolished Lp(a)-induced cell proliferation. In contrast, vasopressin-induced increase in 1,4,5-IP3 and [Ca2+]i was pertussis toxin insensitive.

CONCLUSION

This study revealed that Lp(a) stimulates growth of human mesangial cells. Lp(a)-induced signaling involves binding to a receptor and stimulation of PLC via Gi proteins. Stimulation of PLC appears to be essential for the growth stimulatory effect of Lp(a). Whether these effects of Lp(a) contribute to the pathophysiology of renal disease needs to be determined.

[Magnesium excretion in urine is not a marker of magnesium deficiency. Reliability of an oral magnesium administration test]

BACKGROUND

Serum magnesium analysis does not reflect body content of magnesium. So substitution is based on empirical maneuvers.

PATIENTS AND METHOD

In a study on 44 patients urinary magnesium excretion was analyzed before and after oral magnesium substitution (40 mval). The provable hypothesis was the estimation that patients in magnesium deficiency under chronical diuretic treatment (n = 11) would have a lower magnesium excretion than patients of the control group (n = 10). Further analysis was done with patients after orthotopic cardiac transplantation (n = 12) and those suffering from coronary heart disease (n = 11).

RESULT

After oral administration of magnesium in all 4 groups there was a rise in blood levels, only significant in the patient group under chronic diuretic treatment. Urinary magnesium excretion, however, showed no significant differences. Patients after cardiac transplantation had the lowest rise in urinary magnesium excretion.

CONCLUSION

There was no clear differentiation by means of this oral magnesium substitution test. Magnesium excretion even after oral substitution is of no value to analyze magnesium deficiency.

[Follow-up after kidney transplantation. Sequential functional scintigraphy with technetium-99m-DTPA or technetium-99m-MAG3]

Complications following renal transplantation are associated with transplant dysfunction; their frequency and the nonspecificity of clinical symptoms underscore the importance of choosing the correct diagnostic procedure. Sequential function scintigraphy with technetium-99m-MAG3 is noninvasive and facilitates the diagnosis of different types of organ rejection, of drug-induced malfunction and of surgical complications.

Type III hyperlipoproteinemia acquired by liver transplantation

A case of type III hyperlipoproteinemia (HLP) (dysbetalipoproteinemia) acquired by liver transplantation is reported. The 50-year-old female patient was referred to the Frankfurt University Hospital for orthotopic liver transplantation. She had suffered from ethylic liver cirrhosis. The donor liver showed discrete signs of steatosis. The postoperative course of the patient was satisfactory. Enzyme levels and blood coagulation tests returned to normal within thirty days. However, both cholesterol and triglycerides gradually increased from approximately 2.00 g/L to values ranging from 2.50 to 3.50 g/L within 200 days after transplantation. Cutaneous xanthomas did not develop. The patient's lipoprotein pattern met the criteria of type III HLP: the cholesterol to triglyceride ratio in very low-density lipoproteins (VLDL) was 0.64. Intermediate-density lipoprotein(IDL) cholesterol was 0.48 g/L. Lipoprotein electrophoresis showed a broad beta-band, and beta-migrating particles were present in VLDL. Immunoblotting of apolipoprotein (apo) E from the patient's plasma revealed an E2/2 phenotype. However, restriction isotyping of an in vitro amplified apoE gene fragment showed the genotype of the patient to be epsilon 3/epsilon 4. These data suggest that the development of type III HLP in this patient was due to a change in the apoE phenotype from E3/4 to E2/2 after liver transplantation.

Combined LDL apheresis and hemodialysis in a patient with end-stage renal disease and accelerated coronary atherosclerosis

The first long-term experience with lipid apheresis in a hemodialysis patient with refractory combined hyperlipidemia and coronary heart disease is described. Simultaneous treatment was performed once a week using two separate machines connected by parallel flow. Correction of hyperlipidemia was achieved, accompanied by inhibition of progressive coronary heart disease, enabling kidney transplantation.

Reversal of acute vascular rejection by plasma exchange

The vast majority of grafts with acute vascular rejection (AVR) undergo irreversible loss of function, since this type of rejection usually does not respond to increased levels of immunosuppression. Since 1980 we have treated with plasmafiltration (PF) 14 steroid resistant episodes of AVR in 10 patients. In the treatment of each episode 6 X 5 L plasma were filtered and simultaneously replaced with 3.5% albumin-Ringer-lactate solution. After each PF, 20 g immunoglobulins (Intraglobin) were replaced i.v. In all cases following PF renal function improved. One graft was eventually lost as a result of chronic irreversible vascular rejection; all others are still functioning. Eight of the 10 patients have been observed now for at least 6 months since beginning PF treatment and 5 of these 8 have been followed for more than 12 months. None of them shows signs of rejection. PF with replacement of immunoglobulins after treatment appears to be a simple and safe procedure, which in our hands proved to be quite effective in reversing AVR.