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Arunachala Murthy T, Chapman M, Jones KL, Horowitz M, Marathe CS. Inter-relationships between gastric emptying and glycaemia: Implications for clinical practice. World J Diabetes 2023; 14:447-459. [PMID: 37273253 PMCID: PMC10236995 DOI: 10.4239/wjd.v14.i5.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/09/2022] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
Gastric emptying (GE) exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes; the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired. Conversely, GE is influenced by the acute glycaemic environment acute hyperglycaemia slows, while acute hypoglycaemia accelerates it. Delayed GE (gastroparesis) occurs frequently in diabetes and critical illness. In diabetes, this poses challenges for management, particularly in hospitalised individuals and/or those using insulin. In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence. Substantial advances in knowledge relating to GE, which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and, the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists, which may profoundly impact GE, in the management of type 2 diabetes, has become commonplace. This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia, its implications in hospitalised patients and the relevance of dysglycaemia and its management, particularly in critical illness. Current approaches to management of gastroparesis to achieve more personalised diabetes care, relevant to clinical practice, is detailed. Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients, are required.
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Affiliation(s)
- Tejaswini Arunachala Murthy
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Marianne Chapman
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
- NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
| | - Karen L Jones
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
| | - Michael Horowitz
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Chinmay S Marathe
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
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2
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Peptide VSAK maintains tissue glucose uptake and attenuates pro-inflammatory responses caused by LPS in an experimental model of the systemic inflammatory response syndrome: a PET study. Sci Rep 2021; 11:14752. [PMID: 34285283 PMCID: PMC8292390 DOI: 10.1038/s41598-021-94224-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 07/07/2021] [Indexed: 12/30/2022] Open
Abstract
The present investigation using Positron Emission Tomography shows how peptide VSAK can reduce the detrimental effects produced by lipopolysaccharides in Dutch dwarf rabbits, used to develop the Systemic Inflammatory Response Syndrome (SIRS). Animals concomitantly treated with lipopolysaccharides (LPS) and peptide VSAK show important protection in the loss of radiolabeled-glucose uptake observed in diverse organs when animals are exclusively treated with LPS. Treatment with peptide VSAK prevented the onset of changes in serum levels of glucose and insulin associated with the establishment of SIRS and the insulin resistance-like syndrome. Treatment with peptide VSAK also allowed an important attenuation in the circulating levels of pro-inflammatory molecules in LPS-treated animals. As a whole, our data suggest that peptide VSAK might be considered as a candidate in the development of new therapeutic possibilities focused on mitigating the harmful effects produced by lipopolysaccharides during the course of SIRS.
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Prestwood TR, Asgariroozbehani R, Wu S, Agarwal SM, Logan RW, Ballon JS, Hahn MK, Freyberg Z. Roles of inflammation in intrinsic pathophysiology and antipsychotic drug-induced metabolic disturbances of schizophrenia. Behav Brain Res 2021; 402:113101. [PMID: 33453341 PMCID: PMC7882027 DOI: 10.1016/j.bbr.2020.113101] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/10/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023]
Abstract
Schizophrenia is a debilitating psychiatric illness that remains poorly understood. While the bulk of symptomatology has classically been associated with disrupted brain functioning, accumulating evidence demonstrates that schizophrenia is characterized by systemic inflammation and disturbances in metabolism. Indeed, metabolic disease is a major determinant of the high mortality rate associated with schizophrenia. Antipsychotic drugs (APDs) have revolutionized management of psychosis, making it possible to rapidly control psychotic symptoms. This has ultimately reduced relapse rates of psychotic episodes and improved overall quality of life for people with schizophrenia. However, long-term APD use has also been associated with significant metabolic disturbances including weight gain, dysglycemia, and worsening of the underlying cardiometabolic disease intrinsic to schizophrenia. While the mechanisms for these intrinsic and medication-induced metabolic effects remain unclear, inflammation appears to play a key role. Here, we review the evidence for roles of inflammatory mechanisms in the disease features of schizophrenia and how these mechanisms interact with APD treatment. We also discuss the effects of common inflammatory mediators on metabolic disease. Then, we review the evidence of intrinsic and APD-mediated effects on systemic inflammation in schizophrenia. Finally, we speculate about possible treatment strategies. Developing an improved understanding of inflammatory processes in schizophrenia may therefore introduce new, more effective options for treating not only schizophrenia but also primary metabolic disorders.
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Affiliation(s)
- Tyler R Prestwood
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Roshanak Asgariroozbehani
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sally Wu
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, ON, Canada
| | - Ryan W Logan
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA; Center for Systems Neurogenetics of Addiction, The Jackson Laboratory, Bar Harbor, ME, USA
| | - Jacob S Ballon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Margaret K Hahn
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, ON, Canada.
| | - Zachary Freyberg
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA.
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4
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Camporez JP, Lyu K, Goldberg EL, Zhang D, Cline GW, Jurczak MJ, Dixit VD, Petersen KF, Shulman GI. Anti-inflammatory effects of oestrogen mediate the sexual dimorphic response to lipid-induced insulin resistance. J Physiol 2019; 597:3885-3903. [PMID: 31206703 DOI: 10.1113/jp277270] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
KEY POINTS Oestrogen has been shown to play an important role in the regulation of metabolic homeostasis and insulin sensitivity in both human and rodent studies. Insulin sensitivity is greater in premenopausal women compared with age-matched men, and metabolism-related cardiovascular diseases and type 2 diabetes are less frequent in these same women. Both female and male mice treated with oestradiol are protected against obesity-induced insulin resistance. The protection against obesity-induced insulin resistance is associated with reduced ectopic lipid content in liver and skeletal muscle. These results were associated with increased insulin-stimulated suppression of white adipose tissue lipolysis and reduced inflammation. ABSTRACT Oestrogen has been shown to play an important role in the regulation of metabolic homeostasis and insulin sensitivity in both human and rodent studies. Overall, females are protected against obesity-induced insulin resistance; yet, the mechanisms responsible for this protection are not well understood. Therefore, the aim of the present work was to evaluate the underlying mechanism(s) by which female mice are protected against obesity-induced insulin resistance compared with male mice. We studied male and female mice in age-matched or body weight-matched conditions. They were fed a high-fat diet (HFD) or regular chow for 4 weeks. We also studied HFD male mice treated with oestradiol or vehicle. Both HFD female and HFD male mice treated with oestradiol displayed increased whole-body insulin sensitivity, associated with reduction in ectopic hepatic and muscle lipid content compared to HFD male mice. Reductions in ectopic lipid content in these mice were associated with increased insulin-stimulated suppression of white adipose tissue (WAT) lipolysis. Both HFD female and HFD male mice treated with oestradiol also displayed striking reductions in WAT inflammation, represented by reductions in plasma and adipose tissue tumour necrosis factor α and interleukin 6 concentrations. Taken together these data support the hypothesis that HFD female mice are protected from obesity-induced insulin resistance due to oestradiol-mediated reductions in WAT inflammation, leading to improved insulin-mediated suppression of WAT lipolysis and reduced ectopic lipid content in liver and skeletal muscle.
