Hepatoprotective and cardioprotective effects of empagliflozin in spontaneously hypertensive rats fed a high-fat diet

A combination of liver and heart dysfunction worsens the prognosis of human survival. The aim of this study was to investigate whether empagliflozin (a sodium-glucose transporter-2 inhibitor) has beneficial effects not only on cardiac and renal function but also on hepatic function. Adult (6-month-old) male spontaneously hypertensive rats (SHR) were fed a high-fat diet (60% fat) for four months to induce hepatic steatosis and mild heart failure. For the last two months, the rats were treated with empagliflozin (empa, 10 mg.kg-1.day-1 in the drinking water). Renal function and oral glucose tolerance test were analyzed in control (n=8), high-fat diet (SHR+HF, n=10), and empagliflozin-treated (SHR+HF+empa, n=9) SHR throughout the study. Metabolic parameters and echocardiography were evaluated at the end of the experiment. High-fat diet feeding increased body weight and visceral adiposity, liver triglyceride and cholesterol concentrations, and worsened glucose tolerance. Although the high-fat diet did not affect renal function, it significantly worsened cardiac function in a subset of SHR rats. Empagliflozin reduced body weight gain but not visceral fat deposition. It also improved glucose sensitivity and several metabolic parameters (plasma insulin, uric acid, and HDL cholesterol). In the liver, empagliflozin reduced ectopic lipid accumulation, lipoperoxidation, inflammation and pro-inflammatory HETEs, while increasing anti-inflammatory EETs. In addition, empagliflozin improved cardiac function (systolic, diastolic and pumping) independent of blood pressure. The results of our study suggest that hepatoprotection plays a decisive role in the beneficial effects of empagliflozin in preventing the progression of cardiac dysfunction induced by high-fat diet feeding.

Tannic acid- and N-acetylcysteine-chitosan-modified magnetic nanoparticles reduce hepatic oxidative stress in prediabetic rats

Magnetic nanoparticles (MNPs) modified with tannic acid (TA) have shown remarkable success as an antioxidant and antimicrobial therapeutic agent. Herein, we report a synthetic procedure for the preparation of silica-coated MNPs modified with N-acetylcysteine-modified chitosan and TA. This was achieved by free-radical grafting of NAC onto chitosan (CS), a layer-by-layer technique for modifying negatively charged MNP@SiO2 nanoparticles with positively charged CS-NAC, and crosslinking CS with TA. The antioxidant and metabolic effects of MNP@SiO2-CS-NAC and MNP@SiO2-CS-NAC-TA nanoparticles were tested in a model of prediabetic rats with hepatic steatosis, the hereditary hypertriglyceridemic rats (HHTg). The particles exhibited significant antioxidant properties in the liver, increasing the activity of the antioxidant enzymes superoxide dismutase (SOD), glutathione reductase (GR) and glutathione peroxidase (GPx), decreasing the concentration of the lipoperoxidation product malondialdehyde (MDA), and improving the antioxidant status determined as the ratio of reduced to oxidized glutathione; in particular, TA increased some antioxidant parameters. MNPs carrying antioxidants such as NAC and TA could thus represent a promising therapeutic agent for the treatment of various diseases accompanied by increased oxidative stress.

Spontaneous nonsense mutation in the tuftelin 1 gene is associated with abnormal hair appearance and amelioration of glucose and lipid metabolism in the rat

Recently, we have identified a recessive mutation, an abnormal coat appearance in the BXH6 strain, a member of the HXB/BXH set of recombinant inbred (RI) strains. The RI strains were derived from the spontaneously hypertensive rat (SHR) and Brown Norway rat (BN-Lx) progenitors. Whole genome sequencing of the mutant rats identified the 195875980 G/A mutation in the tuftelin 1 (Tuft1) gene on chromosome 2, which resulted in a premature stop codon. Compared with wild-type BXH6 rats, BXH6-Tuft1 mutant rats exhibited lower body weight due to reduced visceral fat and ectopic fat accumulation in the liver and heart. Reduced adiposity was associated with decreased serum glucose and insulin and increased insulin-stimulated glycogenesis in skeletal muscle. In addition, mutant rats had lower serum monocyte chemoattractant protein-1 and leptin levels, indicative of reduced inflammation. Analysis of the liver proteome identified differentially expressed proteins from fatty acid metabolism and β-oxidation, peroxisomes, carbohydrate metabolism, inflammation, and proteasome pathways. These results provide evidence for the important role of the Tuft1 gene in the regulation of lipid and glucose metabolism and suggest underlying molecular mechanisms.NEW & NOTEWORTHY A new spontaneous mutation, abnormal hair appearance in the rat, has been identified as a nonfunctional tuftelin 1 (Tuft1) gene. The pleiotropic effects of this mutation regulate glucose and lipid metabolism. Analysis of the liver proteome revealed possible molecular mechanisms for the metabolic effects of the Tuft1 gene.

CD36 regulates substrates utilisation in brown adipose tissue of spontaneously hypertensive rats: In vitro study

Thermogenesis in brown adipose tissue (BAT) uses intracellular triglycerides, circulating free fatty acids and glucose as the main substrates. The objective of the current study was to analyse the role of CD36 fatty acid translocase in regulation of glucose and fatty acid utilisation in BAT. BAT isolated from spontaneously hypertensive rat (SHR) with mutant Cd36 gene and SHR-Cd36 transgenic rats with wild type variant was incubated in media containing labeled glucose and palmitate to measure substrate incorporation and oxidation. SHR-Cd36 versus SHR rats showed significantly increased glucose incorporation into intracellular lipids associated with reduced glycogen synthase kinase 3β (GSK-3β) protein expression and phosphorylation and increased oxidation of exogenous palmitate. It can be concluded that CD36 enhances glucose transport for lipogenesis in BAT by suppressing GSK-3β and promotes direct palmitate oxidation.

