Clinical and biochemical correlates of male hypogonadism in type 2 diabetes

The origin of hypogonadism, a condition including both symptoms and biochemical criteria of androgen deficiency, in type 2 diabetes is poorly known. In a cross-sectional study of 267 unselected patients, we analyzed the potential correlation of several clinical and biochemical variables as well as chronic micro- and macrovascular diabetic complications with hypogonadism. Hypogonadism was present in 46 patients (17.2%) using a cutoff of total testosterone 10.4 nmol/L and in 31 (11.6%) with a cutoff of 8 nmol/L. Among these patients, hypogonadotropic hypogonadism was the most prevalent form (82.6%). Compared to eugonadal subjects, hypogonadal men had significantly lower glomerular filtration rate (67.1 ± 23.4 vs. 78.4 ± 24.6 mL/min/1.73 m² , p = 0.005) and higher prevalence of chronic kidney disease (43.5% vs. 20.4%, p = 0.002), abnormal liver function tests (26.7% vs. 12%, p = 0.019), and psychiatric treatment (23.9% vs. 10.4%, p = 0.025). Total testosterone levels correlated inversely with age (R = -0.164, p = 0.007), fasting blood glucose (R = -0.127, p = 0.037), and triglycerides (R = -0.134, p = 0.029) and directly with glomerular filtration rate (R = 0.148, p = 0.015). Calculated free testosterone and bioavailable testosterone correlated directly with hemoglobin (R = 0.171, p = 0.015 and R = 0.234, p = 0.001, respectively). Multivariate logistic regression analysis, after adjusting for relevant confounding variables, showed that age >60 years (OR = 3.58, CI 95% = 1.48-8.69, p = 0.005), body mass index >27 kg/m² (OR = 2.85, CI 95% = 1.14-7.11, p = 0.025), hypertriglyceridemia (OR = 2.16, CI 95% = 1.05-4.41, p = 0.035), glomerular filtration rate <60 mL/min/1.73 m² (OR = 2.51, CI 95% = 1.19-5.29, p = 0.015), and abnormal liver function tests (OR = 3.57, CI 95% = 1.48-8.60, p = 0.005) were independently associated with male hypogonadism. Although older age, body mass index, and hypertriglyceridemia have been previously related to hypogonadism, our results describe that chronic kidney disease and abnormal liver function tests are independently correlated with hypogonadism in type 2 diabetic men.

Testosterone replacement therapy in hypogonadal men is associated with increased expression of LAMP-2 (CD107b) by circulating monocytes and dendritic cells

BACKGROUND

Accumulated experimental data indicates that androgen therapy has effects on inflammation and protects from autoimmune disorders. Despite this, the in vivo effects of testosterone replacement therapy on human antigen-presenting cells-for example, monocytes and dendritic cells- remain unknown.

OBJECTIVE, DESIGN AND PATIENTS

We monitored the effects of testosterone replacement therapy on the number and the functionality -as assessed by the expression of CD107b (lysosome-associated membrane protein 2, LAMP-2)- of resting and in vitro-stimulated peripheral blood (classical and nonclassical) monocytes and dendritic cells (myeloid and plasmacytoid) from hypogonadal men.

RESULTS

Our results show that testosterone replacement therapy induces overexpression of CD107b by circulating monocytes and dendritic cells from hypogonadal men, both under resting (i.e. nonstimulated) conditions and after in vitro stimulation. CD107b overexpression mostly involved monocytes and in vitro stimulation with CpG oligodeoxynucleotides. Of note, a strong correlation was found between CD107b expression on monocytes and serum gonadotrophins levels.

CONCLUSION

These results support the existence of an effect of testosterone therapy, and potentially also of gonadotrophins, on circulating antigen-presenting cells.

Trocar site hernia after laparoscopic ventral hernia repair

BACKGROUND

The incidence of trocar site hernia (TSH) after laparoscopic ventral hernia repair (LVHR) is reported to be low. The present study investigates the associated risk factors, with a view to preventing this complication.

METHODS

A retrospective study was made of the incidence of TSH in a personal series of LVHR, recording anthropometric and clinical data on the patients. Risk factors were assessed by bivariate and multivariate analyses. The patients were subjected to clinical and telephone follow-up.

RESULTS

In a series of 27 LVHR, the incidence of TSH was 22% (6 patients). The use of meshes larger than 10 x 15 cm for LVHR was the only TSH risk factor to reach statistical significance. Female gender and diabetes showed a higher incidence in the TSH group.

CONCLUSIONS

The use of large meshes may be a risk factor for TSH. We believe this to be due to dilatation of the trocar orifice during introduction of the mesh, and also to postoperative retraction of the mesh.

