Capillaria hepatica in rats: focal parasitic hepatic lesions and septal fibrosis run independent courses

Capillaria hepatica causes two main lesions in the liver of rats: multifocal chronic inflammation, directly related to the presence of disintegrating parasites and their eggs, and a process of systematized septal fibrosis. The comparative behavior of these two lesions was investigated in rats experimentally infected with 600 embryonated eggs, following either corticosteroid treatment or specific antigenic stimulation, in an attempt to understand the relationship between these two lesions, and the pathogenesis of septal fibrosis. The two treatments differently modified the morphological aspects of the focal parasitic-related lesions, but did not interfere with the presentation of diffuse septal fibrosis, although a mild decrease in the degree of fibrosis occurred in corticoid-treated animals. These findings indicate that although the two lesions are C. hepatica induced, they are under different pathogenetic control, the induction of septal fibrosis being triggered during early infection to follow an independent pathway.

Remodeling of hepatic vascular changes after specific chemotherapy of schistosomal periportal fibrosis

Hepatosplenic schistosomiasis was the first human disease in which the possibility of extensive long standing hepatic fibrosis being degraded and removed has been demonstrated. When such changes occurred, the main signs of portal hypertension (splenomegaly, esophageal varices) progressively disappeared, implying that a profound vascular remodeling was concomitantly occurring. Hepatic vascular alterations associated with advanced schistosomiasis have already been investigated. Obstruction of the intrahepatic portal vein branches, plus marked angiogenesis and compensatory hyperplasia and hypertrophy of the arterial tree are the main changes present. However, there are no data revealing how these vascular changes behave during the process of fibrosis regression. Here the mouse model of pipestem fibrosis was used in an investigation about these vascular alterations during the course of the infection, and also after treatment and cure of the disease. Animals representing the two polar hepatic forms of the infection were included: (1) "isolated granulomas" characterized by isolated periovular granulomas sparsely distributed throughout the hepatica parenchyma; and (2) 'pipestem fibrosis' with periovular granulomas and fibrosis being concentrated within portal spaces, before and after treatment, were studied by means of histological and vascular injection-corrosion techniques. Instances of widespread portal vein obstruction of several types were commonly found in the livers of the untreated animals. These obstructive lesions were soon repaired, and completely disappeared four months following specific treatment of schistosomiasis. Treatment was accomplished by the simultaneous administration of praziquantel and oxamniquine. The most impressive results were revealed by the technique of injection of colored masses into the portal system, followed by corrosion in strong acid. The vascular lesions of non-treated pipestem fibrosis were represented in the plastic casts by considerable diminution of the fine peripheral portal vein radicles, plus dilatation of periportal collaterals. Four months after treatment, this last picture appeared replaced by tufts of newly interwoven vessels formed along the main portal vein branches, disclosing a strong angiomatoid reparative change. Understanding about the cellular elements at play during fibro-vascular repairing changes of hepatic schistosomiais represents a matter of considerable scientific and conceptual importance. At present time one may only speculate about the participation of some type of natural stem-cell capable of restoring the diseased liver back to normal once the cause of the disorder has been eliminated.

Thalidomide failed to inhibit angiogenesis and fibrosis in hepatic schistosomiasis of the mouse

The relationship between angiogenesis and fibrosis has been demonstrated in several pathological conditions, one of them being schistosomiasis. To observe whether suppression of angiogenesis would interfere with fibrosis, Thalidomide, an anti-angiogenesis drug, was administered during 30 consecutive days to mice with experimental schistosomiasis. Computerized morphometric measurements of fibrosis, and the counting of blood vessels from hepatic schistosomal lesions did not significantly differ when treated animals and their controls were compared at the end of the experiments. These rather unexpected results are presented under the understanding that they may be of interest during further studies on the anti-angiogenesis properties of thalidomide, and the relationship between angiogenesis and fibrosis.