Quercetin supplementation alters adipose tissue and hepatic transcriptomes and ameliorates adiposity, dyslipidemia, and glucose intolerance in adult male rats

Quercetin, a flavonoid present in many fruits and vegetables, exhibits beneficial effects toward abnormalities related to metabolic syndrome. In this study, to further investigate metabolic and transcriptomic responses to quercetin supplementation, we used a genetic model of metabolic syndrome. Adult male rats of the PD/Cub strain were fed either a high-sucrose diet (HSD; control PD rats) or HSD fortified with quercetin (10 g quercetin/kg diet; PD-Q rats). Morphometric and metabolic parameters, along with transcriptomic profiles of the liver and retroperitoneal fat, were assessed. The relative weights of epididymal and retroperitoneal fat were significantly decreased in quercetin-treated animals. Furthermore, a smaller area under the glycemic curve along with a decreased level of fasting insulin were detected in PD-Q rats. While no changes in total cholesterol levels were observed, the overall level of triglycerides decreased in the serum and the liver of the PD-Q rats. The transcriptomic profile of the liver and the adipose tissue corroborated the metabolic and morphometric findings, revealing the pattern consistent with insulin-sensitizing changes, with major regulator nodes being Pparg, Adipoq, Nos2, and Mir378. In conclusion, quercetin supplementation improves abnormalities related to metabolic syndrome, namely adiposity, dyslipidemia and glucose intolerance.

Beneficial Effects of Empagliflozin Are Mediated by Reduced Renal Inflammation and Oxidative Stress in Spontaneously Hypertensive Rats Expressing Human C-Reactive Protein

Gliflozins (inhibitors of sodium-glucose cotransporter 2) show many beneficial actions beyond their antidiabetic effects. The underlying mechanisms of these additional protective effects are still not well understood, especially under non-diabetic conditions. Therefore, we analyzed the effects of empagliflozin in young (3-month-old) and adult (12-month-old) male spontaneously hypertensive rats (SHR) expressing human C-reactive protein (CRP) in the liver. SHR-CRP rats are a non-diabetic model of metabolic syndrome, inflammation, and organ damage. Empagliflozin was given in a daily dose of 10 mg/kg body weight for 8 weeks. Both age groups of SHR-CRP rats treated with empagliflozin had lower body weight, decreased weight of fat depots, reduced ectopic fat accumulation in the liver and kidneys, and decreased levels of plasma insulin and β-hydroxybutyrate. Empagliflozin effectively reduced ectopic renal fat accumulation, and was associated with decreased inflammation. Exclusively in young rats, decreased microalbuminuria after empagliflozin treatment was accompanied by attenuated oxidative stress. In adult animals, empagliflozin also improved left ventricle function. In conclusion, in young animals, the beneficial renoprotective effects of empagliflozin could be ascribed to reduced lipid deposition in the kidney and the attenuation of oxidative stress and inflammation. In contrast, hepatic lipid metabolism was ameliorated in adult rats.

Systems genetics in the rat HXB/BXH family identifies Tti2 as a pleiotropic quantitative trait gene for adult hippocampal neurogenesis and serum glucose

Neurogenesis in the adult hippocampus contributes to learning and memory in the healthy brain but is dysregulated in metabolic and neurodegenerative diseases. The molecular relationships between neural stem cell activity, adult neurogenesis, and global metabolism are largely unknown. Here we applied unbiased systems genetics methods to quantify genetic covariation among adult neurogenesis and metabolic phenotypes in peripheral tissues of a genetically diverse family of rat strains, derived from a cross between the spontaneously hypertensive (SHR/OlaIpcv) strain and Brown Norway (BN-Lx/Cub). The HXB/BXH family is a very well established model to dissect genetic variants that modulate metabolic and cardiovascular diseases and we have accumulated deep phenome and transcriptome data in a FAIR-compliant resource for systematic and integrative analyses. Here we measured rates of precursor cell proliferation, survival of new neurons, and gene expression in the hippocampus of the entire HXB/BXH family, including both parents. These data were combined with published metabolic phenotypes to detect a neurometabolic quantitative trait locus (QTL) for serum glucose and neuronal survival on Chromosome 16: 62.1-66.3 Mb. We subsequently fine-mapped the key phenotype to a locus that includes the Telo2-interacting protein 2 gene (Tti2)-a chaperone that modulates the activity and stability of PIKK kinases. To verify the hypothesis that differences in neurogenesis and glucose levels are caused by a polymorphism in Tti2, we generated a targeted frameshift mutation on the SHR/OlaIpcv background. Heterozygous SHR-Tti2+/- mutants had lower rates of hippocampal neurogenesis and hallmarks of dysglycemia compared to wild-type littermates. Our findings highlight Tti2 as a causal genetic link between glucose metabolism and structural brain plasticity. In humans, more than 800 genomic variants are linked to TTI2 expression, seven of which have associations to protein and blood stem cell factor concentrations, blood pressure and frontotemporal dementia.