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Affiliation(s)
- João Paulo Camporez
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA.,Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil, 05508-000
| | - Kun Lyu
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA.,Cellular & Molecular Physiology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Emily L Goldberg
- Comparative Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA.,Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Dongyan Zhang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Gary W Cline
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Michael J Jurczak
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Vishwa Deep Dixit
- Comparative Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA.,Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Kitt Falk Petersen
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Gerald I Shulman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA.,Cellular & Molecular Physiology, Yale University School of Medicine, New Haven, CT, 06520, USA.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT, 06520, USA
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5
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Wen F, Zhang Y, Lin C, Deng M, Zhang J, Zhang J. Insulin therapy is not associated with improved clinical outcomes in critically ill infants with stress hyperglycemia. Exp Ther Med 2019; 18:397-403. [PMID: 31258678 DOI: 10.3892/etm.2019.7537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 04/16/2019] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to examine the benefits of insulin use and non-use in critically ill infants with stress-induced hyperglycemia. The present retrospective study used clinical data from 302 critically ill infants with stress hyperglycemia admitted to pediatric intensive care units (PICUs). The patients were recruited randomly and divided into three groups: The tight glycemic control, conventional insulin therapy and control groups. Correlations between insulin therapy and improved clinical outcomes were assessed according to key parameters (length of PICU stay, total length of stay, occurrence of organ dysfunction and mortality). Correlations between blood glucose level and these parameters in the three groups were also examined. Blood glucose levels following insulin therapy were not correlated with the length of PICU stay, total length of stay, mortality, secondary coma, or secondary hepatic or renal dysfunction in the three groups. At 96 h following PICU admission, blood glucose levels were statistically similar (5.0±1.2, 4.9±1.3 and 5.1±0.9 mmol/l, respectively; P>0.05). Insulin therapy was revealed to have no benefit on the length of hospitalization, the occurrence of organ dysfunction or mortality in critically ill pediatric patients with stress hyperglycemia. Even with no insulin use, the blood glucose level could spontaneously return to normal, with no associated risk of organ dysfunction or fatality.
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Affiliation(s)
- Fang Wen
- Pediatric Intensive Care Unit, The Shunde Women's and Children's Healthcare Hospital, Foshan, Guangdong 528300, P.R. China
| | - Yi Zhang
- Pediatric Intensive Care Unit, The Yuexiu District Children's Hospital of Guangzhou, Guangzhou, Guangdong 510462, P.R. China
| | - Chunwang Lin
- Pediatric Intensive Care Unit, The Shunde Women's and Children's Healthcare Hospital, Foshan, Guangdong 528300, P.R. China
| | - Minghong Deng
- Pediatric Intensive Care Unit, The Shunde Women's and Children's Healthcare Hospital, Foshan, Guangdong 528300, P.R. China
| | - Jinfeng Zhang
- Pediatric Intensive Care Unit, The Shunde Women's and Children's Healthcare Hospital, Foshan, Guangdong 528300, P.R. China
| | - Jianping Zhang
- Pediatric Intensive Care Unit, The Shunde Women's and Children's Healthcare Hospital, Foshan, Guangdong 528300, P.R. China
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WITHDRAWN: Cytokines and fatty liver diseases. LIVER RESEARCH 2018. [DOI: 10.1016/j.livres.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Ali Abdelhamid Y, Kar P, Finnis ME, Phillips LK, Plummer MP, Shaw JE, Horowitz M, Deane AM. Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis. Crit Care 2016; 20:301. [PMID: 27677709 PMCID: PMC5039881 DOI: 10.1186/s13054-016-1471-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hyperglycaemia occurs frequently in critically ill patients without diabetes. We conducted a systematic review and meta-analysis to evaluate whether this 'stress hyperglycaemia' identifies survivors of critical illness at increased risk of subsequently developing diabetes. METHODS We searched the MEDLINE and Embase databases from their inception to February 2016. We included observational studies evaluating adults admitted to the intensive care unit (ICU) who developed stress hyperglycaemia if the researchers reported incident diabetes or prediabetes diagnosed ≥3 months after hospital discharge. Two reviewers independently screened the titles and abstracts of identified studies and evaluated the full text of relevant studies. Data were extracted using pre-defined data fields, and risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled ORs with 95 % CIs for the occurrence of diabetes were calculated using a random-effects model. RESULTS Four cohort studies provided 2923 participants, including 698 with stress hyperglycaemia and 131 cases of newly diagnosed diabetes. Stress hyperglycaemia was associated with increased risk of incident diabetes (OR 3.48; 95 % CI 2.02-5.98; I 2 = 36.5 %). Studies differed with regard to definitions of stress hyperglycaemia, follow-up and cohorts studied. CONCLUSIONS Stress hyperglycaemia during ICU admission is associated with increased risk of incident diabetes. The strength of this association remains uncertain because of statistical and clinical heterogeneity among the included studies.