Metabolic effects of fructose in humans

Abstract : Fructose is a simple sugar, whose consumption has increased over the past decades. In rodents, a high-fructose diet (HFrD) induces several features of the metabolic syndrome. The aim of the studies included in this thesis was to investigate the metabolic effects of a HFrD in humans, with a focus on insulin sensitivity and ectopic fat deposition. Moreover, we addressed the question whether these effects may differ between individuals according to gender and the genetic background. The first study was designed to evaluate the impact of a 4-week HFrD on insulin sensitivity and lipid metabolism in 7 healthy men. Insulin sensitivity, intrahepatocellular lipids (IHCL) and intramyocellular lipids (IMCL) contents were measured before and after 1 and 4 weeks of HFrD (1.5 g fructose/kg body weight/day). Insulin sensitivity was assessed by a 2-step hyperinsulinemic euglycemic clamp. IHCL and IMCL were measured by 1H-magnetic resonance spectroscopy (MRS). Fructose caused significant (P<0.05) increases in fasting plasma concentrations of triacylglycerol (TG) (+36%), VLDL-TG (+72%) and glucose (+6%) without any change in body weight, IHCL, IMCL, and insulin sensitivity. In the second study, muscle biopsies were taken from five of these healthy male subjects before and after 4 weeks of HFrD. mRNA concentrations of 18 genes involved in lipid and carbohydrate metabolism were quantified by real-time quantitative PCR. We found that a 4-week HFrD increased the expression of genes involved in lipid synthesis, while it decreased those involved in insulin sensitivity and lipid oxidation; these molecular changes maybe early markers of insulin resistance and altered lipid metabolism. The third study aimed at delineating whether male and females equally respond to a HFrD. For this purpose, higher doses of fructose (twice the dose of the previous study) were provided to 8 healthy young males and 8 healthy young females over 6 days. HFrD significantly increased fasting TG in males (+71 %), whereas this increase was markedly blunted in females (+16%). Males also developed hepatic insulin resistance, characterized by increased hepatic glucose output (+12%), and showed higher alanine aminotransferase concentration (+38%), but none of these effect was observed in females. This study suggests that short-term HFrD leads to hypertriglyceridemia and hepatic insulin resistance in men, but premenopausal women seem protected against these effects. Finally, the fourth study investigated whether healthy offspring of type 2 diabetic patients (OffT2D), a subgroup of individuals prone to metabolic disorders due to their genetic background, may have exacerbated response to HFrD. Eight healthy males (Ctrl) and 16 OffT2D received a HFrD and isocaloric diet in a randomized order. In both groups, HFrD significantly increased IHCL (Ctrl: +76%; OffT2D: +79%) and fasting plasma VLDL-TG (Ctrl: +51 %; OffT2D: +110%). In absolute values, these increments were significantly higher in OffT2D, suggesting that these individuals may be more prone to developing metabolic disorders when challenged by high fructose intake. In order to better delineate the specific effects of fructose vs the hypercaloric energy content, we repeated the complete metabolic investigations after an isocaloric high glucose diet in four of the eight Ctrl volunteers. After a high glucose diet, TG and IHCL concentrations remained similar to the control values, in contrast to the marked increases observed after the HFrD. In conclusion, the studies included in this thesis provided novel insights into the metabolic effects of fructose in humans. They showed that fructose may rapidly increase fasting VLDL-TG, IHCL and lead to hepatic insulin resistance; these effects seem specific to fructose, and potential mechanisms may involve both stimulation of hepatic de novo lipogenesis and decreased lipid oxidation. Moreover, the results suggest that women seem protected against such deleterious effects, while OffT2D displayed exacerbated response. Résumé : Le fructose est un sucre simple, dont la consommation a augmenté durant les dernières décennies. Dans les modèles animaux, un régime riche en fructose (RRFru) peut induire plusieurs composantes du syndrome métabolique. Le but de cette thèse était d'étudier les effets d'un régime riche en fructose sur la sensibilité à l'insuline et la déposition de lipides ectopiques chez l'humain, et si ces effets variaient selon le genre ou le background génétique. La première étude avait pour but d'évaluer l'effet d'un RRFru d'une durée de 4 semaines sur la sensibilité à l'insuline et le métabolisme des lipides chez des hommes sains. La sensibilité à l'insuline, les lipides intrahépatiques (IHCL) et intramusculaires (IMCL) ont été mesurés avant, et après 1 et 4 semaines du RRFru (1.5 g fructose/kg/jour). La sensibilité à l'insuline a été déterminée par un clamp hyperinsulinémique euglycémique, et les IHCL/IMCL par spectroscopie à résonnance magnétique. Le fructose a augmenté les concentrations plasmatiques à jeun des VLDL- triglycérides (TG) (+72%) et de glucose (+6%), sans induire de changement au niveau de la sensibilité à l'insuline, IHCL ou IMCL. Dans la deuxième étude, des biopsies de muscle squelettique ont été prélevées chez cinq de ces volontaires avant et après les 4 semaines de RRFru. Les concentrations de mRNA de 18 gènes impliqués dans le métabolisme des lipides et des hydrates de carbone ont été mesurées par RT-PCR quantitative. Le RRFru a augmenté l'expression de gènes impliqués dans la synthèse de lipides, et diminué celles de gènes impliqués dans la sensibilité à l'insuline et l'oxydation de lipides. Ces changements pourraient constituer des altérations précoces de la sensibilité à l'insuline et du métabolisme lipidique en réponse au fructose. La troisième étude avait pour but de définir si les réponses au RRFru étaient semblables entre les hommes et les femmes. Pour ceci, des doses plus