The effect of care intervention for obese patients with type II diabetes

The incidence of type II diabetes mellitus (T2DM) is increasing worldwide and affecting the quality of people's life. This study was designed to evaluate the effect of care intervention on body weight and glycemic parameters in obese T2DM patients.One hundred twenty-six obese T2DM cases were randomly divided into 2 groups. Patients in control group received conventional care, while patients in the intervention group received dietary, exercise, and psychology interventions on the basis of conventional care. Twelve months follow-up was performed to compare the changes of body weight and glycemic parameters in the 2 groups.There were 119 patients completing the research, 60 in the intervention group and 59 in control group. The levels of fasting plasma glucose (FPG), 2 hours postprandial blood glucose (PBG2 h), hemoglobin A1c (HbA1c), and aldose reductase (AR) were all significantly decreased (all, P < .05) in intervention group compared with the control group after 12 months follow-up. Moreover, the body weight and BMI (body mass index) were also significantly reduced in intervention group, and the weight loss was significantly higher in intervention group than that in control group during the follow-up.To implement care intervention for obese T2DM patients could strengthen the management of blood glucose, reduce body weight and complications.

Effects of S-Allylcysteine on Biomarkers of the Polyol Pathway in Rats with Type 2 Diabetes

OBJECTIVES

We evaluated the effects of S-allylcysteine (SAC) on biomarkers of the polyol pathway in streptozotocin-nicotinamide (STZ-NA)-induced diabetes in rats.

METHODS

Diabetes was induced in male albino Wistar rats by intraperitoneal administration of STZ (55 mg kg^-1 bw^-1) and NA (110 mg kg^-1 bw^-1). SAC (150 mg kg^-1 bw^-1) was orally administered to the rats with diabetes for 45 days to assess its effects on blood glucose, insulin, insulin resistance, glycated hemoglobin, aldose reductase (AR), sorbitol dehydrogenase (SDH), sorbitol, fructose, thiobarbituric acid-reactive substances (TBARS), hydroperoxide, hemoglobin and glutathione (GSH).

RESULTS

On SAC administration in the rats with diabetes, the levels of blood glucose, insulin resistance, glycated hemoglobin, AR, SDH, sorbitol, fructose, TBARS and hydroperoxide increased significantly (p<0.05), whereas those of insulin, hemoglobin and GSH decreased. SAC showed therapeutic effects similar to those of gliclazide in decreasing blood glucose, AR, SDH, sorbitol, fructose, glycosylated hemoglobin, TBARS and hydroperoxides levels and significant increases in insulin, hemoglobin and GSH activity in rats with diabetes. Moreover, histopathologic studies also revealed the protective effect of SAC on pancreatic beta cells.

CONCLUSIONS

The results indicate that SAC prevents complications of diabetes by reducing the influx of glucose in the polyol pathway, thereby elevating the GSH level and reducing the activities of AR and SDH. Therefore, SAC may have imperative implications for the deterrence and early treatment of type 2 diabetes.

Detection of AKR1B10 in Peripheral Blood by Anti-AKR1B10-Conjugated CdTe/CdS Quantum Dots

BACKGROUND

Aldo-ketoreductase family 1 member B10 (AKR1B10) is a novel prognostic predictor and therapeutic target for colorectal cancer (CRC), and enzyme-linked immunosorbent assays (ELISAs) and electrochemiluminescence (ELC) assays are sample-consuming and high-cost methods. Therefore, it is very necessary to develop a new, simple, and fast yet highly sensitive and specific method for the detection of AKR1B10 in serum. Semiconducting quantum dots (QDs) possess a high fluorescence quantum yield, stability against photobleaching, and size-controlled luminescence properties; thus, they are suitable for photoelectrochemical tumor marker detection, especially in complex biological samples. However, CdTe/CdS QDs have not been applied for the detection of AKR1B10 in serum.

METHODS

AKR1B10 in peripheral blood has been established using anti-AKR1B10-conjugated CdTe/CdS QDs and measurements. The assay sensitivity was determined by measuring the quenched fluorescence intensity of AKR1B10 at 0.5, 1, 2, 5, or 10 ng/mL in phosphate-buffered solution (PBS) or 0.25%, 0.5%, 1.0%, 2.0%, or 5% human serum diluted in PBS. The assay was optimized under different pH values (7.00 - 7.40) for different reaction durations (10 - 60 minutes). The specificity of anti-AKR1B10-QDs was determined by testing the inhibition of AKR1B10 activity with carcinoembryonic antigen (CEA), immunoglobulin G (IgG), or alpha-fetoprotein (AFP), each at 1 ng/mL.

