C-reactive protein impairs hepatic insulin sensitivity and insulin signaling in rats: role of mitogen-activated protein kinases

Plasma C-reactive protein (CRP) concentration is increased in the metabolic syndrome, which consists of a cluster of cardiovascular disease risk factors, including insulin resistance. It is not known, however, whether CRP is merely a marker of accompanying inflammation or whether it contributes causally to insulin resistance. The objective of this study is to investigate the role that CRP may play in the development of insulin resistance. We examined the effect of single-dose intravenous administration of purified human (h)CRP on insulin sensitivity in Sprague-Dawley rats using the euglycemic, hyperinsulinemic clamp technique. hCRP was associated with impaired insulin suppression of endogenous glucose production with no reduction in peripheral tissue glucose uptake, suggesting that hCRP mediated insulin resistance in the liver but not extrahepatic tissues. We further assessed components of the insulin signaling pathway and mitogen-activated protein kinases (MAPKs) in the liver. Liver tissues derived from hCRP-treated rats showed reduced insulin-stimulated insulin receptor substrate (IRS) tyrosine phosphorylation, IRS/phosphatidylinositol 3-kinase (PI3K) association, and Akt phosphorylation, consistent with hCRP-induced impairment of hepatic insulin signaling. Furthermore, hCRP enhanced phosphorylation of extracellular signal-regulated kinase (ERK)1/2 and p38 MAPK as well as IRS-1 Ser(612) . Finally, we observed in primary cultured rat hepatocytes that U0126 (a selective inhibitor of MAPK/ERK kinase1/2) corrected hCRP-induced impairment of insulin signaling. CONCLUSIONS: hCRP plays an active role in inducing hepatic insulin resistance in the rat, at least in part by activating ERK1/2, with downstream impairment in the insulin signaling pathway.     

Effect of choline-containing phospholipids on brain cholinergic transporters in the rat

The influence of one week treatment with the choline-containing phospholipids cytidine-5'-diphosphocholine (CDP-choline) and choline alphoscerate (L-alpha-glyceryl-phosphorylcholine) at choline-equivalent doses (CDP-choline: 325 mg/kg/day; choline alphoscerate: 150 mg/kg/day) on vesicular acetylcholine transporter (VAChT), on choline transporter (CHT) and on acetylcholine (ACh) concentrations was investigated in rat frontal cortex, striatum and cerebellum. ACh was assayed by HPLC with electrochemical detection, VAChT by Western blot, ELISA and immunohistochemistry, CHT by Western blot and immunohistochemistry. After CDP-treatment, ACh levels were slightly increased in the frontal cortex, not substantially different in the striatum, and reduced significantly in the cerebellum compared to controls. Choline alphoscerate stimulated significantly the neurotransmitter concentration in the frontal cortex, however, the levels were similar to the controls in both the striatum and cerebellum. In comparison to the controls, VAChT expression following either CDP-choline or choline alphoscerate treatment, was enhanced greatly in the striatum and cerebellum. Also, ELISA measurements for VAChT showed significant increases in all choline alphoscerate treated brain areas. In contrast, in the CDP-choline treated rats the vesicular transporter amount was greater than the control only in the striatum. The cholinergic presynaptic transporters VAChT and CHT play a relevant role in sustaining new ACh synthesis and release. To sum up, CDP-choline and choline alphoscerate stimulated to a different extent the expression of VAChT and CHT primarily in a cognitive area such as frontal cortex. In the lack of novel therapeutic strategies, safe compounds developed since a long time such as the choline-containing phospholipids investigated would merit to be further investigated by new and adequate clinical studies. This for assessing their place if any in pharmacotherapy of dementia disorders characterized by diminished cholinergic tone.     

Effects of cholinergic enhancing drugs on cholinergic transporters in the brain and peripheral blood lymphocytes of spontaneously hypertensive rats

Cholinergic hypofunction is a trait of Alzheimer's disease and vascular dementia and countering it is one of the main therapeutic strategies available for these disorders. Cholinergic transporters control cellular mechanisms of acetylcholine (ACh) synthesis and release at presynaptic terminals. This study has assessed the influence of 4 week treatment with two different cholinergic enhancing drugs, the cholinergic precursor choline alphoscerate (alpha-glyceryl-phosphorylcholine) or the acetylcholinesterase (AChE) inhibitor galantamine on high affinity choline uptake transporter (CHT) and vesicular ACh transporter (VAChT) expression in the brain of spontaneously hypertensive rats (SHR). SHR represent an animal model of cerebrovascular injury characterized by cholinergic hypofunction. Analysis was performed by immunochemistry, ELISA and immunohistochemistry on frontal cortex, striatum and hippocampus. Immunochemical and ELISA analysis was extended to peripheral blood lymphocytes (PBL), used as a peripheral reference of changes of brain cholinergic markers. An increased expression of VAChT and CHT was observed in brain areas investigated and in PBL of SHR. The similar trend for cholinergic transporters observed in brain and PBL suggests these cells may represent a marker of brain cholinergic transporters. Treatment with choline alphoscerate increased CHT and to a greater extent VAChT expression. Treatment with galantamine countered the increase of CHT and VAChT. The different activity of the cholinergic precursor and of the AChE inhibitor on parameters investigated is likely related to their mechanism of action. Choline alphoscerate increases ACh synthesis and release. This requires an augmentation of systems regulating neurotransmitter uptake and storage. The effect of choline alphoscerate on CHT and VAChT observed in this study suggests an improved synaptic efficiency elicited by the compound. The AChE inhibitor slows-down ACh degradation in the synaptic cleft. A greater availability of neurotransmitter elicited by galantamine counters the enhanced activity of cholinergic transporters compensating cholinergic deficits. Differences in the activity of the cholinergic precursor and AChE inhibitor investigated on CHT and VAChT suggests that association between choline alphoscerate and AChE/cholinesterase inhibitors may represent a strategy for potentiating deficient cholinergic neurotransmission worthwhile of being investigated in clinical trials.     

