Addressing insulin resistance in Type 1 diabetes

Type 1 diabetes is recognised to include an element of insulin resistance. Insulin resistance is an independent risk factor for the development of macro‐ and microvascular complications of Type 1 diabetes and may also contribute to the development of the disease. This understanding comes at a time when the incidence of Type 1 diabetes appears to be rising and the public health burden from its vascular complications is high. A variety of safe and efficacious manoeuvres are available to redress insulin resistance in Type 2 diabetes. So far however, clinical trials addressing insulin resistance in Type 1 diabetes have been small with only short periods of follow‐up. Regardless, these trials have yielded promising results. This review examines the evidence for insulin resistance in the pathophysiology of Type 1 diabetes and its complications, the problems associated with its measurement, and summarizes the trials aimed at reducing insulin resistance in Type 1 diabetes. This includes a meta‐analysis of controlled trials of adjuvant metformin in Type 1 diabetes.     

Atypical SARS in geriatric patient

We describe an atypical presentation of severe acute respiratory syndrome (SARS) in a geriatric patient with multiple coexisting conditions. Interpretation of radiographic changes was confounded by cardiac failure, with resolution of fever causing delayed diagnosis and a cluster of cases. SARS should be considered even if a contact history is unavailable, during an ongoing outbreak.     

In vivo affinity of [<Superscript>18</Superscript>F]fallypride for striatal and extrastriatal dopamine D<Subscript>2</Subscript> receptors in nonhuman primates

Rationale [¹⁸F]Fallypride is a new and promising radiotracer, suitable for imaging D₂ receptors with Positron Emission Tomography (PET) in both striatal and extrastriatal regions. The high signal to noise ratio of [¹⁸F]fallypride has been attributed to its high affinity for D₂ receptors (K_D of 0.03 nM, measured in vitro at room temperature).Objectives We sought to further characterize this tracer in terms of its in vivo affinity, possible affinity differences between brain regions and dependence of in vitro affinity on temperature.Methods PET scans were performed in baboons over a wide range of concentrations to measure the in vivo K_D of [¹⁸F]fallypride in striatal and extrastriatal regions. Several analytical approaches were used, including nonlinear kinetic modeling and equilibrium methods. Also, in vitro assays were performed at 22 and 37°C.Results No significant differences in the in vivo K_D were detected between regions. In vivo K_D of [¹⁸F]fallypride was 0.22±0.05 nM in striatum, 0.17±0.05 nM in thalamus, and 0.21±0.07 nM in hippocampus. These values were intermediate between in vitro K_D measured at 22 (0.04±0.03 nM) and 37 degrees (2.03±1.07 nM).Conclusion The in vivo affinity of [¹⁸F]fallypride was not as high as previously estimated from in vitro values. This property might contribute to the favorable kinetic properties of the tracer. The in vivo affinity was similar between striatal and extrastriatal regions. This result indicates that the measured regional in vivo affinities of this tracer are not affected by putative regional differences in endogenous dopamine, and that [¹⁸F]fallypride is an appropriate tool to provide unbiased estimates of the occupancy of D₂ receptors by antipsychotic drugs in striatal and extrastriatal regions.     

Quantitative analysis of (-)-N-(11)C-propyl-norapomorphine in vivo binding in nonhuman primates.

(-)-N-(11)C-propyl-norapomorphine ((11)C-NPA) is a new dopamine agonist PET radiotracer that holds potential for imaging the high-affinity states of dopamine D(2)-like receptors in the living brain. The goal of this study was to develop and evaluate analytic strategies to derive in vivo (11)C-NPA binding parameters. METHODS: Two baboons were scanned 4 times after (11)C-NPA injections. The metabolite-corrected arterial input functions were measured. Regional brain time-activity curves were analyzed with kinetic and graphical analyses, using the arterial time-activity curve as the input function. Data were also analyzed with the simplified reference-tissue model (SRTM) and graphical analysis with reference-region input. RESULTS: (11)C-NPA exhibited moderately fast metabolism, with 31% +/- 5% of arterial plasma concentration corresponding to the parent compound at 40 min after injection. Plasma clearance was 29 +/- 1 L/h, and plasma free fraction (f(1)) was 5% +/- 1%. For kinetic analysis, a 1-tissue compartment model (1TCM) provided a good fit to the data and more robust derivations of the tissue distribution volumes (V(T), in mL/g) than a 2-tissue compartment model (2TCM). Using 1TCM, V(T)s in the cerebellum and striatum were 3.4 +/- 0.4 and 7.5 +/- 2 mL/g, respectively, which led to estimates of striatal binding potential (BP) of 4.0 +/- 1.1 mL/g and striatal equilibrium specific-to-nonspecific partition coefficient (V(3)") of 1.2 +/- 0.2. V(T) values derived with graphical analysis were well correlated with but slightly lower than V(T) values derived with kinetic analysis. V(3)" values derived with SRTM were well correlated with but slightly higher than V(3)" values derived with kinetic analysis. Using any method, a significant difference was detected in BP and V(3)" values between the 2 animals. It was determined that 30 min of scanning data were sufficient to derive V(3)" values using kinetic, graphical (arterial input and reference-region input), and SRTM analyses. CONCLUSION: This study indicates that (11)C-NPA is a suitable PET tracer to quantify the agonist high-affinity sites of D(2)-like receptors.     

Prevention of N-methyl-N-nitrosourea-induced breast cancer by alpha-fetoprotein (AFP)-derived peptide, a peptide derived from the active site of AFP.

PURPOSE: alpha-Fetoprotein (AFP) is a protein of pregnancy associated with a decrease in lifetime risk of breast cancer in parous women. A synthetic, cyclic nonapeptide has been developed that mimics the antioncogenic active site of AFP. To test the hypothesis that the AFP-derived peptide (AFPep) can prevent breast cancer, the N-methyl-N-nitrosourea-induced breast cancer model was used in rats. EXPERIMENTAL DESIGN: AFPep was given daily by injection beginning 10 days after N-methyl-N-nitrosourea treatment and continued for 23 days (a time designed to mimic pregnancy) or for other times to assess efficacy as a function of drug duration. Tumor incidence, multiplicity, and latency were noted as end points. At necropsy, pathology analysis of tumors and major organs were obtained. RESULTS: AFPep prevented cancer in a dose-dependent fashion. Significantly longer mean tumor-free days (P < 0.02), lower tumor incidence (P = 0.004), and lower tumor multiplicity were observed for AFPep-treated groups. No evidence of host toxicity as measured by body weight, cage activity, fur texture, and organ weights (liver, uterus, heart, kidney, and spleen) were found in animals treated with AFPep. Mechanistic studies using transplantable human breast cancer xenografts showed that the peptide interfered with estrogen-dependent breast cancer growth inhibited the phosphorylation of the estrogen receptor and activated phosphorylation of p53. CONCLUSIONS: AFPep is a well-tolerated, mechanistically novel, chemopreventive agent in models of breast cancer and warrants further development for the prevention and treatment of this disease in humans.