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Khairy M, Harb H, Eapen A, Melo P, Kazem R, Rajkhowa M, Ndukuwe G, Coomarasamy A. The use of immunomodulation therapy in women with recurrent implantation failure undergoing assisted conception: A multicentre cohort study. Am J Reprod Immunol 2024; 91:e13819. [PMID: 38348954 DOI: 10.1111/aji.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
PROBLEM Recurrent implantation failure (RIF) after multiple embryo transfers remains a vexing problem and immunomodulators have been used with conflicting results. This study aims to assess the effect of immunomodulation therapy on live birth rate (LBR) in women with RIF undergoing assisted reproduction treatment (ART). METHOD OF STUDY DESIGN This is a retrospective cohort study in multicentre network of private assisted conception units in the UK. The study included women who had at least two failed attempts of embryo transfers at CARE fertility network in the period from 1997 to 2018. Women in the treatment group had immunomodulator drugs in the form of corticosteroids, low molecular weight heparin (LMWH), and intravenous intralipid (IVIL) infusions, either separately or in combination, after immunological testing, in addition to standard ART whilst women in the control group had only ART without immunomodulators. The primary outcome was LBR per cycle. Secondary outcomes included the rates of clinical pregnancy (CPR), cumulative live birth (CLBR), and miscarriage. RESULTS A total of 27 163 ART cycles fulfilled the inclusion criteria, of which 5083 had immunomodulation treatment in addition to standard ART treatment, and 22 080 had standard ART treatment alone. Women in the treatment group were significantly older (mean age 38.5 vs. 37.1 years, p < .001), and had a higher number of previous failed ART cycles (mean 4.3 vs. 3.8, p < .01). There was a higher LBR in women who received immunomodulation therapy when compared with the control group (20.9% vs. 15.8%, odds ratio [OR] 1.4, 95% confidence interval [CI] 1.29-1.53, p < .001). Multivariate regression analysis showed that immunomodulation treatment was a significant independent predictor of live birth after adjusting for other confounders (adjusted OR [aOR] 1.33, 95% CI 1.15-1.54, p < .001). Survival analysis showed a higher CLBR in the treatment group (adjusted hazard ratio [aHR] 1.78, 95% CI 1.62-1.94, p < .001). CONCLUSION(S) This study provides evidence of a potential beneficial effect of immunomodulation therapy in women with RIF after immunological testing. There remains a need for high quality, adequately powered multicentre RCTs to robustly address the role of immunomodulation in women with RIF. There is also an urgent need for standardised screening tests for immune disorders that could preclude implantation.
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Affiliation(s)
| | - Hoda Harb
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | - Abey Eapen
- Department of Obstetrics and Gynaecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Pedro Melo
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | | | | | | | - Arri Coomarasamy
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
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Anya OC, Ajayi ER, Solanke HR, Ohanaka AI, Ubana KD. The Use of Intralipid Infusions in the Prevention of Embryo Implantation Failure. Cureus 2024; 16:e53368. [PMID: 38435143 PMCID: PMC10907924 DOI: 10.7759/cureus.53368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Intralipids have been suggested to suppress uterine natural killer cell activity, which could potentially improve implantation rates in women with recurrent loss. We report a case of a 41-year-old African woman with recurrent pregnancy loss who had elevated uterine killer cell activity and for whom intralipid infusion was used to achieve pregnancy. We recommend routine uterine natural killer cell testing for women with recurrent pregnancy loss and further research on newer intravenous lipid emulsions in fertility medicine.
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Affiliation(s)
- Okorie C Anya
- Reproductive Medicine, Primecare Fertility Clinic, Abuja, NGA
| | - Eniola R Ajayi
- Public Health, Central Michigan University College of Medicine, Michigan, USA
| | - Henry R Solanke
- Food Safety and Quality Assurance, Sensei Ag, Aldergrove, CAN
| | - Adaeze I Ohanaka
- Obstetrics and Gynaecology, South Qunfudah General Hospital, Jizan, SAU
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3
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Markert C, Heilmann RM, Kiwitz D, Doerfelt R. Intravenous lipid emulsion for the treatment of poisonings in 313 dogs and 100 cats (2016-2020). Front Vet Sci 2023; 10:1272705. [PMID: 37841477 PMCID: PMC10568331 DOI: 10.3389/fvets.2023.1272705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The aim of this retrospective study was to analyze the effect and potential adverse effects of intravenous lipid emulsion (ILE) in poisoned dogs and cats over a 5 years period. Methods Medical records of 313 dogs and 100 cats receiving ILE between 2016-2020 were analyzed for suspected toxicant, clinical signs, ILE dosages and frequency, the effect and adverse effects of ILE, and patient outcome. Results Dogs and cats were poisoned with mostly unidentified toxicants (48%), rodenticides (8%), recreational drugs and nuts (7% each) and other toxicants. Clinical signs included neurologic deficits (63%), cardiovascular signs (29%), thermoregulation (21%) or gastrointestinal abnormalities (17%). Treatment with ILE was initiated within a median of 6.0 h (1.0-91.0 h) after poisoning. Dogs and cats received a total amount of median 8.0 mL/kg (1.5-66.6 mL/kg) and 15.8 mL/kg (1.8-69.4 mL/kg) ILE, respectively. A positive effect was observed in 74% of the patients, whereas clinical signs worsened in 4% of the patients after ILE administration. No subjective effect was detected in 22% of the patients. Suspected or possible adverse effects of ILE occurred in 6% of the patients, including neurological signs (temporarily reduced consciousness and ataxia), bradycardia, hyperthermia, vomiting, diarrhea, respiratory distress, worsening of the general behavior, facial swelling, and thrombophlebitis. The overall survival rate was 96%. One dog who potentially experienced adverse events was euthanized. Conclusion ILE treatment was successful in most patients but can be associated with adverse effects. Administration of ILE should be carefully selected on an individual basis after weighing the possible benefits against potential adverse effects.
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Affiliation(s)
- Carina Markert
- Veterinary Clinic for Small Animals, Hofheim, Germany
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Romy Monika Heilmann
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | | | - René Doerfelt
- LMU Small Animal Clinic, Ludwig-Maximilians-Universität München, Munich, Germany
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4
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Johnson TE, Fick ME, Haraschak JL, Vernier ME, Kadotani S. Successful management of minoxidil 5% toxicosis in 2 cats from the same household. J Vet Emerg Crit Care (San Antonio) 2023; 33:454-459. [PMID: 37222073 DOI: 10.1111/vec.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/12/2022] [Accepted: 04/25/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the successful management of 2 cats following ingestion of minoxidil 5%. SERIES SUMMARY Two 2-year-old neutered male Savannah cats were presented following suspected minoxidil 5% ingestion. Both cats developed significant myocardial injury, and clinical signs were consistent with congestive heart failure, supported by cardiac troponin I concentrations, echocardiogram, and thoracic radiographs. They required vasopressor therapy and were decontaminated with intravenous lipid emulsion therapy. Following decontamination, both cats were successfully discontinued from vasopressor therapy, and their clinical signs resolved within 24 hours. The cats were successfully discharged without long-lasting cardiac compromise. Their echocardiograms and cardiac troponin concentration 7 weeks after discharge were within reference intervals. NEW OR UNIQUE INFORMATION This is the first detailed report of the successful management of cats following minoxidil 5% ingestion.
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Affiliation(s)
- Tyler E Johnson
- Department of Clinical Medicine, University of Illinois Veterinary Teaching Hospital, Urbana, Illinois, USA
| | - Meghan E Fick
- Department of Clinical Medicine, University of Illinois Veterinary Teaching Hospital, Urbana, Illinois, USA
| | - Jenica L Haraschak
- Department of Clinical Medicine, University of Illinois Veterinary Teaching Hospital, Urbana, Illinois, USA
| | - Mara E Vernier
- Department of Clinical Medicine, University of Illinois Veterinary Teaching Hospital, Urbana, Illinois, USA
| | - Saki Kadotani
- Department of Clinical Medicine, University of Illinois Veterinary Teaching Hospital, Urbana, Illinois, USA
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Mochalova EN, Egorova EA, Komarova KS, Shipunova VO, Khabibullina NF, Nikitin PI, Nikitin MP. Comparative Study of Nanoparticle Blood Circulation after Forced Clearance of Own Erythrocytes (Mononuclear Phagocyte System-Cytoblockade) or Administration of Cytotoxic Doxorubicin- or Clodronate-Loaded Liposomes. Int J Mol Sci 2023; 24:10623. [PMID: 37445804 DOI: 10.3390/ijms241310623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Recent developments in the field of nanomedicine have introduced a wide variety of nanomaterials that are capable of recognizing and killing tumor cells with increased specificity. A major limitation preventing the widespread introduction of nanomaterials into the clinical setting is their fast clearance from the bloodstream via the mononuclear phagocyte system (MPS). One of the most promising methods used to overcome this limitation is the MPS-cytoblockade, which forces the MPS to intensify the clearance of erythrocytes by injecting allogeneic anti-erythrocyte antibodies and, thus, significantly prolongs the circulation of nanoagents in the blood. However, on the way to the clinical application of this approach, the question arises whether the induced suppression of macrophage phagocytosis via the MPS-cytoblockade could pose health risks. Here, we show that highly cytotoxic doxorubicin- or clodronate-loaded liposomes, which are widely used for cancer therapy and biomedical research, induce a similar increase in the nanoparticle blood circulation half-life in mice as the MPS-cytoblockade, which only gently and temporarily saturates the macrophages with the organism's own erythrocytes. This result suggests that from the point of view of in vivo macrophage suppression, the MPS-cytoblockade should be less detrimental than the liposomal anti-cancer drugs that are already approved for clinical application while allowing for the substantial improvement in the nanoagent effectiveness.