élevées de fructose ont été administrées à 8 jeunes hommes et 8 jeunes femmes durant 6 jours. Le RRFru a augmenté les TG chez les hommes (+71 %), et de manière nettement plus modeste chez les femmes (+16%). Les hommes ont développé une résistance hépatique à l'insuline, ainsi qu'une augmentation des concentrations d'alanine aminotransférase (+38%), mais aucun de ces effets n'a été observé chez les femmes. Cette étude suggère qu'à court terme, un RRFru mène à une hypertriglycéridémie et résistance hépatique à l'insuline chez l'homme, tandis que les femmes semblent en être protégées. Finalement, la 4ème étude a investigué si des personnes apparentées à des patients diabétiques de type 2 (AppDT2), qui constituent un groupe d'individus à risque de développer des maladies métaboliques en raison de leur background génétique, avaient des réponses plus marquées au RRFru. Huit hommes sains (Ctrl) et 16 AppDT2 on reçu dans un ordre randomisé un RRFru et une diète isocalorique durant 6 jours. Dans les deux groupes, le RRFru a augmenté significativement les IHCL (Ctrl: +76%; AppDT2: +79%) et les VLDL-TG plasmatiques à jeun (Ctrl: +51%; AppDT2: +110%). En valeurs absolues, ces deux augmentations étaient plus importantes dans le groupe des AppDT2, suggérant que ces individus sont plus à risque de développer des problèmes métaboliques suite à un apport de fructose. Afin de définir les effets spécifiques du fructose, quatre des huit sujets Ctrl ont été soumis à un régime riche en glucose. Après le régime riche en glucose, les concentrations de TG et d'IHCL étaient semblables aux valeurs obtenues après une diète isocalorique, contrairement aux nombreux effets observés après le RRFru. En conclusion, ces différentes études ont démontré que chez l'humain, le fructose peut rapidement induire une augmentation des VLDL-TG à jeun, des IHCL et une résistance hépatique à l'insuline ; ces effets semblent être spécifiques au fructose. De plus, les différents résultats obtenus montrent que les femmes développent des effets moindres en réponse au fructose, contrairement aux AppDT2, chez qui les effets du fructose semblent plus marqués. Résumé grand public : Le fructose est un sucre simple, présent naturellement et en faibles quantités dans les fruits, mais également constituant du sucrose - appelé aussi sucre de table. Depuis les années 1970, la consommation de fructose a augmenté dans les pays industrialisés et émergents, principalement par le biais d'une hausse de consommation de boissons sucrées de type soda. Dans des modèles animaux tels que les rongeurs, un régime riche en fructose mène au développement de plusieurs facteurs de risques étroitement liés aux maladies cardiovasculaires, à l'obésité et au diabète de type 2; ceux-ci sont caractérisés par une augmentation des concentrations de glucose et de lipides sanguins, ainsi qu'une accumulation de lipides dits « ectopiques », à savoir dans le foie et les muscles. Le but de cette thèse était de définir les effets d'un régime riche en fructose chez l'être humain. De plus, nous nous sommes intéressés à savoir si ces effets étaient semblables entre différents groupes d'individus, à savoir des personnes de sexe masculin / féminin, ou des personnes dont au moins un des parents est diabétique de type 2. Pour ceci, différents groupes de volontaires (hommes, femmes, avec histoire familiale de diabète de type 2) âgés de 18-30 ans se sont soumis à une alimentation enrichie en fructose, d'une durée allant de 6 à 28 jours, suivant l'étude à laquelle ils participaient. La quantité de fructose consommée en plus de l'alimentation normale durant ces périodes équivalait au contenu en fructose de 2-4 litres de boissons sucrées par jour. Des prises de sang ont été effectuées au terme de chacun de ces différents régimes, ainsi que des mesures de sensibilité à l'insuline et de concentrations de lipides dans le foie et le muscle par résonnance magnétique nucléaire, en collaboration avec l'Hôpital de l'Ile de Berne. Les résultats montrent qu'après 6 jours de régime riche en fructose, les volontaires sains de sexe masculin ont presque doublé leurs concentrations de lipides sanguins et hépatiques. De plus, le foie de ces volontaires réagissait moins bien à l'insuline, ce qui pourrait mener à long terme à des maladies métaboliques comme le diabète de type 2. Un des mécanismes postulés est que le fructose pourrait stimuler la formation de lipides dans le foie, contribuant ainsi à un dysfonctionnement de cet organe. De manière surprenante, des femmes d'âge et d'IMC (Indice de Masse Corporelle) comparables aux hommes étudiés n'ont pas développé ces différents effets en réponse au régime riche en fructose. Il semblerait donc qu'elles possèdent certaines propriétés pouvant les «protéger », du moins à court terme, des problèmes métaboliques induits par le fructose. De tels mécanismes sont pour l'heure inconnus, mais il est possible que des différences hormonales, ou de répartition de la masse graisseuse dans le corps, puissent jouer un rôle. Enfin, nous avons également démontré que chez certaines personnes ayant au moins un parent (père ou mère) diabétique de type 2, les augmentations de lipides sanguins et hépatiques induits par le fructose étaient plus marquées que chez des volontaires sans parents diabétiques. Ceci est néanmoins à tempérer par le fait que nous avons observé une grande hétérogénéité des réponses parmi ces individus, découlant certainement d'interactions complexes entre différents facteurs tels que la génétique, le mode de vie, l'alimentation et l'activité physique. Ces différents résultats donnent lieu à une meilleure compréhension du rôle de facteurs alimentaires dans le développement de problèmes métaboliques tels que le diabète de type 2. Ils vont également permettre de tester différentes approches thérapeutiques. Bien qu'ayant été obtenus avec des doses de fructose importantes, ces études soulignent l'effet potentiellement dangereux pour la santé d'une alimentation riche en sucres.

