Does vaginal bacterial colonization contribute to preterm birth in women with asymptomatic shortened cervix?

PURPOSE

The aim of this study is to describe the typical microbial spectrum and the influence of distinct vaginal infections on preterm birth in pregnancies affected by cervical incompetence.

METHODS

327 patients were admitted because of asymptomatic shortening of the cervix in the second and third trimester of pregnancy. Clinical data such as age, cervical length, gestational age at admission and at delivery and vaginal microbiologic findings were collected and analyzed.

RESULTS

The spectrum of germs in the vagina revealed seven different distinct species; the most common bacteria were Ureaplasma spp. and E. coli. In 327 included patients, 217 revealed a bacterial colonization, 110 did not. Most common bacteria in women with preterm birth before 34 weeks were Ureaplasma spp., while E. coli was most common in women undergoing preterm birth after 34 weeks. Nevertheless, the rates of occurrence of these bacterial taxa were not significantly different between who underwent preterm birth to those who did not.

CONCLUSIONS

This study gives an overview over the vaginal bacterial colonization in pregnant women with cervical incompetence. The clinical relevance of vaginal bacterial colonization remains unclear.

Inter- and intraspecific diversity of Salix bark phenolic profiles - A resource for the pharmaceutical industry

Due to their content of phenolic compounds, willow bark preparations are used as an herbal remedy. The large diversity of phenolic secondary metabolites in Salix still provides a resource for the identification of bioactive compounds in particular species, including species not yet in focus from a phytopharmaceutical perspective. The present study describes the bark phenolic profile of 13 Salix species analyzed by HPLC-MS: Salix alba, Salix babylonica, Salix daphnoides, Salix fragilis, Salix hastata, Salix myrsinifolia, Salix pentandra, Salix purpurea, Salix repens (including subspecies S. repens ssp. arenaria and S. repens ssp. repens), Salix rosmarinifolia, Salix sachalinensis, Salix triandra and Salix viminalis. The analyzed profiles comprised the chemical groups of salicylates, flavonoids, procyanidins, phenolic acid derivatives, and some unclassified phenolics. Particular compounds were detected in species where they have not been previously reported. Apart from interspecific diversity, qualitative variability within species was observed as certain components were detected only in some of the analyzed genotypes. The knowledge on specific phenolic profiles of species and genotypes is the basis for the selection of suitable willow bark material with certain desired bioactive properties. Furthermore, the high inter- and intraspecific variability points out the necessity for product standardization of willow bark raw material.

Identification of Salicylates in Willow Bark (Salix Cortex) for Targeting Peripheral Inflammation

Salix cortex-containing medicine is used against pain conditions, fever, headaches, and inflammation, which are partly mediated via arachidonic acid-derived prostaglandins (PGs). We used an activity-guided fractionation strategy, followed by structure elucidation experiments using LC-MS/MS, CD-spectroscopy, and 1D/2D NMR techniques, to identify the compounds relevant for the inhibition of PGE2 release from activated human peripheral blood mononuclear cells. Subsequent compound purification by means of preparative and semipreparative HPLC revealed 2'-O-acetylsalicortin (1), 3'-O-acetylsalicortin (2), 2'-O-acetylsalicin (3), 2',6'-O-diacetylsalicortin (4), lasiandrin (5), tremulacin (6), and cinnamrutinose A (7). In contrast to 3 and 7, compounds 1, 2, 4, 5, and 6 showed inhibitory activity against PGE2 release with different potencies. Polyphenols were not relevant for the bioactivity of the Salix extract but salicylates, which degrade to, e.g., catechol, salicylic acid, salicin, and/or 1-hydroxy-6-oxo-2-cycohexenecarboxylate. Inflammation presents an important therapeutic target for pharmacological interventions; thus, the identification of relevant key drugs in Salix could provide new prospects for the improvement and standardization of existing clinical medicine.

