Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Colloid particle and protein deposition - electrokinetic studies

Recent developments in the electrokinetic determination of particle, polyelectrolyte and protein deposition at solid/electrolyte interfaces, are reviewed. In the first section basic theoretical results are discussed enabling a quantitative interpretation of the streaming current/potential and microelectrophoretic measurements. Experimental results are presented, pertinent to electrokinetic characteristics of simple (homogeneous) surfaces such as mica, silica and various polymeric surfaces used in protein studies. The influence of the ionic strength, background electrolyte composition and pH is discussed, and the effective (electrokientic) charge of these interfaces is evaluated. In the next section, experimental data obtained by streaming potential measurements for colloid particle mono- and bilayers are presented and interpreted successfully in terms of available theoretical approaches. These results, obtained for model systems of monodisperse colloid particles are used as reference data for discussion of more complicated experiments performed for polyelectrolyte and protein covered surfaces. Results are discussed, obtained for cationic polyelectrolytes (PEI, PAH) and fibrinogen adsorbing on mica, interpreted quantitatively in terms of the theoretical approach postulating a heterogeneous 3D charge distribution. The Gouy-Chapman model, based on the continuous charge distribution proved inadequate. Interesting experimental data are also discussed, obtained by electrophoretic methods in the case of protein adsorption on colloid latex particles. In the last section, supplementary results on particle deposition on heterogeneous surfaces produced by controlled protein adsorption are discussed. Quantitative relationships between the amount of adsorbed protein, zeta potential of the interface and the particle coverage are specified. Possibility of evaluating the heterogeneity of protein charge distribution is pointed out. The anomalous deposition of colloid particles on protein molecules bearing the same sign of zeta potential, which contradicts classical DLVO theory, is interpreted in terms of the fluctuation theory. It is concluded that theoretical and experimental results obtained for model colloid systems and flat interfaces can be effectively used for interpretation of protein adsorption phenomena, studied by electrophoresis. In this way the universality of electrokinetic phenomena is underlined.

Uptake of a superparamagnetic contrast agent imaged by MR with high spectral and spatial resolution

Conventional MRI implicitly treats the proton signal as a single, narrow Lorentzian. However, water signals in vivo are often in homogeneously broadened and have multiple resolvable components. These components represent discrete populations of water molecules within each pixel which are affected differently by physiology and contrast agents. Accurate measurement of each component of the water resonance can improve anatomic and functional MR images and provide insight into the structure and dynamics of subpixelar microenvironments. This report describes high spectral and spatial resolution (HiSS) MR imaging of rodent prostate tumors before and after injection of a superparamagnetic contrast agent. HiSS datasets were used to synthesize images in which intensity is proportional to peak height, peak frequency, and linewidth. These images showed anatomic features which were not clearly delineated in conventional T(2) and gradient echo images. HiSS images obtained after injection of the contrast agent showed T *(2) and T(1) changes which were not seen in conventional images. These changes are associated with microvessel density and permeability. The results suggest HiSS with superparamagnetic contrast agents has the potential to improve characterization of tumors.

[Diagnostic and therapeutic difficulties in staphylococcal sepsis]

A case is described of a 38-year-old man treated for three years for diabetes mellitus admitted to an internal department for elucidation of the cause of protracted fever. Staphylococcal sepsis was diagnosed with pneumonia and retroperitoneal abscess. Surgical treatment was given and targeted antibiotic-therapy was administered. The patient was discharged from the hospital after 38 days as cured. An observation of 18 months failed to show the recurrence of the infection.