Dietary lipids reduce the expression of carotenoid-based coloration in Lacerta vivipara

1. The importance of dietary lipids for carotenoid-based ornaments has rarely been investigated, although theory predicts that dietary lipids may control the development of these widespread animal signals. Dietary lipids have been suggested to enhance the expression of male carotenoid-based ornaments because they provide carotenoids with a hydrophobic domain that facilitates their absorption and transport. Dietary lipids may also enhance the uptake of tocopherols (vitamin E), which share common absorption and transport routes with carotenoids. Here, we test whether dietary lipids enhance carotenoid availability and male carotenoid-based colorations. We also explore the effects of dietary lipids on plasma tocopherol concentration, which allow disentangling between different pathways that may explain how dietary lipids affect ornamental expression. 2. Following a two-factorial design, we manipulated dietary access of naturally occurring fatty acids (oleic acid) and carotenoids (lutein and zeaxanthin) and measured its effects on the circulating concentrations of carotenoids (lutein and zeaxanthin) and vitamin E (α- and γ-(β-) tocopherols) and on the ventral, carotenoid-based coloration of male common lizards (Lacerta vivipara). 3. Lutein but not zeaxanthin plasma concentrations increased with carotenoid supplementation, which, however, did not affect coloration. Lipid intake negatively affected circulating concentrations of lutein and γ-(β-) tocopherol and led to significantly less orange colorations. The path analysis suggests that a relationship between the observed colour change and the change in plasma concentrations of γ-(β-) tocopherol may exist. 4. Our study shows for the first time that dietary lipids do not enhance but reduce the intensity of male carotenoid-based ornaments. Although dietary lipids affected plasma carotenoid concentration, its negative effect on coloration appeared to be linked to lower vitamin E plasma concentrations. These findings suggest that a conflict between dietary lipids and carotenoid and tocopherol uptake may arise if these nutrients are independently obtained from natural diets and that such conflict may reinforce signal honesty in carotenoid-based ornaments. They also suggest that, at least in the common lizard, sexual selection with respect to carotenoid-based coloration may select for males with low antioxidant capacity and thus for males of superior health.