Antihypertensive and metabolic effects of empagliflozin in Ren-2 transgenic rats, an experimental non-diabetic model of hypertension

The new antidiabetic drugs, gliflozins, inhibit sodium-glucose transporter-2 in renal proximal tubules promoting glucose and sodium excretion. This leads not only to a significant improvement of glucose control but also to the reduction of blood pressure and body weight in both diabetic patients and experimental models. We examined whether these beneficial effects can also be achieved in a non-diabetic hypertensive model, namely in Ren-2 transgenic rats (TGR). Adult 6-month-old hypertensive TGR and their normotensive controls (Hannover Sprague-Dawley rats), were either untreated or treated with empagliflozin (10 mg/kg/day) for two months. Telemetric blood pressure monitoring, renal parameters as well as cardiac function via echocardiography were analyzed during the experiment. At the end of the study, the contribution of major vasoactive systems to blood pressure maintenance was studied. Metabolic parameters and markers of oxidative stress and inflammation were also analyzed. Empagliflozin had no effect on plasma glucose level but partially reduced blood pressure in TGR. Although food consumption was substantially higher in empagliflozin-treated TGR compared to the untreated animals, their body weight and the amount of epididymal and perirenal fat was decreased. Empagliflozin had no effect on proteinuria, but it decreased plasma urea, attenuated renal oxidative stress and temporarily increased urinary urea excretion. Several metabolic (hepatic triglycerides, non-esterified fatty acids, insulin) and inflammatory (TNF-α, leptin) parameters were also improved by empagliflozin treatment. By contrast, echocardiography did not reveal any effect of empagliflozin on cardiac function. In conclusion, empagliflozin exerted beneficial antihypertensive, anti-inflammatory and metabolic effects also in a non-diabetic hypertensive model.

High cysteine diet reduces insulin resistance in SHR-CRP rats

Increased plasma total cysteine (tCys) has been associated with obesity and metabolic syndrome in human and some animal studies but the underlying mechanisms remain unclear. In this study, we aimed at evaluating the effects of high cysteine diet administered to SHR-CRP transgenic rats, a model of metabolic syndrome and inflammation. SHR-CRP rats were fed either standard (3.2 g cystine/kg diet) or high cysteine diet (HCD, enriched with additional 4 g L-cysteine/kg diet). After 4 weeks, urine, plasma and tissue samples were collected and parameters of metabolic syndrome, sulfur metabolites and hepatic gene expression were evaluated. Rats on HCD exhibited similar body weights and weights of fat depots, reduced levels of serum insulin, and reduced oxidative stress in the liver. The HCD did not change concentrations of tCys in tissues and body fluids while taurine in tissues and body fluids, and urinary sulfate were significantly increased. In contrast, betaine levels were significantly reduced possibly compensating for taurine elevation. In summary, increased Cys intake did not induce obesity while it ameliorated insulin resistance in the SHR-CRP rats, possibly due to beneficial effects of accumulating taurine.

Ovariectomy-Induced Hepatic Lipid and Cytochrome P450 Dysmetabolism Precedes Serum Dyslipidemia

Ovarian hormone deficiency leads to increased body weight, visceral adiposity, fatty liver and disorders associated with menopausal metabolic syndrome. To better understand the underlying mechanisms of these disorders in their early phases of development, we investigated the effect of ovariectomy on lipid and glucose metabolism. Compared to sham-operated controls, ovariectomized Wistar female rats markedly increased whole body and visceral adipose tissue weight (p ˂ 0.05) and exhibited insulin resistance in peripheral tissues. Severe hepatic triglyceride accumulation (p ˂ 0.001) after ovariectomy preceded changes in both serum lipids and glucose intolerance, reflecting alterations in some CYP proteins. Increased CYP2E1 (p ˂ 0.05) and decreased CYP4A (p ˂ 0.001) after ovariectomy reduced fatty acid oxidation and induced hepatic steatosis. Decreased triglyceride metabolism and secretion from the liver contributed to hepatic triglyceride accumulation in response to ovariectomy. In addition, interscapular brown adipose tissue of ovariectomized rats exhibited decreased fatty acid oxidation (p ˂ 0.01), lipogenesis (p ˂ 0.05) and lipolysis (p ˂ 0.05) despite an increase in tissue weight. The results provide evidence that impaired hepatic triglycerides and dysregulation of some CYP450 proteins may have been involved in the development of hepatic steatosis. The low metabolic activity of brown adipose tissue may have contributed to visceral adiposity as well as triglyceride accumulation during the postmenopausal period.

Hepatic Transcriptome Profiling Reveals Lack of Acsm3 Expression in Polydactylous Rats with High-Fat Diet-Induced Hypertriglyceridemia and Visceral Fat Accumulation

Metabolic syndrome (MetS) is an important cause of worldwide morbidity and mortality. Its complex pathogenesis includes, on the one hand, sedentary lifestyle and high caloric intake, and, on the other hand, there is a clear genetic predisposition. PD (Polydactylous rat) is an animal model of hypertriglyceridemia, insulin resistance, and obesity. To unravel the genetic and pathophysiologic background of this phenotype, we compared morphometric and metabolic parameters as well as liver transcriptomes among PD, spontaneously hypertensive rat, and Brown Norway (BN) strains fed a high-fat diet (HFD). After 4 weeks of HFD, PD rats displayed marked hypertriglyceridemia but without the expected hepatic steatosis. Moreover, the PD strain showed significant weight gain, including increased weight of retroperitoneal and epididymal fat pads, and impaired glucose tolerance. In the liver transcriptome, we found 5480 differentially expressed genes, which were enriched for pathways involved in fatty acid beta and omega oxidation, glucocorticoid metabolism, oxidative stress, complement activation, triacylglycerol and lipid droplets synthesis, focal adhesion, prostaglandin synthesis, interferon signaling, and tricarboxylic acid cycle pathways. Interestingly, the PD strain, contrary to SHR and BN rats, did not express the Acsm3 (acyl-CoA synthetase medium-chain family member 3) gene in the liver. Together, these results suggest disturbances in fatty acid utilization as a molecular mechanism predisposing PD rats to hypertriglyceridemia and fat accumulation.

