Hyperinsulinism and overgrowth without obesity

We report a 5 year old girl with postnatal overgrowth (height velocity >97th centile), hyperinsulinaemia, and increased insulin-like growth factor 1 for age, without evidence of bioactive or immunoreactive growth hormone excess or pituitary abnormality. Although her overgrowth may be a result of hyperinsulinism, her serum contains a factor (neither insulin nor IGF-1) which is able to stimulate the proliferation of lymphocyte precursors, and this could also account for the overgrowth. Over the course of two years observation she has developed acanthosis nigricans and diabetes mellitus.

Epitope map for a growth hormone receptor agonist monoclonal antibody, MAb 263

Monoclonal antibody (MAb) 263 is a widely used monoclonal antibody that recognizes the extracellular domain (ECD) of the GH receptor. It has been shown to act as a GH agonist both in vitro and in vivo, and we report here that it must be divalent to exert its effect on the full-length receptor. To understand the mechanism of its agonist action, we have determined the precise epitope for this antibody using a novel random PCR mutagenesis approach together with expression screening in yeast. A library of 5200 clones of rabbit GH receptor ECD mutants were screened both with MAb 263 and with an anticarboxy-tag antibody to verify complete ECD expression. Sequencing for clones that expressed complete ECD but were not MAb 263 positive identified 20 epitope residues distributed in a discontinuous manner throughout the ECD. The major part of the epitope, as revealed after mapping onto the crystal structure model of the ECD molecule, was located on the side and upper portion of domain 1, particularly within the D - E strand disulfide loop 79 - 96. Molecular dynamics docking of an antibody of the same isotype as MAb 263 was used to dock the bivalent antibody to the 1528-Angstrom(2) epitope and to visualize the likely consequences of MAb binding. The minimized model enables the antibody to grasp two receptors in a pincer-like movement from opposite sides, facilitating alignment of the receptor dimerization domains in a manner similar to, but not identical with, GH.

Seeking SOCS and sex steroids

In seeking to explain why oral estrogen inhibits the GH-IGF-I axis, a recent study has unearthed a new way that steroid hormones can influence growth hormone action. This involves suppressors of cytokine signalling (SOCS), which offer a new level of understanding in signal control and crosstalk.

Greater replication and differentiation of preadipocytes in inherited corticosteroid-binding globulin deficiency

Glucocorticoids are pivotal for adipose tissue development. Rodent studies suggest that corticosteroid-binding globulin (CBG) modulates glucocorticoid action in adipose tissue. In humans, both genetic CBG deficiency and suppressed CBG concentrations in hyperinsulinemic states are associated with obesity. We hypothesized that CBG deficiency in humans modulates the response of human preadipocytes to glucocorticoids, predisposing them to obesity. We compared normal preadipocytes with subcultured preadipocytes from an individual with the first ever described complete deficiency of CBG due to a homozygous null mutation. CBG-negative preadipocytes proliferated more rapidly and showed greater peroxisome proliferator-activated receptor-gamma-mediated differentiation than normal preadipocytes. CBG was not expressed in normal human preadipocytes. Glucocorticoid receptor number and binding characteristics and 11beta-hydroxysteroid dehydrogenase activity were similar for CBG-negative and normal preadipocytes. We propose that the increased proliferation and enhanced differentiation of CBG-negative preadipocytes may promote adipose tissue deposition and explain the obesity seen in individuals with genetic CBG deficiency. Furthermore, these observations may be relevant to obesity occurring with suppressed CBG concentrations associated with hyperinsulinemia.