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Affiliation(s)
- Elizaveta N Mochalova
- Nanobiomedicine Division, Sirius University of Science and Technology, 1 Olimpiyskiy Ave, 354340 Sirius, Russia
- Moscow Institute of Physics and Technology, 1A Kerchenskaya St., 117303 Moscow, Russia
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 38 Vavilov St., 119991 Moscow, Russia
| | - Elena A Egorova
- Nanobiomedicine Division, Sirius University of Science and Technology, 1 Olimpiyskiy Ave, 354340 Sirius, Russia
| | - Kristina S Komarova
- Moscow Institute of Physics and Technology, 1A Kerchenskaya St., 117303 Moscow, Russia
| | - Victoria O Shipunova
- Nanobiomedicine Division, Sirius University of Science and Technology, 1 Olimpiyskiy Ave, 354340 Sirius, Russia
- Moscow Institute of Physics and Technology, 1A Kerchenskaya St., 117303 Moscow, Russia
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 16/10 Miklukho-Maklaya St., 117997 Moscow, Russia
| | - Nelli F Khabibullina
- Moscow Institute of Physics and Technology, 1A Kerchenskaya St., 117303 Moscow, Russia
| | - Petr I Nikitin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 38 Vavilov St., 119991 Moscow, Russia
| | - Maxim P Nikitin
- Nanobiomedicine Division, Sirius University of Science and Technology, 1 Olimpiyskiy Ave, 354340 Sirius, Russia
- Moscow Institute of Physics and Technology, 1A Kerchenskaya St., 117303 Moscow, Russia
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 16/10 Miklukho-Maklaya St., 117997 Moscow, Russia
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Basarslan SK, Basarslan F. Intralipid and caffeic acid phenethyl ester reverse the neurotoxic effects of organophosphate poisoning in rats. Niger J Clin Pract 2023; 26:686-693. [PMID: 37470640 DOI: 10.4103/njcp.njcp_921_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background Organophosphate (Op)-containing herbicides continue to be widely used in the world. Although its usage and intoxication are widespread, the studies on organophosphate-induced neurotoxicity and treatment protocols are very few in the literature. Aims This study aimed to investigate any potential effects of caffeic acid phenyl ester with/without intralipid on neurotoxicity produced by acute intoxication of glyphosate isopropylamine in an experimental rat model. Materials And Methods Forty-nine wistar albino rats were randomly allotted into seven experimental groups: I, control; II, intralipid (IL); III, caffeic acid phenyl esther (CAPE); IV, glyphosate isopropylamine (GI); V, GI + IL; VI, GI + CAPE; and VII, GI + IL + CAPE. Total antioxidant and oxidant status levels were gauged, and the oxidative stress index was calculated in the serum samples. On the other hand, the tissues were analyzed with hematoxylin-eosin (HE) staining protocol and counted up by immunohistochemical method. Statistical evaluations were conducted using SPSS 11.5 for Windows (SPSS, Chicago, IL, USA). Results Compared to the control, IL, and GI + IL + CAPE groups, the GI group significantly decreased the total antioxidant levels in brain tissues. In a supportive nature, a significant increase in the oxidative site index (OSI) in the GI group compared to other groups. Especially standing out point of these findings is the significant difference between the GI + IL + CAPE and the GI group. Parallelly, histopathological analysis extended severe neurotoxicity in the GI group. Neurotoxic status was reduced significantly in the GI + CAPE + IL group. The histopathologic examinations confirmed biochemical results. The results also revealed that CAPE and IL, probably their antioxidant effects, have a rehabilitative effect on neurotoxicity caused by GI. Conclusion Therefore, CAPE and IL may function as potential cleansing and scavenger agents for supportive therapy regarding tissue damage or facilitate the therapeutic effects of the routine treatment of the patient with GI poisoning.
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Affiliation(s)
- S K Basarslan
- Department of Neurosurgery, Hitit University, School of Medicine, Corum, Turkey
| | - F Basarslan
- Department of Pediatrics, Hitit University, School of Medicine, Corum, Turkey
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Fernández Prendes C, Castro Castro MJ, Sánchez Navarro L, Rapún Mas L, Morales Indiano C, Arrobas Velilla T. Handling of lipemic samples in the clinical laboratory. Adv Lab Med 2023; 4:5-27. [PMID: 37359904 PMCID: PMC10197190 DOI: 10.1515/almed-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/11/2022] [Indexed: 06/28/2023]
Abstract
Interferences in the clinical laboratory may lead physicians misinterpret results for some biological analytes. The most common analytical interferences in the clinical laboratory include hemolysis, icterus and lipemia. Lipemia is defined as turbidity in a sample caused by the accumulation of lipoproteins, mainly very-low density lipoproteins (VLDL) and chylomicrons. Several methods are available for the detection of lipemic samples, including the lipemic index, or triglyceride quantification in serum or plasma samples, or mean corpuscular hemoglobin (MCHC) concentration in blood samples. According to the European Directive 98/79/CE, it is the responsibility of clinical laboratories to monitor the presence of interfering substances that may affect the measurement of an analyte. There is an urgent need to standardize interference studies and the way interferences are reported by manufacturers. Several methods are currently available to remove interference from lipemia and enable accurate measurement of biological quantities. The clinical laboratory should establish a protocol for the handling of lipemic samples according to the biological quantity to be tested.
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Affiliation(s)
- Carla Fernández Prendes
- Laboratory Medicine Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Workgroup of Lipoproteins and Cardiovascular Diseases, Spanish Society of Laboratory Medicine, Barcelona, Spain
| | - María José Castro Castro
- Workgroup of Lipoproteins and Cardiovascular Diseases, Spanish Society of Laboratory Medicine, Barcelona, Spain
- Biochemistry Core, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain
| | - Lourdes Sánchez Navarro
- Haematological Core, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain
| | - Loreto Rapún Mas
- Haematological Core, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain
| | - Cristian Morales Indiano
- Laboratory Medicine Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Workgroup of Lipoproteins and Cardiovascular Diseases, Spanish Society of Laboratory Medicine, Barcelona, Spain
| | - Teresa Arrobas Velilla
- Laboratory of Nutrition and Cardiovascular Risk, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Workgroup of Lipoproteins and Cardiovascular Diseases, Spanish Society of Laboratory Medicine, Barcelona, Spain
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Fernández-Prendes C, Castro-Castro MJ, Jiménez-Añón L, Morales-Indiano C, Martínez-Bujidos M. Discrepancies in Lipemia Interference Between Endogenous Lipemic Samples and Smoflipid ®-Supplemented Samples. EJIFCC 2023; 34:27-41. [PMID: 37124657 PMCID: PMC10131237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Background Manufacturers evaluate lipemia-induced interference using Intralipid®, but it does not contain all lipoprotein types. The aim of this study was to evaluate lipemiainduced interference in biochemical parameters from endogenous lipemic samples and SMOFlipid® supplemented samples, in order to assess if SMOFlipid® can be used in lipemic interference studies. Methods Serum pools were supplemented with SMOFlipid® to achieve 800 mg/dL and 1500 mg/dL triglyceride concentration, and analyzed for 25 biochemical parameters both before and after the supplementation. In another independent phase, lipemic serum pools were prepared choosing patient samples of 800 mg/dL and 1500 mg/dL triglyceride concentration. These lipemic serum pools were ultracentrifugated in order to remove lipids. Biochemical parameters were analyzed before and after ultracentrifugation. The bias between SMOFlipid®-supplemented samples and endogenous lipemic samples were compared. The bias between the lipemic and non-lipemic samples were compared with the reference change value. Results At 800 mg/dL triglyceride concentration, we found that total protein and transferrin had been affected only in endogenous lipemic serum samples. Magnesium and creatinine had been affected only in SMOFlipid®-supplemented samples. At 1500 mg/dL triglyceride concentration, we found that total protein, amylase, ferritin and glucose had lipemic interference only in endogenous lipemic samples, and chloride only in SMOFlipid®-supplemented samples. Conclusions The use of SMOFlipid®-supplemented samples does not provide suitable data to estimate lipemia-induced interference. Thus, interference studies should be performed using a wide variety of lipemic patient samples that represent the heterogeneity of the lipoprotein particles size.