Effect of SGLT2 inhibition on coronary microvascular function in patients with type 2 diabetes

Background

Treatment with sodium-glucose cotransporter 2 (SGLT2) inhibitor reduces risk of cardiovascular death and heart failure but the underlying mechanisms remain poorly understood. It has been suggested that a shift in fuel source in the myocardium from glucose and free fatty acids to the more energy efficient ketogenesis reduces oxidative stress involved in coronary microvascular damage, leading to improved coronary microvascular function.

Purpose

To test the hypothesis that treatment with the SGLT2 inhibitor empagliflozin improves non-endothelial dependent coronary microvascular function.

Methods

We included 26 patients with type 2 diabetes in a double blinded, placebo-controlled cross-over study. Participants were treated with empagliflozin 25 mg and placebo for 12 weeks, interrupted by 2 weeks wash-out period. The primary outcome was change in coronary microvascular function, assessed as coronary flow velocity reserve (CFVR) and measured with transthoracic doppler echocardiography. Secondary endpoints were change in echocardiographic parameters of cardiac systolic function and 184 cardiovascular protein biomarkers.

Results

Nineteen patients completed both study periods according to protocol. There was a significant weight loss and reduction in Hba1c after empagliflozin treatment (table). We found no improvement in CFVR and parameters of cardiac systolic function. We observed a general tendency of reduction in level of cardiovascular biomarkers after empagliflozin treatment (figure) with significant difference between empagliflozin and placebo for 27 proteins, including IL18, ST2, YKL40, ACE2 and leptin.

Conclusions

Despite a significant weight loss and reduction in Hba1c after empagliflozin treatment, we found no effect on non-endothelial dependent coronary microvascular function in patients with type 2 diabetes mellitus. Improvement in multiple biomarkers may indicate underlying mechanisms but need confirmation in larger studies.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Danish Council for Independent Research Table 1. Change in outcome parametersFigure 1. Change in biomarker levels

Chemoprofiling as Breeding Tool for Pharmaceutical Use of Salix

Willow bark is traditionally used for pharmaceutical purposes. Evaluation is so far based on the salicylate content, however, health promoting effects of extracts might be attributed to the interaction of those salicylates with other compounds, which support and complement their action. So far, only S. purpurea, S. daphnoides, and S. fragilis are included in pharmaceutical extracts. Crossing with other species could result in a more diverse secondary metabolite profile with higher pharmacological value. With the help of targeted inter- and intraspecific crossing, new chemotypes were generated, whereby nine different Salix genotypes (S. alba, S. daphnoides, S. humboldtiana, S. lasiandra, S. nigra, S. pentandra, S. purpurea, S. x rubens, S. viminalis) were included in the study. Based on substances known for their health promoting potential and characteristic for Salix (selected phenolic compounds including salicylates), a targeted metabolomics analysis and clustering of 92 generated Salix clones was performed revealing four different cluster/chemoprofiles. In more specific, one group is formed by S. daphnoides clones and inter- and intraspecific hybrids, a second group by S. viminalis clones and inter- and intraspecific hybrids, a third group generally formed by S. alba, S. pentandra, S. x rubens, and S. lasiandra clones and hybrids, and a fourth group by S. purpurea clones and inter- and intraspecific hybrids. Clustering on the basis of the selected phenolic compounds can be used for identifying Salix clones with a different compound profile. New combinations of secondary plant metabolites offer the chance to identify Salix crosses with improved effects on human health.

Compound-specific responses of phenolic metabolites in the bark of drought-stressed Salix daphnoides and Salix purpurea

The bark of willows (Salix spp.) is rich in bioactive phenolic compounds from different compound classes and is therefore used as an herbal remedy. The accumulation of these secondary plant metabolites is influenced by environmental factors, including the availability of water. To analyze the influence of drought stress on the profile of phenolic metabolites in willow bark, a pot experiment with Salix daphnoides Vill. and Salix purpurea L. was conducted. Plants were subjected to three irrigation treatments for four and ten weeks: 65-75% field capacity (well-watered), 33-38% field capacity (moderate drought), and 17-22% field capacity (severe drought). Shoot biomass and proline content were assessed as drought-sensitive traits. Contents of phenolic compounds were analyzed by high-performance liquid chromatography. Drought stress reduced shoot biomass and led to an increase of the bark proline content. The particular effects on phenolics depended on the individual compound, Salix species and drought stress duration. Whereas salicylates were not affected, some flavonoids and phenolic acid derivatives, as well as salireposide indicated treatment effects. The effects comprised decreasing as well as increasing contents. However, beyond the impact of drought stress, the observed responses are assumed to be superimposed by seasonal changes in the content of phenolics. Regarding the yield of willow shoots, the impairment of growth under water shortage seems to be more decisive than drought-induced changes of the bark metabolite content.

