Fibroblast growth factor 23 and kidney function in patients with type 1 diabetes

Diabetic kidney disease (DKD) is a key determinant of morbidity and mortality in patients with type 1 diabetes (T1D). Identifying factors associated with early glomerular filtration rate (GFR) decline in T1D is important in prevention or early intervention for DKD. This study investigated whether phosphate metabolism, including fibroblast growth factor 23 (FGF23) is associated with the kidney function of patients with T1D. We randomly recruited 118 patients with T1D with a normal or mildly impaired kidney function [chronic kidney disease (CKD) stages of G1/G2, A1/A2], and measured their serum FGF23 levels. Serum FGF23 was significantly negatively associated with the estimated GFR (eGFR) (r = -0.292, P = 0.0016), but not urinary albumin creatinine ratio (UACR), and positively associated with serum phosphate (Pi; r = 0.273, P = 0.0027). Serum FGF23 increased with decreasing eGFR quartiles (P for linear trend = 0.0371), while FGF23 was modestly higher in the higher quartiles of UACR (not statistically significant). The multiple linear regression analysis also showed a significant inverse association between FGF23 and eGFR (Model 1: β = -0.149, P = 0.0429; Model 2: β = -0.141, P = 0.0370). The association remained significant after adjustment for Pi. We identified that FGF23 was inversely associated with the eGFR in T1D patients with a normal or mildly impaired kidney function.

Combined treatment by burosumab and a calcimimetic can ameliorate hypophosphatemia due to excessive actions of FGF23 and PTH in adult XLH with tertiary hyperparathyroidism: A case report

INTRODUCTION

X-linked hypophosphatemia (XLH) is the most prevalent type of heritable fibroblast growth factor 23 (FGF23)-related hypophosphatemic rickets. Recently, anti-FGF23 antibody, burosumab, has become clinically available. We herein report a patient with adult XLH and tertiary hyperparathyroidism.

CASE PRESENTATION

The serum phosphate level and tubular maximum reabsorption of phosphate per glomerular filtration rate (TmP/GFR) remained low, despite burosumab treatment. While the influence of the relationship between FGF23 and parathyroid hormone (PTH) on the phosphaturic effect is unclear, it was considered that a high level of PTH due to tertiary hyperparathyroidism remains to suppress renal phosphate reabsorption. A calcimimetic, evocalcet, increased the serum phosphate level and TmP/GFR.

DISCUSSION AND CONCLUSION

Therefore, it is important to evaluate the presence of secondary-tertiary hyperparathyroidism in patients whose serum phosphate level does not increase with burosumab treatment.

Immune and production responses of dairy cows to postruminal supplementation with phytonutrients

This study investigated the effect of phytonutrients (PN) supplied postruminally on nutrient utilization, gut microbial ecology, immune response, and productivity of lactating dairy cows. Eight ruminally cannulated Holstein cows were used in a replicated 4×4 Latin square. Experimental periods lasted 23 d, including 14-d washout and 9-d treatment periods. Treatments were control (no PN) and daily doses of 2g/cow of either curcuma oleoresin (curcumin), garlic extract (garlic), or capsicum oleoresin (capsicum). Phytonutrients were pulse-dosed into the abomasum of the cows, through the rumen cannula, 2 h after feeding during the last 9 d of each experimental period. Dry matter intake was not affected by PN, although it tended to be lower for the garlic treatment compared with the control. Milk yield was decreased (2.2 kg/d) by capsicum treatment compared with the control. Feed efficiency, milk composition, milk fat and protein yields, milk N efficiency, and 4.0% fat-corrected milk yield were not affected by treatment. Rumen fermentation variables, apparent total-tract digestibility of nutrients, N excretion with feces and urine, and diversity of fecal bacteria were also not affected by treatment. Phytonutrients had no effect on blood chemistry, but the relative proportion of lymphocytes was increased by the capsicum treatment compared with the control. All PN increased the proportion of total CD4(+) cells and total CD4(+) cells that co-expressed the activation status signal and CD25 in blood. The percentage of peripheral blood mononuclear cells (PBMC) that proliferated in response to concanavalin A and viability of PBMC were not affected by treatment. Cytokine production by PBMC was not different between control and PN. Expression of mRNA in liver for key enzymes in gluconeogenesis, fatty acid oxidation, and response to reactive oxygen species were not affected by treatment. No difference was observed due to treatment in the oxygen radical absorbance capacity of blood plasma but, compared with the control, garlic treatment increased 8-isoprostane levels. Overall, the PN used in this study had subtle or no effects on blood cells and blood chemistry, nutrient digestibility, and fecal bacterial diversity, but appeared to have an immune-stimulatory effect by activating and inducing the expansion of CD4 cells in dairy cows. Capsicum treatment decreased milk yield, but this and other effects observed in this study should be interpreted with caution because of the short duration of treatment.