In overweight patients with chronic hepatitis C, circulating insulin is associated with hepatic fibrosis: implications for therapy

Background/Aims: Host factors such as increased body mass index (BMI) and genotype-specific viral factors contribute to the development of steatosis in patients with chronic hepatitis C (HCV). We hypothesized that host metabolic factors associated with increased BMI may play a role in disease progression. Methods: Fasting serum was collected from 160 patients with chronic HCV at the time of liver biopsy and 45 age, gender and BMI matched controls, and assessed for levels of insulin, c-peptide and leptin. Results: Patients with viral genotype 3 had more severe steatosis (P = 0.0001) and developed stages 1 and 2 fibrosis at a younger age (P < 0.05) than patients with genotype 1. For both genotypes, overweight patients had significantly more steatosis and increased insulin and leptin levels. In contrast to lean patients, there was a statistically significant increase in circulating insulin levels with increasing fibrosis in overweight patients with chronic HCV (P = 0.03). Following multivariate analysis, insulin was independently associated with fibrosis (P = 0.046) but not inflammation (P = 0.83). There was no association between serum leptin levels and stage of fibrosis. Conclusions: Increasing circulating insulin levels may be a factor responsible for the association between BMI and fibrosis in patients with HCV, irrespective of viral genotype. (C) 2003 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Parathyroid hormone venous sampling prior to reoperation for primary hyperparathyroidism

Background: The surgical cure rate for primary hyperparathyroidism is greater than 95%. For those who have recurrent or persistent disease, preoperative localization improves reoperation success rates. Selective parathyroid venous sampling (SPVS) for intact parathyroid hormone is particularly useful when non-invasive localization techniques are negative or inconclusive. Methods: We present all known cases (n = 13) between 1994 and 2002 who had venous sampling for localization at our institution prior to reoperation for recurrent or persistent primary hyperparathyroidism. Comparison was made with non-invasive localization procedures. Results of invasive and non-invasive localization were correlated with surgical findings. Results: Of the nine reoperated cases, eight had positive correlations between SPVS and operative findings and histopathology. SPVS did not reveal the parathyroid hormone source in one case with negative non-invasive localization procedures. Comparisons between SPVS, computerized tomography (CT), and parathyroid scintigraphy (MIBI) as expressed in terms of true positive (TP), false positive (FP) and false negative (FN) were: SPVS - TP 88.8%, FP 0%, FN 11.1%; CT - TP 22.2%, FP 22.2%, FN 55.5%; and MIBI - TP 33.3%, FP 0%, FN 66.6%. At least seven of the nine operated cases have been cured; another remained normocalcaemic 2 weeks after subtotal parathyroidectomy. Conclusion: In our institution SPVS has proven to be a valuable tool in cases with recurrent or persistent primary hyperparathyroidism and negative non-invasive localization procedures.

Effects of heat treatment on the nutritional value of raw soybean selected for low trypsin inhibitor activity

1. Two broiler experiments and a layer experiments were conducted on Kunitz trypsin inhibitor (Kti) soybeans (SB) of low trypsin inhibitor (TI) activity to determine their nutritive value when included as mash in least-cost poultry diets. 2. Experiment 1 compared chick performance on the Kti or raw SB using a commercial full-fat SB meal (FFSBM) and a solvent extracted SB meal (SBM) as controls during a 20 d experimental period. Broiler experiment 2 compared Kti and raw SB, non-steamed, or steam-pelleted with and without DL-methionine supplementation added to every treatment containing 170 g SB/kg. For each broiler experiment the levels of each SB were 70, 120 and 170 g/kg with the control birds fed only 170 g SB/kg. 3. The layer experiment, compared steam-pelleted Kti and raw SB against a non-steamed Kti and raw SB each fed at two levels (70 and 110 g/kg) x 30 replicates from 29 weeks of age for 19 weeks in a completely randomised design. Production parameters were measured when diets were formulated to contain minimum required specifications and calculated apparent metabolisable energy (AME). At the completion of each trial, 2 broiler birds from each cage and 5 layer birds per treatment were killed, weighed, and their liver and pancreas weighed. 4. Both broiler experiments indicated that production parameters on the Kti SB treatments were significantly lower (P < 0.05) than on the two commercial control SB treatments. However, the Kti treatments were superior to the raw SB treatments. 5. Pancreas weight increased with increasing inclusion of both raw and Kti SB, suggesting that a TI was causing the depression in performance. The AME of the Kti SB was similar to that of commercial FFSB meal. After steam conditioning, the raw SB meal AME value of 9.5 MJ/kg dry matter (DM) was improved to 14.1 MJ/kg DM by reduced TI activity, but this AME improvement with TI activity reduction, plus the supplementation with DL-methionine on birds fed the raw SB had no effect (P > 0.05) on any parameter evaluated in experiment 2. 6. The layer experiment showed that hens on the Kti SB treatments had significantly greater live weight gain (LWG), egg weight and daily egg mass than birds given raw SB. A reduced food intake (FI) was observed in the Kti treatments but egg mass was generally similar to that on the FFSB control diet, indicating that Kti SB supported excellent egg production at an inclusion of 110 g/kg. The depressed performance observed for broiler chicks suggest that younger birds are more susceptible to the effects of SB TI.