Severe hypoglycaemia during treatment with sulphonylureas in patients with type 2 diabetes in the Capital Region of Denmark

AIMS

Sulphonylureas (SU) are currently recommended as a well-established second line treatment in guidelines for type 2 diabetes (T2DM). In the Capital Region of Denmark 16,865 patients were given SU as part of their treatment of T2DM in 2010-2011. To what extent SU are associated with hospitalizations due to severe hypoglycaemic episodes, defined as episodes with a need for external assistance, was investigated. The prevalence and characteristics of these patients and potential risk factors were studied.

METHODS

ICD-10 diagnosis codes were used to identify patients hospitalized due to hypoglycaemia and T2DM for a period of 2 years (2010-2011). Inclusion criteria were T2DM, hospitalization due to hypoglycaemia and treatment with SU as monotherapy or in combination with other glucose-lowering drugs except insulin treatment.

RESULTS

We identified 161 patients fulfilling the inclusion criteria. Their mean age was 76 (53-97) years and 54% were males. Sixty percent of the patients had diabetic complications, including 19% with diabetic nephropathy. The major reason for severe hypoglycaemia was an unchanged dose of SU despite of a significant decline in food intake (45%). In 22% of the patients more than one reason was listed, most commonly a concomitant infection associated with decreased food intake and unchanged dose of SU.

CONCLUSION

The incidence of hospital admission-requiring severe hypoglycaemia in patients treated with SU was 0.48 episodes per 100 patient-years of SU-treated patients. It was mainly older patients with diminished food intake, excessive alcohol use or other medications, concomitant infection, and with diabetic complications.

Preparation and Spectroscopic Characterization of Cyclopenta[1,2-a : 3,4,5-b′c′]dicoronene

The non-alternant hydrocarbon cyclopenta[1,2-a : 3,4,5-b′c′]dicoronene (3) has been prepared by aluminium chloride catalyzed dimerization of coronene (1). The UV/VIS absorption spectrum, fluorescence spectrum and fluorescence quantum yield of 3 is reported and compared with that of the alternant isomer benzo[1,2,3-bc:4,5,6-b′c′]dicoronene (2). Relationships observed in the UV/VIS absorption spectra of alternant and non-alternant polycyclic aromatic hydrocarbons and preliminary theoretical investigations (PMO calculations) on two model systems (C, E) are also reported.

Zum Phosphoreszenz- und Fluoreszenzverhalten von N-Aryl-carbazolen

Am N -(9-phenanthryl)-carbazol (II) und dem Maleinsäureanhydrid-Addukt III des Anthraceno- 2′.3′:2.3-carbazols wird intramolekulare Triplettenergieübertragung beobachtet (Donator: Carbazol- Kern: Akzeptor: Phenanthren- bzw. Naphthalin-Kern). - N-(α-Naphthyl)-carbazol (I) und II zeigen ein für diese Stoffklasse in bezug auf Lösungsmittel- und Temperaturabhängigkeit ungewöhnliches Fluoreszenzverhalten.

On the Fluorescence Quenching of Polycyclic Aromatic Hydrocarbons by Nitromethane

Fluorescence quenching of 22 polycyclic aromatic hydrocarbons by nitromethane in toluene and acetonitrile solutions has been studied. Contrary to Sawicki’s observations that the fluorescence of hydrocarbons with the fluoranthene skeleton is not quenched that of 11.12-and 3.4-benzofluor-anthene and fluoranthene itself is quenched. These compounds have a high energy of the fluorescence transition. The fluorescence quenching of the compounds investigated follows a dynamic quenching mechanism. The bimolecular rate constant of fluorescence quenching increases exponentially with the energy of the fluorescing state of alternant hydrocarbons.