Androgen-replacement therapy depresses the ex vivo production of inflammatory cytokines by circulating antigen-presenting cells in aging type-2 diabetic men with partial androgen deficiency

Androgens are considered to have immunomodulatory effects but their cellular mechanisms of action remain largely unknown. In the present study we prospectively analyzed the serial effects of androgen-replacement therapy on both the distribution of peripheral blood lymphocytes, monocytes and dendritic cells as well as on the production of interleukin (IL)-1beta, IL-6 and tumor necrosis factor alpha (TNFalpha) inflammatory cytokines by circulating monocytes and CD33 myeloid, CD16 and plasmacytoid dendritic cell subsets, the most potent antigen-presenting cells (APCs) in type-2 diabetic men with partial androgen deficiency. Analyses were performed before therapy and at 1, 3, 6 and 12 months after treatment with 150 mg testosterone enanthate every 2 weeks in a group of 13 type-2 diabetic men. Our results show for the first time that testosterone-replacement therapy is associated with a reduction or complete abrogation of spontaneous ex vivo production of IL-1beta, IL-6 and TNFalpha by APCs. Meanwhile, the in vitro production of inflammatory cytokines by these cells after stimulation with lipopolysaccharide plus recombinant human interferon-gamma remained unchanged, suggesting that APCs preserve their constitutive machinery to produce inflammatory cytokines under androgen treatment. These results confirm and extend previous observations about the anti-inflammatory effects of androgen therapy on APCs in a new, previously unexplored model of androgen deficiency; namely, aging type-2 diabetic men. A decreased production of inflammatory cytokines by APCs might have important consequences for sex differences in susceptibility to autoimmune diseases, inflammatory response to injury and atheromatosis.

Partial androgen deficiency in aging type 2 diabetic men and its relationship to glycemic control

Aging in the male is associated with both a higher incidence of type 2 diabetes and hypogonadism. However, little information is available about the complex of symptoms and hormonal changes related to partial androgen deficiency in aging (called andropause) in type 2 diabetic men. Here, for the first time, we used a combination of clinical and hormonal criteria to define andropause and to analyze the relationships between the androgen environment and glucose metabolism in 55 type 2 diabetic men (63.6 +/- 7.9 years, mean +/- SD). Low plasma levels of total testosterone (< or =3.4 ng/mL) and free testosterone (< or =11 pg/mL) were found in 20% and 54.5%, respectively, of the diabetic men. The fraction of diabetic men with subnormal levels of total testosterone increased with aging: 14.2% (50 to 59 years), 17.4% (60 to 69 years) and 36% (> 70 years). The corresponding figures for subnormal values of free testosterone were 38%, 69.6%, and 54.5%, respectively. In the whole group of type 2 diabetic men, no significant linear correlations between total or free testosterone with fasting plasma glucose, insulin, C-peptide, or fructosamine values could be established. Total testosterone was positively correlated with glycosylated haemoglobin (HbA(1c)) levels (r =.322, P =.01). Although fasting plasma glucose was marginally higher in aging type 2 diabetic patients with andropause than in those without andropause (162 +/- 6.9 v 139 +/- 8.9, mean +/- SEM, P =.05), there were no differences between both subgroups for plasma fasting insulin, C-peptide, fructosamine, or HbA(1c) levels. Replacement therapy (150 mg intramuscular [IM] of enanthate of testosterone every 14 days for 6 months) was applied in 10 type 2 diabetic men with clinical features of andropause associated with subnormal concentrations of serum testosterone. The treatment induced significant increases in total plasma testosterone (baseline: 3.9 +/- 0.3; at 6 months: 7.1 +/- 0.9 ng/mL, mean +/- SEM, P =.003) and free testosterone (baseline: 9.3 +/- 0.6; at 6 months 17.6 +/- 2.4 pg/mL, P =.003), but had a neutral effect on overall glycemic control. These data show a high prevalence of andropause in aging type 2 diabetic men and suggest that the endogenous androgen environment, as well as correction of the partial androgen deficiency, do not have a meaningful effect on glycemic control.

Abnormal expression of acid glycosidases in seminal plasma and spermatozoa from infertile men with varicocele

The activities of acid beta-glucuronidase, alpha-mannosidase, alpha-glucosidase, alpha-galactosidase, beta-galactosidase and beta-N-acetylglucosaminidase were analysed in seminal plasma and spermatozoa from 26 infertile men with varicocele and from 36 men of normal fertility. Semen samples from ten men with non-obstructive azoospermia were used as control specimens that contained the other components of semen. Spermatozoa were solubilized by both physical (homogenization) and chemical (Triton-X100) methods to obtain the soluble and non-soluble fractions. The activities of several glycosidases measured both in seminal plasma and spermatozoa were directly correlated with the numbers of spermatozoa and sperm motility, confirming previous studies. As some infertile patients with varicocele have normal semen parameters, whereas others have low numbers of spermatozoa and low sperm motility, the varicocele patients were prospectively divided into two groups: one (n = 15) with normal spermiograms and the other (n = 11) with abnormal spermiograms. The activities (expressed in mU ml(-1)) of alpha-mannosidase, beta-galactosidase and beta-N-acetylglucosaminidase in seminal plasma of normozoospermic infertile patients with varicocele were significantly higher than those of fertile controls, but not when expressed in U per 10(8) spermatozoa. The activities of beta-glucuronidase, alpha-mannosidase, beta-galactosidase and beta-N-acetylglucosaminidase in seminal plasma when expressed in U per 10(8) spermatozoa in varicocele patients with abnormal spermiograms were significantly higher than in those of men of normal fertility. The activity of alpha-mannosidase in the soluble fraction of sperm homogenates, expressed as U per 10(8) spermatozoa, was significantly higher in infertile patients with varicocele and abnormal spermiograms than in controls. In the non-soluble fraction of spermatozoa from infertile patients with varicocele, there was an increase in the expression of beta-galactosidase and beta-N-acetylglucosaminidase activities compared with the fraction of spermatozoa from fertile subjects. In summary, infertile patients with varicocele displayed an overexpression of acid alpha-mannosidase, beta-galactosidase and beta-N-acetylglucosaminidase activities in seminal plasma and spermatozoa that may be associated with functional defects in spermatozoa as these glycosidases play an important role in mammalian fertilization.