The peroxisome proliferator-activated receptor beta/delta agonist, GW501516, regulates the expression of genes involved in lipid catabolism and energy uncoupling in skeletal muscle cells

Lipid homeostasis is controlled by the peroxisome proliferator-activated receptors (PPARalpha, -beta/delta, and -gamma) that function as fatty acid-dependent DNA-binding proteins that regulate lipid metabolism. In vitro and in vivo genetic and pharmacological studies have demonstrated PPARalpha regulates lipid catabolism. In contrast, PPARgamma regulates the conflicting process of lipid storage. However, relatively little is known about PPARbeta/delta in the context of target tissues, target genes, lipid homeostasis, and functional overlap with PPARalpha and -gamma. PPARbeta/delta, a very low-density lipoprotein sensor, is abundantly expressed in skeletal muscle, a major mass peripheral tissue that accounts for approximately 40% of total body weight. Skeletal muscle is a metabolically active tissue, and a primary site of glucose metabolism, fatty acid oxidation, and cholesterol efflux. Consequently, it has a significant role in insulin sensitivity, the blood-lipid profile, and lipid homeostasis. Surprisingly, the role of PPARbeta/delta in skeletal muscle has not been investigated. We utilize selective PPARalpha, -beta/delta, -gamma, and liver X receptor agonists in skeletal muscle cells to understand the functional role of PPARbeta/delta, and the complementary and/or contrasting roles of PPARs in this major mass peripheral tissue. Activation of PPARbeta/delta by GW501516 in skeletal muscle cells induces the expression of genes involved in preferential lipid utilization, beta-oxidation, cholesterol efflux, and energy uncoupling. Furthermore, we show that treatment of muscle cells with GW501516 increases apolipoprotein-A1 specific efflux of intracellular cholesterol, thus identifying this tissue as an important target of PPARbeta/delta agonists. Interestingly, fenofibrate induces genes involved in fructose uptake, and glycogen formation. In contrast, rosiglitazone-mediated activation of PPARgamma induces gene expression associated with glucose uptake, fatty acid synthesis, and lipid storage. Furthermore, we show that the PPAR-dependent reporter in the muscle carnitine palmitoyltransferase-1 promoter is directly regulated by PPARbeta/delta, and not PPARalpha in skeletal muscle cells in a PPARgamma coactivator-1-dependent manner. This study demonstrates that PPARs have distinct roles in skeletal muscle cells with respect to the regulation of lipid, carbohydrate, and energy homeostasis. Moreover, we surmise that PPARgamma/delta agonists would increase fatty acid catabolism, cholesterol efflux, and energy expenditure in muscle, and speculate selective activators of PPARbeta/delta may have therapeutic utility in the treatment of hyperlipidemia, atherosclerosis, and obesity.