The Intra-annular Internal Heavy-atom Effect on the Fluorescence and Phosphorescence Properties of Oxygen, Sulphur or Selenium Containing Heterocyclic Systems Related to Dibenzo [b,n] perylene

Fluorescence and phosphorescence properties of dibenzo [2,3:10,11] perylo [1,12-bcd] furan (1), dibenzo [2,3:10,11] perylo [1,12-bcd] thiophene (2), and dibenzo [2,3:10,11 ] perylo [1,12-bcd] selenophene (3) have been studied. Fluorescence quantum yields as well as phosphorescence lifetimes correlate linearly with where ck are the Hückel AO coefficients in the HOMO of the parent carbocyclic system dibenzo [b, n] perylene (4) on carbon centres k to which the hetero-atom is bound, and ζ is the spin-orbit coupling constant of the heavy-atom present. The half-value concentration of fluorescence quenching (quencher: methyl iodide) of 1 - 3 increases with increasing strength of the internal heavy-atom effect present

Topological Effect on MO Energies, II

The recently introduced approach of S, T isomers [1] has been applied to aza-benzenes and aza-perylenes. Ab initio and HMO calculations as well as experimental results clearly show that the S.T approach is a suitable means to derive definite predictions concerning the MO patterns and HOMO energies of structurally related aza-arenes.

Heiße Banden im Phosphoreszenzspektrum von Coronen

Two temperature-dependent bands on the short wavelengths side of the phosphorescence spectrum of coronene in a perhydro-coronene matrix are identified as hot bands (from higher vibrational levels of the triplet state T1) by measurement of lifetimes and activation energies.

Photoluminescence of [22]Paracyclophane and p-Xylene in the Presence of Silver Ions

Phosphorescence spectra and phosphorescence lifetimes of [22]paracyclophane (I) and p-xylene have been measured in ethanol glass at 77 K in the presence of silver Perchlorate at various concentrations. From the results it is concluded that the ground state complex formed with AgClO4 is much more stable in the case of the cyclophane than with p-xylene. The results would indicate that under the conditions used [22]paracyclophane forms a 1:1 complex with AgClO4 with the silver ion being located within the cyclophane cage. Fluorescence quenching measurements in fluid solution at room temperature using ethyl bromide and AgClO4 as quenchers support this assumption.

Photochemisches Verhalten und spektroskopische Eigenschaften von Anilino-naphthalinen

From the fluorescence and phosphorescence spectra of several aromatic amines it is concluded that the conjugation between nitrogen and aryl groups in the excited state is restricted. With this result a sterical explanation for the lack of the expected photochemical carbazole ring closure of 1-and 2-anilino naphthalene is given.

Einfluß von Chlorsubstitution auf die El ektronenspektren von Biphenyl

Absorption spectra in liquid solution, fluorescence and phosphorescence spectra, phosphores-cence quantum yields, phosphorescence to fluorescence quantum yield ratios, and phosphorescence decay times of 9 chloro substituted biphenyls dissolved in low temperature EPA glass were in-vestigated. The emission spectra of sterically unhindered systems are structured and significantly Stokes-shifted. Ortho substitution shifts the conjugation band in absorption as well as the un-structured fluorescence and phosphorescence bands to shorter wave lengths presumably by pre-venting the system from attaining a planar excited state. Chloro substitution which increases the rate constant of phosphorescence in the order meta < para < ortho, is nearly additive for multiple substituted systems and is correlated to the MO coefficients at the chloro substituted position in the absence of steric hindrance

Fluoreszenzlöschung alternierender und nicht-alternierender polycyclischer aromatischer Kohlenwasserstoffe durch Nitroverbindungen / Fluorescence Quenching of Alternant and Non-alternant Polycyclic Hydrocarbons by Nitro Compounds

Fluorescence Quenching of Alternant and Non-alternant Polycyclic Hydrocarbons by Nitro Compounds Fluorescence quenching of polycyclic aromatic hydro­ carbons by nitromethane or nitrobenzene in fluid solutions is due to an electron transfer mechanism. The non diffusion controlled rate constant of quenching is very much greater for alternant than for non-alternant hydrocarbons with equal singlet excitation energy. This is explained by the known more positive reduction potential of non-alternant compared to alternant hydrocarbons.