Ellagic Acid Affects Metabolic and Transcriptomic Profiles and Attenuates Features of Metabolic Syndrome in Adult Male Rats

Ellagic acid, a natural substance found in various fruits and nuts, was previously shown to exhibit beneficial effects towards metabolic syndrome. In this study, using a genetic rat model of metabolic syndrome, we aimed to further specify metabolic and transcriptomic responses to ellagic acid treatment. Adult male rats of the SHR-Zbtb16^Lx/k.o. strain were fed a high-fat diet accompanied by daily intragastric gavage of ellagic acid (50 mg/kg body weight; high-fat diet–ellagic acid (HFD-EA) rats) or vehicle only (high-fat diet–control (HFD-CTL) rats). Morphometric and metabolic parameters, along with transcriptomic profile of liver and brown and epididymal adipose tissues, were assessed. HFD-EA rats showed higher relative weight of brown adipose tissue (BAT) and decreased weight of epididymal adipose tissue, although no change in total body weight was observed. Glucose area under the curve, serum insulin, and cholesterol levels, as well as the level of oxidative stress, were significantly lower in HFD-EA rats. The most differentially expressed transcripts reflecting the shift induced by ellagic acid were detected in BAT, showing downregulation of BAT activation markers Dio2 and Nr4a1 and upregulation of insulin-sensitizing gene Pla2g2a. Ellagic acid may provide a useful nutritional supplement to ameliorate features of metabolic syndrome, possibly by suppressing oxidative stress and its effects on brown adipose tissue.

The combination of atorvastatin with silymarin enhances hypolipidemic, antioxidant and anti-inflammatory effects in a rat model of metabolic syndrome

Hypolipidemic and cardioprotective effects of statins can be associated with the development of myopathies and new-onset type 2 diabetes. These adverse effects may be related to increased oxidative stress. The plant extract silymarin (SM) is known for its antioxidant and anti-inflammatory actions. We tested the hypothesis that the combination of atorvastatin (ATV) with SM could improve therapy efficacy and eliminate some negative effects of statin on hypertriglyceridemia-induced metabolic disorders. Hereditary hypertriglyceridemic rats were fed a standard diet for four weeks without supplementation; supplemented with ATV (5 mg/kg b. wt./day) or a combination of ATV with 1 % micronized SM (ATV+SM). ATV treatment elevated plasma levels of HDL-cholesterol (p<0.01), glucose and insulin and decreased triglycerides (p<0.001). The combination of ATV+SM led to a significant reduction in insulin, an improvement of glucose tolerance, and the hypolipidemic effect was enhanced compared to ATV alone. Furthermore, ATV supplementation increased skeletal muscle triglycerides but its combination with SM decreased triglycerides accumulation in the muscle (p<0.05) and the liver (p<0.01). In the liver, ATV+SM treatment increased the activities of antioxidant enzymes, glutathione and reduced lipid peroxidation (p<0.001). The combined administration of ATV with SM potentiated the hypolipidemic effect, reduced ectopic lipid accumulation, improved glucose metabolism, and increased antioxidant and anti-inflammatory actions. Our results show that SM increased the effectiveness of statin therapy in a hypertriglyceridemic rat model of metabolic syndrome.

Downregulation of the Glo1 Gene Is Associated with Reduced Adiposity and Ectopic Fat Accumulation in Spontaneously Hypertensive Rats

Methylglyoxal (MG), a potent precursor of advanced glycation end-products (AGE), is increased in metabolic disorders such as diabetes and obesity. MG and other dicarbonyl metabolites are detoxified by the glyoxalase system in which glyoxalase 1, coded by the Glo1 gene, serves as the rate-limiting enzyme. In this study, we analyzed the effects of Glo1 downregulation on glucose and lipid metabolism parameters in spontaneously hypertensive rats (SHR) by targeting the Glo1 gene (SHR-Glo1^+/− heterozygotes). Compared to SHR wild-type animals, SHR-Glo1^+/− rats showed significantly reduced Glo1 expression and lower GLO1 activity in tissues associated with increased MG levels. In contrast to SHR controls, SHR-Glo1^+/− rats exhibited lower relative weight of epididymal fat, reduced ectopic fat accumulation in the liver and heart, and decreased serum triglycerides. In addition, compared to controls, SHR-Glo1^+/− rats showed reduced serum insulin and increased basal and insulin stimulated incorporation of glucose into white adipose tissue lipids (lipogenesis). Reduced ectopic fat accumulation in the heart was associated with significantly increased pAMPK/AMPK ratio and GLUT4 activity. These results provide evidence that Glo1 downregulation in SHR is associated with reduced adiposity and ectopic fat accumulation, most likely mediated by AMPK activation in the heart.

Cerium Oxide-Decorated γ-Fe2O3 Nanoparticles: Design, Synthesis and in vivo Effects on Parameters of Oxidative Stress

Magnetic γ-Fe₂O₃/CeO_x nanoparticles were obtained by basic coprecipitation/oxidation of iron chlorides with hydrogen peroxide, followed by precipitation of Ce(NO₃)₃ with ammonia. The appearance of CeO_x on the magnetic particle surface was confirmed by X-ray photoelectron spectroscopy (XPS), powder X-ray diffraction (XRD), and elemental analysis; a magnetometer was used to measure the magnetic properties of γ-Fe₂O₃/CeO_x. The relatively high saturation magnetization of the particles (41.1 A·m²/kg) enabled magnetic separation. The surface of γ-Fe₂O₃/CeO_x particles was functionalized with PEG-neridronate of two different molecular weights to ensure colloidal stability and biocompatibility. The ability of the particles to affect oxidative stress in hereditary hypertriglyceridemic (HHTg) rats was tested by biological assay of the liver, kidney cortex, and brain tissues. An improvement was observed in both enzymatic [superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx)] and non-enzymatic (reduced (GSH) and oxidized (GSSG) glutathione) levels of antioxidant defense and lipid peroxidation parameters [4-hydroxynonenal (4-HNE) and malondialdehyde (MDA)]. The results corresponded with chemical determination of antioxidant activity based on 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, proving that in the animal model γ-Fe₂O₃/CeO_x@PEG_2,000 nanoparticles effectively scavenged radicals due to the presence of cerium oxide, in turn decreasing oxidative stress. These particles may therefore have the potential to reduce disorders associated with oxidative stress and inflammation.