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Affiliation(s)
- Carla Fernández-Prendes
- Laboratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Commission on Lipoprotein and Vascular Diseases, Sociedad Española de Química Clínica
- Biomedicine Departament. Universitat de Barcelona, Barcelona, Spain
- Corresponding author: Carla Fernández-Prendes University Hospital Germans Trias i Pujol Commission on Lipoprotein and Vascular Diseases, Sociedad Española de Química Clínica Biomedicine Departament Universitat de Barcelona Spain E-mail:
| | - Maria-José Castro-Castro
- Commission on Lipoprotein and Vascular Diseases, Sociedad Española de Química Clínica
- Laboratory Medicine Department, Hospital Universitario de Bellvitge, Barcelona, Spain
- Biochemistry and Physiology Departament, Universitat de Barcelona, Barcelona, Spain
| | - Laura Jiménez-Añón
- Laboratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - María Martínez-Bujidos
- Laboratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Schmidt LK, Keller KA, Tonozzi C, Brandão J, Christman J, W Stern A, Allen-Durrance AE, Alexander AB. Intralipid Emulsion Therapy for the Treatment of Suspected Toxicity in 2 Avian Species. J Avian Med Surg 2023; 36:394-399. [PMID: 36935211 DOI: 10.1647/21-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Intravenous lipid emulsion (ILE) therapy has shown promise as a treatment option for a variety of lipophilic toxins. Two birds presented for suspected ingestion of a toxic substance. A blue-and-gold macaw (Ara ararauna) presented after chewing a block of bromethalin rodenticide without overt clinical signs at the time of presentation. Additionally, a free-ranging bald eagle (Haliaeetus leucocephalus) was found weak and depressed near a municipal landfill after presumptive ingestion of pentobarbital. Both birds were treated with ILE therapy for potential intoxication without any adverse events. The macaw was clinically normal after 3 days of hospitalization and at a 1-week reevaluation. The eagle was transferred to a rehabilitation center after markedly improved mentation and strength and was released 7 days later. Clinicians should consider ILE therapy for the treatment of lipophilic toxicities; however, monitoring is recommended for persistent lipemia and other adverse effects that have been reported in the veterinary literature.
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Affiliation(s)
- Lauren K Schmidt
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, USA
| | - Krista A Keller
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61821, USA,
| | - Caroline Tonozzi
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61821, USA
| | - João Brandão
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, USA
| | - Jane Christman
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Adam W Stern
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ashley E Allen-Durrance
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Amy B Alexander
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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Asfour SS, Alshaikh B, AlMahmoud L, Sumaily HH, Alodhaidan NA, Alkhourmi M, Abahussain HA, Khalil TM, Albeshri BA, Alhamidi AA, Al-Anazi MR, Asfour RS, Al-Mouqdad MM. SMOFlipid Impact on Growth and Neonatal Morbidities in Very Preterm Infants. Nutrients 2022; 14:nu14193952. [PMID: 36235604 PMCID: PMC9573282 DOI: 10.3390/nu14193952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022] Open
Abstract
The soybean oil, medium-chain triglycerides, olive oil, and fish oil lipid (SMOFlipid) is increasingly being used worldwide without definite evidence of its benefits. We examined the effect of SMOFlipid on growth velocity and neonatal morbidities in very preterm infants. Very preterm infants who received soybean-based lipid emulsion between January 2015 and 2018 were compared with those who received SMOFlipids between 2019 and January 2022 in our neonatal tertiary center. Linear regression analysis was conducted to analyze the association between type of lipid emulsion and growth velocity. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber−White) were applied to adjust for potential confounding factors. A total of 858 infants met our inclusion criteria. Of them, 238 (27.7%) received SMOFlipid. SMOFlipid was associated with lower growth velocity between birth and 36-week corrected gestational age compared with intralipid Δ weight z-score (adjusted mean difference (aMD) −0.67; 95% CI −0.69, −0.39). Subgroup analysis indicated that mainly male infants in the SMOFlipid−LE group had a lower Δ weight z-score compared to those in the intralipid group (p < 0.001), with no difference observed in females (p = 0.82). SMOFlipid was associated with a lower rate of bronchopulmonary dysplasia (BPD) (aRR 0.61; 95% CI 0.46, 0.8) and higher rate of late-onset sepsis compared with intralipid (aRR 1.44; 95% CI 1.22−1.69). SMOFlipid was associated with lower growth velocity and BPD but higher rate of late-onset sepsis—it is a double-edged sword.
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Affiliation(s)
- Suzan S. Asfour
- Clinical Pharmacy Department, Pharmaceutical Care Services, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Belal Alshaikh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Latifah AlMahmoud
- Neonatal Intensive Care, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Haider H. Sumaily
- Neonatal Intensive Care, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Nabeel A. Alodhaidan
- Neonatal Intensive Care, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Mousa Alkhourmi
- Pediatric Gastroenterology Department, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Hissah A. Abahussain
- General Pediatrics Department, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Thanaa M. Khalil
- Obstetric and Gynecology Department, Maternity Hospital, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Bushra A. Albeshri
- Pharmacy Department, Pharmaceutical Care Services, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Aroub A. Alhamidi
- Pharmacy Department, Pharmaceutical Care Services, Ministry of Health, Riyadh 12613, Saudi Arabia
| | - Maha R. Al-Anazi
- Pharmacy Department, Pharmaceutical Care Services, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Raneem S. Asfour
- Pharmacy College, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Mountasser M. Al-Mouqdad
- Neonatal Intensive Care, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
- Correspondence: ; Tel.: +966-114355555 (ext. 506); Fax: +966-114354406
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Turner W, Butler K, Sheppard M. Bubble trap occlusion leading to difficulty administering intralipid during an emergency caesarean section. Anaesth Rep 2022; 9:e12143. [PMID: 34977586 DOI: 10.1002/anr3.12143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- W Turner
- Department of Anesthesia and Pain Management Mount Sinai Hospital University of Toronto Toronto ON Canada
| | - K Butler
- Department of Anesthesia and Pain Management Mount Sinai Hospital University of Toronto Toronto ON Canada
| | - M Sheppard
- Department of Anesthesia and Pain Management Mount Sinai Hospital University of Toronto Toronto ON Canada
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12
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Spillane AM, Haraschak JL, McMichael MA. Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report. Front Vet Sci 2021; 8:798198. [PMID: 34957288 PMCID: PMC8694260 DOI: 10.3389/fvets.2021.798198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.
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Affiliation(s)
- Amanda M Spillane
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jenica L Haraschak
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Maureen A McMichael
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
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13
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Chan B, Lian A, Baer V, Robinson M, Ou Z, Presson AP, Zinkhan EK. An Evaluation to Establish the Acceptable Serum Triglyceride Levels in Neonates Receiving Intravenous Fat Emulsion Infusion in a Multicenter Retrospective Study. Am J Perinatol 2021; 38:e92-e101. [PMID: 32120418 PMCID: PMC10649198 DOI: 10.1055/s-0040-1705174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to establish neonatal serum triglyceride (TG) level reference ranges during lipid infusion and correlate peak TG with neonatal outcomes. STUDY DESIGN This is a retrospective review of 356 neonates with 696 TG measures obtained in four neonatal intensive care units between 2015 and 2017. TG was evaluated collectively to establish a reference range and a threshold limit. To analyze the effects of a higher TG threshold, neonates were categorized by their peak TG: <180 (TG<180), 180 to 400 (TG180-400), and > 400 mg/dL (TG>400). Univariable and multivariable regression models were constructed to compare peak TG to patient characteristic and clinical outcomes. RESULTS The frequency of TG > 400 mg/dL was 5% and found only in neonates weighing < 1.5 kg. Neonates in the TG180-400 (n = 91) group were significantly lower in birth weight and gestational age, had lower 5-minute APGAR scores, and had increased ventilatory requirement when compared with neonates in the TG<180 (n = 240) group (all p < 0.001). The TG180-400 group had increased risk of severe intraventricular hemorrhage (p = 0.02) and bronchopulmonary dysplasia (p = 0.03). Elevated TG was associated with mortality (odds ratio [OR]: 14.4, p < 0.001) in univariable analysis, but the relationship weakened (OR: 4.4, p = 0.05) after adjusting for comorbidities in multivariable logistic regression. CONCLUSION It is unclear if the adverse outcomes seen in neonates with higher peak TG were due to elevated TG alone, or whether illness severity predicted the increased TG. More prospective studies are needed to further delineate the relationships.
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Affiliation(s)
- Belinda Chan
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anh Lian
- Pharmacy Services, Intermountain Healthcare, Salt Lake City, Utah
| | - Vickie Baer
- Women and Newborn Research, Intermountain Healthcare, Salt Lake City, Utah
| | - Mandy Robinson
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Erin K. Zinkhan
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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14
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Dong ZH, Lin HY, Chen FL, Che XQ, Bi WK, Shi SL, Wang J, Gao L, He Z, Zhao JJ. Berberine improves intralipid-induced insulin resistance in murine. Acta Pharmacol Sin 2021; 42:735-743. [PMID: 32770172 PMCID: PMC8115075 DOI: 10.1038/s41401-020-0493-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/26/2020] [Indexed: 12/13/2022] Open
Abstract
Insulin resistance (IR) is a major metabolic risk factor even before the onset of hyperglycemia. Recently, berberine (BBR) is found to improve hyperglycemia and IR. In this study, we investigated whether BBR could improve IR independent of hyperglycemia. Acute insulin-resistant state was induced in rats by systemic infusion of intralipid (6.6%). BBR was administered via different delivery routes before or after the beginning of a 2-h euglycemic-hyperinsulinemic clamp. At the end of experiment, rats were sacrificed, gastrocnemius muscle was collected for detecting mitochondrial swelling, phosphorylation of Akt and AMPK, as well as the mitochondrial permeability regulator cyclophilin D (CypD) protein expression. We showed that BBR administration markedly ameliorated intralipid-induced IR without affecting blood glucose, which was accompanied by alleviated mitochondrial swelling in skeletal muscle. We used human skeletal muscle cells (HSMCs), AML12 hepatocytes, human umbilical vein endothelial cells, and CypD knockout mice to investigate metabolic and molecular alternations. In either HSMCs or AML12 hepatocytes, BBR (5 μM) abolished palmitate acid (PA)-induced increase of CypD protein levels. In CypD-deficient mice, intralipid-induced IR was greatly attenuated and the beneficial effect of BBR was diminished. Furthermore, we demonstrated that the inhibitory effect of BBR on intralipid-induced IR was mainly mediated by skeletal muscle, but not by intestine, liver, or microvasculature; BBR administration suppressed intralipid-induced upregulation of CypD expression in skeletal muscle. These results suggest that BBR alleviates intralipid-induced IR, which is related to the inhibition of CypD protein expression in skeletal muscle.
