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Stroek K, Ruiter A, van der Linde A, Ackermans M, Bouva MJ, Engel H, Jakobs B, Kemper EA, van den Akker ELT, van Albada ME, Bocca G, Finken MJJ, Hannema SE, Mieke Houdijk ECA, van der Kamp HJ, van Tellingen V, Paul van Trotsenburg AS, Zwaveling-Soonawala N, Bosch AM, de Jonge R, Heijboer AC, Claahsen-van der Grinten HL, Boelen A. Second-tier Testing for 21-Hydroxylase Deficiency in the Netherlands: A Newborn Screening Pilot Study. J Clin Endocrinol Metab 2021; 106:e4487-e4496. [PMID: 34171085 DOI: 10.1210/clinem/dgab464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Newborn screening (NBS) for classic congenital adrenal hyperplasia (CAH) consists of 17-hydroxyprogesterone (17-OHP) measurement with gestational age-adjusted cutoffs. A second heel puncture (HP) is performed in newborns with inconclusive results to reduce false positives. OBJECTIVE We assessed the accuracy and turnaround time of the current CAH NBS algorithm in comparison with alternative algorithms by performing a second-tier 21-deoxycortisol (21-DF) pilot study. METHODS Dried blood spots (DBS) of newborns with inconclusive and positive 17-OHP (immunoassay) first HP results were sent from regional NBS laboratories to the Amsterdam UMC Endocrine Laboratory. In 2017-2019, 21-DF concentrations were analyzed by LC-MS/MS in parallel with routine NBS. Diagnoses were confirmed by mutation analysis. RESULTS A total of 328 DBS were analyzed; 37 newborns had confirmed classic CAH, 33 were false-positive and 258 were categorized as negative in the second HP following the current algorithm. With second-tier testing, all 37 confirmed CAH had elevated 21-DF, while all 33 false positives and 253/258 second-HP negatives had undetectable 21-DF. The elevated 21-DF of the other 5 newborns may be NBS false negatives or second-tier false positives. Adding the second-tier results to inconclusive first HPs reduced the number of false positives to 11 and prevented all 286 second HPs. Adding the second tier to both positive and inconclusive first HPs eliminated all false positives but delayed referral for 31 CAH patients (1-4 days). CONCLUSION Application of the second-tier 21-DF measurement to inconclusive first HPs improved our CAH NBS by reducing false positives, abolishing the second HP, and thereby shortening referral time.
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Affiliation(s)
- Kevin Stroek
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - An Ruiter
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Annelieke van der Linde
- Department of Pediatric Endocrinology, Radboud University Nijmegen Medical Centre, 6525GA Nijmegen, The Netherlands
- Department of Pediatrics, Amphia Hospital, 4818CK Breda, The Netherlands
| | - Mariette Ackermans
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Marelle J Bouva
- Center for Health protection, National Institute for Public Health and the Environment, 3721MA Bilthoven, The Netherlands
| | - Henk Engel
- Department of Clinical Chemistry, Isala Hospital, 8025AB Zwolle, The Netherlands
| | - Bernadette Jakobs
- Department of Clinical Chemistry, Elisabeth-Tweesteden Hospital, 5022GC Tilburg, The Netherlands
| | - Evelien A Kemper
- Department of Clinical Chemistry, IJsselland Hospital, 2906ZC Capelle aan den IJssel, The Netherlands
| | - Erica L T van den Akker
- Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, 3015CN Rotterdam, The Netherlands
| | - Mirjam E van Albada
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, 9713GZ Groningen, The Netherlands
| | - Gianni Bocca
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, 9713GZ Groningen, The Netherlands
| | - Martijn J J Finken
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, Vrije Universiteit, 1105AZ Amsterdam, The Netherlands
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, Vrije Universiteit, 1105AZ Amsterdam, The Netherlands
| | - E C A Mieke Houdijk
- Department of Pediatrics, Juliana Children's Hospital, 2545AA the Hague, The Netherlands
| | - Hetty J van der Kamp
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584EA Utrecht, The Netherlands
| | - Vera van Tellingen
- Department of Pediatrics, Catharina Hospital, 5623EJ Eindhoven, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Nitash Zwaveling-Soonawala
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Annet M Bosch
- Department of Pediatrics, Division of Metabolic Disorders, Emma Children's Hospital, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit & University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Annemieke C Heijboer
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, Vrije Universiteit, 1105AZ Amsterdam, The Netherlands
| | | | - Anita Boelen
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