Abnormalities in sperm acid glycosidases from infertile men with idiopathic oligoasthenoteratozoospermia

OBJECTIVE

To analyze and compare acid beta-glucuronidase, alpha-mannosidase, alpha-glycosidase, alpha-galactosidase, beta-galactosidase, and beta-N-acetylglucosaminidase activities in fertile and infertile patients.

DESIGN

An observational, controlled, clinical study.

SETTING

A university tertiary hospital.

PATIENT(S)

Thirty-six fertile controls, 24 infertile oligoasthenoteratozoospermic (OAT) patients, and 10 azoospermic patients, who served as negative controls.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Analysis of the six glycosidase activities in seminal plasma and in solubilized spermatozoa.

RESULT(S)

alpha-galactosidase and beta-galactosidase activities in spermatozoa were significantly correlated with the serum levels of gonadotropins both in fertile controls and in OAT patients. The relative contribution of alpha-galactosidase and beta-galactosidase from the soluble fraction of spermatozoa to the total activity measured in the ejaculate of OAT patients was significantly lower than in fertile controls. The activities of beta-galactosidase and beta-N-acetylglucosaminidase in the soluble fraction of spermatozoa from OAT patients were significantly lower than in fertile controls. In seminal plasma, the activity of alpha-mannosidase from OAT patients was significantly higher than in fertile controls. The activity of beta-N-acetylglucosaminidase in the nonsoluble fraction of spermatozoa from OAT patients was three times higher than in fertile controls.

CONCLUSION(S)

The abnormalities in the distributions and contents of alpha-galactosidase, beta-galactosidase, and beta-N-acetylglucosaminidase in sperm suggest possible functional defects in spermatozoa from OAT infertile patients.

Methimazole therapy in Graves' disease influences the abnormal expression of CD69 (early activation antigen) on T cells

At present, the in vivo response of T, B and natural killer (NK) cells to antithyroid drug therapy remains largely unknown. In the present study, we have prospectively analyzed the in vivo effects of methimazole treatment on a large number of circulating T and NK cell subsets, some of them expressing cell surface activation antigens involved in the very early phase of the immune response, in a group of 17 hyperthyroid, untreated patients with Graves' disease (GD). As one of the first events during T cell activation is the expression of interleukin (IL) receptors, we also studied the binding of IL-2 and IL-6 to T cells. Patients with Graves' disease were sequentially studied at diagnosis/before treatment (day 0) and 7, 14, 30, 90 and 180 days after methimazole therapy. The results were compared with both a group of 19 age- and sex-matched control volunteers and a group of 20 untreated/euthyroid patients with Graves' disease in long-term remission. The combination of flow cytometry and three-color immunofluorescence revealed a clear (P < 0.01) decrease in the percentage of NK cells before and during the whole course of therapy with respect to both controls and patients with Graves' disease who were in long-term remission. Before therapy, a marked increase (P < 0.001) in the ratio of B to NK cells was also observed; thereafter, a slight decrease in this ratio was observed, although normal values were detected only in patients in long-term remission. Expression of the CD69 early activation antigen in the hyperthyroid untreated patients with Graves' disease was clearly increased (P < 0.01) with respect to both controls and patients with Graves' disease who were in long-term remission. This abnormal CD69 expression was found to be significantly reduced (P < 0.001) by methimazole therapy, and this represents a new effect of the drug. Expression of the low-affinity receptor for IL-2 (CD25)--another early T cell activation marker--was not altered in Graves' disease, but the binding of IL-2 and IL-6 to T cells exhibited a progressive and parallel increase during the first 30 days of therapy, decreasing thereafter. Our results show that methimazole therapy downregulates the abnormally high expression of the CD69 early activation antigen on T cells, being less effective on inducing changes in other T cell activation markers and in NK cells.