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Affiliation(s)
- Yasmine Ali Abdelhamid
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Palash Kar
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Mark E. Finnis
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Liza K. Phillips
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
| | - Mark P. Plummer
- Intensive Care Unit, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ UK
| | - Jonathan E. Shaw
- Clinical Diabetes Laboratory, Baker IDI, 75 Commercial Road, Melbourne, VIC 3004 Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
| | - Adam M. Deane
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
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Liu PP, Lu XL, Xiao ZH, Qiu J, Zhu YM. Relationship Between Beta Cell Dysfunction and Severity of Disease Among Critically Ill Children: A STROBE-Compliant Prospective Observational Study. Medicine (Baltimore) 2016; 95:e3104. [PMID: 27175627 PMCID: PMC4902469 DOI: 10.1097/md.0000000000003104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Although beta cell dysfunction has been proved to predict prognosis among humans and animals, its prediction on severity of disease remains unclear among children. The present study was aimed to examine the relationship between beta cell dysfunction and severity of disease among critically ill children.This prospective study included 1146 critically ill children, who were admitted to Pediatric Intensive Care Unit (PICU) of Hunan Children's Hospital from November 2011 to August 2013. Information on characteristics, laboratory tests, and prognostic outcomes was collected. Homeostasis model assessment (HOMA)-β, evaluating beta cell function, was used to divide all participants into 4 groups: HOMA-β = 100% (group I, n = 339), 80% ≤ HOMA-β < 100% (group II, n = 71), 40% ≤ HOMA-β < 80% (group III, n = 293), and HOMA-β < 40% (group IV, n = 443). Severity of disease was assessed using the worst Sequential Organ Failure Assessment (SOFA) score, Pediatric Risk of Mortality (PRISM) III score, incidence of organ damage, septic shock, multiple organ dysfunction syndrome (MODS), mechanical ventilation (MV) and mortality. Logistic regression analysis was used to evaluate the risk of developing poor outcomes among patients in different HOMA-β groups, with group I as the reference group.Among 1146 children, incidence of HOMA-β < 100% was 70.41%. C-peptide and insulin declined with the decrement of HOMA-β (P < 0.01). C-reactive protein and procalcitonin levels, rather than white blood cell, were significantly different among 4 groups (P < 0.01). In addition, the worst SOFA score and the worst PRISMIII score increased with declined HOMA-β. For example, the worst SOFA score in group I, II, III, and IV was 1.55 ± 1.85, 1.71 ± 1.93, 1.92 ± 1.63, and 2.18 ± 1.77, respectively. Furthermore, patients with declined HOMA-β had higher risk of developing septic shock, MODS, MV, and mortality, even after adjusting age, gender, myocardial injury, and lung injury. For instance, compared with group I, the multivariate-adjusted odds ratio (95% confidence interval) for developing septic shock was 2.17 (0.59, 8.02), 2.94 (2.18, 6.46), and 2.76 (1.18, 6.46) among patients in group II, III, and IV, respectively.Beta cell dysfunction reflected the severity of disease among critically ill children. Therefore, assessment of beta cell function is critically important to reduce incidence of adverse events in PICU.
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Affiliation(s)
- Ping-Ping Liu
- From the Emergency Center of Hunan Children's Hospital (P-PL, X-LL, Z-HX, JQ) and Pediatric Medical Center of Hunan People's Hospital (Y-MZ), Changsha, Hunan, China
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Choe SS, Huh JY, Hwang IJ, Kim JI, Kim JB. Adipose Tissue Remodeling: Its Role in Energy Metabolism and Metabolic Disorders. Front Endocrinol (Lausanne) 2016; 7:30. [PMID: 27148161 PMCID: PMC4829583 DOI: 10.3389/fendo.2016.00030] [Citation(s) in RCA: 656] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/31/2016] [Indexed: 12/12/2022] Open
Abstract
The adipose tissue is a central metabolic organ in the regulation of whole-body energy homeostasis. The white adipose tissue functions as a key energy reservoir for other organs, whereas the brown adipose tissue accumulates lipids for cold-induced adaptive thermogenesis. Adipose tissues secrete various hormones, cytokines, and metabolites (termed as adipokines) that control systemic energy balance by regulating appetitive signals from the central nerve system as well as metabolic activity in peripheral tissues. In response to changes in the nutritional status, the adipose tissue undergoes dynamic remodeling, including quantitative and qualitative alterations in adipose tissue-resident cells. A growing body of evidence indicates that adipose tissue remodeling in obesity is closely associated with adipose tissue function. Changes in the number and size of the adipocytes affect the microenvironment of expanded fat tissues, accompanied by alterations in adipokine secretion, adipocyte death, local hypoxia, and fatty acid fluxes. Concurrently, stromal vascular cells in the adipose tissue, including immune cells, are involved in numerous adaptive processes, such as dead adipocyte clearance, adipogenesis, and angiogenesis, all of which are dysregulated in obese adipose tissue remodeling. Chronic overnutrition triggers uncontrolled inflammatory responses, leading to systemic low-grade inflammation and metabolic disorders, such as insulin resistance. This review will discuss current mechanistic understandings of adipose tissue remodeling processes in adaptive energy homeostasis and pathological remodeling of adipose tissue in connection with immune response.
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Affiliation(s)
- Sung Sik Choe
- Department of Biological Sciences, National Creative Research Initiatives Center for Adipose Tissue Remodeling, Institute of Molecular Biology and Genetics, Seoul National University, Seoul, South Korea
| | - Jin Young Huh
- Department of Biological Sciences, National Creative Research Initiatives Center for Adipose Tissue Remodeling, Institute of Molecular Biology and Genetics, Seoul National University, Seoul, South Korea
| | - In Jae Hwang
- Department of Biological Sciences, National Creative Research Initiatives Center for Adipose Tissue Remodeling, Institute of Molecular Biology and Genetics, Seoul National University, Seoul, South Korea
| | - Jong In Kim
- Department of Biological Sciences, National Creative Research Initiatives Center for Adipose Tissue Remodeling, Institute of Molecular Biology and Genetics, Seoul National University, Seoul, South Korea
| | - Jae Bum Kim
- Department of Biological Sciences, National Creative Research Initiatives Center for Adipose Tissue Remodeling, Institute of Molecular Biology and Genetics, Seoul National University, Seoul, South Korea
- *Correspondence: Jae Bum Kim,
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Ezhumalai M, Ashokkumar N, Pugalendi KV. RETRACTED: Combination of carvacrol and rosiglitazone ameliorates high fat diet induced changes in lipids and inflammatory markers in C57BL/6J mice. Biochimie 2014; 110:129-136. [PMID: 25527325 DOI: 10.1016/j.biochi.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 12/09/2014] [Indexed: 11/19/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).
This article has been retracted at the request of the Editor-in-Chief.
Following concerns raised by Dr. E. Bik, the journal conducted an investigation and found evidence that there had been improper manipulation and duplication of images in Figure 4. The editors would like to thank Dr. Bik for her valuable insight in this matter. The authors have not responded to requests for an explanation of these irregularities so this article is retracted without their approval.
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Affiliation(s)
- Muthukrishnan Ezhumalai
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar 608 002, Tamilnadu, India
| | - Natarajan Ashokkumar
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar 608 002, Tamilnadu, India
| | - Kodukkur Viswanathan Pugalendi
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar 608 002, Tamilnadu, India.