171 CELLULAR EXPRESSION, LOCALIZATION, AND SECRETION OF OVINE Mx2 (oMx2) IN OVINE GLANDULAR EPITHELIAL CELLS (oGE)

Mx proteins are antiviral proteins that belong to the dynamin super-family of large GTPases. In a number of species Mx proteins were shown to be important components of the innate response to viral infection. Work in our laboratory showed that during early pregnancy Mx proteins are up-regulated in the ruminant uterus by conceptus-derived IFN tau. Transient oMx1 knockdown in ovine glandular epithelial cells (oGE) reduced oMx1 secretion and secretion of other unconventionally secreted proteins without affecting secretion via the classical secretory pathway. We further showed that oMx1 was present in uterine flushes from pregnant ewes. We recently characterized another Mx protein, oMx2, in sheep. The newly characterized oMx2 has higher homology with bovine Mx2 (93%) than with oMx1 (60%). The purpose of this study was to characterize cellular expression and localization of oMx2 in oGE cells and in cell lines derived from the luminal epithelium (oLE) and stroma (oSC). In addition we determined if oMx2 was secreted by oGE cells in vitro. Expressions of oMx1 and oMx2 were low to undetectable in all three lines in the absence of IFN tau and were increased by IFN tau (P < 0.01). Induction of oMx1 was greatest in oGE cells (8.4-fold increase; P < 0.01), whereas expression of oMx2 was greatest in oSC cells (19.9-fold increase; P < 0.01). Immunofluorescence analysis confirmed the high level of expression of oMx1 and oMx2 in response to IFN tau in oGE cells. Immunofluorescence analysis revealed that oMx2 co-localized with lamin A/C and nucleoporins, whereas oMx1 was distributed throughout the cytoplasm in oGE cells, suggesting that oMx2 is a nuclear membrane-associated protein. SignalP analysis indicated that oMx2 lacked a traditional leader sequence. Using an inhibitor of the classical secretory pathway, Monensin, we showed that oMx2 levels were not reduced in response to Monensin treatment. The oMx1, oMx2, and ISG15 levels in oGE-conditioned culture medium actually increased in secretions in response to Monensin (2.7-fold, 4.6-fold, and 2.9-fold increases, respectively; P < 0.1), whereas there was no effect of Monensin on �2MG levels (P > 0.1). Results show that oMx2 expression, like that of oMx1, is regulated by IFN tau. The functional significance of the different cellular localization between oMx1 and oMx2 is not clear, but may suggest that these related proteins possess distinct cellular functions. Finally, this is the first report that oMx2 is secreted, perhaps via poorly described unconventional secretory pathways. The potential intracellular and extracellular functions of oMx2 are currently being investigated. This work was supported by USDA grant 2002-02398 and NIH NCRR grant P20-RR15587-01 to T.L.O.

Exogenous hyaluronic acid enhances porcine parthenogenetic embryo development in vitro possibly mediated by CD44

Exogenous hyaluronic acid (HA) has been reported to improve early embryo development in vitro in pigs and cows. Although early embryo development in vitro is improved by exogenous HA, the mechanism mediating the action of HA is not clearly defined. In the present study, two possible HA actions on early embryo development were proposed to understand interactions between HA and the embryos using porcine parthenotes. We hypothesized that improvement of early embryo development mediated by HA would be caused by embryo-derived growth factors due to the high molecular weight of HA or cellular response through its receptor (CD44). We examined the effects of HA molecular weight on parthenogenetic embryo development, permeability of HA into the zona pellucida, expression of CD44 in porcine parthenotes at various stages, and blocking interactions between HA and CD44 by monoclonal anti-CD44 antibody (mCD44Ab). As a result, although development of porcine parthenotes to the blastocyst stage was significantly enhanced by exogenous HA with various molecular weights, there was no difference in blastocyst formation among the various molecular weights (P < 0.05). Immunofluorescence revealed that exogenous HA was accessible to CD44 through the zona pellucida, irrespective of the oocyte activation and that CD44 was also expressed in both oocytes and parthenotes at all developmental stages. In addition, development of parthenotes was partially blocked by mCD44Ab. In conclusion, we demonstrated that exogenous HA enhanced development of porcine parthenotes in vitro. This improvement mediated by exogenous HA on parthenogenetic embryo development was possibly caused by cellular response via CD44.