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de Groot P, Scheithauer T, Bakker GJ, Prodan A, Levin E, Khan MT, Herrema H, Ackermans M, Serlie MJM, de Brauw M, Levels JHM, Sales A, Gerdes VE, Ståhlman M, Schimmel AWM, Dallinga-Thie G, Bergman JJGHM, Holleman F, Hoekstra JBL, Groen A, Bäckhed F, Nieuwdorp M. Donor metabolic characteristics drive effects of faecal microbiota transplantation on recipient insulin sensitivity, energy expenditure and intestinal transit time. Gut 2020; 69:502-512. [PMID: 31147381 PMCID: PMC7034343 DOI: 10.1136/gutjnl-2019-318320] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Bariatric surgery improves glucose metabolism. Recent data suggest that faecal microbiota transplantation (FMT) using faeces from postbariatric surgery diet-induced obese mice in germ-free mice improves glucose metabolism and intestinal homeostasis. We here investigated whether allogenic FMT using faeces from post-Roux-en-Y gastric bypass donors (RYGB-D) compared with using faeces from metabolic syndrome donors (METS-D) has short-term effects on glucose metabolism, intestinal transit time and adipose tissue inflammation in treatment-naïve, obese, insulin-resistant male subjects. DESIGN Subjects with metabolic syndrome (n=22) received allogenic FMT either from RYGB-D or METS-D. Hepatic and peripheral insulin sensitivity as well as lipolysis were measured at baseline and 2 weeks after FMT by hyperinsulinaemic euglycaemic stable isotope (2H2-glucose and 2H5-glycerol) clamp. Secondary outcome parameters were changes in resting energy expenditure, intestinal transit time, faecal short-chain fatty acids (SCFA) and bile acids, and inflammatory markers in subcutaneous adipose tissue related to intestinal microbiota composition. Faecal SCFA, bile acids, glycaemic control and inflammatory parameters were also evaluated at 8 weeks. RESULTS We observed a significant decrease in insulin sensitivity 2 weeks after allogenic METS-D FMT (median rate of glucose disappearance: from 40.6 to 34.0 µmol/kg/min; p<0.01). Moreover, a trend (p=0.052) towards faster intestinal transit time following RYGB-D FMT was seen. Finally, we observed changes in faecal bile acids (increased lithocholic, deoxycholic and (iso)lithocholic acid after METS-D FMT), inflammatory markers (decreased adipose tissue chemokine ligand 2 (CCL2) gene expression and plasma CCL2 after RYGB-D FMT) and changes in several intestinal microbiota taxa. CONCLUSION Allogenic FMT using METS-D decreases insulin sensitivity in metabolic syndrome recipients when compared with using post-RYGB-D. Further research is needed to delineate the role of donor characteristics in FMT efficacy in human insulin-resistant subjects. TRIAL REGISTRATION NUMBER NTR4327.
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Affiliation(s)
- Pieter de Groot
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Torsten Scheithauer
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Guido J Bakker
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Andrei Prodan
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Evgeni Levin
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Muhammad Tanweer Khan
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborgs Universitet, Gothenburg, Sweden
| | - Hilde Herrema
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Mariette Ackermans
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Mireille J M Serlie
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Maurits de Brauw
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Johannes H M Levels
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Amber Sales
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Victor E Gerdes
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Marcus Ståhlman
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborgs Universitet, Gothenburg, Sweden
| | - Alinda W M Schimmel
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Geesje Dallinga-Thie
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Jacques JGHM Bergman
- Department of Gastroenterology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Frits Holleman
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Joost B L Hoekstra
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Albert Groen
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Fredrik Bäckhed
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborgs Universitet, Gothenburg, Sweden
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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van der Valk F, Hassing C, Visser M, Thakkar P, Mohanan A, Pathak K, Dutt C, Chauthaiwale V, Ackermans M, Nederveen A, Serlie M, Nieuwdorp M, Stroes E. The effect of a diiodothyronine mimetic on insulin sensitivity in male cardiometabolic patients: a double-blind randomized controlled trial. PLoS One 2014; 9:e86890. [PMID: 24586256 PMCID: PMC3931609 DOI: 10.1371/journal.pone.0086890] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 12/13/2013] [Indexed: 01/22/2023] Open
Abstract