Analysis of IL-2 and IL-6 binding to peripheral blood lymphocytes in Graves disease: relationship with disease activity

Growing evidence points to the involvement of cytokines in the pathogenesis of some autoimmune diseases. To investigate the possible role of interleukin 2 (IL-2) and interleukin 6 (IL-6) on the pathogenesis of Graves disease (GD), the binding of both exogenous IL-2 and IL-6 and the expression of the IL-2 receptor subunit p55 (CD25) were evaluated by flow cytometry in peripheral blood T and B cells from 70 GD patients, in different states of the disease, and from 19 age- and sex-matched healthy volunteers. Serum levels of total T3 and T4, of free T4, and of anti-TSH receptor antibodies were also simultaneously determined. All GD patients displayed significantly increased numbers of B cells bound to IL-2. Hyperthyroid untreated GD patients had significantly higher numbers of T and B cells expressing the IL-2 receptor subunit p55 as compared to euthyroid patients in long-term remission. In addition, serum anti-TSH receptor antibody levels were directly correlated with the absolute numbers of T cells bound to IL-2 (r = 0.565, P < 0.05) and to IL-6 (r = 0.653), P = 0.02) in the hyperthyroid untreated patients, but not in long-term remission euthyroid GD patients or in patients treated with methimazole. The serum levels of total T3 and free T4 were significantly correlated with the absolute numbers of circulating T cells binding IL-2 (r = 0.720, P < 0.01 and r = 0.783, P < 0.002, respectively) as well as with the absolute numbers of circulating T cells binding IL-6 (r = 0.671, P < 0.02 and r = 0.626, P < 0.02, respectively). The serum levels of total T3 were also correlated with both the absolute numbers of B cells binding to IL-2 (r = 0.586, P < 0.05) and to IL-6 (r = 0.757, P < 0.001). These findings suggest that IL-2 and IL-6 may play a role in the pathogenesis of GD.

CD5+ B cells in Graves' disease: correlation with disease activity

In the present paper the distribution of peripheral blood CD5+/CD19+ (CD5+B) and CD5-/CD19+ (CD5-B) B-lymphocytes in Graves' disease (GD) patients is analyzed in order to correlate them with disease activity, interleukin-2 (IL-2) and IL-6 binding to T and B cells as well as with anti-thyrotropin (TSH) receptor antibodies and the thyroid hormone serum levels. The combination of flow cytometry and 3-color immunofluorescence revealed a remarkable increase in the absolute numbers of CD5+ B cells in hyperthyroid-untreated GD patients (218 +/- 137 x 10(6)/l vs. 66 +/- 69 x 10(6)/l in healthy subjects, p < 0.01) that gradually fell to normal values once hyperthyroidism had been controlled by methimazole. However, relative numbers of CD5+ B cells persisted at a relatively stable but increased level in GD patients in long term remission of an average of 3.1 years. This was also confirmed in a follow-up study of a group of 12 newly diagnosed patients during the first 90 days of anti-thyroid drug therapy with methimazole. No correlation was observed between either CD5+ B cells or CD5- B cells and the serum levels of pathogenic anti-TSH receptor antibodies. Increased numbers of CD5+ B cells were related to the increased free thyroxine and total triiodothyronine serum levels. In addition, a strong correlation between both the absolute levels of B cells binding to exogenous IL-2 and IL-6 and the absolute number of CD5+ B cells in hyperthyroid GD patients (LR = 0.798, p < 0.001; LR = 0.569, p < 0.01, respectively) was observed. These results suggest that CD5+ B cells in GD are partly regulated by thyroid hormone serum levels as well as by IL-2 and IL-6 binding to B cells. Nevertheless, they are not involved, at least directly, in the production of anti-TSH receptor antibodies.

The relationship between hyperthyroidism and the distribution of peripheral blood T, NK and B-lymphocytes in multinodular goiter

Peripheral blood T, NK and B-cell subsets were analyzed in 18 patients with nontoxic multinodular goiter (NMG) and 11 patients with toxic multinodular goiter (TMG) in order to evaluate whether hyperthyroidism modifies the distribution of these cell populations. As a control group, 26 age and sex-matched healthy individuals were included in the study. Lymphoid subsets were analyzed with flow cytometry by double staining immunofluorescence techniques using a large panel of monoclonal antibodies. No differences were found in the absolute or relative numbers in any of the cell populations analyzed in both groups--NMG and TMG--, with the exception of a significant decrease in CD19+ cells in TMG. However, patients with multinodular goiter showed important abnormalities in the distribution of T, NK and B lymphocytes with respect to the control subjects. The pattern of abnormalities detected was characterized by a marked increase in the absolute and relative counts of activated T-lymphocytes (CD3+/HLA-DR+), cytotoxic T-cells (CD57+/CD8+) and of cells expressing NK-related antigens. None of these alterations were related to the serum levels of T3, T4 or TSH. Our results point to the existence of important abnormalities in the distribution of several lymphoid subsets in multinodular goiter, regardless of whether the subjects are euthyroid or hyperthyroid.