Early and late results of total correction of tetralogy of Fallot

The purpose of this study was to evaluate the early and late outcome after total correction of tetralogy of fallot (TOF) in 101 consecutive patients with a mean age of 8.23 +/- 4.90 years underwent repair of surgery at one institution between 1995 and 2006. Forty two patients had initial palliative operations. A transannular patch was inserted in 60 (58.5%) patients. Risk factors for operative mortality were analyzed. Follow-up was obtained from clinical appointments and telephone questionnaires. The operative mortality was 6.9%. Aortic cross-clamp time more than 90 minutes (P<0.01) and cardiopulmonary bypass time more than 120 minute (P<0.01), affected operative mortality, whereas previous palliative procedure, hematocrit level, and use of transannular patch did not. Mean follow-up is 34.08 +/- 31.09 months (range, 1 month to 120 months). Actuarial survival is 91% alive 10 years after total correction. On Postoperative echocardiography, 22 patients had mild pulmonary regurgitation, 19 had a right ventricular outflow tract gradient more than 50 mmHg, and 10 had a small residual ventricular septal defect. There were two late deaths. Late sudden death from cardiac causes occurred in one patients. Total correction of TOF can have low operative mortality and provide excellent long-term survival. This experience suggests that the key factor in the total correction of TOF is to correct the pathology completely, to protect the myocardium, and to manage the complication properly.     

Clinical laboratory reference intervals in pediatrics: The CALIPER initiative

Objective and rationaleReference intervals provided on laboratory reports are essential for appropriate interpretation of test results, and can significantly impact clinical decision-making and the quality of patient care. Careful determination and/or validation of reference intervals by the laboratory for use in the patient population it serves are therefore important to ensure their proper utility. Unfortunately, critical gaps currently exist in accurate and up-to-date pediatric reference intervals for accurate interpretation of laboratory tests performed in children and adolescents. These critical gaps in the available pediatric laboratory reference intervals have the clear potential of contributing to erroneous diagnosis or misdiagnosis of many diseases of childhood and adolescence. Most of the available “normal” ranges for laboratory tests were determined over 2 decades ago on older instruments and technologies, and are no longer relevant considering the current testing technology used by clinical laboratories. It is thus critical and of utmost urgency that a more acceptable and comprehensive database be established.Discussion and conclusionIn the present review, we discuss the considerations and challenges faced when generating and validating reference intervals in accordance to the current guidelines published by the Clinical Laboratory Standards Institute (CLSI). We raise particular attention to the present-day deficiencies in available pediatric reference intervals, and highlight the special issues and unique difficulties that are additionally faced when establishing reference intervals in children. Finally, we highlight a recent Canadian initiative, the CALIPER project, whose mandate is to establish and maintain a database of comprehensive and up-to-date pediatric reference intervals to be eventually made available to all clinical laboratories worldwide.     

Analytical evaluation of the VITROS® 5600 Integrated System in a pediatric setting and determination of pediatric reference intervals

ObjectivesTo evaluate the VITROS^® 5600 Integrated System in a pediatric setting and to determine age- and gender-specific pediatric reference intervals for several common analytes.Design and methodsThe instrument was evaluated using QC material and patient samples. Reference intervals were determined using samples obtained from children attending select outpatient clinics.ResultsImprecision analysis for 25 analytes and serum indices, the turnaround time for a simulated workload, and MicroSensor performance were assessed in our pediatric laboratory. Pediatric reference intervals for 25 analytes were also determined according to the CLSI/IFCC C28-A3 guidelines using 770 samples and over 15,000 analyses.ConclusionThe VITROS 5600 Integrated System is suitable for use in a pediatric setting. Age- and gender-partitioned pediatric reference intervals for 25 common analytes were also determined as a pilot to the ongoing CALIPER project. These reference intervals are valuable for all VITROS^® users as well as any laboratory assessing these analytes once they demonstrate the acceptability of transference to their laboratory.     

Apolipoprotein B gene polymorphism and plasma lipids and lipoproteins in a Canadian Caucasian population

We have investigated the frequency of Hind III DNA polymorphism of the human apolipoprotein B gene in a Canadian Caucasian population with coronary artery disease, as documented by angiography, and a healthy control population. Patients had significantly (p < 0.05) higher levels of cholesterol, triglycerides, LDL-cholesterol, apolipoprotein B, and lower level of apoAI compared to the controls. Restriction fragment-length polymorphism analysis detected nine hybridizable fragments denoted as H1 to H9. The H1, H2, H3, and H7 alleles were polymorphic. The [H4-H9] genotype seems to be the normal genotype within the population studied since it was detected in 69% of the control group. The [H1-H9] genotype was most frequently observed in the patients (frequency = 0.68). We were unable to strongly associate any of the alleles or genotypes detected with the changes in lipids. The additional alleles observed in the patient group may indicate possible mutations at the 3' end of the apolipoprotein B gene locus.