Dissecting the role of Folr1 and Folh1 genes in the pathogenesis of metabolic syndrome in spontaneously hypertensive rats

Increased levels of plasma cysteine predispose to obesity and metabolic disturbances. Our recent genetic analyses in spontaneously hypertensive rats (SHR) revealed mutated Folr1 (folate receptor 1) on chromosome 1 as a quantitative trait gene associated with reduced folate levels, hypercysteinemia and metabolic disturbances. The Folr1 gene is closely linked to the Folh1 (folate hydrolase 1) gene which codes for an enzyme involved in the hydrolysis of dietary polyglutamyl folates in the intestine. In the current study, we obtained evidence that Folh1 mRNA of the BN (Brown Norway) origin is weakly but significantly expressed in the small intestine. Next we analyzed the effects of the Folh1 alleles on folate and sulfur amino acid levels and consecutively on glucose and lipid metabolism using SHR-1 congenic sublines harboring either Folr1 BN and Folh1 SHR alleles or Folr1 SHR and Folh1 BN alleles. Both congenic sublines when compared to SHR controls, exhibited significantly reduced folate clearance and lower plasma cysteine and homocysteine levels which was associated with significantly decreased serum glucose and insulin concentrations and reduced adiposity. These results strongly suggest that, in addition to Folr1, the Folh1 gene also plays an important role in folate and sulfur amino acid levels and affects glucose and lipid metabolism in the rat.

First-trimester screening for preeclampsia

DESIGN

Review article.

SETTING

Department of Clinical Biochemistry, University Hospital Olomouc; Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child and 3rd Faculty of Medicine Charles University, Prague; G-CENTRUM Olomouc, Olomouc; Genetika Plze&#328;, Pilsen. Methods, results: Preeclampsia (PE) is a multisystem disorder complicating pregnancy. It is the leading cause of maternal and perinatal mortality and morbidity worldwide. Recent studies have shown that high-risk pregnant women may benefit from low-dose acetylsalicylic acid early therapy in prevention of the development of severe forms of the disease. The risk group of pregnant women should be identified in 11-13 gestational week for effective prevention. The only procedure validated in many studies for performing PE screening with sufficient diagnostic accuracy in the first trimester of pregnancy is given by The Fetal Medicine Foundation (FMF) and has been adopted and published in a new recommendation by The International Federation of Gynecology and Obstetrics (FIGO).

CONCLUSION

This article summarizes the recent findings and recommendation for performing screening of preeclampsia in 1st trimester of pregnancy and how to prevent the development of severe forms of PE by low-dose acetylsalicylic acid therapy.

Mutant Wars2 gene in spontaneously hypertensive rats impairs brown adipose tissue function and predisposes to visceral obesity

Brown adipose tissue (BAT) plays an important role in lipid and glucose metabolism in rodents and possibly also in humans. Identification of genes responsible for BAT function would shed light on underlying pathophysiological mechanisms of metabolic disturbances. Recent linkage analysis in the BXH/HXB recombinant inbred (RI) strains, derived from Brown Norway (BN) and spontaneously hypertensive rats (SHR), identified two closely linked quantitative trait loci (QTL) associated with glucose oxidation and glucose incorporation into BAT lipids in the vicinity of Wars2 (tryptophanyl tRNA synthetase 2 (mitochondrial)) gene on chromosome 2. The SHR harbors L53F WARS2 protein variant that was associated with reduced angiogenesis and Wars2 thus represents a prominent positional candidate gene. In the current study, we validated this candidate as a quantitative trait gene (QTG) using transgenic rescue experiment. SHR-Wars2 transgenic rats with wild type Wars2 gene when compared to SHR, showed more efficient mitochondrial proteosynthesis and increased mitochondrial respiration, which was associated with increased glucose oxidation and incorporation into BAT lipids, and with reduced weight of visceral fat. Correlation analyses in RI strains showed that increased activity of BAT was associated with amelioration of insulin resistance in muscle and white adipose tissue. In summary, these results demonstrate important role of Wars2 gene in regulating BAT function and consequently lipid and glucose metabolism.

Systems genetic analysis of brown adipose tissue function

Brown adipose tissue (BAT) has been suggested to play an important role in lipid and glucose metabolism in rodents and possibly also in humans. In the current study, we used genetic and correlation analyses in the BXH/HXB recombinant inbred (RI) strains, derived from Brown Norway (BN) and spontaneously hypertensive rats (SHR), to identify genetic determinants of BAT function. Linkage analyses revealed a quantitative trait locus (QTL) associated with interscapular BAT mass on chromosome 4 and two closely linked QTLs associated with glucose oxidation and glucose incorporation into BAT lipids on chromosome 2. Using weighted gene coexpression network analysis (WGCNA) we identified 1,147 gene coexpression modules in the BAT from BXH/HXB rats and mapped their module eigengene QTLs. Through an unsupervised analysis, we identified modules related to BAT relative mass and function. The Coral4.1 coexpression module is associated with BAT relative mass (includes Cd36 highly connected gene), and the Darkseagreen coexpression module is associated with glucose incorporation into BAT lipids (includes Hiat1, Fmo5, and Sort1 highly connected transcripts). Because multiple statistical criteria were used to identify candidate modules, significance thresholds for individual tests were not adjusted for multiple comparisons across modules. In summary, a systems genetic analysis using genomic and quantitative transcriptomic and physiological information has produced confirmation of several known genetic factors and significant insight into novel genetic components functioning in BAT and possibly contributing to traits characteristic of the metabolic syndrome.