Immunological features of sporadic multinodular goiter

The origin of sporadic multinodular goiter is still uncertain. To obtain information on a number of unexplored immunological features, the distribution and characterization of T, B, and natural killer lymphocyte subsets were studied in the peripheral blood of 15 patients with multinodular goiter; 8 patients with Graves' disease (for reference purposes with a well-characterized autoimmune disease) and 29 age- and sex-matched healthy controls, combining double-staining immunofluorescence technique with monoclonal antibodies and flow cytometry. Although in both thyroid diseases increased CD3+ HLA-DR+ activated T cells (P < 0.01) were detected, in Graves' disease this was associated with decreased numbers of CD8 cells (P < 0.05) and an increased CD4/CD8 ratio (P < 0.01). These abnormalities were absent in multinodular goiter, which displayed increased CD8+ CD57+ cytotoxic/suppressor cells (P < 0.01). There was an increase in the percentage of natural killer cells expressing CD16 and CD57 antigens in multinodular goiter but not in Graves' disease. The B-cell associated antigens CD19 and CD19+ CD5+ were significantly increased in Graves' disease (P < 0.01), while the multinodular goiter patients exhibited only an increased number of B cells coexpressing the CD5 antigen (CD19+ CD5+), which was unrelated to the titers of anti-microsomal and antithyroglobulin autoantibodies. Our results point to the presence of several abnormalities of peripheral T, B, and natural killer lymphocytes in sporadic multinodular goiter, with a distribution pattern quite different from that observed in Graves' disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective study of the enzymatic activities in urine of N-acetyl-beta-D-glucosaminidase, alpha-D-mannosidase, alpha- and beta-D-glucosidases, alpha-L- and beta-D-fucosidases, and beta-D-galactosidase in type I diabetes mellitus with early nephropathy

Different surveys have been carried out on the plasma activities of different glycosidases in patients with insulin-dependent diabetes mellitus, but research on urinary glycosidases in this disease is scanty and incomplete. To elucidate the behavior of these lysosomal enzymes in the metabolic alterations occurring in the glomerular basal membrane during the initial stages of diabetic nephropathy, we conducted a prospective study to examine the urinary activities of N-acetyl-beta-D-glucosaminidase (NAG), alpha-D-mannosidase, alpha- and beta-D-glucosidase, alpha-L- and beta-D-fucosidase, and beta-D-galactosidase in patients with type I insulin-dependent diabetes mellitus, surveyed over 18 months, whose early diabetic nephropathy was detected by the presence of microalbuminuria. The simultaneous determination of beta 2-microglobulin in urine confirmed the glomerular origin of the albuminuria. No statistically significant correlation was found between the levels of albuminuria and the activities of any of the glycosidases analyzed. In the diabetic patients, a significant decrease was observed in the activities of all the enzymes (p < 0.05), except NAG and alpha-D-mannosidase, although the decrease in the latter was very close to statistical significance (p = 0.028, unilateral; p = 0.057 bilateral). Similarly, in the patients, there was a significant negative correlation (p < 0.05) with the serum levels of fructosamine, except with beta-D-galactosidase, which showed a positive correlation (p < 0.05) with fructosamine and blood HbA1c.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroglobulin gene point mutation associated with non-endemic simple goitre

Simple goitre is defined as an enlargement of the thyroid gland that is not the result of an inflammatory or neoplastic process and is not associated with thyrotoxicosis or myxoedema; the cause is unknown in most cases. Structural or regulatory defects in the proteins involved in thyroid metabolism might be involved in the functional abnormality that brings about the disorder. We have found a mutation within exon 10 of the thyroglobulin gene in 25 of 56 members of three families affected by simple goitre; 14 of the gene carriers had the disorder. DNA sequencing showed a mis-sense mutation within thyroglobulin gene exon 10, resulting in a glutamine to histidine substitution. Thus, some cases of non-endemic simple goitre are associated with a mutation at the thyroglobulin locus.

Increased serum N-acetyl-beta-D-glucosaminidase and alpha-D-mannosidase activities in obese subjects

We have studied N-acetyl-beta-D-glucosaminidase and alpha-D-mannosidase activities in human sera from 35 control subjects, 47 normo- and hyperinsulinemic obese persons, and 12 diabetic patients after a fasting period of 12 h and at 30, 60, 90, and 120 min after an oral glucose overload. The results show a significantly higher activity of these 2 enzymes in obese subjects and diabetic patients, of similar magnitude, especially in those obese persons with a higher grade of obesity. Moreover, the activity of these glycosidases decreases in a similar way in all these 3 groups after the oral glucose overload.

Enzymatic glycosidase activities in experimental obesity

Glycosidases are lysosomal enzymes that participate in the catabolism of glycoproteins and other glycoconjugates, and in some way may modify their activity in situations in which carbohydrate metabolism could be altered, such as the case of obesity. Using a fluorometric assay, a study was made of four glycosidase activities: N-acetyl-beta-D-hexosaminidase (NAG), alpha-mannosidase and alpha- and beta-glucosidase in the serum, pancreas, liver and kidney of 22 Zucker fa/fa genetically obese rats and of 23 fa/? controls, both with ages ranging between 13 and 15 weeks. After 12-14 hours fast and prior anaesthesia with sodium pentobarbital intraperitoneally, blood and the afore-mentioned organs were removed for enzymatic study of the serum and the organs after homogenization and centrifugation. In the serum a statistically significant increase in alpha-mannosidase (p < 0.0001) and alpha-glucosidase (p < 0.02) activities was found in the fa/fa obese rats as compared with the controls. No statistically significant differences were found in serum hexosaminidase activity between the two groups, and no serum beta-glucosidase enzymatic activity was detected. In liver, a decrease was observed in hexosaminidase (p < 0.002) and alpha-glucosidase (p < 0.01) activities in the obese rats as compared with the controls. In whole pancreas an increase was found in alpha-glucosidase activity in the obese rats with respect to the controls (p < 0.001), with no statistically significant differences in the hexosaminidase, alpha-mannosidase and beta-glucosidase activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Enzyme and hormonal markers in the differential diagnosis of human azoospermia