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Affiliation(s)
- Zhen-Hua Dong
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Cheeloo College of Medicine, Shandong University, Ji-nan, 250000, China
- Department of Endocrinology, Ji-nan Central Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250000, China
| | - Hai-Yan Lin
- Department of Health Management Center, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250000, China
| | - Fu-Lian Chen
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
| | - Xiao-Qi Che
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Cheeloo College of Medicine, Shandong University, Ji-nan, 250000, China
| | - Wen-Kai Bi
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Cheeloo College of Medicine, Shandong University, Ji-nan, 250000, China
| | - Shu-Long Shi
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
| | - Jing Wang
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China
- Cheeloo College of Medicine, Shandong University, Ji-nan, 250000, China
| | - Ling Gao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Ji-nan, 250000, China.
| | - Zhao He
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250021, China.
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China.
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China.
- Cheeloo College of Medicine, Shandong University, Ji-nan, 250000, China.
| | - Jia-Jun Zhao
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji-nan, 250021, China.
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China.
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Ji-nan, 250021, China.
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15
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Rimmer MP, Black N, Keay S, Quenby S, Al Wattar BH. Intralipid infusion at time of embryo transfer in women with history of recurrent implantation failure: A systematic review and meta-analysis. J Obstet Gynaecol Res 2021; 47:2149-2156. [PMID: 33754451 DOI: 10.1111/jog.14763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 01/15/2023]
Abstract
AIM Recurrent implantation failure (RIF) affects 10% of couples undergoing assisted conception, often due to poor endometrial receptivity. We conducted a systematic review and meta-analysis to evaluate the effectiveness of Intra-venous intralipid (IVI) in improving pregnancy rates in women with history of RIF using. METHODS We searched MEDLINE, EMBASE, and CENTRAL for any randomized trials evaluating the use of IVI at the time of embryo transfer in women undergoing assisted conception until September 2020. We extracted data in duplicate and assessed risk of bias using the Cochrane Risk of Bias tools. We meta-analyzed data using a random effect model. RESULTS We included five randomized trials reporting on 843 women with an overall moderate risk of bias. All trials used 20% IVI solution at the time of embryo transfer compared to normal saline infusion or no intervention (routine care). The IVI group had a higher chance of clinical pregnancy (172 vs 119, risk ratio [RR] 1.55, 95% confidence interval [CI] 1.16-2.07, I2 44.2%) and live birth (132 vs 73, RR 1.83, 95% CI 1.42-2.35, I2 0%) post treatment compared to no intervention. Our findings are limited by the small sample size and the variations in treatment protocols and population characteristics. CONCLUSION There is limited evidence to support the use of IVI at the time of embryo transfer in women with the history of RIF. More research is needed before adopting it in clinical practice.
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Affiliation(s)
- Michael P Rimmer
- MRC Centre for Reproductive Health, Queens Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Naomi Black
- Warwick Medical School, Warwick University, Coventry, UK.,University Hospital Coventry and Warwickshire, Coventry, UK
| | - Stephen Keay
- University Hospital Coventry and Warwickshire, Coventry, UK
| | - Siobhan Quenby
- Warwick Medical School, Warwick University, Coventry, UK.,University Hospital Coventry and Warwickshire, Coventry, UK
| | - Bassel H Al Wattar
- Warwick Medical School, Warwick University, Coventry, UK.,University Hospital Coventry and Warwickshire, Coventry, UK
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16
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Mungala Lengo A, Guiraut C, Mohamed I, Lavoie JC. Relationship between redox potential of glutathione and DNA methylation level in liver of newborn guinea pigs. Epigenetics 2020; 15:1348-1360. [PMID: 32594836 PMCID: PMC7678935 DOI: 10.1080/15592294.2020.1781024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The metabolism of DNA methylation is reported to be sensitive to oxidant molecules or oxidative stress. Hypothesis: early-life oxidative stress characterized by the redox potential of glutathione influences the DNA methylation level. The in vivo study aimed at the impact of modulating redox potential of glutathione on DNA methylation. Newborn guinea pigs received different nutritive modalities for 4 days: oral nutrition, parenteral nutrition including lipid emulsion Intralipid (PN-IL) or SMOFLipid (PN-SF), protected or not from ambient light. Livers were collected for biochemical determinations. Redox potential (p < 0.001) and DNA methylation (p < 0.01) were higher in PN-infused animals and even higher in PN-SF. Their positive correlation was significant (r2 = 0.51; p < 0.001). Methylation activity was higher in PN groups (p < 0.01). Protein levels of DNA methyltransferase (DNMT)-1 were lower in PN groups (p < 0.01) while those of both DNMT3a isoforms were increased (p < 0.01) and significantly correlated with redox potential (r2 > 0.42; p < 0.001). The ratio of SAM (substrate) to SAH (inhibitor) was positively correlated with the redox potential (r2 = 0.36; p < 0.001). In conclusion, early in life, the redox potential value strongly influences the DNA methylation metabolism, resulting in an increase of DNA methylation as a function of increased oxidative stress. These results support the notion that early-life oxidative stress can reprogram the metabolism epigenetically. This study emphasizes once again the importance of improving the quality of parenteral nutrition solutions administered early in life, especially to newborn infants. Abbreviation of Title: Parenteral nutrition and DNA methylation
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Affiliation(s)
- Angela Mungala Lengo
- Department of Nutrition, Université De Montréal, CHU Sainte-Justine , Montréal, QC, Canada
| | - Clémence Guiraut
- Department of Paediatrics, CHU Sainte-Justine, Université De Montréal , Montréal, QC, Canada
| | - Ibrahim Mohamed
- Department of Nutrition, Université De Montréal, CHU Sainte-Justine , Montréal, QC, Canada.,Department of Paediatrics, CHU Sainte-Justine, Université De Montréal , Montréal, QC, Canada
| | - Jean-Claude Lavoie
- Department of Nutrition, Université De Montréal, CHU Sainte-Justine , Montréal, QC, Canada.,Department of Paediatrics, CHU Sainte-Justine, Université De Montréal , Montréal, QC, Canada
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17
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Terashima S, Muroya T, Ikegawa H, Kajino K, Sakuramoto K, Yui R, Kishimoto M, Takahashi H, Nakajima M, Nakamura F, Nakamori Y, Kuwagata Y. Propofol suppresses ventricular arrhythmias: a case report of acute caffeine intoxication. Acute Med Surg 2020; 7:e514. [PMID: 32537172 PMCID: PMC7283990 DOI: 10.1002/ams2.514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Caffeine is widely used as a stimulant drug throughout the world, and fatal arrhythmia is a known side‐effect. We experienced a patient with caffeine intoxication causing fatal arrhythmias who was successfully treated with the infusion of propofol. Case Presentation A 27‐year‐old woman was transferred to our hospital with nausea and poor general condition after intentional ingestion of 23.2 g of caffeine tablets. She was in cardiac arrest due to ventricular fibrillation just before hospital arrival. Advanced life support including defibrillation was started immediately, and we succeeded in resuscitating her 23 min later. Although she suffered from polymorphic ventricular premature beats and frequent transition to ventricular fibrillation, propofol administration converted her from a ventricular arrhythmia to sinus rhythm. Conclusion We report this case focusing on the cardiovascular effects of propofol and the lipid sink phenomenon. As a result, propofol could have the potential to suppress ventricular arrhythmias.
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Affiliation(s)
- Shinya Terashima
- Department of Emergency and Critical Care Medicine Kansai Medical University Medical Center Moriguchi Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Hiroki Takahashi
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine Kansai Medical University Medical Center Moriguchi Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
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18
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Tanioka M, Park WK, Shim I, Kim K, Choi S, Kim UJ, Lee KH, Hong SK, Lee BH. Neuroprotection from Excitotoxic Injury by Local Administration of Lipid Emulsion into the Brain of Rats. Int J Mol Sci 2020; 21:ijms21082706. [PMID: 32295117 PMCID: PMC7215821 DOI: 10.3390/ijms21082706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 01/10/2023] Open
Abstract
Lipid emulsion was recently shown to attenuate cell death caused by excitotoxic conditions in the heart. There are key similarities between neurons and cardiomyocytes, such as excitability and conductibility, which yield vulnerability to excitotoxic conditions. However, systematic investigations on the protective effects of lipid emulsion in the central nervous system are still lacking. This study aimed to determine the neuroprotective effects of lipid emulsion in an in vivo rat model of kainic acid-induced excitotoxicity through intrahippocampal microinjections. Kainic acid and/or lipid emulsion-injected rats were subjected to the passive avoidance test and elevated plus maze for behavioral assessment. Rats were sacrificed at 24 h and 72 h after kainic acid injections for molecular study, including immunoblotting and qPCR. Brains were also cryosectioned for morphological analysis through cresyl violet staining and Fluorojade-C staining. Anxiety and memory functions were significantly preserved in 1% lipid emulsion-treated rats. Lipid emulsion was dose-dependent on the protein expression of β-catenin and the phosphorylation of GSK3-β and Akt. Wnt1 mRNA expression was elevated in lipid emulsion-treated rats compared to the vehicle. Neurodegeneration was significantly reduced mainly in the CA1 region with increased cell survival. Our results suggest that lipid emulsion has neuroprotective effects against excitotoxic conditions in the brain and may provide new insight into its potential therapeutic utility.