[Spontaneous antepartal RhD alloimmunization]

AIM OF THE STUDY

Assess the incidence of spontaneous antepartal RhD alloimmunization in RhD negative pregnant women with an RhD positive fetus.

DESIGN

Clinical study.

SETTING

Department of Obstetrics and Gynecology, Medical School and University Hospital Olomouc.

METHODS

A total of 906 RhD negative women with an RhD positive fetus and without the presence of anti-Dalloantibodies at the beginning of pregnancy were examined. Always it was a singleton pregnancy, RhD blood group of the pregnant women was assessed in the 1st trimester of pregnancy, RhD status of the fetus was determined after delivery. Screening for irregular antierythrocyte antibodies was performed in all women in the 1st trimester of pregnancy, at 28-32 weeks gestation and immediately prior to delivery at 38-42 weeks gestation. Screening for irregular antierythrocyte antibodies was performed also at 6 months following delivery in all cases of positive antibodies before delivery. Antibody screening was performed using the indirect antiglobulin (LISS/NAT) and enzyme (papain) test with their subsequent identification using a panel of reference erythrocytes by column agglutination method Dia-Med. After delivery, the volume of fetomaternal hemorrhage was assesed in all RhD negative women and RhD alloimmunization prophylaxis was performed by administering the necessary IgG anti-D dose; none of the women were administered IgG anti-D antepartally.

RESULTS

During screening for irregular antierythrocyte antibodies at 28-32 weeks gestation, anti-D alloantibodies were diagnosed in 0.2% of the women (2/906); immediately prior to the delivery at 38-42 weeks gestation, anti-D alloantibodies were diagnosed in 2.3% of the women (21/906) and repeatedly even at 6 months following delivery (21/157). In 82.7% of the women (749/906), examination at 6 months following delivery was not performed, therefore in these women spontaneous antepartal RhD alloimmunization cannot reliably be ruled out. Alloimmunization may not be diagnosed yet at term of delivery. If anti-D alloantibodies were not present prior to the delivery, these women were all administered IgG anti-D in a dose of at least 125 μg after delivery.

CONCLUSION

In RhD negative women with an RhD positive fetus, the incidence of spontaneous antepartal RhD alloimmunization was at least 2.3%. Most cases may theoretically be prevented by prophylactic administration of 250 μg of IgG anti-D to all RhD negative women at 28 weeks gestation.

Carbon exchange between ecosystems and atmosphere in the Czech Republic is affected by climate factors

By comparing five ecosystem types in the Czech Republic over several years, we recorded the highest carbon sequestration potential in an evergreen Norway spruce forest (100%) and an agroecosystem (65%), followed by European beech forest (25%) and a wetland ecosystem (20%). Because of a massive ecosystem respiration, the final carbon gain of the grassland was negative. Climate was shown to be an important factor of carbon uptake by ecosystems: by varying the growing season length (a 22-d longer season in 2005 than in 2007 increased carbon sink by 13%) or by the effect of short- term synoptic situations (e.g. summer hot and dry days reduced net carbon storage by 58% relative to hot and wet days). Carbon uptake is strongly affected by the ontogeny and a production strategy which is demonstrated by the comparison of seasonal course of carbon uptake between coniferous (Norway spruce) and deciduous (European beech) stands.

[Prognostic significance of clinic pathological and selected immunohistochemical factors in endometrial cancer]

OBJECTIVE

To assess the immunohistochemical expression of p53, bcl-2, c-erbB-2, Ki-67, estrogen (ER) and progesterone (PR) receptors in endometrial cancer patients. To assess the relation between steroid receptors positivity and other markers. To evaluate the prognostic significance of clinicopathologic and immunohistochemical markers on patient disease free survival.

DESIGN

Experimental prospective study.

SETTING

Department of Obstetrics and Gynaecology, Institute of Human Genetics, Department of Pathology, Department of Biophysics, Palacky University Medical School and University Hospital, Olomouc.

METHODS

We studied 144 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, c-erbB-2, Ki-67, ER and PR antigens were investigated with the use of an immunohistochemical method. In a group of 122 patients we assessed disease free survival (DFS) in relation to clinicopathologic and immunohistochemical factors.

RESULTS

From the total group of 144 patients, 122 were included for survival analysis. We found 15 (12.3%) patients with recurrence of the disease. Mean age was 64,5 (34-88) years. Immunohistologic expression was p53 positive in 29 (23.8%), bcl-2 positive in 87 (71.3%), c-erbB-2 positive in 34 (27.9%), Ki-67 positive in 56 (45.9%), ER positive in 97 (79.5%) and PR positive in 106 (86.9%) of cases. In the survival analysis significantly shorter DFS was present in tumours with poor differentiation (G3), deep myometrial invasion (M2) and positive lymphoinvasion (N).

CONCLUSION

Only poor differentiation (G3) and deep myometrial invasion (M2) are significant independent factors for the length of DFS.

[Immunohistochemical markers expression in hysteroscopy and hysterectomy specimens from endometrial cancer patients: comparison]

OBJECTIVE

To assess the immunohistochemical expression of p53, bcl-2, c-erbB-2, Ki-67, estrogen (ER) and progesterone receptors (PR), MMP-7, MMP-26 in samplex from diagnostic hysteroscopy and therapeutic hysterectomy in endometrial cancer patients.

DESIGN

Experimental prospective study.

SETTING

Department of Obstetrics and Gynecology, Institute of Human Genetics, Department of Pathology, Palacky University Medical School and University Hospital, Olomouc.

METHODS

We studied 43 cases of primary untreated endometrial carcinoma in which the grade and immunomarkers assessed by histoscore were investigated in specimens obtained at hysteroscopy and hysterectomy.