The serum concentrations of FSH, LH, prolactin, testosterone, and estradiol and the enzymatic activities of hyaluronidase, glucosidases (alpha-glucosidase, beta-glucosidase, alpha-mannosidase, N-acetyl-beta-D-glucosaminidase, beta-glucuronidase, and beta-galactosidase), lactate dehydrogenase and its isoenzymes (LDH1, LDH2, LDH3, LDH-X, LDH4), and total proteins were measured in the semen of 69 subjects (8 normozoospermic controls, 7 secretory, and 54 excretory azoospermic subjects). FSH levels rose with the deterioration in spermatogenesis and served to differentiate the secretory from the excretory azoospermias. The only source of hyaluronidase and LDH-X in the ejaculate is the spermatozoa. alpha-Glucosidase activity essentially originates in the epididymis. The seminal determination of alpha-glucosidase and, to a lesser extent, alpha-mannosidase and N-acetyl-beta-D-glucosaminidase helps rapidly, sensitivity, reliably, and noninvasively to differentiate secretory azoospermias (with higher enzymatic activity) from the excretory type (less enzymatic activity) and may be of use in identifying with a certain degree of reliability the site of obstruction in the male genital tract.

A study of thyroglobulin and peroxidase activity in the thyroid tissue of patients with non-endemic non-toxic nodular goitre

1. A study was made of the activity of the enzyme thyroid peroxidase and of the concentration, carbohydrate composition and the degree of iodination of thyroglobulin in the thyroid glands of 60 patients with non-endemic non-toxic goitre in the nodular phase and in those of 25 control subjects. 2. Thyroid peroxidase activity was determined by the guaiacol assay and was significantly higher in patients with non-endemic non-toxic goitre than in control subjects (3.60 +/- 2.51 and 2.07 +/- 1.08 mumol of guaiacol oxidized min-1 g-1 of tissue, respectively; ranges 0.16-10.57 and 0.52-4.85 mumol of guaiacol oxidized min-1 g-1 of tissue, respectively; P less than 0.05). 3. Thyroglobulin was purified by precipitation with ammonium sulphate and Sephadex G-200 gel filtration. Two protein peaks were obtained which were identified as thyroglobulin and measured by radioimmunoassay. The concentration of thyroglobulin in the first peak was 98.94 (SD 84.87, range 0.60-455.54) mg/g of tissue for the patients with non-endemic, non-toxic goitre and 51.41 (SD 28.34, range 14.99-106.39) mg/g of tissue for the control subjects (P less than 0.01). The second peak showed 1.26 (SD 1.27, range 0.09-6.50) mg of thyroglobulin/mg of tissue for the group with non-endemic non-toxic goitre and 0.51 (SD 0.25, range 0.15-0.98 mg of thyroglobulin/mg of tissue) for the control subjects (P less than 0.01). 4. The carbohydrate composition of thyroglobulin was determined by acid hydrolysis and colorimetry, evaluating the levels of hexoses, hexosamines and sialic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Semen characteristics and diabetes mellitus: significance of insulin in male infertility

A study was made of semen quality and serum hormonal profiles (FSH, LH, prolactin, testosterone) of patients with type I diabetes mellitus. Semen parameters and levels of prolactin and testosterone were significantly altered in the diabetic state. The concentration of insulin in serum and seminal plasma and the serum levels of FSH, LH, and testosterone were measured in 80 men classified in the following groups: fertile subjects, infertile normoglycemic subjects, subjects with carbohydrate intolerance, and excretory and secretory azoospermic subjects. In all groups, seminal insulin concentrations were higher than those obtained in serum. The hormone appears to freely cross the blood-testis barrier, there to be concentrated in the semen. The levels of insulin in serum and seminal plasma did not correlate with semen parameters and are not suitable markers of seminal quality. For unknown reasons, the concentrations of insulin in seminal plasma were lower in the subjects suffering from carbohydrate intolerance.

Effects of subclinical hyperthyroidism on renal handling of water and electrolytes in patients with nodular goiter

Evidence is beginning to accumulate that minor degrees of hyperthyroidism lead to adverse effects in various tissues, even though clinically the patients are euthyroid. To determine whether these anomalies in thyroid function have deleterious effects on renal function and electrolyte metabolism, the plasma concentrations of electrolytes, urea, and creatinine, the renal handling of water and sodium, and the urinary excretion of these substances were measured in patients with nodular goiter who were displaying stable subclinical hyperthyroidism. The studies were carried out before and after correcting the thyroid dysfunction. Restoration of euthyroidism did not modify any of the renal function parameters studied and did not cause changes in blood analyte levels. The data show that treatment of minor degrees of hyperthyroidism does not have any effects on renal function and electrolyte metabolism, and confirm the well-known capacity of the kidney to adjust its functions to changes induced by an abnormal secretion of thyroid hormones.