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Saturated and unsaturated fat induce hepatic insulin resistance independently of TLR-4 signaling and ceramide synthesis in vivo. Proc Natl Acad Sci U S A 2013; 110:12780-5. [PMID: 23840067 DOI: 10.1073/pnas.1311176110] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Hepatic insulin resistance is a principal component of type 2 diabetes, but the cellular and molecular mechanisms responsible for its pathogenesis remain unknown. Recent studies have suggested that saturated fatty acids induce hepatic insulin resistance through activation of the toll-like receptor 4 (TLR-4) receptor in the liver, which in turn transcriptionally activates hepatic ceramide synthesis leading to inhibition of insulin signaling. In this study, we demonstrate that TLR-4 receptor signaling is not directly required for saturated or unsaturated fat-induced hepatic insulin resistance in both TLR-4 antisense oligonucleotide treated and TLR-4 knockout mice, and that ceramide accumulation is not dependent on TLR-4 signaling or a primary event in hepatic steatosis and impairment of insulin signaling. Further, we show that both saturated and unsaturated fats lead to hepatic accumulation of diacylglycerols, activation of PKCε, and impairment of insulin-stimulated IRS-2 signaling. These data demonstrate that saturated fat-induced insulin resistance is independent of TLR-4 activation and ceramides.
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Wieser V, Moschen AR, Tilg H. Inflammation, Cytokines and Insulin Resistance: A Clinical Perspective. Arch Immunol Ther Exp (Warsz) 2013; 61:119-25. [PMID: 23307037 DOI: 10.1007/s00005-012-0210-1] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 12/20/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Verena Wieser
- Department of Medicine I, Gastroenterology, Endocrinology and Metabolism and Christian Doppler Research Laboratory for Gut Inflammation, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Samuel VT, Shulman GI. Mechanisms for insulin resistance: common threads and missing links. Cell 2012; 148:852-71. [PMID: 22385956 DOI: 10.1016/j.cell.2012.02.017] [Citation(s) in RCA: 1467] [Impact Index Per Article: 122.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Indexed: 02/07/2023]
Abstract
Insulin resistance is a complex metabolic disorder that defies explanation by a single etiological pathway. Accumulation of ectopic lipid metabolites, activation of the unfolded protein response (UPR) pathway, and innate immune pathways have all been implicated in the pathogenesis of insulin resistance. However, these pathways are also closely linked to changes in fatty acid uptake, lipogenesis, and energy expenditure that can impact ectopic lipid deposition. Ultimately, these cellular changes may converge to promote the accumulation of specific lipid metabolites (diacylglycerols and/or ceramides) in liver and skeletal muscle, a common final pathway leading to impaired insulin signaling and insulin resistance.
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Affiliation(s)
- Varman T Samuel
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
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Abstract
The modern rise in obesity and its strong association with insulin resistance and type 2 diabetes have elicited interest in the underlying mechanisms of these pathologies. The discovery that obesity itself results in an inflammatory state in metabolic tissues ushered in a research field that examines the inflammatory mechanisms in obesity. Here, we summarize the unique features of this metabolic inflammatory state, termed metaflammation and defined as low-grade, chronic inflammation orchestrated by metabolic cells in response to excess nutrients and energy. We explore the effects of such inflammation in metabolic tissues including adipose, liver, muscle, pancreas, and brain and its contribution to insulin resistance and metabolic dysfunction. Another area in which many unknowns still exist is the origin or mechanism of initiation of inflammatory signaling in obesity. We discuss signals or triggers to the inflammatory response, including the possibility of endoplasmic reticulum stress as an important contributor to metaflammation. Finally, we examine anti-inflammatory therapies for their potential in the treatment of obesity-related insulin resistance and glucose intolerance.
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Affiliation(s)
- Margaret F Gregor
- Departments of Genetics and Complex Diseases and Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
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16
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Kruyt ND, Musters A, Biessels GJ, Devries JH, Coert BA, Vergouwen MDI, Horn J, Roos YB. Beta-cell dysfunction and insulin resistance after subarachnoid haemorrhage. Neuroendocrinology 2011; 93:126-32. [PMID: 21293115 DOI: 10.1159/000324097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 01/02/2011] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hyperglycaemia is a common finding and an independent risk factor for increased morbidity and mortality in aneurysmal subarachnoid haemorrhage (SAH). Although in these patients hyperglycaemia is commonly ascribed to insulin resistance, there is little understanding of underlying mechanisms. AIMS To prospectively study temporal disturbances of glucose metabolism after aneurysmal SAH in patients without known abnormalities of glucose metabolism and to explore possible correlations with markers of stress. METHODS In consecutive aneurysmal SAH patients not subjected to insulin therapy, in-hospital and follow-up oral glucose tolerance tests (OGTTs) and assessments of insulin resistance, pancreatic β-cell function, free fatty acids (FFA) and cortisol were performed and compared with reference values. RESULTS We included 13 patients. In the first 2 weeks of admission, median fasting glucose and FFA levels were elevated while insulin levels were not. OGTTs were indicative of glucose intolerance in all patients at days 3 and 7, while on follow-up 1 patient had glucose intolerance and all patients had normal fasting glucose levels. Pancreatic β-cell function was impaired throughout the first week and insulin resistance from day 4 to 10. Levels of cortisol correlated with higher fasting glucose and increased FFA. FFA in turn correlated with pancreatic β-cell dysfunction. CONCLUSIONS Aneurysmal SAH patients have transient abnormalities of glucose metabolism. During the first week, it appears to result predominantly from transient pancreatic β-cell dysfunction, in combination with insulin resistance.
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Affiliation(s)
- N D Kruyt
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Gornik I, Vujaklija A, Lukić E, Madžarac G, Gašparović V. Hyperglycaemia in critical illness is a risk factor for later development of type II diabetes mellitus. Acta Diabetol 2010; 47 Suppl 1:29-33. [PMID: 19340390 DOI: 10.1007/s00592-009-0115-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 03/17/2009] [Indexed: 12/16/2022]
Abstract
Hyperglycaemia caused by stress and inflammation is common during critical illness. We hypothesised that a latent glucose metabolism disturbance contributes to development of hyperglycaemia and that those patients have increased risk for diabetes. We included patients with sepsis, acute coronary syndrome and acute heart failure with no history of impaired glucose metabolism and divided them in the hyperglycaemia group (glucose ≥ 7.8 mmol/l) and normoglycaemia group. Patients were followed for 5 years. Follow-up was completed for 115 patients in the normoglycaemia group, of which 4 (3.5%) developed type 2 diabetes. In the hyperglycaemia group 51 patients finished follow-up and 8 (15.7%) developed type 2 diabetes. Relative risk in 5-year period for patients with hyperglycaemia was 4.51 for development of type 2 diabetes. Patients with hyperglycaemia during critical illness who are not diagnosed with diabetes before or during the hospitalisation should be considered a population at increased risk for developing diabetes.