Background and aims Obesity and its associated cardiometabolic co-morbidities are increasing worldwide. Since thyroid hormone mimetics are capable of uncoupling the beneficial metabolic effects of thyroid hormones from their deleterious effects on heart, bone and muscle, this class of drug is considered as adjacent therapeutics to weight-lowering strategies. This study investigated the safety and efficacy of TRC150094, a thyroid hormone mimetic. Materials and Methods This 4-week, randomized, placebo-controlled, double-blind trial was conducted in India and The Netherlands. Forty subjects were randomized at a 1∶1 ratio to receive either TRC150094 dosed at 50 mg or placebo once daily for 4 weeks. Hyperinsulinemic euglycemic clamp and 1H-Magnetic Resonance Spectroscopy (MRS) were performed before and after treatment. Results At baseline, subjects were characterized by markedly impaired hepatic and peripheral insulin sensitivity. TRC150094 dosed 50 mg once daily was safe and well tolerated. Hepatic nor peripheral insulin sensitivity improved after TRC150094 treatment, expressed as the suppression of Endogenous Glucose Production from 59.5 to 62.1%; p = 0.477, and the rate of glucose disappearance from 28.8 to 26.4 µmol kg−1min−1, p = 0.185. TRC150094 administration did not result in differences in fasting plasma free fatty acids from 0.51 to 0.51 mmol/L, p = 0.887 or in insulin-mediated suppression of lipolysis from 57 to 54%, p = 0.102. Also, intrahepatic triglyceride content was unaltered. Conclusion Collectively, these data show that, in contrast to the potent metabolic effects in experimental models, TRC150094 at a dose of 50 mg daily does not improve the metabolic homeostasis in subjects at an increased cardiometabolic risk. Further studies are needed to evaluate whether TRC150094 has beneficial effects in patients with more severe metabolic derangement, such as overt diabetes mellitus and hypertriglyceridemia. Trial Registration clinicaltrials.gov NCT01408667
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Affiliation(s)
- Fleur van der Valk
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Carlijne Hassing
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Maartje Visser
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Purav Thakkar
- Clinical Research Department, Torrent Pharmaceuticals Limited, Village-Bhat, Dist. Gandhinagar, India
| | - Anookh Mohanan
- Clinical Research Department, Torrent Pharmaceuticals Limited, Village-Bhat, Dist. Gandhinagar, India
| | - Kaushal Pathak
- Clinical Research Department, Torrent Pharmaceuticals Limited, Village-Bhat, Dist. Gandhinagar, India
| | - Chaitanya Dutt
- Clinical Research Department, Torrent Pharmaceuticals Limited, Village-Bhat, Dist. Gandhinagar, India
| | - Vijay Chauthaiwale
- Clinical Research Department, Torrent Pharmaceuticals Limited, Village-Bhat, Dist. Gandhinagar, India
| | - Mariette Ackermans
- Department of Clinical Chemistry, Laboratory of Endocrinology, Academic Medical Center, Amsterdam, the Netherlands
| | - Aart Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mireille Serlie
- Department of Endocrinology, Academic Medical Center, Amsterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Erik Stroes
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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Vrisekoop N, Den Braber I, Mugwagwa T, Westera L, Mogling R, De Boer AB, Willems N, Schrijver E, Spierenburg G, Gaiser K, Mul E, Otto S, Ruiter A, Ackermans M, Miedema F, Borghans J, De Boer R, Tesselaar K. Maintenance of peripheral naive T cells: a mouse-man divide (159.1). The Journal of Immunology 2011. [DOI: 10.4049/jimmunol.186.supp.159.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Insights from T-cell dynamic studies in mice are widely extrapolated to men and vice versa, while no formal proof exists that such extrapolations are justified. At the same time, there is a lot of controversy about the dynamic properties of T cells, including life span and the relative contributions of thymus output and peripheral proliferation to the maintenance of the naive T-cell pool during aging. We have investigated the hypothesis that part of this controversy is due to improper extrapolation of dynamic parameters of T cells from mice to men. By combining in vivo kinetic labeling using deuterated water, thymectomy experiments, analysis of TRECs, the expression of the thymic proximity marker CD31, and mathematical modeling, we have quantified the contributions of de novo T-cell production by the thymus and peripheral naive T-cell division to life-long maintenance of the naive T-cell pool in both mice and men under normal physiological conditions. Our results show that mice and men are incomparable with respect to naive T-cell maintenance. While in mice - throughout their life time - the naive T-cell pool is almost exclusively sustained by thymus output, the maintenance of the adult human naive T-cell pool occurs almost exclusively through peripheral T-cell division. These findings put serious constraints on the use of mouse experiments to understand immunological processes such as T-cell reconstitution in lymphopenic patients or the effects of aging in healthy humans.