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Affiliation(s)
- Motomasa Tanioka
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Insop Shim
- Department of Physiology, School of Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Kyeongmin Kim
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Songyeon Choi
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Un Jeng Kim
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
| | - Kyung Hee Lee
- Department of Dental Hygiene, Division of Health Science, Dongseo University, Busan 47011, Korea;
| | - Seong-Karp Hong
- Division of Biomedical Engineering, Mokwon University, Daejeon 35349, Korea;
| | - Bae Hwan Lee
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: ; Tel.: + 82-2-2228-1711
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19
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Al-Zebeidi J, Agdi M, Lary S, Al-Obaid S, Salim G, Al-Jaroudi D. Effect of empiric intravenous intralipid therapy on pregnancy outcome in women with unexplained recurrent implantation failure undergoing intracytoplasmic sperm injection-embryo transfer cycle: a randomized controlled trial. Gynecol Endocrinol 2020; 36:131-134. [PMID: 31220957 DOI: 10.1080/09513590.2019.1631280] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Indexed: 01/20/2023] Open
Abstract
To evaluate the effect of empiric intralipid infusion therapy on pregnancy outcomes for patients with unexplained recurrent implantation failure (RIF) undergoing intracytoplasmic sperm injection (ICSI). A total of 142 patients with a history of unexplained RIF (3 or more cycles) were included in this randomized controlled trial. Patients were randomized into two groups, study group (n = 71) and control group (n = 71). The study group received intralipid 20% infusion on the day of embryo transfer (ET) and a second dose on the day of pregnancy test. The clinical pregnancy rate in the study group was 36.6% (n = 26) compared to 28.2% (n = 20) in the control group (OR 1.47, CI 0.72-2.98, p = .282). The live birth rate in the study group was 18.3% (n = 13) and 14.1% (n = 10) in the control group (OR 1.37, CI 0.55-3.36, p=.49). No side effects of intralipid therapy were reported in the study period. There was improvement in the pregnancy rate among women with unexplained RIF who received empiric intralipid infusion therapy; however, this improvement did not reach statistical significance.
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Affiliation(s)
- Jawharah Al-Zebeidi
- Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Agdi
- Reproductive Medicine, Bnoon Medical Center, Riyadh, Saudi Arabia
| | - Sahar Lary
- Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Solaiman Al-Obaid
- Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gamar Salim
- Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dania Al-Jaroudi
- Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
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20
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Abstract
Introduction: Intravenous lipid emulsion (ILE) administration is capable of reversing the acute cardiac and neurological toxicity caused by local anesthetic agents. In recent years, ILE has also been explored as a potential antidote for cardiotoxicity caused by non-anesthetic agents too. Areas covered: The potential mechanisms, safety, and efficacy of this approach are considered. Data were sought from published reports listed in PubMed and EMBASE, and abstracts of meetings of the North American Congress of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists. There were reports involving 298 patients where ILE has been administered for severe drug toxicity. Clinical improvement was observed in 57 of 59 patients with local anesthetic toxicity (96.6%); there were 239 patients where toxicity was due to non-anesthetic agents, and ILE apparently improved clinical outcome in 215 (72.1%). Expert opinion: Response rates were similar between ILE treated toxicity caused by lipid soluble and non-lipid soluble drugs. Potential adverse effects of ILE include interference with laboratory assays, acute pancreatitis, and adult respiratory distress syndrome, although the rate of occurrence is difficult to ascertain.
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Affiliation(s)
- Maria Paneta
- a Acute Medical Unit , York Teaching Hospital NHS Foundation Trust , York , UK
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Halama A, Aye MM, Dargham SR, Kulinski M, Suhre K, Atkin SL. Metabolomics of Dynamic Changes in Insulin Resistance Before and After Exercise in PCOS. Front Endocrinol (Lausanne) 2019; 10:116. [PMID: 30873121 PMCID: PMC6400834 DOI: 10.3389/fendo.2019.00116] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 09/16/2018] [Accepted: 02/07/2019] [Indexed: 01/17/2023] Open
Abstract
Background: Plasma elevated levels of branched chain amino acids (BCAA) and aromatic amino acids (AAA) have been associated with obesity and insulin resistance, but their relationship to stimulated insulin resistance (IR) in PCOS and in response to exercise is unknown. Indeed, it is unknown whether the mechanism of IR in PCOS is mediated through changes in the metabolome. Methods: Twelve women with polycystic ovary syndrome (PCOS) and ten age and body mass index matched controls completed an 8 week supervised exercise program at 60% maximal oxygen consumption. Before and after the exercise program, all participants underwent maximal IR stimulation with intralipid infusions followed by insulin sensitivity (IS) measurement by hyperinsulinaemic euglycaemic clamps. Amino acid profiles and metabolites were taken at baseline and at maximal insulin resistance stimulation before and after the exercise program. Results: At baseline, PCOS subjects showed increased leucine/isoleucine, glutamate, methionine, ornithine, phenylalanine, tyrosine and proline (p < 0.05) that, following exercise, did not differ from controls. While compering within the groups, no significant changes in the amino acid levels before and after exercise were observed. Exercise improved VO2 max (p < 0.01) but did not alter weight. Amino acid profiles were unaffected by an acute increase in IR induced by the lipid infusion. IS was lower in PCOS (p < 0.001) and was further decreased by the lipid infusion in both PCOS and controls. Although, exercise improved IS in both PCOS and in controls, the IS remained compromised in PCOS. Conclusion: The baseline amino acid profile in PCOS reflected that seen in obese subjects and differed to controls. After exercise, and despite no change in weight in either group, there were no differences in the amino acid profile between PCOS and controls. This shows that exercise may normalize the amino acid metabolome, irrespective of weight. ISRCTN number: ISRCTN42448814.
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Affiliation(s)
- Anna Halama
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Myint Myint Aye
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, United Kingdom
| | - Soha R. Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine, Doha, Qatar
| | - Michal Kulinski
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Karsten Suhre
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Stephen L. Atkin
- Weill Cornell Medicine-Qatar, Doha, Qatar
- *Correspondence: Stephen L. Atkin
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Hegyi T, Weinberger B, Memon N, Carayannopoulos M, Huber AH, Kleinfeld AM. Plasma unbound free fatty acid profiles in premature infants before and after intralipid infusion. J Matern Fetal Neonatal Med 2018; 33:2320-2325. [PMID: 30554540 DOI: 10.1080/14767058.2018.1548599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Unbound free fatty acids (FFAu) are the bioactive fraction of plasma free fatty acids (FFA). Most plasma FFA are bound to albumin. Only when FFA dissociate from albumin, do they become biologically active.Objective: To measure the first FFAu profiles in human infants and to measure these profiles before and during intravenous administration of the soybean lipid, intralipid (IL).Study design: The study population was 16 premature infants, from a parent study of 130 infants with birth weights 500-2000 g and gestational age 23-34 weeks. The infants chosen had plasma samples of ≥120 µL (volume needed for each FFAu profile measurement) in the first day of life. Infants received IL infusions starting in the second day of life at 1 g/kg/day, increasing by 1-g/kg/day daily up to 3 g/kg/day. FFAu profiles were determined during IL infusion when plasma was available. Profiles are the concentrations of the nine most abundant long-chain FFAu and were determined using novel fluorescent probes.Results: Before intralipid infusion unbound myristic acid was the dominant FFAu, as high as 78% of the total FFAu (sum of the 9 FFAu). In contrast, unbound linoleic acid was 0% in all infants. With increasing infusion of IL to 3 g/kg/day, unbound linoleic increased to 26% of the total FFAu, with unbound oleic, myristic, and linolenic acid the second, third and fourth most abundant. The average total FFAu concentration also increased from 4 nM before intralipid to 53 nM at 3 g/kg/day. During IL infusion the FFAu profiles approached the fatty acid composition of intralipid at 3 g/kg/day.Conclusions: This first study of FFAu profiles in neonates revealed that before IL infusion unbound linoleic acid was zero in all 16 infants and levels of myristic acid were exceptionally large, as much as 78% of the total FFAu profile. These results suggest important and previously unrecognized roles of lipid metabolism in early development. Zero unbound linoleic acid before IL infusion may help promote closure of the ductus arteriosus but after IL infusion, synthesis of arachidonic from linoleic acid may tend to promote patency. The high levels of unbound myristate may be needed for immediate neonatal energy needs.