RESULTS

Under the optimized incubation time (30 minutes) at room temperature and optimal pH (7.1 - 7.2), a correlation between the decreased fluorescence intensity of anti-AKR1B10-conjugated CdTe/CdS QDs and the concentration of AKR1B10 in the range from 0.05 to 100 ng/mL was established. The assay was sensitive for the detection of AKR1B10 in the range from 0.05 to 100 ng/mL, and the detection limit was 0.02 ng/mL. The assay presented a high specificity because the anti-AKR1B10-conjugated CdTe/CdS QDs only reacted with AKR1B10 in the sera in the presence of CEA, IgG, or AFP.

CONCLUSIONS

In conclusion, the immunofluorescence assay to detect AKR1B10 in serum using anti-AKR1B10-conjugated CdTe/CdS QDs was simple and fast yet presented high sensitivity and specificity. Our findings provide a promising tool for the early prediction of CRC.

[Aldehyde reductase activity and blood aldo-keto reductase spectrum in adolescents with neuroendocrine obesity]

Investigation of aldehyde-reductase activity and blood aldo-keto reductase spectrum has been performed in 13-15 and 16-18-years old adolescents with obesity to clear up the mechanisms of neuroendocrine obesity at the age of puberty. It has been established that basal aldehyde reductase activity and blood aldo-keto reductase spectrum of healthy adolescents in early puberty do not differ from those of healthy adolescents in late puberty. A decreased aldehyde reductase activity and some alterations in blood aldo-keto reductase spectrum have been observed in late puberty in adolescents with neuroendocrine obesity. In adolescents with obesity there have been registered some changes in blood aldo-keto reductase spectrum which are not accompanied by any alterations in its aldehyde reductase activity. The results obtained suggest that certain prerequisites are formed in late puberty to complicate the course of neuroendocrine obesity.

Evaluation of antidiabetic potential of selected traditional Chinese medicines in STZ-induced diabetic mice

AIMS

Traditional Chinese medicine (TCM) has been used for treating complex chronic diseases owing to their fewer side-effects, better patient tolerance and relatively less cost. The present work was carried out to study the anti-diabetic efficacy and mechanisms of 34 TCMs.

MATERIALS AND METHODS

Streptozotocin (STZ)-diabetic mice were orally administrated with corresponding herbal solution once a day for 4 weeks. At the end of experiment, the level of plasma glucose, malondialdehyde (MDA), the activity of superoxide dismutase (SOD) and the serum aldose reductase (AR) were determined, the effects of TCM extract on α-glucosidase and angiotensin-converting enzyme (ACE) in vitro were also evaluated.

RESULTS

13 out of the 34 herbs showed a statistically significant plasma glucose lowering action compared with the diabetic control group. Biochemical analysis revealed that Atractylodes macrocephala, Codonopsis pilosula, Dioscorea opposite, Flos lonicerae and Pueraria lobata may retard the progression of diabetes via reduce the blood glucose level and prevent the increase of AR activity. Other tested herbs, such as Ramulus cinnamomi, Cinnamomum cassia, and Eucommia ulmoides, showed the antidiabetic ability by either prevent the decrease in SOD activity or suppress the increase of MDA. Zymologic assay reveals that Pueraria lobata and Anemarrhena asphodeloides showed the highest inhibition against α-glucosidase and ACE respectively. Interestingly, the post-treatment glucose levels and AR activity were positively correlated with kidney/body weight of 34 herbs treated diabetic mice (p = 0.02, 0.04 respectively).

CONCLUSIONS

Several potential antidiabetic herbs derived from Chinese traditional pharmacopeia such as Dioscorea opposite, Pueraria lobata, Codonopsis pilosula and Ramulus cinnamomi, have been found to exert a beneficial action on diabetes and diabetic complications via multi-mechanisms.