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Affiliation(s)
- Ivan Gornik
- Department of Intensive Care Medicine, University Hospital Centre Rebro, Kišpatićeva 12, Zagreb 10000, Croatia.
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19
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A prospective observational study of the relationship of critical illness associated hyperglycaemia in medical ICU patients and subsequent development of type 2 diabetes. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R130. [PMID: 20615210 PMCID: PMC2945097 DOI: 10.1186/cc9101] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 04/30/2010] [Accepted: 07/08/2010] [Indexed: 12/16/2022]
Abstract
Introduction Critical illness is commonly complicated by hyperglycaemia caused by mediators of stress and inflammation. Severity of disease is the main risk factor for development of hyperglycaemia, but not all severely ill develop hyperglycemia and some do even in mild disease. We hypothesised that acute disease only exposes a latent disturbance of glucose metabolism which puts those patients at higher risk for developing diabetes. Methods Medical patients with no history of impaired glucose metabolism or other endocrine disorder admitted to an intensive care unit between July 1998 and June 2004 were considered for inclusion. Glucose was measured at least two times a day, and patients were divided into the hyperglycaemia group (glucose ≥7.8 mmol/l) and normoglycaemia group. An oral glucose tolerance test was performed within six weeks after discharge to disclose patients with unknown diabetes or pre-diabetes who were excluded. Patients treated with corticosteroids and those terminally ill were also excluded from the follow-up which lasted for a minimum of five years with annual oral glucose tolerance tests. Results A five-year follow-up was completed for 398 patients in the normoglycaemia group, of which 14 (3.5%) developed type 2 diabetes. In the hyperglycaemia group 193 patients finished follow-up and 33 (17.1%) developed type 2 diabetes. The relative risk for type 2 diabetes during five years after the acute illness was 5.6 (95% confidence interval (CI) 3.1 to 10.2). Conclusions Patients with hyperglycaemia during acute illness who are not diagnosed with diabetes before or during the hospitalization should be considered a population at increased risk for developing diabetes. They should, therefore, be followed-up, in order to be timely diagnosed and treated.
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Hyperglycemia in sepsis is a risk factor for development of type II diabetes. J Crit Care 2010; 25:263-9. [DOI: 10.1016/j.jcrc.2009.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 09/03/2009] [Accepted: 10/01/2009] [Indexed: 11/22/2022]
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Zijlmans WCWR, van Kempen AAMW, Serlie MJ, Sauerwein HP. Glucose metabolism in children: influence of age, fasting, and infectious diseases. Metabolism 2009; 58:1356-65. [PMID: 19501855 DOI: 10.1016/j.metabol.2009.04.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 04/22/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
Abstract
This review describes the occurrence of hypoglycemia in young children as a common and serious complication that needs to be avoided because of the high risk of brain damage and mortality. Young age, fasting, and severe infectious disease are considered important risk factors. The limited data on the effect of these risk factors on glucose metabolism in children are discussed and compared with data on glucose metabolism in adults. The observations discussed may have implications for further research on glucose kinetics in young children with infectious disease.
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Affiliation(s)
- Wilco C W R Zijlmans
- Department of Pediatrics, Diakonessen Hospital, PO Box 1814, Paramaribo, Suriname (SA).
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22
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Preissig CM, Rigby MR. Hyperglycaemia results from beta-cell dysfunction in critically ill children with respiratory and cardiovascular failure: a prospective observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R27. [PMID: 19245691 PMCID: PMC2688145 DOI: 10.1186/cc7732] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 12/16/2008] [Accepted: 02/26/2009] [Indexed: 01/04/2023]
Abstract
Introduction Hyperglycaemia is common in critical illness and associated with poor outcome. Glycaemic control using insulin may decrease morbidity and mortality. Many questions remain about the cause of critical illness hyperglycaemia (CIH). Our objective was to investigate the endocrinological basis of paediatric CIH. Methods C-peptide and blood glucose (BG) levels were assessed in 41 children aged 2 to 18 years old who were admitted to our paediatric intensive care unit (PICU). Patients who developed CIH, defined as persistent BG above 7.7 mmol/L, were treated with insulin infusion to achieve BG levels between 4.4 and 7.7 mmol/L. C-peptide levels were compared with respect to CIH development and degree of organ failure in all patients. Respiratory and cardiovascular failure were defined as need for mechanical ventilation and need for vasoactive infusions, respectively. Clinical and laboratory parameters, including c-peptide levels, were assessed. Results Of 41 children enrolled, 18 had respiratory failure only, 11 had both respiratory and cardiovascular failure, and 12 had neither respiratory or cardiovascular failure. Nine patients with respiratory failure only, 10 with both respiratory and cardiovascular failure, and none with no respiratory or cardiovascular failure developed CIH. Patients with CIH and respiratory and cardiovascular failure (n = 10) had very low c-peptide levels (4.4 ng/mL) despite significantly elevated mean BG levels (10.8 mmol/L), while those with CIH and respiratory failure only had very high c-peptide levels (11.5 ng/mL) with mean BG of 9.9 mmol/L. Low endogenous insulin production in those with respiratory and cardiovascular failure was associated with rapid onset of CIH, illness severity, higher insulin requirement and longer mechanical ventilation days, PICU length of stay and CIH duration. Conclusions Primary beta-cell dysfunction as defined by low endogenous c-peptide production appears to be prevalent in critically ill children with both respiratory and cardiovascular failure who develop CIH, whereas elevated insulin resistance appears to be the prominent cause of CIH in children with respiratory failure only. Our finding that beta-cell dysfunction is present in a subset of critically ill children with CIH challenges the assertion from adult studies that CIH is primarily the result of elevated insulin resistance.
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Affiliation(s)
- Catherine M Preissig
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA 30322, USA.
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Marik PE, Raghavan M. Stress-hyperglycemia, insulin and immunomodulation in sepsis. Intensive Care Med 2004; 30:748-56. [PMID: 14991101 DOI: 10.1007/s00134-004-2167-y] [Citation(s) in RCA: 248] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2003] [Accepted: 12/29/2003] [Indexed: 12/27/2022]
Abstract
Stress-hyperglycemia and insulin resistance are exceedingly common in critically ill patients, particularly those with sepsis. Multiple pathogenetic mechanisms are responsible for this metabolic syndrome; however, increased release of pro-inflammatory mediators and counter-regulatory hormones may play a pivotal role. Recent data suggests that hyperglycemia may potentiate the pro-inflammatory response while insulin has the opposite effect. Furthermore, emerging evidence suggests that tight glycemic control will improve the outcome of critically ill patients. This paper reviews the pathophysiology of stress hyperglycemia in the critically ill septic patient and outlines a treatment strategy for the management of this disorder.