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Affiliation(s)
- Thomas Hegyi
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Barry Weinberger
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Naureen Memon
- Mid Atlantic Neonatology Associates, Goryeb Children's Hospital, Morristown, NJ, USA
| | - Mary Carayannopoulos
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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23
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Bellis TJ, Gibeon L. The use of intralipid emulsion therapy to treat severe cardiotoxicity secondary to lamotrigine ingestion in a dog. Clin Case Rep 2018; 6:1982-1988. [PMID: 30349712 PMCID: PMC6186877 DOI: 10.1002/ccr3.1733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 12/03/2022] Open
Abstract
Lamotrigine is a sodium and calcium channel blocker, used to treat seizures in people. Dogs metabolize Lamotrigine to a cardiotoxic metabolite that causes severe, often fatal ventricular arrhythmias. This report documents the successful treatment of refractory Lamotrigine cardiotoxicity in a dog, using intralipid emulsion therapy.
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Affiliation(s)
- Tara J. Bellis
- Emergency and Critical Care DepartmentBluePearl Veterinary PartnersNew YorkNew York
| | - Laura Gibeon
- Emergency and Critical Care DepartmentBluePearl Veterinary PartnersNew YorkNew York
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24
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Yu H, Li Q, Chen C, Li T, Xiong JY, Qin Z, Luo M, Tan ZX, Liu T, Yu H, Yin XR, Yu H, Zhou RH. Effect of intralipid on myocardial injury during valve replacement surgery with concomitant radiofrequency ablation: A randomized controlled trial. Medicine (Baltimore) 2018; 97:e9603. [PMID: 29505549 PMCID: PMC5943091 DOI: 10.1097/md.0000000000009603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of intralipid postconditioning (ILPC) on myocardial damage in patients undergoing valve replacement surgery with concomitant radiofrequency ablation (RFA) for atrial fibrillation (AF). METHODS Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing valve replacement surgery with concomitant RFA. Sixty-nine patients were randomly assigned to ILPC group (n = 34) or control group (n = 35): ILPC group received an intravenous infusion of 20% intralipid (2 mL/kg) just 10 minutes before aortic cross-unclamping, and control group received an equivalent volume of normal saline. Serum cardiac troponin-T (cTnT) and creatine kinase-MB (CK-MB) was measured before surgery and at 4, 12, 24, 48, and 72 hours after surgery. The primary endpoints were the 72-hour area under the curve (AUC) for cTnT and CK-MB. RESULTS The total 72-hour AUC of cTnT (P = .33) and CK-MB (P = .52) were comparable between 2 groups. The left ventricle ejection fraction at discharge (P = .011) was higher in the ILPC group than that in the control group, while the AF recurrence did not differ significantly between 2 groups. CONCLUSIONS There was no observed beneficial effect of ILPC on myocardial injury documented by the cardiac biomarkers in patients undergoing valve replacement surgery with concomitant RFA, and the effect of intralipid against myocardial I/R injury is undetectable within the background of massive biomarker release following ablation owing to localized myocardial necrosis. Besides, there are no other published data about the cardioprotective role of intralipid in patients undergoing this procedure and benefits of this protection need further studies to validate.
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Affiliation(s)
- Hong Yu
- Department of Anesthesiology
| | - Qi Li
- Department of Anesthesiology
| | | | - Tao Li
- Department of Anesthesiology
| | | | | | | | | | | | - Hui Yu
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | | | - Hai Yu
- Department of Anesthesiology
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25
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Aye MM, Butler AE, Kilpatrick ES, Kirk R, Vince R, Rigby AS, Sandeman D, Atkin SL. Dynamic Change in Insulin Resistance Induced by Free Fatty Acids Is Unchanged Though Insulin Sensitivity Improves Following Endurance Exercise in PCOS. Front Endocrinol (Lausanne) 2018; 9:592. [PMID: 30344510 PMCID: PMC6182066 DOI: 10.3389/fendo.2018.00592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/08/2018] [Accepted: 09/18/2018] [Indexed: 01/02/2023] Open
Abstract
Background: Insulin resistance (IR) is the hallmark of PCOS and it is known that exercise may decrease it. What is unknown is whether exercise may mechanistically alter the underlying IR, attenuating the dynamic lipid induced IR in insulin resistant subjects. Methods: 12 women with polycystic ovary syndrome (PCOS) and 10 age and body mass index matched controls completed an 8 week supervised exercise program at 60% maximal oxygen consumption. Before and after the exercise program, all participants underwent hyperinsulinaemic euglycaemic clamps with either saline or intralipid infusions. Skewed data were log transformed and expressed as mean ± SEM. Results: Before exercise, women with PCOS had a higher HOMA-IR and lower VO2 max than controls. Compared to saline, lipid infusion lowered the rate of insulin stimulated glucose disposal (M value; mg/kg/min) by 67 ± 5% (from 0.5 ± 0.03 to -0.25 ± 0.2, p = 0.01) in PCOS, and by 49 ± 7% (from 0.65 ± 0.06 to 0.3 ± 0.1, p = 0.01) in controls. The M value was significantly less in PCOS compared to controls for both saline (p < 0.01) and lipid (p < 0.05). Endurance exercise in PCOS improved VO2 max and HOMA-IR, but not weight, to those of pre-exercise control subjects. The glucose disposal rate during the lipid infusion was reduced following exercise in PCOS, indicating decreased IR (67 ± 5 vs. 50 ± 7%, p = 0.02), but IR was not altered in controls (49 ± 7 vs. 45 ± 6%, p = 0.58). The incrementally increased IR induced by the lipid infusion did not differ between controls and PCOS. Conclusion: Insulin sensitivity improved with exercise in the PCOS group alone showing that IR can be modified, though likely transiently. However, the maximal IR response to the lipid infusion did not differ within and between control and PCOS subjects, indicating that the fundamental mechanism underlying insulin resistance was unchanged with exercise. Precis: Maximal insulin resistance induced by lipid infusion determined at baseline and 8 weeks after exercise in control and PCOS women did not differ, though insulin sensitivity increased in PCOS after exercise.
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Affiliation(s)
- Myint Myint Aye
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, United Kingdom
| | | | | | - Richard Kirk
- Department of Sport, Health and Exercise Science, Hull York Medical School, The University of Hull, Hull, United Kingdom
| | - Rebecca Vince
- Department of Sport, Health and Exercise Science, Hull York Medical School, The University of Hull, Hull, United Kingdom
| | - Alan S. Rigby
- The University of Hull, Hull York Medical School, Hull, United Kingdom
| | - Derek Sandeman
- Department of Diabetes and Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Stephen L. Atkin
- Weill Cornell Medicine Qatar, Education City, Doha, Qatar
- *Correspondence: Stephen L. Atkin
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26
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Feinstein DL, Akpa BS, Ayee MA, Boullerne AI, Braun D, Brodsky SV, Gidalevitz D, Hauck Z, Kalinin S, Kowal K, Kuzmenko I, Lis K, Marangoni N, Martynowycz MW, Rubinstein I, van Breemen R, Ware K, Weinberg G. The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures. Ann N Y Acad Sci 2016; 1374:111-22. [PMID: 27244102 DOI: 10.1111/nyas.13085] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 12/11/2022]
Abstract
Superwarfarins were developed following the emergence of warfarin resistance in rodents. Compared to warfarin, superwarfarins have much longer half-lives and stronger affinity to vitamin K epoxide reductase and therefore can cause death in warfarin-resistant rodents. By the mid-1970s, the superwarfarins brodifacoum and difenacoum were the most widely used rodenticides throughout the world. Unfortunately, increased use was accompanied by a rise in accidental poisonings, reaching >16,000 per year in the United States. Risk of exposure has become a concern since large quantities, up to hundreds of kilograms of rodent bait, are applied by aerial dispersion over regions with rodent infestations. Reports of intentional use of superwarfarins in civilian and military scenarios raise the specter of larger incidents or mass casualties. Unlike warfarin overdose, for which 1-2 days of treatment with vitamin K is effective, treatment of superwarfarin poisoning with vitamin K is limited by extremely high cost and can require daily treatment for a year or longer. Furthermore, superwarfarins have actions that are independent of their anticoagulant effects, including both vitamin K-dependent and -independent effects, which are not mitigated by vitamin K therapy. In this review, we summarize superwarfarin development, biology and pathophysiology, their threat as weapons, and possible therapeutic approaches.