Absence of mTOR Inhibitor Effect on Hepatic Cyst Growth: A Case Report of a Kidney Transplant Recipient with Autosomal Dominant Polycystic Kidney Disease.

Some experimental studies have suggested a beneficial effect of the mammalian target of rapamycin (mTOR) inhibitor use on hepatic and renal cyst growth in patients with autosomal dominant polycystic kidney disease (ADPKD). However, the results of clinical studies are conflicting and the role of mTOR inhibitors is still uncertain. We report the case of a patient with ADPKD who underwent deceased kidney transplantation because of an end-stage renal disease. The evolution was uneventful with an excellent graft function under cyclosporine (CsA) monotherapy. Some years later, the patient developed a symptomatic hepatomegaly due to growth of cysts. CsA was replaced by sirolimus, an mTOR inhibitor, in order to reduce or control the increase in the cyst and liver volume. Despite the switch, the hepatic volume increased by 25% in two years. Finally sirolimus was stopped because of the lack of effect on hepatic cyst growth and the presence of sirolimus side effects. The interest of our case resides in the followup by MRI imaging during the mTOR inhibitor treatment and 15 months after the restart of the initial immunosuppressive therapy. This observation indicates that mTOR inhibitors did not have significant effect on cyst-associated hepatic growth in our patient, which is consistent with some results of recent large clinical studies.

Hepatic Manifestations of Wilson Disease - CHUV Experience 2005-2010

Background and aim: Wilson disease (WD) is an inherited disorder ofhepatic copper excretion leading to toxic accumulation of copper in theliver as well as the brain, cornea, and other organs. The defect is due tomutations of the copper-transporting ATPase ATP7B. Here, we describethe adult cases of hepatic WD diagnosed at the CHUV between 2005and 2010.Methods: Clinical manifestions, results of diagnostic tests, and follow-upof adult patients with hepatic WD were recorded systematically.Results: Seven new adult cases of hepatic WD were diagnosed in ourcenter between 2005 and 2010. Three were women and 4 men, with amedian a ge at d iagnosis o f 24 (range, 1 8-56) years. Three patientspresented with acute liver failure (ALF), three with persistently elevatedliver function tests, and one with a dvanced cirrhosis. None hadneurological manifestations. Only one patient, presenting with ALF, had aKayser-Fleischer corneal ring. Median ceruloplasmin levels at diagnosiswere 0.13 (range, <0.03-0.30) g/l, median 24 h urinary copper excretion6.3 (range, 0.4-62.0) μmol/24 h, and median hepatic copperconcentration 591 (range, 284-1049) μg/g. At least one mutation in theATP7B g ene was i dentified in a ll patients. Allelic frequency of t hecommon H1069Q mutation was 14%. Two patients presenting with ALFand the one with advanced cirrhosis underwent successful l ivertransplantation. One patient with ALF recovered under chelator therapy.D-penicillamine was used as first-line chelator treatment, with a switch totrientine due to adverse effects in 2 out of 4 patients u nder l ong-termtreatment.Conclusions: The clinical presentation of WD and the performance ofdiagnostic tests are variable. A high index of suspicion i n clinicallycompatible situations i s key, with a combination of tests allowing thediagnosis of WD.

