Metabolic and hormonal response to intermittent high-intensity and continuous moderate intensity exercise in individuals with type 1 diabetes: a randomised crossover study.

AIMS/HYPOTHESIS To investigate exercise-related fuel metabolism in intermittent high-intensity (IHE) and continuous moderate intensity (CONT) exercise in individuals with type 1 diabetes mellitus. METHODS In a prospective randomised open-label cross-over trial twelve male individuals with well-controlled type 1 diabetes underwent a 90 min iso-energetic cycling session at 50% maximal oxygen consumption ([Formula: see text]), with (IHE) or without (CONT) interspersed 10 s sprints every 10 min without insulin adaptation. Euglycaemia was maintained using oral (13)C-labelled glucose. (13)C Magnetic resonance spectroscopy (MRS) served to quantify hepatocellular and intramyocellular glycogen. Measurements of glucose kinetics (stable isotopes), hormones and metabolites complemented the investigation. RESULTS Glucose and insulin levels were comparable between interventions. Exogenous glucose requirements during the last 30 min of exercise were significantly lower in IHE (p = 0.02). Hepatic glucose output did not differ significantly between interventions, but glucose disposal was significantly lower in IHE (p < 0.05). There was no significant difference in glycogen consumption. Growth hormone, catecholamine and lactate levels were significantly higher in IHE (p < 0.05). CONCLUSIONS/INTERPRETATION IHE in individuals with type 1 diabetes without insulin adaptation reduced exogenous glucose requirements compared with CONT. The difference was not related to increased hepatic glucose output, nor to enhanced muscle glycogen utilisation, but to decreased glucose uptake. The lower glucose disposal in IHE implies a shift towards consumption of alternative substrates. These findings indicate a high flexibility of exercise-related fuel metabolism in type 1 diabetes, and point towards a novel and potentially beneficial role of IHE in these individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT02068638 FUNDING: Swiss National Science Foundation (grant number 320030_149321/) and R&A Scherbarth Foundation (Switzerland).

IMMUNOLOGICAL MECHANISMS OF EXTRACORPOREAL PHOTOPHERESIS IN CUTANEOUS T CELL LYMPHOMA AND GRAFT VERSUS HOST DISEASE

IMMUNOLOGICAL MECHANISMS OF EXTRACORPOREAL PHOTOPHERESIS IN CUTANEOUS T CELL LYMPHOMA AND GRAFT VERSUS HOST DISEASE Publication No.___________ Lisa Harn-Ging Shiue, B.S. Supervisory Professor: Madeleine Duvic, M.D. Extracorporeal photopheresis (ECP) is an effective, low-risk immunomodulating therapy for leukemic cutaneous T cell lymphoma (L-CTCL) and graft versus host disease (GVHD), but whether the mechanism(s) of action in these two diseases is (are) identical or different is unclear. To determine the effects of ECP in vivo, we studied regulatory T cells (T-regs), cytotoxic T lymphocytes (CTLs), and dendritic cells (DCs) by immunofluorescence flow cytometry in 18 L-CTCL and 11 GVHD patients before and after ECP at Day 2, 1 month, 3 months, and 6 months. In this study, ECP was effective in 12/18 L-CTCL patients with a 66.7% overall response rate (ORR) and 6/11 GVHD patients with a 54.5% ORR. Prior to ECP, the percentages of CD4+Foxp3+ T cells in 9 L-CTCL patients were either lower (L-CTCL-Low, n=2) or higher (L-CTCL-High, n=7) than normal. Five of the 7 GVHD patients had high percentages of CD4+Foxp3+ T cells (GVHD-High). Six of 7 L-CTCL-High patients had >80% CD4+Foxp3+ T cells which were correlated with tumor cells, and were responders. Both L-CTCL-High and GVHD-High patients had decreased percentages of CD4+Foxp3+ and CD4+Foxp3+CD25- T cells after 3 months of treatment. CD4+Foxp3+CD25+ T cells increased in GVHD-High patients but decreased in L-CTCL-High patients after 3 months of ECP. In addition, numbers of CTLs were abnormal. We confirmed that numbers of CTLs were low in L-CTCL patients, but high in GVHD patients prior to ECP. After ECP, CTLs increased after 1 month in 4/6 L-CTCL patients whereas CTLs decreased after 6 months in 3/3 GVHD patients. Myeloid (mDCs) and plasmacytoid DCs (pDCs) were also low at baseline in L-CTCL and GVHD patients confirming the DC defect. After 6 months of ECP, numbers and percentages of mDCs and pDCs increased in L-CTCL and GVHD. MDCs were favorably increased in 8/12 L-CTCL responders whereas pDCs were favorably increased in GVHD patients. These data suggest that ECP is favorably modulating the DC subsets. In L-CTCL patients, the mDCs may orchestrate Th1 cell responses to overcome immune suppression and facilitate disease regression. However, in GVHD patients, ECP is favorably down-regulating the immune system and may be facilitating immune tolerance to auto-or allo-antigens. In both L-CTCL and GVHD patients, DCs are modulated, but the T cell responses orchestrated by the DCs are different, suggesting that ECP modulates depending on the immune milieu. _______________

Abundance of bacteria, cyanobacteria and nanoflagellates at sime series station DYNAPROC

The variability in microbial communities (abundance and biomass), bacterial production and ectoaminopeptidase activity, particulate and dissolved organic carbon (POC, DOC), and particulate and dissolved lipids was examined in spring 1995 in the northwestern Mediterranean, where a transition from the end of a bloom to pre-oligotrophic conditions was observed. Four time series of 36 h each and 4 h sampling intervals were performed at 5 m and at the chlorophyll maximum (30 m) between 11 and 31 May. Simultaneous measurements of pigments, abundance of hetero- and autotrophic flagellates, bacteria and POC enabled the estimation of living POC (defined as autotrophic-C plus heterotrophic-C biomass), and thus the detrital organic carbon. During the first 2 time series (11 to 15 May), the bacterial-C biomass was higher than the autotrophic-C biomass at 5 m (ratio 1.4 and 1.7), whereas the opposite trend was observed in the chlorophyll peak (ratio 0.7 for the first cycle). However, at the end of May, autotrophic-C biomass was equivalent to bacterial-C biomass at both depths studied. The detrital pool remained a more or less constant fraction of the POC (52, 53 and 47% on 11-12 May, 14-15 May and 30-31 May) at the chlorophyll peak, whereas it decreased significantly with time (62 to 53%) at 5 m. Relationships between bacterial activities and evolution of available resources were not systematically evidenced from our 36 h diel cycle data. Nevertheless, at the monthly scale, comparison of bacterial carbon demand (BCD) to potential carbon resources (detrital POC and DOC) showed that bacteria fed differently on the various pools. From ectoaminopeptidase turnover rates and detrital POC, the potential hydrolysis rate of detritus was calculated. Depending on the choice of conversion factors for bacterial production and estimates of hydrolysis turnover rates, it was shown that bacterial hydrolysis of detritus could be one of the DOC accumulation sources. We observed that the percentage of BCD supplied by detrital POC hydrolysis increased in the surface and decreased in the chlorophyll peak. An index of lipid degradation in POC, the lipolysis index, increased during the month at 5 m, also indicating a higher hydrolysis of POC. The opposite trend was observed in the chlorophyll maximum layer. The selective decrease in dissolved lipids in DOC in the chlorophyll maximum layer, particularly free fatty acids, also suggests that bacteria utilized increased fractions of carbon sources from the DOC. We concluded that partitioning between DOC and detritus as resources for bacteria can change during the rapid transition period from mesotrophy to oligotrophy in the northwestern Mediterranean.