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Affiliation(s)
- Douglas L Feinstein
- Department of Anesthesiology, University of Illinois, Chicago, Illinois.,Jesse Brown VA Medical Center, Chicago, Illinois
| | - Belinda S Akpa
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina
| | - Manuela A Ayee
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Anne I Boullerne
- Department of Anesthesiology, University of Illinois, Chicago, Illinois.,Jesse Brown VA Medical Center, Chicago, Illinois
| | - David Braun
- Department of Anesthesiology, University of Illinois, Chicago, Illinois
| | - Sergey V Brodsky
- Department of Pathology, the Ohio State University, Columbus, Ohio
| | - David Gidalevitz
- Department of Physics and the Center for the Molecular Study of Condensed Soft Matter, Illinois Institute of Technology, Chicago, Illinois
| | - Zane Hauck
- Department of Medicinal Chemistry and Pharmacognosy, University of Illinois, Chicago, Illinois
| | - Sergey Kalinin
- Department of Anesthesiology, University of Illinois, Chicago, Illinois
| | - Kathy Kowal
- Department of Anesthesiology, University of Illinois, Chicago, Illinois
| | - Ivan Kuzmenko
- X-ray Science Division, Argonne National Laboratory, Lemont, Illinois
| | - Kinga Lis
- Department of Anesthesiology, University of Illinois, Chicago, Illinois
| | - Natalia Marangoni
- Department of Anesthesiology, University of Illinois, Chicago, Illinois
| | - Michael W Martynowycz
- Department of Physics and the Center for the Molecular Study of Condensed Soft Matter, Illinois Institute of Technology, Chicago, Illinois.,X-ray Science Division, Argonne National Laboratory, Lemont, Illinois
| | - Israel Rubinstein
- Department of Anesthesiology, University of Illinois, Chicago, Illinois.,Department of Medicine, University of Illinois, Chicago, Illinois
| | | | - Kyle Ware
- Department of Pathology, the Ohio State University, Columbus, Ohio
| | - Guy Weinberg
- Department of Anesthesiology, University of Illinois, Chicago, Illinois.,Jesse Brown VA Medical Center, Chicago, Illinois
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27
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Seitz MA, Burkitt-Creedon JM. Persistent gross lipemia and suspected corneal lipidosis following intravenous lipid therapy in a cat with permethrin toxicosis. J Vet Emerg Crit Care (San Antonio) 2016; 26:804-808. [PMID: 26748969 DOI: 10.1111/vec.12440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 08/17/2014] [Accepted: 09/15/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the observation of persistent gross lipemia and suspected corneal lipidosis following intravenous lipid therapy (IVLT) in a cat with permethrin toxicosis. CASE SUMMARY A 5-year-old, spayed female, domestic short-haired cat with permethrin toxicosis was treated with a high dose of IVLT as an adjunct treatment when it remained severely obtunded following traditional supportive care. The cat received intravenous 20% lipid emulsion as a 1.5 mL/kg bolus given over 10 minutes followed by a constant rate infusion of 0.25 mL/kg/min for 2 hours. The cat developed gross lipemia that persisted at least 48 hours after the single dose of IVLT. Changes consistent with corneal lipidosis were observed and resolved within 1 week after IVLT. NEW OR UNIQUE INFORMATION PROVIDED This is the first report documenting the complications of persistent gross lipemia and suspected corneal lipidosis in a cat following IVLT. This report underscores the off-label, experimental nature of IVLT as a treatment for intoxication in cats.
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Affiliation(s)
- Marc A Seitz
- Emergency Department, Red Bank Veterinary Hospital - Cherry Hill, Cherry Hill, NJ, 08108.
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28
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Jourdan G, Boyer G, Raymond-Letron I, Bouhsira E, Bedel B, Verwaerde P. Intravenous lipid emulsion therapy in 20 cats accidentally overdosed with ivermectin. J Vet Emerg Crit Care (San Antonio) 2015; 25:667-71. [PMID: 26397735 DOI: 10.1111/vec.12371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 07/01/2015] [Accepted: 07/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the outcome of 20 cats treated with intravenous lipid emulsion (IVLE) after an accidental parenteral ivermectin overdose. CASE SERIES SUMMARY Twenty adult cats presented after receiving a 4 mg/kg accidental subcutaneous overdose of ivermectin. After admission, two IVLE treatments were initiated in asymptomatic cats: a single bolus (1.5 mL/kg; n = 16) versus a bolus followed by a 30-minute constant rate infusion (0.25 mL/kg/min; n = 4). Six out of the 16 cats that received only the single bolus developed clinical signs of ivermectin intoxication. Based on the severity of the clinical signs and their duration (approximately 48 hours), these 6 cats were retrospectively considered either moderately (n = 3) or severely (n = 3) intoxicated by ivermectin. Cats with a low body condition score (BCS) had more severe signs of ivermectin toxicity. Additional IVLE was administered until clinical resolution was complete. Median (min to max) cumulative dose of IVLE per cat was 4.5 (3.0-4.5) mL/kg for 36 (12-36) hours and 19.5 (7.5-37.5) mL/kg for 96 (72-168) hours for moderately and severely intoxicated cats, respectively. NEW OR UNIQUE INFORMATION PROVIDED Our series describes the treatment of accidental ivermectin parenteral overdose in 20 cats with early initiation of IVLE therapy. An early bolus followed by a 30-minute constant rate infusion of IVLE appeared to mitigate the signs of ivermectin toxicosis in cats compared to a single treatment bolus. Our observations also suggest that cats with a low BCS given only a bolus of IVLE treatment were more likely to develop signs of ivermectin intoxication and require a greater amount of IVLE for the resolution of clinical signs. Based on our observations, BCS appears to influence the severity of ivermectin toxicity with a low BCS being associated with more severe signs of ivermectin toxicity.
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Affiliation(s)
- Geraldine Jourdan
- Critical and Intensive Care, Anesthesia Unit, Toulouse National Veterinary School, Toulouse, France
| | - Guillaume Boyer
- Critical and Intensive Care, Anesthesia Unit, Toulouse National Veterinary School, Toulouse, France
| | | | - Emilie Bouhsira
- the Parasitology-Dermatology Unit, Toulouse National Veterinary School, Toulouse, France
| | - Benjamin Bedel
- the Emergency, Critical and Intensive Care Unit, Alfort National Veterinary School, Maisons-Alfort, France
| | - Patrick Verwaerde
- Critical and Intensive Care, Anesthesia Unit, Toulouse National Veterinary School, Toulouse, France.,the Emergency, Critical and Intensive Care Unit, Alfort National Veterinary School, Maisons-Alfort, France
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29
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Ozkan U, Osun A, Basarslan K, Senol S, Kaplan I, Alp H. Effects of intralipid and caffeic acid phenethyl ester on neurotoxicity, oxidative stress, and acetylcholinesterase activity in acute chlorpyriphos intoxication. Int J Clin Exp Med 2014; 7:837-846. [PMID: 24955152 PMCID: PMC4057831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED Chlorpyriphos is one of the most widely used organophosphate (OP) insecticide in agriculture with potential toxicity. Current post-exposure treatments consist of anti-cholinergic drugs and oxime compounds. We studied the effects of intralipid and caffeic acid phenethyl ester (CAPE) on chlorpyriphos toxicity to compose an alternative or supportive treatment for OP poisoning. METHODS Forty-nine rats were randomly divided into seven groups. Chlorpyriphos was administered for toxicity. Intralipid (IL) and CAPE administered immediately after chlorpyriphos. Serum acetylcholinesterase (AChE) level, total oxidant status (TOS), total antioxidant response (TAR), and histologic examination of cerebellum and brain tissue with Hematoxylin-Eosin and immunohistochemical dyes were examined. RESULTS Serum enzym levels showed that chlorpyriphos and CAPE inhibited AChE while IL alone had no effect, chlorpyriphos and CAPE intensifies the inhibition effect. Significant difference at AChE levels between the chlorpyriphos+IL and chlorpyriphos+CAPE verified that IL has a protective effect on AChE inhibition. TAR levels were significantly increased in all groups except chlorpyriphos group, TOS levels revealed that CAPE and IL decrease the amount of oxidative stress. Histologic examination revealed that neuronal degeneration was slightly decreased at chlorpyriphos+IL group, but CAPE had a significant effect on protection of neuronal degeneration. CONCLUSION The results of this study gave us three key points. 1) AChE activity is important for diagnosis of OP intoxication but it has no value for determining the neuro-degeneration. 2) CAPE inhibits AChE activity and may increase the muscarinic-nicotinic hyperactivation. Therefore it should not be used for treatment of OP intoxication. 3) IL decreases the severity of neurodegeneration and symptoms of OP intoxication and it can be used as a supportive agent.
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Affiliation(s)
- Umit Ozkan
- Department of Neurosurgery, Medical Faculty, Dumlupinar UniversityKütahya, Turkey
| | - Arif Osun
- Department of Neurosurgery, Medical Faculty, Dumlupinar UniversityKütahya, Turkey
| | - Kagan Basarslan
- Department of Neurosurgery, Medical Faculty, Mustafa Kemal UniversityHatay, Turkey
| | - Serkan Senol
- Department of Pathology, Göztepe Egitim ve Arastirma Hastanesi, Medeniyet Universityİstanbul, Turkey
| | - Ibrahim Kaplan
- Department of Biochemistry, Medical Faculty, Dicle UniversityDiyarbakir, Turkey
| | - Harun Alp
- Department of Pharmacology, Medical Faculty, Mustafa Kemal UniversityHatay, Turkey
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30
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Aye MM, Kilpatrick ES, Aburima A, Wraith KS, Magwenzi S, Spurgeon B, Rigby AS, Sandeman D, Naseem KM, Atkin SL. Acute hypertriglyceridemia induces platelet hyperactivity that is not attenuated by insulin in polycystic ovary syndrome. J Am Heart Assoc 2014; 3:e000706. [PMID: 24584741 PMCID: PMC3959686 DOI: 10.1161/jaha.113.000706] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
Background Atherothrombosis is associated with platelet hyperactivity. Hypertriglyceridemia and insulin resistance (IR) are features of polycystic ovary syndrome (PCOS). The effect of induced hypertriglyceridemia on IR and platelet function was examined in young women with PCOS. Methods and Results Following overnight fasting, 13 PCOS and 12 healthy women were infused with saline or 20% intralipid for 5 hours on separate days. Insulin sensitivity was measured using a hyperinsulinemic euglycaemic clamp in the final 2 hours of each infusion. Platelet responses to adenosine diphosphate (ADP) and prostacyclin (PGI2) were measured by flow cytometric analysis of platelet fibrinogen binding and P‐selectin expression using whole blood taken during each infusion (at 2 hours) and at the end of each clamp. Lipid infusion increased triglycerides and reduced insulin sensitivity in both controls (median, interquartile range ) (5.25 [3.3, 6.48] versus 2.60 [0.88, 3.88] mg kg−1 min−1, P<0.001) and PCOS (3.15 [2.94, 3.85] versus 1.06 [0.72, 1.43] mg kg−1 min−1, P<0.001). Platelet activation by ADP was enhanced and ability to suppress platelet activation by PGI2 diminished during lipid infusion in both groups when compared to saline. Importantly, insulin infusion decreased lipid‐induced platelet hyperactivity by decreasing their response to 1 μmol/L ADP (78.7% [67.9, 82.3] versus 62.8% [51.8, 73.3], P=0.02) and increasing sensitivity to 0.01 μmol/L PGI2 (67.6% [39.5, 83.8] versus 40.9% [23.8, 60.9], P=0.01) in controls, but not in PCOS. Conclusion Acute hypertriglyceridemia induced IR, and increased platelet activation in both groups that was not reversed by insulin in PCOS subjects compared to controls. This suggests that platelet hyperactivity induced by acute hypertriglyceridemia and IR could contribute athero‐thrombotic risk. Clinical Trial Registration URL: www.isrctn.org. Unique Identifier: ISRCTN42448814.