RESULTS

Based on hysterosopy, 31 (72.1%) patients were classified as G1, G2 7 (16.3%) and G3 5 (11.6%) respective. In grade 1 the concordance rate was 77.4% of cases, in grade 2 it was in 14.3% of cases and in grade 3 it was in 80.0% of cases. In hysterosocpy samples the p53 expression was found in 23 (53.5%), bcl-2 in 37 (86.0%), c-erbB-2 in 20 (46.5%), Ki-67 in 29 (67.4%), ER in 37 (86.0%), PR in 36 (83.7%), MMP-7 in 25 (58.1%) and MMP-26 in 23 (53.5%) cases. Expression in hysterectomy specimens was p53 positive in 13 (30.2%), bcl-2 positive in 33 (76.7%), c-erbB-2 positive in 24 (55.8%), Ki-67 positive in 25 (58.1%), ER positive in 36 (83.7%), PR positive in 40 (93.0%), MMP-7 positive in 27 (62.8%) and MMP-26 positive in 23 (53.5%) of total 43 cases.

CONCLUSION

We found high concordance in expression of p53, bcl-2, PR and MMP-7 in hysteroscopy and hysterectomy samples which could be of importance for therapeutic algorithm in endometrial cancer patients.

Immunohistochemical evaluation and lymph node metastasis in surgically staged endometrial carcinoma

OBJECTIVE

To assess the expression of immunohistochemical markers in surgically staged endometrial cancer patients.

METHODS

We studied 107 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, her-2/neu, Ki-67, estrogen receptor (ER) and progesterone receptor (PR) antigens were investigated by an immunohistochemical method. In the last 50 consecutive patients immunoreactivity for MMP-7 and MMP-26 was assessed as well. We evaluated the correlations among the immunohistochemical staining assessed by histoscore, and the age, grading, depth of invasion, stage of the neoplasia and extrauterine disease.

RESULTS

Mean age was 65 years (range 34-88). All patients were submitted to total abdominal or modified radical vaginal hysterectomy plus bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy; p53, bcl-2, her-2/neu, Ki-67, MMP-7, MMP-26, estrogen and progesterone receptors were positive in 36 (43%), 71 (86%), 13 (16%), 80 (96%), 65 (78%), 80 (96%), 61 (73%) and 71 (86%) patients, respectively. p53 overexpression was found to be related to poor grade of differentiation and deep myometrial invasion. Immunostaining for ER was inversely related to the histopathological differentiation of the tumors. Decreased expression of PR was related to advanced stage, poor histopathologic differentiation and extrauterine spread of disease.

CONCLUSION

The overexpression of p53 seems to indicate more malignant phenotype, while PR expression correlates with parameters of better clinical outcome.

Long-term pioglitazone treatment augments insulin sensitivity and PKC-epsilon and PKC-theta activation in skeletal muscles in sucrose fed rats

It has been suggested that thiazolidinediones (TZDs) ameliorate insulin resistance in muscle tissue by suppressing muscle lipid storage and the activity of novel protein kinase C (nPKC) isoforms. To test this hypothesis, we analyzed long-term metabolic effects of pioglitazone and the activation of nPKC-epsilon and -theta isoforms in an animal model of the metabolic syndrome, the spontaneously hypertensive rat (a congenic SHR strain with wild type Cd36 gene) fed a diet with 60 % sucrose from the age of 4 to 8 months. Compared to untreated controls, pioglitazone treatment was associated with significantly increased basal (809+/-36 vs 527+/-47 nmol glucose/g/2h, P<0.005) and insulin-stimulated glycogenesis (1321+/-62 vs 749+/-60 nmol glucose/g/2h, P<0.0001) in isolated gastrocnemius muscles despite increased concentrations of muscle triglycerides (3.83+/-0.33 vs 2.25+/-0.12 micromol/g, P<0.005). Pioglitazone-treated rats exhibited significantly increased membrane/total (cytosolic plus membrane) ratio of both PKC-epsilon and PKC-theta isoforms compared to untreated controls. These results suggest that amelioration of insulin resistance after long-term pioglitazone treatment is associated with increased activation of PKC-epsilon and -theta isoforms in spite of increased lipid concentration in skeletal muscles.

Increased expression and altered subcellular distribution of PKC-delta in chronically hypoxic rat myocardium: involvement in cardioprotection

We examined the role of protein kinase C (PKC) in the cardioprotective mechanism induced by long-term adaptation to chronic intermittent hypoxia. Adult male Wistar rats were exposed to hypobaric hypoxia of 7,000 m for 8 h/day, 5 days/wk; the total number of exposures was 24-32. A control group was kept under normoxic conditions. Western blot analysis of PKC isoforms-delta and -epsilon was performed in the cytosol and three particulate fractions of left ventricular myocardium. Infarct size was determined in open-chest animals subjected to 20-min coronary artery occlusion and 3-h reperfusion. The PKC inhibitors chelerythrine (1 or 5 mg/kg) or rottlerin (selective for PKC-delta isoform; 0.3 mg/kg) were administered intravenously as a single bolus 15 min before ischemia. Chronic hypoxia had no effect on the expression and distribution of PKC-epsilon. The relative amount of PKC-delta increased in the cytosol and nuclear-cytoskeletal, mitochondrial, and microsomal fractions of chronically hypoxic myocardium by 100%, 212%, 237%, and 146%, respectively, compared with corresponding normoxic values. Chronic hypoxia decreased the size of myocardial infarction (normalized to the area at risk) by about one-third on the average (P < 0.05). Both doses of chelerythrine tended to reduce infarction in controls, and only the high dose completely abolished the improvement of ischemic tolerance in hypoxic hearts (P < 0.05). Rottlerin attenuated the infarct size-limiting effect of chronic hypoxia (P < 0.05), and it had no effect in controls. These results suggest that chronic intermittent hypoxia-induced cardioprotection in rats is partially mediated by PKC-delta; the contribution of other isoforms remains to be determined.