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Affiliation(s)
- Paul E Marik
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, 640A Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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Ma Y, Wang P, Kuebler JF, Chaudry IH, Messina JL. Hemorrhage induces the rapid development of hepatic insulin resistance. Am J Physiol Gastrointest Liver Physiol 2003; 284:G107-15. [PMID: 12388175 DOI: 10.1152/ajpgi.00217.2002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hyperglycemia is an early metabolic response to trauma and hemorrhage. The role of hepatic insulin resistance to the development of this hyperglycemia is not well understood. The aim of this study was to determine whether the liver becomes insulin resistant and to identify the particular hepatic insulin signaling pathways that may be compromised following trauma and hemorrhage. Male adult rats were bled to a mean arterial pressure of 40 mmHg and maintained at that pressure for 90 min followed by resuscitation with Ringer lactate. Data showed that trauma and hemorrhage rapidly induced profound hyperinsulinemia in combination with significant hyperglycemia, suggesting the development of insulin resistance. After trauma and hemorrhage, hepatic insulin signaling via the insulin-induced phosphatidylinositol 3 (PI3)-kinase-Akt pathway was abolished, whereas ERK1/2 signaling was relatively normal. The regulation (inhibition) of a hepatic-, insulin-, and the PI3-kinase-dependent gene, IGF binding protein-1, was also lost. The present study provides convincing evidence of a rapid onset hepatic insulin resistance following a combination of trauma and hemorrhage.
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Affiliation(s)
- Yuchen Ma
- Department of Pathology, Division of Molecular and Cellular Pathology, The University of Alabama at Birmingham, 35294, USA
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25
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Thermogenic, hormonal and metabolic effects of intravenous glucose infusion in human sepsis. Br J Surg 1997. [DOI: 10.1002/bjs.1800841032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Carlson GL, Gray P, Arnold J, Little RA, Irving MH. Thermogenic, hormonal and metabolic effects of intravenous glucose infusion in human sepsis. Br J Surg 1997. [DOI: 10.1111/j.1365-2168.1997.02798.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Patel J, Movahed A, Reeves WC. Electrocardiographic and segmental wall motion abnormalities in pancreatitis mimicking myocardial infarction. Clin Cardiol 1994; 17:505-9. [PMID: 8001316 DOI: 10.1002/clc.4960170910] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Transient electrocardiographic changes in patients with acute cholecystitis, pancreatitis, and pneumonia have been reported in the past. These changes usually are in the form of T-wave inversion, ST-segment depression, and rarely ST-segment elevation in the absence of coronary artery disease. To the authors' knowledge, this is the first report documenting both left ventricular segmental wall motion abnormality and electrocardiographic changes of myocardial injury in the presence of acute pancreatitis.
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Affiliation(s)
- J Patel
- Department of Medicine, East Carolina University School of Medicine, Greenville, North Carolina 27858
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Ueta E, Osaki T, Yoneda K, Yamamoto T. Prevalence of diabetes mellitus in odontogenic infections and oral candidiasis: an analysis of neutrophil suppression. J Oral Pathol Med 1993; 22:168-74. [PMID: 8391079 DOI: 10.1111/j.1600-0714.1993.tb01051.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The prevalence of diabetes mellitus (DM) in odontogenic infections and oral candidiasis was examined, and influences of DM on the clinical manifestations of the infections and neutrophil functions were investigated. Among 21 severe and 221 mild odontogenic infections, DM was detected in 5 cases in each group. Of 64 cases of symptomatic oral candidiasis, 8 cases were complicated with DM which was detected by blood examination during treatment. During the period of infection, the mean fasting blood sugar level was 16.0 +/- 4.4 and 9.8 +/- 1.2 mmol/l in the DM-complicated odontogenic infections and candidiasis, respectively. All white blood counts, C-reactive protein levels and erythrocyte sedimentation rates were more elevated in DM(+) odontogenic infection cases than in DM(-) ones. In DM(+) candidiasis, hyposalivation (0.79 +/- 0.54 ml/10 min) was observed. The polymorphonuclear leukocytes from diabetic patients, especially those with candidiasis, produced less free oxygen radicals and exhibited reduced phagocytosis and intracellular killing of Candida cells associated with this reduced O2- generation during the infection. These suppressed neutrophil functions increased after treatment but did not reach control levels. These results indicate that DM is a predisposing condition for odontogenic infections and oral candidiasis, that DM-complicated infections become severe because of neutrophil suppression, and that examination of blood sugar level should be essential for patients with oral infections.
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Affiliation(s)
- E Ueta
- Department of Oral Surgery, Kocki Medical School, Kohasu, Japan
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Abstract
The physiologic events accompanying postoperative septic complications in surgical patients represent a coordinated response to bacterial invasion, which is aimed at maintaining the function of key organ systems. When sepsis is prolonged or overwhelming, physiologic dysfunction and multiorgan failure develop. This review outlines the pathophysiologic response to sepsis and correlates it with recent therapeutic advances in the metabolic management of the postoperative septic patient.