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Affiliation(s)
- Myint Myint Aye
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK
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Sclafani A, Zukerman S, Ackroff K. GPR40 and GPR120 fatty acid sensors are critical for postoral but not oral mediation of fat preferences in the mouse. Am J Physiol Regul Integr Comp Physiol 2013; 305:R1490-7. [PMID: 24154510 DOI: 10.1152/ajpregu.00440.2013] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In addition to orosensory signals, postoral actions of fat stimulate appetite and condition flavor preferences, but the gut sensors mediating these responses are unknown. Here, we investigated the role of the fatty acid sensors GPR40 and GPR120 in postoral and oral preferences for a soybean oil emulsion (Intralipid). Mice were trained to drink a flavored solution (CS+) paired with intragastric (IG) oil infusions and another flavored solution (CS-) paired with water infusions. Knockout (KO) mice missing GPR40 or GPR120 sensors increased their CS+ intake in one-bottle tests (1 h/day) but less so than wild-type (WT) mice. The KO mice also preferred the CS+ to CS- in a two-bottle test, but the preference was attenuated in GPR40 KO mice. Double-knockout (DoKO) mice missing both GPR40 and GPR120 displayed attenuated stimulation of CS+ intake and only a marginal CS+ preference. The DoKO mice developed a more substantial CS+ preference when tested 24 h/day, although weaker than that of WT mice. The DoKO mice also consumed less of the CS+ paired with IG Intralipid, as well as less Intralipid in oral tests. However, DoKO mice, like GPR40 KO and GPR120 KO mice did not differ from WT mice in their preference for Intralipid over water at 0.001%-20% concentrations. In contrast to prior results obtained with mice missing the CD36 fatty acid sensor, these findings indicate that, together, GPR40 and GPR120 play a critical role in the postoral stimulation of appetite by fat but are not essential for oral fat preferences.
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Affiliation(s)
- Anthony Sclafani
- Department of Psychology, Brooklyn College, City University of New York, Brooklyn, New York, and
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Warren M, Thompson KS, Popek EJ, Vogel H, Hicks J. Pericardial effusion and cardiac tamponade in neonates: sudden unexpected death associated with total parenteral nutrition via central venous catheterization. Ann Clin Lab Sci 2013; 43:163-171. [PMID: 23694791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Total parenteral nutrition (TPN) via central venous catheter (CVC) is used routinely to provide adequate nutrition for neonates, especially those with very low birth weights (VLBWN). Pericardial effusion and cardiac tamponade (PCE/CT) is a potentially life-threatening CVC complication. DESIGN This autopsy study presents the gross and histopathologic findings in 5 neonates receiving continuous TPN via CVCs, who suddenly and unexpectedly died from PCECT. RESULTS The study population included five neonates (age 4-29 days, 3 males, 2 females, 4 VLBWN neonates, 1 full-term neonate). Chemical analysis of the milky-white PCE fluid showed high triglyceride levels (717-777 mg/dL) consistent with intralipid. Right atrial microscopic examination with the four VLBWNs showed interstitial edema and dilated lymphatics (n=4), atrial thrombus (n=1), and focal fibrinous epicardial exudate (n=1). The full-term neonate RA revealed focal myocyte coagulative necrosis, acute organizing hemorrhage, focal collagen deposition, myocardial hypertrophy, and endocardial thickening. CONCLUSIONS Right atria in PCE/CT demonstrated marked interstitial edema and dilated fine vascular channels. Endocardial injury with permeation of hyperosmotic TPN fluid into the interstitium and egress into the pericardial sac is hypothesized as the etiology of PCE/CT. Recognition of PCE and impending CT in neonates with CVCs for TPN with expedient intervention may avoid sudden unexpected deaths.
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Affiliation(s)
- Mikako Warren
- Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
This study tests the hypothesis that lipids could act as an alternative fuel source in the brain during insulin-induced hypoglycemia. Male Sprague-Dawley rats were subjected to hyperinsulinemic (5 mU.kg(-1).min(-1)) hypoglycemic (approximately 50 mg/dl) clamps. In protocol 1, intralipid (IL), a fat emulsion, was infused intravenously to prevent the fall in free fatty acid levels that occurs in response to hyperinsulinemic hypoglycemia. Intravenous lipid infusion did not alter the counterregulatory responses to hypoglycemia. To test whether IL could have central effects in mediating the counterregulatory response to hypoglycemia, in protocol 2 the brains of precannulated rats were intracerebroventricularly (icv) infused with IL or artificial cerebrospinal fluid (aCSF) as control. Unexpectedly, the epinephrine and glucagon response to hypoglycemia was significantly augmented with icv IL infusion. To determine whether central IL infusion could restore defective counterregulation, in protocol 3 rats were made recurrently hypoglycemic (RH) for 3 days and on the 4th day underwent hyperinsulinemic hypoglycemic clamps with icv IL or aCSF infusion. RH rats had the expected impaired epinephrine response to hypoglycemia, and icv IL infusion again significantly augmented the epinephrine response in RH rats to normal. With regard to our experimental model of hypoglycemic counterregulation, we conclude that 1) systemic lipid infusion did not alter the counterregulatory response to hypoglycemia, 2) the icv infusion of lipids markedly increased CSF FFA levels and paradoxically augmented the epinephrine and glucagon responses, and 3) the blunted sympathoadrenal response in recurrently hypoglycemic rats was completely normalized with the icv lipid infusion. It is concluded that, in the setting of insulin-induced hypoglycemia, increased brain lipids can enhance the sympathoadrenal response.
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Affiliation(s)
- Samuel C Haywood
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University in St. Louis, 660 South Euclid Ave., St. Louis, MO 63110, USA
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Chen SS, Santomango TS, Williams PE, Lacy DB, McGuinness OP. Glucagon-mediated impairments in hepatic and peripheral tissue nutrient disposal are not aggravated by increased lipid availability. Am J Physiol Endocrinol Metab 2009; 296:E1172-8. [PMID: 19208853 PMCID: PMC2681308 DOI: 10.1152/ajpendo.90821.2008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Glucose, fat, and glucagon availability are increased in diabetes. The normal response of the liver to chronic increases in glucose availability is to adapt to become a marked consumer of glucose. Yet this fails to occur in diabetes. The aim was to determine whether increased glucagon and lipid interact to impair the adaptation to increased glucose availability. Chronically catheterized well controlled depancreatized conscious dogs (n = 21) received 3 days of continuous parenteral nutrition (TPN) that was either high in glucose [C; 75% nonprotein calories (NPC)] or in lipid (HL; 75% NPC) in the presence or absence of a low dose (one-third basal) chronic intraportal infusion of glucagon (GN; 0.25 ng.kg(-1).min(-1)). During the 3 days of TPN, all groups received the same insulin algorithm; the total amount of glucose infused (GIR) was varied to maintain isoglycemia ( approximately 120 mg/dl). On day 3 of TPN, hepatic metabolism was assessed. Glucose and insulin levels were similar in all groups. GIR was decreased in HL and C + GN ( approximately 30%) and was further decreased in HL + GN (55%). Net hepatic glucose uptake was decreased approximately 15% in C + GN, and HL and was decreased approximately 50% in HL + GN. Lipid alone or combined with glucagon decreased glucose uptake by peripheral tissues. Despite impairing whole body glucose utilization, HL did not limit whole body energy disposal. In contrast, glucagon suppressed whole body energy disposal irrespective of the diet composition. In summary, failure to appropriately suppress glucagon secretion adds to the dietary fat-induced impairment in both hepatic and peripheral glucose disposal. In addition, unlike increasing the percentage of calories as fat, inappropriate glucagon secretion in the absence of compensatory hyperinsulinemia limits whole body nutrient disposition.
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Affiliation(s)
- Sheng-Song Chen
- Department of Molecular Physiology, Vanderbilt University, Nashville, TN 37232-061, USA
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