Über die Löschung von „Twisted Intramolecular Charge Transfer" (TICT)-Fluoreszenzen durch äußere Schweratom-Störer

The quenching by methyl iodide and ethyl bromide of the TICT fluorescence of N-(p-cyanophenyl)- carbazole (II) and N-(l-naphthyl)-carbazole (III) has been studied in solvents of different polarity. It is found that the heavy atom induced bimolecular fluorescence quenching increases with increasing energy of the TICT fluorescence transition, contrary to the energy-gaprule, and that TICT states are much less readily quenched than locally excited (LE) states. These results are explained by assuming a very small S-T energy gap for TICT states and a solvent polarity dependent distribution function for the intramolecular twist angle.

Löschung der Perylen-Fluoreszenz durch Schweratom-induzierte intermolekulare Singlett Triplett-Energieübertragung

The fluorescence of perylene is quenched by bromonaphthalene but not by bromo-benzene. This is explained with the assumption of an intermolecular energy transfer from the fluorescing state S1 of perylene to the lowest triplet state T1 of the halogen-naphthalene.

Die Bedeutung von Donor-Acceptor-Wechselwirkungen im äußeren Schweratom-Effekt von AgNO3 auf das Lumineszenzverhalten von Aza-aromaten und Carbazolen / The Significance of Donor-Acceptor Interactions in the External Heavy Atom Effect of AgNO3 on the Luminescence Behaviour of Aza-aromatic Systems and Carbazoles

The transition probabilities of spin-forbidden processes become much more enhanced in the case of aza-aromatic systems than for structurally related aromatic hydrocarbons when AgNO3 is used as an external heavy atom perturber. This is explained with the strong electron donor properties of aza-aromatic systems thus causing strong interaction between the π-electronic system and the perturber. Since carbazoles are weaker electron donors than aza-aromatic systems, the enhancement of the phosphorescence/fluorescence quantum yield ratio by AgNO3 is lower than for aza-aromatic systems. The different behaviour of aza-aromatic systems and aromatic hydrocarbons in the heavy atom experiment with AgNO3 can find applications in fluorescence analysis.

Notizen: Some Remarks on the Concept of Molecular Topology

Some general aspects of the concept of molecular topology are delt with. The role of the separability of topological and non-topological factors that determine molecular properties, as well as the "holistic" behaviour of certain classes of compounds are discussed. A suggestion regarding a deeper understanding of the role of molecular topology is made

On the Phosphorescence of Benzologues of Furan , Thiophene , Selenophene , and Tellurophene . A Systematic Study of the Intra -annular Internal Heavy-atom Effect

Phosphorescence in ethanol and n-pentane at 77 K of the benzologues 1-8 of furan, thiophene, selenophene and tellurophene has been investigated. The rate constants of both the radiative (kPT) and non-radiative (kGT) deactivation of the lowest triplet state correlate linearly with where ck denotes the Hückel AO coefficients in the HOMO of the carbon atoms bound to the hetero-atom and ζ is the spin-orbit coupling constant of the hetero-atom present. - The linear correlation observed between kPT and kGT is an example for the Orlandi-Siebrand rule. - The influence of an external heavy-atom perturber (methyl iodide) on phosphorescence lifetimes and the vibrational structure of phosphorescence spectra is the more efficient the less efficient is the internal perturbation caused by the intra-annular heavy-atom.

Eine PMO-theoretische Untersuchung der benzogenen Diels-Alder-Reaktion polycyclischer aromatischer Kohlenwasserstoffe / APMO-theoretical Treatment of the Benzogenic Diels-Alder Reaction of Polycyclic Arom atic Hydrocarbons

Experimental reaction rates of the benzogenic Diels- Alder reaction of polycyclic aromatic hydrocarbons with maleic anhydride are correlated with the corresponding bislocalization energies calculated by the PMO method. The observed relations between the localization energies of the reacting centres and the topology of the hydrocarbons can be qualitatively understood on the basis of Clar’s π-sextet model of polycyclic systems and Polansky’s pars orbital method.