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Affiliation(s)
- J H Shaw
- Department of Surgery, Auckland Hospital, New Zealand
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Clowes GH, Hirsch E, George BC, Bigatello LM, Mazuski JE, Villee CA. Survival from sepsis. The significance of altered protein metabolism regulated by proteolysis inducing factor, the circulating cleavage product of interleukin-1. Ann Surg 1985; 202:446-58. [PMID: 3931593 PMCID: PMC1250944 DOI: 10.1097/00000658-198510000-00006] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Amino acid (AA) arterial blood plasma concentrations, K1 (peripheral production + infusion rates), and central plasma clearance rates (K1 divided by arterial concentration) (CPCR-AA) were measured in 70 seriously septic patients. All of these people were in the "hyperdynamic" state at the time of observation. Thirty-seven recovered and 33 died. In addition, 10 noninfected, nontraumatized patients about to undergo laparotomy were studied. In 31 patients receiving parenteral alimentation, CPCR-AA was 326 +/- 38 in survivors and 160 +/- 17 ml/M2/min in the deaths (p less than 0.005). In 58 patients studied, while fasted with no intravenous amino acid infusion, values for CPCR-AA were: survivors 202 +/- 22 (28) and deaths 112 +/- 16 (30) ml/M2/min (p less than 0.002). The CPCR-AA in 10 noninfected patients was only 68 +/- 11 ml/M2/min. CPCR-AA in 19 patients correlated with hepatic protein synthetic rates in liver biopsies obtained simultaneously (r = 0.658, p less than 0.01), which shows that CPCR-AA is an indicator of visceral protein synthesis. To study the regulation of amino acid metabolism by synthesis. To study the regulation of amino acid metabolism by proteolysis inducing factor (PIF), the proteolysis inducing activity (PIA) of the plasma fraction (0-50,000 D) was measured 55 times in conjunction with metabolic studies. No significant differences existed in PIA between survivors and deaths. However, in those patients who recovered, PIA was significantly correlated to both peripheral amino acid production (r = 0.773, p less than 0.001) and to CPCR-AA (r = 0.721, p less than 0.001). This observation demonstrates the presence of one or more circulating agents affecting amino acid flux. PIA measured simultaneously in vivo correlated with in vitro protein synthetic rate in incubated liver biopsies (r = 0.653, p less than 0.01). PIF (4,000 D), isolated by chromatography, in patients without amino acid infusion was 35 +/- 3% in survivors and 33 +/- 6% in deaths (N.S.) and only 9 +/- 3% over control in noninfected patients. In patients who recovered, PIF titre was strongly correlated with peripheral amino acid production (r = 0.798, p less than 0.001) and with CPCR-AA (r = 0.835, p less than 0.001). However, values for patients who later died were significantly less for a given PIF titre. Thus, it is concluded that survival from sepsis is, in part, dependent on a significantly elevated CPCR-AA and hepatic protein synthesis, both of which appear to be related to the blood plasma PIF titre.
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Ellrodt AG, Riedinger MS, Kimchi A, Berman DS, Maddahi J, Swan HJ, Murata GH. Left ventricular performance in septic shock: reversible segmental and global abnormalities. Am Heart J 1985; 110:402-9. [PMID: 4025116 DOI: 10.1016/0002-8703(85)90163-2] [Citation(s) in RCA: 175] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Left ventricular dysfunction has been implicated in the pathogenesis of septic shock, but little is known about its natural history, cause, and prognostic significance. Left ventricular performance was assessed by serial radionuclide and hemodynamic studies in 35 patients with culture-proven septic shock. The mean age (+/- S.D.) of the group was 64 +/- 18 years; 16 of the subjects were women, and 15 had antecedent heart disease. On the first study, the left ventricular stroke work index was depressed in 33 (94%) patients, and nineteen (54%) had a left ventricular ejection fraction less than 0.48. Twenty-two (63%) of the patients had segmental and four had generalized wall motion abnormalities. Conventional hemodynamic parameters were of no value in predicting the patients who had a depressed left ventricular ejection fraction or segmental abnormalities. Patients with underlying heart disease had a much higher frequency (87%) of segmental dysfunction than those without underlying heart disease (45%; p = 0.016), but no differences were noted in the left ventricular ejection fraction or left ventricular stroke work index of these two groups. Segmental abnormalities and low ejection fractions were seen more often in patients with a large left ventricular end-diastolic volume index. Only five subjects had a systemic vascular resistance index greater than 2580 dynes X sec X cm-5 per m2, and the correlation between systemic vascular resistance index and left ventricular ejection fraction was poor. No difference was found in the mean coronary perfusion pressure of those with segmental abnormalities and those with normal wall motion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Gelfand RA, Matthews DE, Bier DM, Sherwin RS. Role of counterregulatory hormones in the catabolic response to stress. J Clin Invest 1984; 74:2238-48. [PMID: 6511925 PMCID: PMC425416 DOI: 10.1172/jci111650] [Citation(s) in RCA: 188] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Patients with major injury or illness develop protein wasting, hypermetabolism, and hyperglycemia with increased glucose flux. To assess the role of elevated counterregulatory hormones in this response, we simultaneously infused cortisol (6 mg/m2 per h), glucagon (4 ng/kg per min), epinephrine (0.6 microgram/m2 per min), and norepinephrine (0.8 micrograms/m2 per min) for 72 h into five obese subjects receiving only intravenous glucose (150 g/d). Four obese subjects received cortisol alone under identical conditions. Combined infusion maintained plasma hormone elevations typical of severe stress for 3 d. This caused a sustained increase in plasma glucose (60-80%), glucose production (100%), and total glucose flux (40%), despite persistent hyperinsulinemia. In contrast, resting metabolic rate changed little (9% rise, P = NS). Urinary nitrogen excretion promptly doubled and remained increased by approximately 4 g/d, reflecting increased excretion of urea and ammonia. Virtually all plasma amino acids declined. The increment in nitrogen excretion was similar in three additional combined infusion studies performed in 3-d fasted subjects not receiving glucose. Cortisol alone produced a smaller glycemic response (20-25%), an initially smaller insulin response, and a delayed rise in nitrogen excretion. By day 3, however, daily nitrogen excretion was equal to the combined group as was the elevation in plasma insulin. Most plasma amino acids rose rather than fell. In both infusion protocols nitrogen wasting was accompanied by only modest increments in 3-methylhistidine excretion (approximately 20-30%) and no significant change in leucine flux. We conclude: (a) Prolonged elevations of multiple stress hormones cause persistent hyperglycemia, increased glucose turnover, and increased nitrogen loss; (b) The sustained nitrogen loss is no greater than that produced by cortisol alone; (c) Glucagon, epinephrine, and norepinephrine transiently augment cortisol-induced nitrogen loss and persistently accentuate hyperglycemia; (d) Counterregulatory hormones contribute to, but are probably not the sole mediators of the massive nitrogen loss, muscle proteolysis, and hypermetabolism seen in some clinical settings of severe stress.
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Kimchi A, Ellrodt AG, Berman DS, Riedinger MS, Swan HJ, Murata GH. Right ventricular performance in septic shock: a combined radionuclide and hemodynamic study. J Am Coll Cardiol 1984; 4:945-51. [PMID: 6491086 DOI: 10.1016/s0735-1097(84)80055-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Twenty-five patients with septic shock underwent simultaneous radionuclide ventriculography and right heart catheterization to clarify the role of the right ventricle in this syndrome. A depressed right ventricular ejection fraction (less than 38%) was present in 13 patients and was found in patients with elevated cardiac output (4 of 6 patients) and with normal or low cardiac output (9 of 19 patients). Right ventricular dysfunction was seen with or without acute respiratory failure. In eight patients, a depressed right ventricular ejection fraction was seen in combination with an abnormal left ventricular ejection fraction (less than 48%), but in five patients, right ventricular ejection fraction impairment occurred with normal left ventricular ejection fraction. There was no significant correlation between abnormal right ventricular afterload and depressed right ventricular ejection fraction. No clinical or hemodynamic finding could be used to identify patients with diminished right ventricular ejection fraction. On follow-up study in 17 surviving patients, right ventricular ejection fraction improved in 6 and was unchanged in 11. Improvement in right ventricular ejection fraction occurred more frequently in patients without pulmonary hypertension or respiratory distress. The results suggest that right ventricular dysfunction in septic shock may be more common than previously suspected. It may be caused by abnormalities in right ventricular afterload in some patients and depressed myocardial contractility in others. The findings are of therapeutic importance since interventions that diminish right ventricular afterload and increase right ventricular contractility would be appropriate in patients with septic shock and right ventricular dysfunction.