Epithelial cell density in cataractous lenses of patients with diabetes: association with erythrocyte aldose reductase

In the present study we evaluated the cell density of lens epithelium and its relation to the degree of erythrocyte aldose reductase (AR) in patients with type 2 diabetes. This prospective clinical study included 46 eyes of patients with type 2 diabetes and 48 eyes of patients without diabetes mellitus (DM). Flat preparations of lens epithelial cells (LECs) attached to the anterior capsule were studied. Multiple regression analysis was performed to evaluate the association between lens cell density and age, gender, type of cataract, duration of diabetes, diabetic retinopathy (DR), the levels of glycosylated hemoglobin (HbA1c) and erythrocyte AR. The mean density of LECs of patients with type 2 diabetes was 4,141+/-508cells/mm(2), which was significantly lower than that of patients without DM (4,560+/-458cells/mm(2); p<0.0001). Multiple regression analysis revealed that the level of erythrocyte AR was correlated with the reduction of LECs in the eyes of patients with type 2 diabetes. The correlation between the density of LECs and the amount of erythrocyte AR was significant in the diabetic group with a high value of HbA1c (>6.5%) or with DR. These results suggest that the polyol pathway via AR may be associated with the reduction of epithelial cell density in the eyes of patients with DM.

Inhibitory effects of astragaloside IV on diabetic peripheral neuropathy in rats

Astragaloside IV (AGS-IV), a new glycoside of cycloartane-type triterpene isolated from the root of Astragalus membranaceus (Fisch.) Bunge, has been used experimentally for its potent immune-stimulating, anti-inflammatory, and antioxidative actions. A recent study has shown AGS-IV to be an aldose-reductase inhibitor and a free-radical scavenger. This study examined the effects of AGS-IV on motor nerve conduction velocity (MNCV), tailflick threshold temperature, biochemical indexes, and the histology of the sural nerve after diabetes was induced in rats with 75 mg/kg streptozotocin (STZ). AGS-IV (3, 6, 12 mg/kg, twice a day) was administered by oral gavage for 12 weeks after diabetes was induced. Compared with control (nondiabetic) rats, obvious changes in physiological behaviors and a significant reduction in sciatic MNCV in diabetic rats were observed after 12 weeks of STZ administration. Morphological analysis showed that AGS-IV suppressed a decrease in myelinated fiber area, an increase in myelinated fiber density, and an increase in segmental demyelination in diabetic rats. The protective mechanism of AGS-IV involved a decrease in declining blood glucose concentration and HbA1C levels, and an increase in plasma insulin levels. AGS-IV increased the activity of glutathione peroxidase in nerves, depressed the activation of aldose reductase in erythrocytes, and decreased the accumulation of advanced glycation end products in both nerves and erythrocytes. Moreover, AGS-IV elevated Na+,K+-ATPase activity in both the nerves and erythrocytes of diabetic rats. These results indicate that AGS-IV exerts protective effects against the progression of peripheral neuropathy in STZ-induced diabetes in rats through several interrelated mechanisms.

Effects of melatonin on plasma oxidative stress in rats with streptozotocin induced diabetes

The aim of this study was to evaluate the effect of single melatonin injection on plasma oxidative stress in rats with streptozotocin induced diabetes. Diabetes was induced after a single intraperitoneal dose of streptozotocin (60 mg/kg), while hyperglycemia was determined 10 days upon injection. Diabetic rats were divided into two groups. In the first group the injection of melatonin was applied intraperitoneally (20 mg/kg), while the second group received physiological solution. Twenty-four hours later the rats were killed and their blood was centrifuged. In the rat plasma the following parameters were evaluated: the glucose level, superoxide radical, lipid peroxidation, reduced glutathione, total antioxidant capacity, antioxidant enzymes and the aldose reductase activity. The injected melatonin decreased the superoxide radical in the rat plasma. Moreover, melatonin increased the total antioxidative capacity and the activity of antioxidative enzymes superoxide dismutase and glutathione peroxidase. These results indicate that melatonin is a strong scavenger, which may diminish negative effects of oxidative stress in diabetic rats 24 hours after its application The findings suggest that melatonin is also a strong antioxidant. It increases the antioxidant enzymes activity, inhibiting the release of superoxide radicals. A high total antioxidative capacity and the lower activity of aldose reductase enlarge melatonin scavenger capacity against reactive oxygen species in diabetic rats.

