The dipeptidyl peptidase-4 inhibitor vildagliptin has the capacity to repair β-cell dysfunction and insulin resistance

The aim of the present study was to determine whether the dipeptidyl peptidase (DPP)-4 inhibitor could repair pancreatic β-cell dysfunction and insulin resistance. Ten subjects with type 2 diabetes who had never received DPP-4 inhibitor treatment were enrolled in the study. Just before and 3 months after twice-daily administration of vildagliptin (50 mg tablets), insulin secretion and insulin sensitivity were estimated using 2-compartment model analysis of C-peptide kinetics and insulin-modified minimal model parameters, respectively. The first-phase insulin secretion (CS1) was determined as the sum of the C-peptide secretion rate (CSR) from 0 to 5 min (normal range 6.8-18.5 ng/ml/min). The whole-body insulin sensitivity index (SI) was calculated using a minimal model software program (normal range 2.6-7.6×10(-4)/min/μU/ml). After vildagliptin treatment, reductions in mean (± SE) HbA1c were noted (43.28±1.53 vs. 40.98±1.77 mmol/mol; p=0.019). Vildagliptin treatment increased the area under the curve for the C peptide reactivity (CPR) (AUCCPR; 26.66±5.15 vs. 33.02±6.12 ng/ml · 20 min; p=0.003) and CS1 (0.80±0.20 vs. 1.35±0.38 ng/ml/min; p=0.037) in response to an intravenous glucose load. -Vildagliptin treatment significantly increased SI (0.46±0.27 vs. 1.21±0.48×10(-4)/min/μU/ml; p=0.037). The long-term administration of vildagliptin improved CS1 and Si suggesting that this drug has the capacity to repair impairments in pancreatic β-cell function and insulin resistance in type 2 diabetes.

The outcome of Japanese anorexia nervosa patients treated with an inpatient therapy in an internal medicine unit

OBJECTIVE

To investigate the outcome of Japanese anorexia nervosa (AN) patients who were treated with the standard Japanese inpatient therapy.

METHOD

Of the 88 female AN patients treated with our inpatient therapy between January 1997 and December 2002, 67 (76.1%) who agreed to cooperate in this study were assessed by the Global Clinical Score (GCS) at admission and follow-up, 6.3±1.8 years after discharge. Their clinical characteristics at admission and discharge were also examined.

RESULTS

Four (6.0%) patients had died before follow-up. BMI was significantly increased during inpatient therapy. At follow-up, excellent, much improved, symptomatic, and poor outcomes on GCS were 57.1%, 14.3%, 14.3% and 14.3%, respectively. Younger age at admission and larger BMI at discharge were significantly associated with a better outcome.

DISCUSSION

This study shows the potential for the use of this method for the treatment of AN patients in countries without specialized eating disorder units.

Specific immune response to the 40-kDa outer-membrane protein of Porphyromonas gingivalis in mice

Whether B-cell activation to Porphyromonas gingivalis in periodontal diseases is the consequence of a specific immune response or is due to non-specific polyclonal activation is still not clear. Here the immune response of mice to a purified 40-kDa recombinant protein antigen, a major outer-membrane protein specific to P. gingivalis, was investigated. Patients' sera strongly reacted to this recombinant antigen. Purified splenic T and B cells from mice immunized with 40-kDa antigen or from normal mice were reconstituted in vitro and cultured in the presence or absence of the P. gingivalis 40-kDa protein antigen and antigen-presenting cells (APCs). In vitro antibody production to this particular antigen was analysed with respect to the requirement of helper T cells and APCs by enzyme-linked immunosorbent assay. The results clearly showed that an effective secondary response required the presence of B cells, T cells and APCs. In the absence of CD4+ helper T cells, an antibody response to the 40-kDa protein was not observed. In addition, the requirement of H-2 restricted, Ia-positive APCs was evident for an adequate response to the 40-kDa protein of P. gingivalis. Thus the antibody response to the 40-kDa protein of P. gingivalis was generated in an immunologically antigen-specific manner and was not simply the result of polyclonal B-cell activation. This in vitro system could be used in the detection of antigen-specific memory B or T cells in patients with periodontal diseases.