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Affiliation(s)
| | | | | | - Liset Westera
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | - Ramona Mogling
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | | | - Koos Gaiser
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | - Erik Mul
- 3Sanquin Research, Landsteiner Lab and Academic Medical Center, Amsterdam, Netherlands
| | - Sigrid Otto
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | - An Ruiter
- 4Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mariette Ackermans
- 4Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Frank Miedema
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | - Jose Borghans
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Kiki Tesselaar
- 1University Medical Center Utrecht, Utrecht, Netherlands
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Blümer RME, van der Valk M, Ackermans M, Endert E, Serlie MJ, Reiss P, Sauerwein HP. A rosiglitazone-induced increase in adiponectin does not improve glucose metabolism in HIV-infected patients with overt lipoatrophy. Am J Physiol Endocrinol Metab 2009; 297:E1097-104. [PMID: 19690066 DOI: 10.1152/ajpendo.90988.2008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
HIV-infected patients on antiretroviral therapy frequently develop changes in body fat distribution and disturbances in glucose metabolism, associated with reduced adiponectin levels. Because adiponectin, principally the high-molecular-weight (HMW) form, has insulin-sensitizing properties, we investigated the effects of an increase in adiponectin on glucose metabolism in HIV-lipodystrophy. In this randomized, double-blind, placebo-controlled trial, we included HIV-1-infected patients with severe lipoatrophy, with an undetectable viral load and who had received neither protease inhibitors nor stavudine for ≥6 mo. Patients were randomized to rosiglitazone [8 mg daily (n = 8)] to increase adiponectin levels or placebo (n = 5) for 16 wk. Peripheral glucose disposal, glucose production, and lipolysis were measured after an overnight fast and during a hyperinsulinemic-euglycemic clamp using stable isotopes. Body composition was assessed by computed tomography and dual-energy X-ray absorptiometry. Although body fat distribution was unaffected, rosiglitazone increased total plasma adiponectin levels by 107% (P < 0.02) and the ratio of HMW to total adiponectin by 73% (P < 0.001). In the placebo group, neither total adiponectin levels (P = 0.62) nor the ratio of HMW to total adiponectin changed (P = 0.94). The marked increase in adiponectin induced by rosiglitazone was not associated with significant changes in basal endogenous glucose production (P = 0.90), basal lipolysis (P = 0.90), insulin-mediated suppression of glucose production (P = 0.17) and lipolysis (P = 0.54) nor with changes in peripheral glucose disposal (P = 0.13). Acknowledging the limited statistical power of our small study, these findings, if confirmed by larger studies, could question the importance of adiponectin in regulating glucose metabolism in HIV-lipodystrophy.
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Affiliation(s)
- Regje M E Blümer
- Dept. of Endocrinology and Metabolism, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Birjmohun RS, Bisoendial RJ, van Leuven SI, Ackermans M, Zwinderman A, Kastelein JJP, Stroes ESG, Sauerwein HP. A single bolus infusion of C-reactive protein increases gluconeogenesis and plasma glucose concentration in humans. Metabolism 2007; 56:1576-82. [PMID: 17950110 DOI: 10.1016/j.metabol.2007.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 06/11/2007] [Indexed: 10/22/2022]
Abstract
Recently, we reported that C-reactive protein (CRP) elicits inflammatory and procoagulant responses in humans. In addition, CRP has been associated with the development of type 2 diabetes mellitus. To further explore interactions between CRP and glucose handling, we evaluated the effects of CRP infusion on glucose metabolism in humans. Seven healthy white male volunteers (age, 39.3 +/- 16.9 years) received a single bolus infusion of 1.25 mg/kg purified recombinant human (rh) CRP or CRP-free diluent in a crossover design. C-reactive protein infusion induced an inflammatory response, which was followed by increased plasma concentrations of norepinephrine (3 hours) and cortisol (4 hours). Concomitantly, plasma concentrations of insulin and C-peptide decreased transiently. These metabolic changes increased plasma glucose concentrations from 8 hours after CRP infusion, which was preceded by an increased rate of glucose appearance that was a direct consequence of increased gluconeogenesis. In conclusion, CRP infusion induces an inflammatory response followed by increased norepinephrine and cortisol levels, which results in increased gluconeogenesis. This finding implies that elevated levels of CRP in humans may in fact contribute to altered glucose metabolism and thereby may contribute to the induction of type 2 diabetes mellitus.