Epidemiology of suicidal ideation and help-seeking behaviors among the elderly in Japan

This study offers an analysis of the elderly (over 65 years of age) among a general community population in terms of the percentages of: (i) persons with recurring thoughts of death and/or of committing suicide, and (ii) people who have consulted others, including medical professionals, with regard to these problems. Among 433 elderly over the age of 65 in one community in a town in Aomori Prefecture, 358 agreed to participate in the project. Forty-four participants (12.3%) responded that they had either 'thoughts of death' or 'thoughts of suicide', and these thoughts had continued for more than 2 weeks in 12 participants (3.4%). Only 15 of the 44 suicidal elderly responded that they had consulted someone about their problems. Although there are many elderly people exhibiting a subclinical depressive state with recurring thoughts of death or thoughts of suicide, the number of people who consult family members, professionals, or others is very low. This suggests the importance of community networking through educational activities so that people can more readily talk to and support one another.

[Assessment of exhaled NO concentration in monitoring radiation pneumonitis in patient who underwent thoracic radiotherapy for lung cancer]

To monitor radiation pneumonitis, we assessed the exhaled nitrogen oxide (NO) level in patient with lung cancer. A 73-year-old man with idiopathic interstitial pneumonitis underwent thoracic radiotherapy without chemotherapy for squamous cell lung cancer (T2N1M0). He showed elevation of exhaled NO level at 30 Gy-50 Gy, after a decrease at 10-20 Gy. He also showed an abnormal shadow on CT examination at 50 Gy. Although exhaled NO may have had the benefit of predicting radiation pneumonitis before severe clinical symptom appeared, he died three months after radiotherapy because of worsening of the radiation pneumonitis.

Influence of thoracic radiotherapy on exhaled nitric oxide levels in patients with lung cancer

BACKGROUND

To determine the physiological role of exhaled nitric oxide (NO) in patients with lung cancer.

METHODS

We investigated changes in exhaled NO levels in 29 patients undergoing thoracic radiation therapy with or without chemotherapy. The exhaled NO level was assessed using a chemiluminescence analyzer.

RESULTS

The level of exhaled NO was higher in patients with lung cancer before treatment than in controls. With radiotherapy, the exhaled NO level decreased for patients undergoing 40 Gy irradiation and post-radiotherapy. However, five patients showed elevated levels of exhaled NO three times or more than that before radiotherapy. Three of these patients showed signs of radiation pneumonitis. However, none of the other patients showed signs of radiation pneumonitis (p = 0.002).

CONCLUSION

Radiation therapy can lower exhaled levels of NO and the levels of exhaled NO may be a useful index for the early prediction of radiation pneumonitis.

A simple method for the quantitative analysis of urinary delta-aminol evulinic acid to evaluate lead absorption

Wada, O., Toyokawa, K., Urata, G., Yano, Y., and Nakao, K. (1969).Brit. J. industr. Med.,26, 240-243. A simple method for the quantitative analysis of urinary delta-aminolevulinic acid to evaluate lead absorption. A procedure is given for the rapid, quantitative determination of urinary delta-aminolevulinic acid (ALA). Interfering substances are removed by n-butanol extraction. After pyrrole formation with ethyl acetoacetate, Ehrlich's reagent is added to produce the chromophore, which is then extracted with chloroform and measured spectrophotometrically or by comparison of the depth of colour with standard colour solutions. The recoveries were about 91% and the results agreed well with those obtained using ion-exchange column chromatography (r=0·985). This assay is simple, dependable, and suitable for large-scale screening of industrial workers exposed to lead poisoning, because the critical level of urinary ALA (20 mg./l. urine), which indicates dangerous lead absorption, gives a convenient absorbance.