Note on the Influence of External Heavy-Atom Perturbers on the Phosphorescence Spectrum of Triphenylene

Spectral changes in symmetry-forbidden phosphorescence spectra observed in the presence of external heavyatom perturbers may have quite different causes depending on the chemical nature of the perturber. This is exemplified using triphenylene as the phosphorescent compound and methyl iodide and silver Perchlorate respectively as the perturber. Intensification of the 0-0 band of the symmetry-forbidden phosphorescence spectrum of triphenylene by silver Perchlorate is assumed to result from symmetry-reduction of the hydrocarbon by ground-state complex formation with silver Perchlorate.

Notizen: E-Typ-verzögerte Fluoreszenz von 1,1′-Dicoronyl in einer Kunststoffmatrix / E-type Delayed Fluorescence of 1,1′-dycoronyl in a Plastic Matrix

E-type delayed fluorescence of 1,1′-dicoronyl (III) has been established by measurement of luminescence lifetimes and activation energy.

On the Role of Microcrystal Formation in Intermolecular Triplet-Triplet Energy Transfer in Rigid Glasses

The intermolecular triplet-triplet energy transfer system benzophenone (donor)/naphthalene (acceptor) was studied in various rigid glasses at 77 K. It is shown that energy transfer is much more efficient if the donor is present in the form of microcrystals than in the case where both donor and acceptor compound are in true solution.

Factors influencing the variability of antioxidative phenolic glycosides in Salix species

Phenolic glycosides, especially the salicylates, are important secondary metabolites in the bark of willows (Salix spp.). Because of their anti-inflammatory, analgesic, and fever-reducing properties, they are of particular interest to society. Compared to the fabrication of synthetic salicylacetylic acid, the commercial production of willow bark extracts with adequate amounts of salicylate is very difficult due to several biological and technical reasons. Therefore, one of the objectives was to identify salicylate-rich clones from three species, Salix daphnoides , Salix purpurea , and Salix pentandra , with potentially high amounts of phenolic glycosides. Three hundred different Salix clones were collected, and the chemical profiles of their bark were analyzed by HPLC. Overall, S. daphnoides clones showed the highest phenolic glycoside contents, followed by S. purpurea and S. pentandra. Second, seasonal changes of secondary compounds in willow bark were analyzed to determine the optimal harvesting time. The phenolic glycoside levels decreased over the growing season, with highest contents detected during plant dormancy. The effects of different cultivation conditions were also examined, and none of these treatments were found to have a significant effect on the phenolic glycoside content in willow bark. Biomass accumulation in the clones with grass competition was significantly lower than in the other three treatments.

Four weeks of near-normalization of blood glucose has no effect on postprandial GLP-1 and GIP secretion, but augments pancreatic B-cell responsiveness to a meal in patients with Type 2 diabetes

OBJECTIVE

The aim of the present study was to investigate whether 4 weeks of near-normalization of blood glucose (BG) improves incretin hormone secretion and pancreatic B-cell function during a mixed meal.

RESEARCH DESIGN AND METHODS

Nine patients with Type 2 diabetes in poor glycaemic control [glycated haemoglobin (HbA(1c)) 8.0 +/- 0.4%] were investigated before and after 4 weeks of near-normalization of BG (mean BG 6.4 +/- 0.3 mmol/l) using insulin treatment. HbA(1c) after insulin treatment was 6.6 +/- 0.3%. For comparison, nine healthy control subjects were also studied. Postprandial glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) incremental responses were assessed during a mixed meal test. Fasting and postprandial pancreatic B-cell function was determined from calculations of insulin secretion rates in relation to plasma glucose.