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Affiliation(s)
- Rakesh S Birjmohun
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Koopmans SJ, Mroz Z, Dekker R, Corbijn H, Ackermans M, Sauerwein H. Association of insulin resistance with hyperglycemia in streptozotocin-diabetic pigs: effects of metformin at isoenergetic feeding in a type 2-like diabetic pig model. Metabolism 2006; 55:960-71. [PMID: 16784971 DOI: 10.1016/j.metabol.2006.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 03/17/2006] [Indexed: 10/24/2022]
Abstract
Insulin-mediated glucose metabolism was investigated in streptozotocin (STZ)-treated diabetic pigs to explore if the STZ-diabetic pig can be a suitable model for insulin-resistant, type 2 diabetes mellitus. Pigs (approximately 40 kg) were meal-fed with a low-fat (5%) diet. Hyperinsulinemic (1, 2, and 8 mU kg(-1) min(-1)) clamps and/or 6,6-(2)H-glucose infusion studies were performed in 36 pigs. Diabetic (slow, 30-minute infusion of 130 mg STZ/kg) vs normal pigs were nonketotic, showed fasting hyperglycemia (21.7 +/- 1.1 vs 5.3 +/- 0.2 mmol/L), comparable plasma insulin (9 +/- 7 vs 5 +/- 1 mU/L), and elevated triglyceride concentrations (1.0 +/- 0.3 vs 0.2 +/- 0.1 mmol/L). After a standard meal, plasma triglycerides, cholesterol, and nonesterified fatty acid concentrations were significantly higher in diabetic vs normal pigs (1.2 +/- 0.3 vs 0.3 +/- 0.1, 2.3 +/- 0.2 vs 1.7 +/- 0.1, and 1.5 +/- 0.5 vs 0.2 +/- 0.1 mmol/L, respectively, P < .05). Fasting whole-body glucose uptake, hepatic glucose production, and urinary glucose excretion were increased (P < .01) in diabetic vs normal pigs (9.1 +/- 0.6 vs 4.8 +/- 0.4, 11.4 +/- 0.6 vs 4.8 +/- 0.4, and 2.3 +/- 0.2 vs 0.0 +/- 0.0 mg kg(-1) min(-1)). During hyperinsulinemic euglycemia (approximately 6 mmol/L), whole-body glucose uptake was severely reduced (P < .01) and hepatic glucose production was moderately increased (P < .05) in diabetic vs normal pigs (6.7 +/- 1.3 vs 21.1 +/- 2.2 and 1.7 +/- 0.5 vs 0.8 +/- 0.3 mg kg(-1) min(-1)) despite plasma insulin concentrations of 45 +/- 5 vs 24 +/- 5 mU/L, respectively. Metformin vs placebo treatment of diabetic pigs (twice 1.5 g/d) for 2 weeks during isoenergetic feeding (1045 kJ/kg body weight(0.75)) resulted in a reduction in both fasting and postprandial hyperglycemia (14.7 +/- 1.5 vs 19.4 +/- 0.6 and 24.9 +/- 2.2 vs 35.5 +/- 4.9 mmol/L), a reduction in daily urinary glucose excretion (approximately 250 vs approximately 350 g/kg food), and an increase in insulin-stimulated glucose disposal (9.4 +/- 2.2 vs 5.8 +/- 1.7 mg kg(-1) min(-1); P < .05), respectively. In conclusion, a slow infusion of STZ (130 mg/kg) in pigs on a low-fat diet induces the characteristic metabolic abnormalities of type 2 diabetes mellitus and its sensitivity to oral metformin therapy. It is therefore a suitable humanoid animal model for studying different aspects of metabolic changes in type 2 diabetes mellitus. Insulin resistance in STZ-diabetic pigs is most likely secondary to hyperglycemia and/or hyperlipidemia and therefore of metabolic origin.