[Analysis of correlative factors affecting IIEF-5 scores of type 2 diabetic patients]

OBJECTIVE

To investigate the correlative factors affecting the IIEF-5 scores of the patient with type 2 diabetic mellitus (T2DM).

METHODS

A total of 149 T2DM patients were investigated for the relationships between their IIEF-5 score and such factors as age, body mass index (BMI), fasting plasma glucose (FPG), 2hPG, insulin (INS), GHbA1c, C-peptide, nitric oxide (NO), testosterone (T), estradiol (E2), the ratio of testosterone to estradiol (T/E), erythrocyte aldose reductase (AR), drinking, smoking, concomitant diseases, complications and medication.

RESULTS

The scores of the groups of smoking, complication, medication and concomitant disease were significantly lower than those of the controls. There was significant negative correlation between IIEF-5 scores and age, BMI, FPG, 2hPG, INS, GHbA1c and AR (P < 0.05), and significant positive correlation between IIEF-5 scores and NO (P < 0.05). But there was no correlation between drinking, T, E2 and T/E2 (P > 0.05).

CONCLUSION

Many factors may affect the IIEF-5 scores of T2DM patients.

Protective effects of bendazac lysine on early experimental diabetic nephropathy in rats

AIM

To investigate the preventive and protective effects of bendazac lysine (BDL) on experimental early diabetic nephropathy (DN) rats.

METHODS

After an early DN model was induced by streptozotocin, rats were administered BDL at doses of 100, 200, and 400 mg/kg for 8 weeks. Blood glucose, microalbuminuria, kidney index, total antioxidative capacity, laminin, advanced glycation end products (AGE), aldose reductase (AR) activity, and the relative quantity of transforming growth factor beta1 (TGF- beta1) mRNA were measured by different methods. The ultrastructural morphology was observed by transmission electron microscope.

RESULTS

The physical behaviors of early DN rats were hypopraxia, cachexia, and polyuria, while those treated with high doses of BDL were vibrant and vigorous. For BDL-treated DN rats, when compared with vehicle-treated DN rats, the blood glucose level and the intensity of oxidative stress were ameliorated. Also, the microalbuminuria level, AGE either in serum or in renal, and AR activity were significantly reduced. Furthermore, the expression of TGF-beta1 mRNA in the kidney cortex was declined and the thickness of glomerular base membrane was decreased significantly. The ultrastructure of glomerulus and mesangial matrix of BDL-treated DN rats were ameliorated.

CONCLUSION

BDL has protective effects on several pharmacological targets in the progress of DN and is a potential drug for the prevention of early DN.

Preventing and treating actions of compound lian zhu capsule on micrangium lesions in diabetic rats

Tissue culture, biochemical techniques and radioimmunoassay were used to study the effects of Compound Lian Zhu Capsule on micrangium lesions in diabetic rats. The results indicated that blood sugar, glycosylated hemoglobin (GHb), urinary protein and malondialdehyde (MDA) contents, aldose reductase (AR) activity and 3H-TdR incorporation rate in the vascular smooth muscle cell (VSMC) were significantly higher, and plasma NO content in the diabetes mellitus (DM) group were significantly lower than those in the normal control group (both P < 0.05). The above indexes in the Chinese medicine (TCM) treatment group were improved significantly as compared with the DM group, with no significantly differences, except urine volume and urinary protein, as compared with the normal control group. It is suggested that Compound Lian Zhu Capsules cansignificantly alleviate the complicated lesions of the micrangium in diabetic rats.

Erythrocytic sorbitol contents in diabetic patients correlate with blood aldose reductase protein contents and plasma glucose levels, and are normalized by the potent aldose reductase inhibitor fidarestat (SNK-860)