RESULTS

There was no difference in IAUC(totalGLP-1) or in IAUC(totalGIP) between the two experimental days. B-cell sensitivity to glucose (insulinogenic index) did not differ before and after insulin treatment in the fasting state (0.21 +/- 0.17 vs. 0.25 +/- 0.10 pmol kg(-1) min(-1)/mmol l(-1)), but improved significantly during the first 30 min after start of the meal (0.28 +/- 0.07 vs. 0.46 +/- 0.06 pmol kg(-1) min(-1)/mmol l(-1)) and during the following 4 h (0.34 +/- 0.09 vs. 0.56 +/- 0.07 pmol kg(-1) min(-1)/ mmol l(-1)). The B-cell responsiveness to changes in plasma glucose, expressed as the slope of the linear relationship between the insulin secretion rate and the concomitant plasma glucose increased from 0.59 +/- 0.16 to 0.94 +/- 0.13 pmol kg(-1) min(-1)/ mmol l(-1) (P < 0.07).

CONCLUSIONS

Four weeks of near-normalization of BG had no effect on postprandial secretion of incretin hormones. Nevertheless, several parameters of meal-induced insulin secretion improved after insulin treatment.

Near normalisation of blood glucose improves the potentiating effect of GLP-1 on glucose-induced insulin secretion in patients with type 2 diabetes

AIMS/HYPOTHESIS

The ability of glucagon-like peptide-1 (GLP-1) to enhance beta cell responsiveness to i.v. glucose is impaired in patients with type 2 diabetes mellitus compared with healthy individuals. We investigated whether 4 weeks of near normalisation of blood glucose (BG) improves the potentiation of glucose-stimulated insulin secretion by GLP-1.

METHODS

Nine obese patients with type 2 diabetes and inadequate glycaemic control (HbA(1c) 8.0+/-0.4%) were investigated before and after 4 weeks of near normalisation of BG using insulin treatment (mean diurnal blood glucose 6.4+/-0.3 mmol/l, HbA(1c) 6.6+/-0.3%). Nine matched healthy participants were also studied. Beta cell function was investigated before and after insulin treatment using stepwise glucose infusions and infusion of saline or GLP-1 (1.0 pmol kg(-1) min(-1)), resulting in supraphysiological total GLP-1 concentrations of approximately 200 pmol/l. The responsiveness to glucose or glucose+GLP-1 was expressed as the slope of the linear regression line relating insulin secretion rate (ISR) and plasma glucose concentration (pmol kg(-1) min(-1) [mmol/l](-1)).

RESULTS

In the diabetic participants, the slopes during glucose+saline infusion did not differ before and after insulin treatment (0.33+/-0.07 and 0.39+/-0.04, respectively; p=NS). In contrast, near normalisation of blood glucose improved beta cell sensitivity to glucose during glucose+GLP-1 infusion (1.27+/-0.2 before vs 1.73+/-0.31 after; p<0.01). In the healthy participants, the slopes during the glucose+saline and glucose+GLP-1 infusions were 1.01+/-0.14 and 4.79+/-0.53, respectively.

CONCLUSIONS/INTERPRETATION

A supraphysiological dose of GLP-1 enhances beta cell responses to glucose in patients with type 2 diabetes, and 4 weeks of near normalisation of blood glucose further improves this effect.

The metabolite generated by dipeptidyl-peptidase 4 metabolism of glucagon-like peptide-1 has no influence on plasma glucose levels in patients with type 2 diabetes

AIM/HYPOTHESIS

Glucagon-like peptide-1 (GLP-1) is metabolised by the enzyme dipeptidyl-peptidase 4 (DPP-4), generating a metabolite with potential antagonistic properties. This study was conducted to evaluate the effect of that metabolite on plasma glucose levels in patients with type 2 diabetes.

MATERIALS AND METHODS

The randomised crossover study consisted of five regimens: (1) i.v. infusion of GLP-1 (1.2 pmol kg(-1) min(-1); IV); (2 and 3) s.c. infusion of GLP-1 (2.4 and 9.6 pmol kg(-1) min(-1); LSC, HSC); (4) s.c. infusion of GLP-1 (2.4 pmol kg(-1) min(-1)) in combination with a DPP-4 inhibitor (IB); and (5) s.c. infusion of saline (154 mmol NaCl/l; SAL). Seven patients with type 2 diabetes participated in all protocols.