Correlation of biological serum markers with the degree of hepatic fibrosis and necroinflammatory activity in hepatitis C and schistosomiasis patients

Liver biopsy is the gold-standard method to stage fibrosis; however, it is an invasive procedure and is potentially dangerous. The main objective of this study was to evaluate biological markers, such as cytokines IL-13, IFN-γ, TNF-α and TGF-β, platelets, bilirubins (Bil), alanine aminotransferase (ALT) and aspartate aminotransferase (AST), total proteins, γ-glutamil transferase (γ-GT) and alkaline phosphatase (AP), that could be used to predict the severity of hepatic fibrosis in schistosomiasis and hepatitis C (HC) as isolated diseases or co-infections. The following patient groups were selected: HC (n = 39), HC/hepatosplenic schistosomiasis (HSS) (n = 19), HSS (n = 22) and a control group (n = 13). ANOVA and ROC curves were used for statistical analysis. P < 0.05 was considered significant. With HC patients we showed that TNF-α (p = 0.020) and AP (p = 0.005) could differentiate mild and severe fibrosis. With regard to necroinflammatory activity, AST (p = 0.002), γ-GT (p = 0.034) and AP (p = 0.001) were the best markers to differentiate mild and severe activity. In HC + HSS patients, total Bil (p = 0.008) was capable of differentiating between mild and severe fibrosis. In conclusion, our study was able to suggest biological markers that are non-invasive candidates to evaluate fibrosis and necroinflammatory activity in HC and HC + HSS.

Angiogenesis and experimental hepatic fibrosis

Angiogenesis is a basic change occurring during repair by granulation tissue. This process seems to precede fibrosis formation in most types of chronic liver disease. To examine its presence and significance in different types of hepatic insults, this paper sought to identify the presence, evolution and peculiarities of angiogenesis in the most common experimental models of hepatic fibrosis. The characterization of cells, vessels and extracellular matrix and the identification of factors associated with endothelium (factor VIII RA), vascular basement membrane, other components of the vascular walls (actin, elastin) and the presence of the vascular-endothelial growth factor were investigated. The models examined included Capillaria hepatica septal fibrosis, whole pig serum injections, carbon tetrachloride administration, main bile duct ligation and Schistosoma mansoni infection. The first four models were performed in rats, while the last used mice. All models studied exhibited prominent angiogenesis. The most evident relationship between angiogenesis and fibrosis occurred with the C. hepatica model due to circumstances to be discussed. Special attention was paid to the presence of pericytes and to their tendency to become detached from the vascular wall and be transformed into myofibroblasts, which is a sequence of events that explains the decisive role angiogenesis plays in fibrosis.

Evaluation of local immune response to Fasciola hepatica experimental infection in the liver and hepatic lymph nodes of goats immunized with Sm14 vaccine antigen

Protection against Fasciola hepatica in goats immunized with a synthetic recombinant antigen from Schistosoma mansoni fatty acid-binding protein 14 (rSm14) was investigated by assessing worm burdens, serum levels of hepatic enzymes, faecal egg count and hepatic damage, which was evaluated using gross and microscopic morphometric observation. The nature of the local immune response was assessed by examining the distribution of CD2+, CD4+, CD8+ and γ´+ T lymphocytes along with IgG+, IL-4+ and IFN-γ+ cells in the liver and hepatic lymph nodes (HLN). The goats used consisted of group 1 (unimmunized and uninfected), group 2 [infected control - immunized with Quillaia A (Quil A)] and group 3 (immunized with rSm14 in Quil A and infected), each containing seven animals. Immunization with rSm14 in Quil A adjuvant induced a reduction in gross hepatic lesions of 56.6% (p < 0.001) and reduced hepatic and HLN infiltration of CD2+, CD4+, CD8+ and γ´+ T lymphocytes as well as IL-4+ and IFN-γ+ cells (p < 0.05). This is the first report of caprine immunization against F. hepatica using a complete rSm14 molecule derived from S. mansoni. Immunization reduced hepatic damage and local inflammatory infiltration into the liver and HLN. However, considering that Quil A is not the preferential/first choice adjuvant for Sm14 immunization, further studies will be undertaken using the monophosphoryl lipid A-based family of adjuvants during clinical trials to facilitate anti-Fasciolavaccine development.