Androgen environment and beta-glucuronidase activity in the human kidney

Basal beta-glucuronidase activity was measured in the cytosol of renal cortex in 10 women and nine men, and its levels were correlated to the concentrations of the main circulating androgens and to the cytoplasmic androgen receptor content. beta-Glucuronidase activity in women was similar to that found in men, despite blood testosterone levels being higher in the latter. The activity of the enzyme does not appear to be related to circulating levels of either testosterone or androstenedione. Only in men the androgen receptor content and dehydroepiandrosterone-sulphate levels were inversely correlated to beta-glucuronidase. In the human kidney cytosol there is no evidence of sexual dimorphism in basal beta-glucuronidase activity; whereas the total testosterone circulating levels do not seem to control the enzyme activity.

Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure

Plasma renin activity, plasma aldosterone levels and renal tubular capacity to excrete hydrogen ions were studied in 13 patients suffering from diabetes mellitus with a creatinine clearance of less than 40 ml/min. The results were compared with those obtained in a control group, in a group of nondiabetic subjects with chronic renal failure (CRF) and in a group of diabetic patients without CRF. Twelve of the thirteen diabetic patients with CRF had data characteristic of hyporeninemic hypoaldosteronism associated with type IV renal tubular acidosis. On comparing the results with those of the other two groups of patients, it was observed that the manifestations of the latter two groups considered separately were different from those of the problem group, although in the diabetic patients with normal glomerular filtration rate (GFR) hyporeninism but not hypoaldosteronism was present accompanied by a lower net acid excretion (p less than 0.001) due to a lower excretion of NH4 (p less than 0.05) and titratable acid (p less than 0.001) when the patients were challenged with an NH4Cl overload. We believe that a conjunction of diabetes and renal failure is necessary for the diabetic patients with a decrease in GFR to show hyporeninemic hypoaldosteronism and type IV tubular acidosis.

Cytoplasmic creatine kinase in normal and pathological human kidney tissue

Cytoplasmic creatine kinase (CK) activity was measured in 39 renal cortex samples from various kidney diseases. The highest CK values were observed in normal tissues (507 +/- 71). The mean values of CK enzymatic activity in the other groups decreased in the following order: chronic pyelonephritis (273 +/- 98), hydronephrosis (233 +/- 102), renal tuberculosis (133 +/- 34), pyonephrosis (96 +/- 46), and hypernephroma (45 +/- 33). The decrease in CK activity in kidney tissue paralleled tissue damage, and affects cellular functionality in relation with the processes that use adenosine 5'-triphosphate, such as the ionic pumps.

Androgen receptor content in cytosol from non-tumoral human kidney and its relation to steroid hormone environment

The content of cytoplasmic androgen receptors (Bmax) was analyzed in non-tumoral renal tissue of 12 men and 15 postmenopausal women using a synthetic androgen (methyltrienolone) as ligand and a method of dextran-coated charcoal. The Bmax in both sexes was compared, establishing correlations between it and circulating levels of testosterone, dehydroepiandrosterone sulfate, androstenedione, and estradiol to find out the possible influence of the hormonal environment on androgen receptors in the human kidney. No differences in Bmax were observed between males (46.3 +/- 24 fmol/g of tissue) and females (45.4 +/- 26 fmol/g), in spite of the significantly greater (p less than 0.01) levels of circulating testosterone in the former group. No significant linear correlations existed between any of the steroids analyzed and the Bmax. These results demonstrate the existence of androgenic receptors in non-tumoral human kidney and indicate that its content is not regulated by circulating levels of testosterone. The concentrations of the principal extratesticular androgens and estradiol do not seem to have a quantitative influence on these androphilic proteins either.

Serum glycosidases in diabetes mellitus in relation to the retinopathy and to the length of the disease

The following glycosidase activities in sera have been studied: alpha-D-mannosidase, beta-D-glucuronidase, N-acetyl-beta-D-galactosaminidase, alpha-D-galactosidase, beta-D-galactosidase, alpha-D-glucosidase, beta-D-glucosidase and beta-D-fucosidase, in diabetic patients in relation to the presence of microangiopathy, evident by retinopathy, and to the length of the disease. A significant increase of all the enzyme activities, except for alpha-D-galactosidase was found. These elevations were independent of the development of retinopathy and the duration of the diabetic process.