Interaction between impaired and unimpaired speakers: inter-subjectivity and the interplay of culturally shared and situation specific knowledge

The part played by culturally shared knowledge in interaction is generally recognised. However, the details of how it may be manifested in interaction are largely undocumented. This study explores this issue in the context of interactions between impaired and unimpaired speakers, using a conversation analytic approach in combination with a communication task commonly employed in experimental social psychology. Three exemplary cases are analysed. Results show that when the task interaction is co-constructed, the interaction is collaboratively enacted, participants' actions are in alignment, and the task outcome is relatively accurate. When the unimpaired speaker proceeds on the basis of culturally shared knowledge, and thereby 'unilaterally' manages the interaction, two courses of action are available to the impaired speaker. The impaired speaker may make attempts to provide situation specific details. In this case, because each participant is drawing on different resources to construct the interaction, their actions are out of alignment, and the task outcome is less accurate. Alternatively, the impaired speaker may concur with the culturally shared knowledge drawn on by the unimpaired speaker, in which case the participants' actions are in alignment, but the task outcome is highly inaccurate. The authors conclude that by combining a conversation analytic approach with a communication task which reflects participants' everyday experiences, orientations to different interaction resources can be drawn out. This can have relevance for, and help to elicit, practices in everyday interaction.

Reflex sympathetic dystrophy of the lower limbs after kidney transplantation

Reflex sympathetic dystrophy syndrome (RSDS) is a rarely described complication after different types of organ transplants. Three out of 147 kidney recipients treated at our center during the last 6 years developed severe bilateral symmetrical pain in the ankles and knees, with great difficulties in walking 2-3 months after kidney transplantation. Clinical examination revealed periarticular soft tissue swelling and vasomotor changes with no effusion. Patchy osteoporotic patterns were seen radiographically in clinically affected areas. Scintigraphy showed increased epiphyseal uptake of 99mTc with a periarticular distribution. Clinical symptoms, radiographic, and scintigraphic signs were compatible with so-called RSDS. The exact cause of the syndrome remained obscure. All patients received standard immunosuppression with cyclosporine A (CyA), azathioprine, and prednisone. Symptoms of RSDS improved when doses of CyA were reduced and blood levels declined; patients were treated with calcitonin and calcium channel blockers simultaneously. Non-steroidal antiinflammatory drugs were not effective in symptom relief. In all three cases, most probably spontaneous complete recovery was achieved over the course of 2-8 months; no one patient progressed to aseptic osteonecrosis.

Perspectives on AAC systems by the users and by their communication partners

The study examined the perspectives of augmentative and alternative communication (AAC) users and their 'formal' and 'informal' communication partners in relation to two areas of relevance to AAC: firstly, communication strategies, and secondly, advantages and disadvantages of AAC systems. With respect to communication strategies, it was found that formal communication partners thought that more vocabulary for communicating social purposes was actually available to AAC users and they were less aware of daily routines within day and residential environments. With respect to advantages and disadvantages, three main areas of concern emerged: the effect of the AAC system on the users' communication; features of AAC systems; and the effect of AAC on the users' quality of life. Both high- and low-technology AAC systems were seen as having advantages and disadvantages. This study demonstrates the important contribution to be made by AAC users in the provision of a new set of priorities based on their user experiences.

[The reflex sympathetic dystrophy syndrome of the lower extremities in patients after kidney transplantation--another complication of cyclosporin A therapy?]

The authors describe a new complication observed in patients after transplantation of the kidneys, characterized by intensive periarticular pain of the joints of the lower extremities, mostly with a symmetrical affection of the heels and knees, associated with vasomotor changes in the affected area, X-ray evidence of patchy osteoporosis and an increased periarticular activity of radionuclide on bone scans. The symptoms develop shortly after transplantation and recede within several months. The clinical findings, X-ray and scintigraphic changes are typical for the syndrome of reflex sympathetic dystrophy. The etiology of the syndrome remains obscure, the symptomatology recedes parallel with reduction of the dosage and levels of cyclosporin A.

AAC systems: obstacles to effective use

This paper investigates some of the issues which contribute to the lack of use of Augmentative and Alternative Communication (AAC) systems. It presents findings from a two-year research study which examined the communication of 93 adolescent and adult AAC users with cerebral palsy and 186 of their communication partners. The methods of data collection were questionnaires, interviews and field notes. The results show that some of the obstacles to effective use of AAC systems include lack of availability and accessibility of AAC systems, communication partners' lack of knowledge of AAC systems, insufficient amount of therapy provided, type of vocabulary in AAC systems and other modes of communication available to AAC user.

Concern, perceived risk and attitudes towards HIV/AIDS in Scottish prisons

Four hundred and eighty male prisoners and 500 male staff from 7 Scottish prisons took part in a study assessing perception of risk and attitudes towards HIV/AIDS. Prison staff were found to perceive prison as a higher-risk environment for HIV/AIDS than outside prison, whereas prisoners perceived the opposite. Prisoners perceived less personal risk of HIV/AIDS inside prison than staff. Staff and prisoner concern towards HIV/AIDS was greater than perceived risk of HIV/AIDS, and concern was found to be associated with a number of demographic variables, whereas perceived risk was less influenced by such variables. These findings suggest that the process of risk perception may operate on more than one level. Factor analysis of attitudes towards HIV/AIDS produced four factors for both staff and prisoners: 'Interacting with people with HIV/AIDS'; 'Social control of HIV/AIDS'; 'HIV/AIDS prevention for high-risk groups'; and 'Response to HIV/AIDS high-risk behaviour'. For both staff and prisoners, greater concern and perceived risk towards HIV/AIDS was associated with a lower tolerance for interacting with people with HIV/AIDS and more support for strict social control measures against people with HIV/AIDS.