Lipoprotein lipase activity and mass, apolipoprotein C-II mass and polymorphisms of apolipoproteins E and A5 in subjects with prior acute hypertriglyceridaemic pancreatitis

BACKGROUND Severe hypertriglyceridaemia due to chylomicronemia may trigger an acute pancreatitis. However, the basic underlying mechanism is usually not well understood. We decided to analyze some proteins involved in the catabolism of triglyceride-rich lipoproteins in patients with severe hypertriglyceridaemia. METHODS Twenty-four survivors of acute hypertriglyceridaemic pancreatitis (cases) and 31 patients with severe hypertriglyceridaemia (controls) were included. Clinical and anthropometrical data, chylomicronaemia, lipoprotein profile, postheparin lipoprotein lipase mass and activity, hepatic lipase activity, apolipoprotein C II and CIII mass, apo E and A5 polymorphisms were assessed. RESULTS Only five cases were found to have LPL mass and activity deficiency, all of them thin and having the first episode in childhood. No cases had apolipoprotein CII deficiency. No significant differences were found between the non-deficient LPL cases and the controls in terms of obesity, diabetes, alcohol consumption, drug therapy, gender distribution, evidence of fasting chylomicronaemia, lipid levels, LPL activity and mass, hepatic lipase activity, CII and CIII mass or apo E polymorphisms. However, the SNP S19W of apo A5 tended to be more prevalent in cases than controls (40% vs. 23%, NS). CONCLUSION Primary defects in LPL and C-II are rare in survivors of acute hypertriglyceridaemic pancreatitis; lipase activity measurements should be restricted to those having their first episode during childhood.

Adverse hepatic reactions associated with calcium carbimide and disulfiram therapy: is there still a role for these drugs?

Disulfiram and calcium carbimide are two alcohol deterrants widely used in alcoholism treatment, however, there exist great concerns over their safety. Reports on hepatotoxicity, mainly related to disulfiram therapy, have been published. The hepatotoxic potential of calcium carbimide is less well characterized. Here, we describe four cases of liver damage related to this therapeutic group that were submitted to a Registry of hepatotoxicity and point out the limitations that we face when prescribing these compounds. A reassessment of the role of these compounds in the management of alcohol dependence is clearly needed.

Hepatic safety of antibiotics used in primary care

Antibiotics used by general practitioners frequently appear in adverse-event reports of drug-induced hepatotoxicity. Most cases are idiosyncratic (the adverse reaction cannot be predicted from the drug's pharmacological profile or from pre-clinical toxicology tests) and occur via an immunological reaction or in response to the presence of hepatotoxic metabolites. With the exception of trovafloxacin and telithromycin (now severely restricted), hepatotoxicity crude incidence remains globally low but variable. Thus, amoxicillin/clavulanate and co-trimoxazole, as well as flucloxacillin, cause hepatotoxic reactions at rates that make them visible in general practice (cases are often isolated, may have a delayed onset, sometimes appear only after cessation of therapy and can produce an array of hepatic lesions that mirror hepatobiliary disease, making causality often difficult to establish). Conversely, hepatotoxic reactions related to macrolides, tetracyclines and fluoroquinolones (in that order, from high to low) are much rarer, and are identifiable only through large-scale studies or worldwide pharmacovigilance reporting. For antibiotics specifically used for tuberculosis, adverse effects range from asymptomatic increases in liver enzymes to acute hepatitis and fulminant hepatic failure. Yet, it is difficult to single out individual drugs, as treatment always entails associations. Patients at risk are mainly those with previous experience of hepatotoxic reaction to antibiotics, the aged or those with impaired hepatic function in the absence of close monitoring, making it important to carefully balance potential risks with expected benefits in primary care. Pharmacogenetic testing using the new genome-wide association studies approach holds promise for better understanding the mechanism(s) underlying hepatotoxicity.