RESULTS

Plasma levels of intact GLP-1 increased from 7+/-1 (SAL) to 17+/-3 (LSC), 61+/-7 (IB), 62+/-5 (IV) and 94+/-10 (9.6 s.c.) pmol/l, p<0.0001. Plasma concentrations of the metabolite increased from 1+/-3 (SAL) and 2+/-6 (IB) pmol/l to 42+/-4 (LSC), 64+/-8 (IV) and 327+/-16 (HSC) pmol/l, p<0.0001. Mean plasma glucose levels at 6 h decreased from 12.4+/-1.1 (SAL) mmol/l to 10.4+/-1.1 (LSC), 8.6+/-0.6 (IB), 8.8+/-0.8 (IV) and 9.1+/-0.9 (HSC) mmol/l, p<0.0001.

CONCLUSIONS/INTERPRETATION

At approximately similar concentrations of intact GLP-1 (IV, IB, HSC), but with widely ranging metabolite concentrations, the effect on plasma glucose levels was equal, indicating that the presence of the metabolite does not antagonise the glucose-lowering effect of GLP-1.

Additive glucose-lowering effects of glucagon-like peptide-1 and metformin in type 2 diabetes

OBJECTIVE

The incretin hormone glucagon-like peptide-1 (GLP-1) reduces plasma glucose in type 2 diabetic patients by stimulating insulin secretion and inhibiting glucagon secretion. The biguanide metformin is believed to lower plasma glucose without affecting insulin secretion. We conducted this study to investigate the effect of a combination therapy with GLP-1 and metformin, which could theoretically be additive, in type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

In a semiblinded randomized crossover study, seven patients received treatment with metformin (1,500 mg daily orally) alternating with GLP-1 (continuous subcutaneous infusion of 2.4 pmol x kg(-1) x min(-1)) alternating with a combination of metformin and GLP-1 for 48 h. Under fixed energy intake, we examined the effects on plasma glucose, insulin, C-peptide, glucagon, and appetite.

RESULTS

Fasting plasma glucose (day 2) decreased from 13.9 +/- 1 (no treatment) to 11.2 +/- 0.4 (metformin) and 11.5 +/- 0.5 (GLP-1) and further decreased to 9.4 +/- 0.7 (combination therapy) (P = 0.0005, no difference between monotherapy with GLP-1 and metformin). The 24-h mean plasma glucose (day 2) decreased from 11.8 +/- 0.5 (metformin) and 11.7 +/- 0.8 (GLP-1) to 9.8 +/- 0.5 (combination) (P = 0.02, no difference between GLP-1 and metformin). Insulin levels were similar between the three regimens, but glucagon levels were significantly reduced with GLP-1 compared with metformin (P = 0.0003). Combination therapy had no additional effect on appetite scores.

CONCLUSIONS

Monotherapy with GLP-1 and metformin have equal effects on plasma glucose and additive effects upon combination.

[Tricuspid valve endocarditis. Demonstration of a rare disease exemplified with 3 case reports]

BACKGROUND

Endocarditis of the tricuspid valve is a rare form of valvular endocarditis and occurs mainly in patients with special risk factors.

CASE REPORTS

The three case reports demonstrate 3 young patients (age 30 to 37 years, 2 female and 1 male) with a typical history of those risk factors. The two women were intravenous drug addicts and one of them had suffered already an episode of tricuspid valve endocarditis several years ago. The man developed his infection after implantation of a pacemaker. In all of the three patients the endocarditis was due to infection with staphylococci twice staphylococcus epidermidis and once staphylococcus aureus. In two of the three patients the endocarditis could not be cured by intravenous antibiotics alone and these patients had to undergo cardiac valvular surgery. All patients left the hospital after several weeks without signs of infection.

CONCLUSION

In clinical praxis the introduction of a special endocarditis service, a small team which has to be consulted in every suspected case of endocarditis, seems to be beneficial as well as the use of the Duke criteria for diagnosis in those cases.