The accumulation of sorbitol by the activated polyol pathway is considered to be a major cause of diabetic neuropathy. Because the erythrocytic sorbitol contents reportedly reflects that in nerves, erythrocytic sorbitol measurement would be useful for confirming the effect of an aldose reductase inhibitor (ARI). In this study, we examined erythrocytic sorbitol contents in healthy subjects and diabetic patients under fasting and postprandial conditions. Then, the contributions of blood aldose reductase (AR) contents and plasma glucose levels to the accumulated erythrocytic sorbitol contents were also analyzed. Erythrocytic sorbitol contents in the healthy subjects were 11.7 and 12.5-12.6 nmol/g Hb in fasting and postprandial status, respectively. In contrast, the erythrocytic sorbitol contents in diabetic patients were apparently higher (approximately 2.5-fold), but fidarestat treatment restored the elevated erythrocytic sorbitol contents to normal. In the diabetic patients, erythrocytic sorbitol contents were highly correlated with blood AR contents multiplied by the plasma glucose levels, whereas in the normal and fidarestat-treated diabetic patients no such correlation was observed. Taken together, these results suggest both the blood AR contents and the plasma glucose levels are factors determining erythrocytic sorbitol contents in diabetic patients. Notably, the potent ARI fidarestat was shown to normalize elevated erythrocytic sorbitol contents.

Systemic and ocular pharmacokinetics of N-4-benzoylaminophenylsulfonylglycine (BAPSG), a novel aldose reductase inhibitor

To better develop N-[4-(benzoylamino)phenylsulfonyl]glycine (BAPSG), a potent and selective aldose reductase inhibitor capable of delaying the progression of ocular diabetic complications, the objective of this study was to assess its pharmacokinetics. The plasma pharmacokinetics of BASPG was assessed in male Sprague-Dawley rats following intravenous, intraperitoneal and oral routes of administration and its distribution to various tissues including those of the eye was studied following intraperitoneal administration. In addition, rat plasma protein binding of BAPSG was studied using ultracentrifugation method and its ocular tissue disposition was assessed following topical administration in rabbits. Plasma and tissue levels of BAPSG were analysed using an HPLC assay. BAPSG exhibited dose-proportionate AUC0 --> infinity (area under the plasma concentration-time curve) following both intravenous and intraperitoneal administration over the dose range (5-50 mg kg(-1)) studied and an erratic oral absorption profile with low oral bioavailability. The fraction bioavailability following oral and intraperitoneal administration was 0.06 and 0.7-1, respectively. BAPSG exhibited short plasma elimination half-lives in the range 0.5-1.5 h. BAPSG was bound to rat plasma proteins and the percent protein binding ranged from 83 to 99.8%. BAPSG was better distributed to cornea, lens and retina than to brain, following intraperitoneal administration in rats. However, the distribution was lower compared with kidney and liver. Following topical administration in rabbits, BAPSG delivery to the surface ocular tissues, cornea and conjunctiva was higher compared with intraocular tissues, aqueous humour, iris-ciliary body and lens. Thus, BAPSG was distributed to ocular tissues following systemic and topical modes of administration.

Regulation of aldose reductase and the polyol pathway activity by nitric oxide

Increased flux of glucose through the polyol pathway has been implicated in the pathophysiology of secondary diabetic complications. The first step of this pathway, which generates sorbitol from glucose, is catalyzed by aldose reductase (AR) (AKR1B). In vitro, the binding of substrates and inhibitors to AR is highly sensitive to the oxidation state of the enzyme due to the presence of a hyper-reactive cysteine residue at the active site of the enzyme. This residue (Cys-298) can be readily modified in air or, by thiol-modifying reagents, nitric oxide (NO) donors and nitrosothiols. We show that exposure of rat erythrocytes to NO donors inhibits AR activity and AR mediated accumulation of sorbitol, possibly by S-glutathiolation of Cys-298. Both glutathiolation and inhibition of AR are reversible upon subsequent incubation of the cells with fresh media without NO donors. These observations suggest that NO regulates the cellular activity of AR and in turn the flux of glucose via the polyol pathway. The inhibition of AR by exogenous or endogenous NO appears to be related to reversible S-glutathiolation of the AR protein. Because hyperglycemic states are associated with a decrease in NO generation, the loss of NO-mediated repression of AR may be a significant factor in the activation of the polyol pathway and the development of secondary diabetic complications.

Plasma 3-deoxyglucosone elevation in chronic renal failure is associated with increased aldose reductase in erythrocytes

BACKGROUND

Serum concentrations of 3-deoxyglucosone (3DG), a highly reactive dicarbonyl compound, are elevated in uremic patients. Aldose reductase (AR) is an enzyme involved in both the detoxification of 3DG and producing precursors of 3DG.