Interaction between dietary lipids an physical inactivity on insulin sensitivity and on intramyocellular lipids in healthy men

Résumé Interaction entre les lipides alimentaires et l'inactivité physique sur la sensibilité à l'insuline et les lipides intramyocellulaires chez le sujet masculin en bonne santé Ces deux dernières décennies, l'incidence de la résistance à l'insuline n'a cessé de progresser dans les pays industrialisés. Un grand nombre de travaux suggèrent que ce trouble métabolique joue un rôle important dans la pathogenèse de maladies propres au monde industrialisé, telles que le diabète, l'hypertension et les maladies cardiovasculaires. Malgré de nombreuses études, les mécanismes à l'origine de la résistance à l'insuline restent encore incomplètement élucidés. En plus d'une composante génétique, de nombreux facteurs environnementaux semblent impliqués parmi ces derniers, nous nous sommes intéressés à l'effet d'une alimentation riche en graisses associée à une période d'inactivité physique de courte durée. Nous nous sommes également penchés sur la corrélation décrite entre la résistance à l'insuline et la concentration de graisses présentes à l'intérieur des cellules musculaires squelettiques, appelées lipides intramyocellulaires. Pour ce faire, 8 volontaires masculins ont été étudiés à deux occasions. Après deux jours de diète équilibrée associée à une activité physique, les participants étaient confinés au lit strict pour 60 heures et devaient manger une alimentation soit riche en graisses saturées soit riche en hydrates de carbones. Pour évaluer l'effet de l'alimentation seule, 6 des 8 volontaires ont été réétudiés après deux jours de diète équilibrée suivie par 60 heures d'alimentation riche en graisses saturées associées à une activité physique contrôlée. Nous avons estimé la sensibilité à l'insuline par la technique du clamp hyperinsulinémique euglycémique alors que la concentration de lipides intramyocellulaires a été déterminée par spectroscopie par résonance magnétique. Après 60 heures d'inactivité physique associée à une alimentation riche en lipides, nous avons observé une diminution de l'utilisation de glucose dépendante de l'insuline (-24±6%; p<0.05), alors qu'aucune modification significative de ce même paramètre n'a été constatée lorsque l'inactivité physique était associée à une alimentation riche en hydrates de carbones (+19±10%). Ces deux conditions se sont accompagnées d'une augmentation des lipides intramyocellulaires (+32±7% et +17±8% respectivement). Bien que l'augmentation des lipides intramyocellulaires observée après 60 heures d'une alimentation riche en graisses saturées associée à une activité physique modérée fût d'une ampleur similaire à celle de la condition associant une alimentation riche en graisses et inactivité physique, l'utilisation de glucose induite par l'insuline n'a pas été modifiée de manière significative (-7±9%) Ces résultats indiquent que l'inactivité physique et une alimentation riche en graisses saturées semblent interagir, induisant une diminution de la sensibilité à l'insuline globale. La concentration de lipides intramyocellulaires a été influencée par les lipides issus de l'alimentation et l'inactivité physique, sans être toutefois corrélée à la résistance à l'insuline. Abstract OBJECTIVE - To assess the effect of a possible interaction between dietary fat and physical inactivity on whole-body insulin sensitivity and intramyocellular lipids (IMCLs). RESEARCH DESIGN AND METHODS - Eight healthy male volunteers were studied on two occasions. After 2 days of an equilibrated diet and moderate physical activity, participants remained inactive (bed rest) for 60 h and consumed either a high-saturated fat (45% fat, of which ~60% was saturated fat [BR-HF]) or a high-carbohydrate (70% carbohydrate [BR-HCHO]) diet. To evaluate the effect of a high-fat diet alone, six of the eight volunteers were restudied after a 2-day equilibrated diet followed by 60 h on a high-saturated fat diet and controlled physical activity (PA-HF). Insulin sensitivity was measured by hyperinsulinemic-euglycemic clamp and IMCL concentrations by H-magnetic resonance spectroscopy. RESULTS - Insulin-mediated glucose disposal was decreased by BR-HF condition (-24 ± 6%, P < 0.05) but did not change with BR-HCHO ( + 19 ± 10%, NS). BR-HF and BR-HCHO increased IMCL levels (+32 ± 7%, P < 0.05 and +17 ± 8%, P < 0.0011, respectively). Although the increase in IMCL levels with PA-HF (+31 ± 19%, P = 0.12) was similar to that during BR-HF, insulin-mediated glucose disposal ( -7 ± 9%, NS) was not decreased. CONCLUSIONS - These data indicate that physical inactivity and a high-saturated fat diet may interact to reduce whole-body insulin sensitivity. IMCL content was influenced by dietary lipid and physical inactivity but was not directly associated with insulin resistance.