Expressão de transtirretina no sistema gastrointestinal do murganho

A transtirretina (TTR) é uma proteína plasmática constituída por quatro subunidades idênticas de aproximadamente 14KDa e de massa molecular de 55 KDa (Blake et al., 1978). A TTR é responsável pelo transporte de tiroxina (T4) (Andrea et al., 1980) e retinol (vitamina A), neste último tipo de transporte através da ligação à proteina de ligação ao retinol (RBP) (Kanai et al., 1968). É sintetizada principalmente pelo fígado e secretada para o sangue (Murakami et al., 1987) e também sintetizada pelas células epiteliais do plexo coróide e secretada para o líquido cefaloraquidiano (LCR) (Aleshire et al., 1983). Existem outros locais que expressam TTR mas em menor quantidade, nomeadamente: a retina do olho (Martone et al., 1988), o pâncreas (Kato et al., 1985), o saco vitelino visceral (Soprano et al., 1986) o intestino (Loughna et al., 1995); o estômago, coração, músculo e baço (Soprano et al., 1985). A TTR é uma proteína, do ponto de vista filogenético, extremamente conservada o que já de si é um indicador da sua importância biológica (Richardson, 2009) O objectivo deste trabalho foi avaliar a expressão de transtirretina ao longo do sistema gastrointestinal do murganho, nos seguintes órgãos esófago, estômago, duodeno, cólon e também bexiga, com cerca de 3 meses de idade. O segundo objectivo foi identificar as células responsáveis por essa expressão, nos órgãos em estudo. Foi possível verificar que apenas o estômago apresenta valores de expressão normalizada de TTR diferente de zero, expressão essa muito inferior à do fígado, tal como se esperava. Por imunohistoquímica/imunofluorescência foi possível determinar que as células que expressam TTR são pouco abundantes e estão presentes na região glandular do estômago do murganho e também do humano. Para além disto, verificou-se que a TTR co-localiza com somatostatina e que as células que sintetizam TTR correspondem às células D, responsáveis pela secreção de somatostatina

Linfangiogénese no tecido adiposo em modelos de doença inflamatória crónica (asma e obesidade): uma abordagem por imunohistoquímica e lipidómica

O tecido adiposo é um órgão endócrino dinâmico, secretando factores importantes na regulação do metabolismo, fluxo vascular sanguíneo e linfático, e função imunológica, entre outros. Em caso de acumulação de tecido adiposo por ingestão de uma dieta gorda, ou por disfunção metabólica, os adipócitos podem desencadear uma reacção inflamatória por falha na drenagem linfática, acumulando-se mediadores inflamatórios, os quais potenciam a propagação da reacção. Assim, questiona-se uma potencial associação entre o aumento de tecido adiposo na obesidade, hipóxia adipocitária e estimulação da linfangiogénese. Além disso, a expressão de adipocinas varia de acordo com a distribuição do tecido adiposo (subcutâneo, TAS e visceral, TAV). Deste modo, pretende-se com este estudo contribuir para o aumento do conhecimento sobre os complexos mecanismos moleculares subjacentes à linfangiogénese. Ensaios com ratinhos da estirpe C57Bl/6J (modelo de obesidade) e BALB/c (modelo de asma e obesidade), divididos em grupos submetidos a dieta normal e dieta rica em gordura. Avaliação semi-quantitativa da expressão tecidular de LYVE-1 (marcador da linfangiogénese) por imunohistoquímica em material embebido em parafina, no TAS e TAV, e cromatografia líquida de ultra-performance acoplada de espectrometria de massa (UPLC-MS) para análise da expressão plasmática de ceramida e esfingosina-1-fosfato (S1P). No modelo de obesidade observou- -se diminuição do número de vasos linfáticos e expressão de LYVE-1 ao longo do tempo no TAV, e aumento de ambos os parâmetros e hipertrofia adipocitária no TAS. As concentrações de ceramida e S1P corroboram a existência de um processo inflamatório nos ratinhos em estudo, ainda que numa fase muito inicial. No modelo de asma e obesidade, após 17 semanas de tratamento, observou-se incremento da linfangiogénese no TAV, mas não no TAS. A resposta inflamatória avaliada através dos diferentes parâmetros permite afirmar que num estadio inicial de obesidade a proliferação linfática poderá estar a ser retardada pela hipertrofia adipocitária. A libertação de adipocinas será observada apenas numa fase posterior, desencadeando todo o processo inflamatório que incrementará a proliferação linfática. Adicionalmente, é possível sugerir que a maior pressão à qual o TAV se encontra sujeito não favorece a proliferação linfática, pelo menos num estadio incial.