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Affiliation(s)
- Sietse Jan Koopmans
- Department of Nutrition and Food, Animal Sciences Group, Wageningen UR., P.O. Box 65, 8200 AB Lelystad, The Netherlands.
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Heijligenberg R, Romijn JA, Ackermans M, Endert E, Timmer JG, Sauerwein HP. The maximal tolerable intravenous dosage of pentoxifylline in AIDS patients does not inhibit lipopolysaccharide-stimulated tumor necrosis factor alpha production. AIDS Res Hum Retroviruses 1998; 14:299-303. [PMID: 9519890 DOI: 10.1089/aid.1998.14.299] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Tumor necrosis factor alpha (TNF-alpha) may be involved in the pathogenesis of metabolic and endocrine changes in HIV infection. Pentoxifylline (PTX) is able to suppress the production of TNF-alpha in vitro. The effect of two dosages of intravenously administered PTX on clinical symptoms and ex vivo LPS-stimulated TNF-alpha production was evaluated in six clinically stable AIDS patients in a saline-controlled study. PTX in a dosage of 1.5 mg/min was tolerated without side effects. PTX in a dosage of 2.1 mg/min resulted in intolerable nausea and necessitated termination of infusion after 30 min. The average plasma concentration of PTX after infusion of 1.5 mg/min for 6 hr was 510+/-56 ng/ml, which is considerably below the concentrations that have been reported to suppress TNF-alpha production in vitro. No effect of PTX infusion (1.5 mg/min) on LPS-stimulated TNF production ex vivo was found. Our conclusion is that the maximally tolerated i.v. dosage of PTX in AIDS patients is 1.5 mg/min. LPS-stimulated ex vivo TNF-alpha production, at the LPS concentrations tested, was not inhibited by the plasma concentration of PTX that could be achieved at this dosage.
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Affiliation(s)
- R Heijligenberg
- Department of Endocrinology and Metabolism, Academic Hospital of Amsterdam University, The Netherlands
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Heikens J, Fliers E, Endert E, Ackermans M, van Montfrans G. Liquorice-induced hypertension--a new understanding of an old disease: case report and brief review. Neth J Med 1995; 47:230-4. [PMID: 8544895 DOI: 10.1016/0300-2977(95)00015-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The case is described of a 40-year-old female with severe hypertension and hypokalaemic metabolic alkalosis, due to prolonged liquorice ingestion. The pseudo-aldosterone-like effects of liquorice have always been attributed to glycyrrhizic acid, but its biochemical substrate has remained elusive. It is now known that glycyrrhetenic acid, the hydrolytic metabolite of glycerrhizic acid, is the active component of liquorice which causes inhibition of the peripheral metabolism of cortisol. Cortisol binds with the same affinity as aldosterone to the mineralocorticoid receptor resulting in a hypermineralocorticoid condition. Ingestion of liquorice may therefore result in retention of sodium and water, hypertension, hypokalaemia, alkalosis and suppression of the renin-aldosterone system. The literature on liquorice-induced hypertension is briefly reviewed with emphasis on the biochemical features of this mineralocorticoid excess syndrome.
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Affiliation(s)
- J Heikens
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands
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Takkenberg B, Endert E, van Ingen HE, Ackermans M. Improved method for the determination of serotonin in plasma by high-performance liquid chromatography using on-line sample pre-treatment. J Chromatogr 1991; 565:430-5. [PMID: 1874888 DOI: 10.1016/0378-4347(91)80405-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An improved method for the determination of serotonin in platelet-rich plasma (PRP) and platelet-poor plasma (PPP), by reversed-phase high-performance liquid chromatography with electrochemical detection and direct plasma injection, is described. The chromatographic system comprises a strong cation-exchange pre-column and a C18 analytical column. The method is selective, rapid, simple and sensitive, and offers good reproducibility and recovery. Reference values for serotonin concentrations in healthy adults (n = 10) are 31 nM for PPP and 6 nmol per 10(9) platelets for PRP. The conditions used for the preparation of PRP and PPP may influence the serotonin concentration in PRP.
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Affiliation(s)
- B Takkenberg
- Department of Clinical Chemistry, University of Amsterdam, The Netherlands
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