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Mok KT, Maiz A, Yamazaki K, Sobrado J, Babayan VK, Moldawer LL, Bistrian BR, Blackburn GL. Structured medium-chain and long-chain triglyceride emulsions are superior to physical mixtures in sparing body protein in the burned rat. Metabolism 1984; 33:910-5. [PMID: 6434898 DOI: 10.1016/0026-0495(84)90244-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study was undertaken to compare the effectiveness of a physical mixture of long-chain and medium-chain triglycerides with an emulsion consisting of chemically synthesized triglycerides composed of medium-chain and long-chain fatty acids in similar proportions. Sprague-Dawley rats received a 25% body surface area full-thickness scald burn on the dorsum. For the next three days, all rats received 300 kcal/kg/day as 160 kcal/kg/day glucose, 50 kcal/kg/day amino acid, and an additional 90 kcal/kg/day lipid emulsion as either long-chain triglyceride, medium-chain triglyceride, a 1:1 physical mix of medium-chain and long-chain triglycerides or a chemically structured triglyceride made up of 60% medium-chain fatty acid and a 40% safflower oil. Rats receiving the chemically structured lipid emulsion showed the greatest gain in body weight, the greatest positive nitrogen balance, and the highest serum albumin concentration, outstripping rats receiving the long-chain triglyceride, medium-chain triglyceride, and even the physical mixture long-chain and medium-chain triglycerides (P less than 0.01). A 30% increase in oxygen consumption and 35% increase in energy expenditure in rats given the medium-chain triglyceride emulsion alone (P less than 0.01) was observed. This study confirms that the metabolism of chemically structured triglycerides composed of medium-chain and long-chain fatty acids markedly differs from similar physical mixtures. For these reasons, the new structured lipid emulsions may prove advantageous in feeding the severely injured patient.
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Dahn MS, Lange P. Hormonal changes and their influence on metabolism and nutrition in the critically ill. Intensive Care Med 1982; 8:209-13. [PMID: 6752238 DOI: 10.1007/bf01694523] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This is a brief review of the observed hormonal alterations following trauma and sepsis. The major changes noted in the metabolic status of the stressed patient have been characterized by deranged carbohydrate metabolism, altered metabolic rate as measured by oxygen consumption and increased ureagenesis. Each of these phenomena are regulated to a large extent by the specific hormonal profile of the patient. Failure of insulin and growth hormone production have been associated with glucose intolerance, excessive urinary nitrogen loss and a fatal outcome. Glucagon, cortisol and catecholamines exhibit sustained elevation and have been associated with increased metabolic rate and excessive ureagenesis. These changes are usually self limited following trauma but will persist if the patient enters a septic phase. The use of specific nutritional support, namely hypertonic glucose versus a balanced fat emulsion system in the face of sepsis is considered.
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Hinshaw LB, Beller-Todd BK, Archer LT, Benjamin B, Flournoy DJ, Passey R, Wilson MF. Effectiveness of steroid/antibiotic treatment in primates administered LD100 Escherichia coli. Ann Surg 1981; 194:51-6. [PMID: 7018430 PMCID: PMC1345194 DOI: 10.1097/00000658-198107000-00009] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Early aggressive therapy with maintenance infusions of methylprednisolone sodium succinate and gentamicin sulfate significantly increases the probability for survival of baboons given LD100 Escherichia coli. The present study was designed to determine if baboons would recover when initiation of treatment was delayed until they had sustained E. coli-induced systemic hypotension for a period of approximately three hours. Sixteen adult baboons were each administered a two-hour infusion of LD100 E. coli. All eight untreated animals died within 42 hours. Five of the eight baboons treated after approximately three hours of hypotension with methylprednisolone sodium succinate and gentamicin sulfate survived. Treated animals had significantly higher blood glucose and insulin levels and lower blood urea nitrogen concentrations than baboons receiving E. coli alone. E. coli blood concentrations were lower in the treated than in the untreated baboon group by the sixth hour (less than 0.02). Heart rates increased in all animals but were not as high in the treated baboons. Both groups experienced similar decreases in mean systemic arterial pressure, PCO2, base excess, leukocyte, lymphocyte, and platelet concentrations, and increases in creatinine and lactate concentrations. Data from the present study indicate that the probability of recovery from shock is significantly increased even when initiation of steroid/antibiotic therapy is postponed until baboons have experienced sustained systemic hypotension.
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Abstract
Altered carbohydrate metabolism has been reported during episodes of neonatal infection. To document that there is more rapid glucose disappearance during infection, intravenous glucose tolerance tests (IVGTT) and serial plasma growth hormone and insulin levels were determined in eight full-term neonates during the first three days of an acute episode of infection and during convalescence, 5 to 15 days later. Eight healthy infants were each studied once using the same study protocol. Glucose disappearance rates, measured as K1 of glucose, were increased (p less than 0.01) during both the acute septic period (3.7 +/- 0.3% disappearance/min; mean +/- S.E.M.) and convalescent period (2.5 +/- 0.2% min) when compared with values in control infants (1.3 +/- 0.3%/min). Gram-negative, gram-positive, and viral infections were all associated with rapid glucose disposal. The abnormality in carbohydrate homeostasis persisted for at least 5 to 15 days after treatment was begun. Baseline and stimulated (20-minutes post bolus glucose infusion) plasma insulin and growth hormone levels did not differ among the groups. Thus, there is no evidence that hyperinsulinism produced the rapid glucose disappeared rate and enhanced glucose utilization. The reason for the disturbed carbohydrate metabolism in neonatal infections remains unknown.
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Clowes GH, Randall HT, Cha CJ. Amino acid and energy metabolism in septic and traumatized patients. JPEN J Parenter Enteral Nutr 1980; 4:195-205. [PMID: 6995629 DOI: 10.1177/014860718000400225] [Citation(s) in RCA: 126] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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