Avaliação da infecção de megacariócitos e plaquetas pelo VHC e sua influência na fisiopatologia da hepatite C

Pós-graduação em Pesquisa e Desenvolvimento (Biotecnologia Médica) - FMB

Monitorização de desreguladores endócrinos em águas

Da crescente necessidade de alimentos e da necessidade de travar a destruição de culturas por animais e insectos foram sintetizados os pesticidas. Por entre uma vasta gama de pesticidas alguns são desreguladores endócrinos o que se traduz num perigo para a saúde humana pois pode despoletar alterações nos seres vivos mesmo em concentrações muito baixas. Devido a diversos factores nomeadamente a lixiviação, ventos e outros agentes ambientais assim como a presença de terrenos agrícolas junto a diversos rios, estes encontram-se contaminados com pesticidas desreguladores endócrinos. O objectivo deste trabalho foi avaliar quais os pesticidas desreguladores endócrinos presentes nas águas de rios da região Norte. Neste trabalho utilizou-se a técnica de microextracção em fase sólida recorrendo a uma fibra de PDMS (100 μm). Para tal as condições de optimização foram testadas nomeadamente a quantidade de NaCl, quantidade de metanol, temperatura do injector e tempo de exposição. Os parâmetros obtidos óptimos foram 0 % de NaCl, tempo de exposição de 45 min, temperatura do injector de 260 ºC e 2,5 % de metanol. Conseguiu-se a separação de todos os pesticidas desreguladores endócrinos com a seguinte programação temperaturas: inicio a 60ºC por um minuto seguido de um aumento de 20 °C/min até aos 200 °C onde permanece por um minuto e de seguida um aumento de 5 °C/min até aos 245 °C onde permanece por 40 min. Fizeram-se curvas de calibração entre 0,01 μg/L e 10 μg/L. Constatou-se no entanto uma falta de reprodutibilidade entre as injecções utilizando esta técnica. Os rios analisados foram o Rio Douro, Rio Tâmega, Ria de Aveiro, Rio Lima, Rio Minho, Rio Sousa, Rio Águeda, Rio Cávado e Rio Leça. No Rio Tâmega foram encontrados os seguintes pesticidas: diazinão, α-HCH, β-HCH, δ-HCH, lindano, HCB, simazina/ atrazina, vinclozolina, alacloro, 2,4-D, malatião, aldrina, bifentrina, metoxicloro e fenvalerato. No rio Douro estão presentes HCB, simazina/ atrazina, vinclozolina, 2,4-D, malatião, aldrina, fenvalerato e deltametrina. No rio Lima encontra-se diazinão, α-HCH, δ-HCH, 2,4-D, HCB, vinclozolina, lindano, simazina/atrazina, alacloro, malatião, aldrina, fenvalerato e deltametrina. No rio Sousa os pesticidas encontrados foram: diazinão, HCB, aldrina, α-HCH, β-HCH, δ-HCH, lindano, simazina/ atrazina, 2,4-D, cipermetrina, alacloro, fenvalerato e malatião. No rio Cávado estão presentes o diazinão, α-HCH, β-HCH, δ-HCH, lindano, HCB, 2,4-D, malatião, metoxicloro, cipermetrina e o fenvalerato. Na ria de Aveiro encontrou-se o diazinão, α-HCH, β-HCH, δ-HCH, lindano, HCB, simazina/atrazina, 2,4-D, Malatião e aldrina. No rio Águeda estão presentes o diazinão, HCB, 2,4-D, aldrina e malatião. E por último no rio Leça esta presente o diazinão, 2,4-D, alacloro, malatião, aldrina, cipermetrina e fenvalerato. A importância deste trabalho reside na demonstração da presença destes pesticidas, desreguladores endócrinos nas águas superficiais da região Norte.

Occurrence of bisphenol A, estrone, 17b-estradiol and 17a-ethinylestradiol in Portuguese rivers

This study focused on the occurrence of several EDCs including bisphenol A, estrone (E1), the 17b-estradiol (E2) and 17a- thinylestradiol (EE2) in fourteen rivers of Portugal. Samples analysis revealed a widespread contamination of BPA especially in Ave, Cávado, Douro, Ferro, Sousa and Vizela Rivers. Achieving 98.4 ng/L for the highest concentration. The estrogens achieved above the method quantification limit (MQL) were E1 in Águeda River and E2 in Ave, Lima and Tâmega Rivers. The maximum concentration detected for E1 was 26.9 ng/L. EE2 was detected only below MQL.