Hormone levels in serum and seminal plasma of men with different types of azoospermia

Hormone concentrations in the serum and seminal plasma of 15 normozoospermic, 17 excretory azoospermic and 14 secretory azoospermic men were measured. The results indicate that: (a) serum FSH and LH levels are markedly elevated in secretory azoospermia, as compared with excretory azoospermia and normozoospermia; (b) serum 17 alpha-hydroxyprogesterone levels are somewhat raised in secretory azoospermia as compared with excretory azoospermia and normozoospermia; (c) serum testosterone levels are lower in both types of azoospermia with respect to normozoospermia; (d) in secretory azoospermia the oestradiol serum levels are relatively high and dihydrotestosterone serum levels relatively low, whereas the serum levels of these hormones in excretory azoospermia are similar to those in normozoospermic men; (e) in the seminal plasma of azoospermic patients the levels of prolactin, progesterone, testosterone, dihydrotestosterone and oestradiol were depressed, but only dihydrotestosterone levels could be of value in differentiating types of azoospermia because they are lower in secretory azoospermia. We suggest that the measurement of FSH, LH, 17 alpha-hydroxyprogesterone, dihydrotestosterone and oestradiol in serum and dihydrotestosterone in seminal plasma may be used in the differential diagnosis between secretory and excretory azoospermia when invasive tests are unavailable.

N-acetyl beta-D-glucosaminidase and alpha-L-fucosidase activities in relation to glycosylated hemoglobin levels and to retinopathy in diabetes

N-Acetyl beta-D-glucosaminidase and alpha-L-fucosidase were determined in human sera from 25 control subjects, in 23 diabetic patients without retinopathy and in 22 diabetic patients with retinopathy. The results show significantly higher N-acetyl beta-D-glucosaminidase activity in diabetic patients independently of the development of retinopathy and also independently of the length of diabetes. No correlation was found between either serum enzymes and serum glucose concentration and glycosylated hemoglobin (HbA1).

LSH-X and HBDH/LDH ratio in human semen

The enzymatic activities of lactate dehydrogenase (LDH) and alpha-hydroxybutyrate dehdyrogenase (HBDH) were measured in 87 semen samples. The highest values of these enzymes correspond to the specimens with greatest sperm density and motility. There was a positive correlation between the enzymatic parameters and sperm density and motility. There was a positive correlation between the HBDH/LDH ratio and the percent LDH-X. The estimation of the HBDH/LDH ratio, easily and rapidly done, can be a substitute for direct LDH-X estimations. The HBDH/LDH ratio greater than 1.0 that was noted in men with good sperm motility and normal sperm counts, could represent a reliable index of semen quality.

Seminal plasma creatine kinase activity in fertility studies

Creatine kinase activity was measured in the seminal fluid of 70 males undergoing fertility studies. The average value obtained at 30 degrees C was 333 +/- 197 IU/l (average +/- SD). There was no evidence of a significant correlation between creatine kinase enzymatic activity and density, active lineal motility, or number of normal motile spermatozoa; nor was there any correlation seen between creatine kinase activity and concentration of citric acid, (indicator of prostatic function) or fructose, (indicator of seminal vesicle function). Nonetheless, in two cases of excretory azoospermia, very high values of creatine kinase (2510 and 1280 IU/l) and citric acid levels (4000 and 3000 mg/dl) were observed. These would indicate that the origin of creatine kinase is fundamentally prostatic, in contradiction to previous studies by other authors. In this sense, creatine kinase would be a parameter of prostatic function in studies of male fertility. In two cases of secretory azoospermia due to cryptorchidism and in several very severe oligoasthenozoospermias, low creatine kinase levels were seen, while fructose and citric acid levels were normal. This would give relative value to creatine kinase as an indicator of spermatogenesis.

Pharmacokinetics of naproxen in healthy volunteers and in patients with diabetic microangiopathy

The pharmacokinetics of Naproxen administered as a single oral dose of 250 mg, have been determined in 7 healthy volunteers and 9 patients who had been diagnosed as suffering from diabetes mellitus with varying degrees of angiopathy. A two-compartment model was used to describe the biphasic decline in serum concentrations and to calculate the amount of drug in the central and peripheral compartments. In healthy volunteers the following values were obtained for various pharmacokinetic parameters: tmax = 2 hr; Cmax = 52.63 micrograms/ml; Ka = 1.893 hr-1; alpha = 0.393 hr-1; beta = 0.049 hr-1; K12 = 0.147 hr-1; K21 = 0.198 hr-1; K13 = 0.097 hr-1. In patients with severe diabetic microangiopathy, a decrease may be seen in the fraction of the dose absorbed shown by a decrease in the Cmax and the (AUC) 0--8 hr. The glomerular impairment of some patients leads to a decrease in the elimination constant.

Is "T4 toxicosis" a normal biochemical finding in elderly women?

The lack of equivalence in the distrubtion of normal ranges for free thyroxine index (FT4I) and free triiodothyronine index (FT3I) in the over sixty-five age-group, as compared with the fifteen-sixty-five age-group, supports the idea that "T4 toxicosis" is a common biochemical finding in elderly women. The disparity between FT4I and FT3I ranges was also reflected in the true free T4 and free T3 levels which were measured in some cases. These results suggest that when an increased FT4I is found in an elderly woman with cardiac disease, caution should be exercised in interpreting the result as indicating that thyrotoxicosis is the cause of the cardiac disorder. Estimation of total T3, FT3I, or free T3 seems useful in confirming euthyroidism in such cases.