METHODS

We examined the relationship between plasma 3DG and erythrocyte AR content in uremic patients. Patients were divided into three groups: (1) progressive renal disease without hemodialysis (HD; chronic renal failure [CRF] group), (2) patients without diabetes mellitus (DM) treated with maintenance HD (HD group), and (3) patients with DM treated with maintenance HD (DM-HD group). High-performance liquid chromatography was used to measure 3DG, and erythrocyte AR was measured by means of enzyme-linked immunosorbent assay.

RESULTS

Both 3DG and erythrocyte AR levels were significantly greater in the CRF, HD, and DM-HD groups than in healthy controls. These results did not change after HD sessions in the HD or DM-HD groups. Serum creatinine levels correlated with 3DG and erythrocyte AR levels in the control and CRF groups (3DG: r = 0.67; P < 0.001; erythrocyte AR: r = 0.71; P < 0.001). Both erythrocyte AR and 3DG levels then increased as renal function declined. A positive correlation was seen between 3DG and erythrocyte AR levels in all groups (r = 0.65; P < 0.001), and also between plasma osmolality and erythrocyte AR level (r = 0.46; P < 0.001).

CONCLUSION

Both erythrocyte AR and 3DG levels are increased in uremic patients, and these increases could possibly contribute to the development of uremic symptoms.

Oxidative stress and male IGF-1, gonadotropin and related hormones in diabetic patients

Elevation of glucose concentration in diabetes may induce generation of oxygen free radicals such as superoxide (O2*-) and hydroxyl (*OH). The aim of the present study was to investigate the effect of the oxidative stress on the activities of blood superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione reductase (GSSG-R) and aldose reductase, the levels of reduced glutathione (GSH), lipid peroxidation (thiobarbituric acid reactive substances; TBARS) and plasma levels of insulin-like growth factor-1 (IGF-1), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone in type 2 (non-insulin-dependent diabetes) patients and in healthy controls. Blood SOD, CAT, GSH-Px and GSSG-R were lower in type 2 diabetic patients compared with the the control group. Blood aldose reductase activity was elevated in patients with type 2 diabetes compared with the control group. GSH was decreased while TBARS concentration was increased in red blood cells (RBC) and leukocytes from the patients with type 2 diabetes mellitus in comparison to the control group. The mean values of plasma LH, FSH and testosterone were decreased, whereas the mean plasma IGF-1 concentration was increased in type 2 diabetes compared with controls. These findings support the hypothesis that hyperglycemia enhances the activity of the polyol pathway and impairs the antioxidant status, particularly glutathione redox cycle, resulting in poorer defense against oxidative stress. In addition, decreased circulating testosterone and gonadotropin levels may reflect the oxidative stress exerted by diabetes.

Metabolism of lipid peroxidation product, 4-hydroxynonenal (HNE) in rat erythrocytes: role of aldose reductase

Lipid peroxidation represents a significant source of erythrocyte dysfunction and aging. Because the toxicity of lipid peroxidation appears to be in part due to aldehydic end products, we examined, in rat erythrocytes, the metabolism of 4-hydroxy-trans-2-nonenal (HNE), one of the most abundant and toxic lipid-derived aldehydes. Packed erythrocytes, 0.1 ml, completely metabolized 20 nmoles of HNE in 20 min. The glutathione conjugate of HNE and 4-hydroxynonanoic acid (HNA) represented 70 and 25% of the total metabolism, respectively. Approximately 70% of the metabolites were extruded to the medium. Upon electrospray ionization mass spectrometry, the glutathione conjugate resolved into two distinct species corresponding to glutathionyl HNE (GS-HNE) and glutathionyl 1,4-dihydroxynonene (GS-DHN). The concentration of GS-DHN formed was twice that of GS-HNE. Inhibition of aldose reductase by sorbinil and tolrestat led to a selective decrease in the formation of GS-DHN, although the extent of HNE glutathiolation was unaffected. Inhibitors of aldehyde or alcohol dehydrogenase, i.e., cyanamide and 4-methyl pyrazole, had no effect on the formation of HNA and GS-DHN, indicating that these enzymes are not significant participants in the erythrocyte HNE metabolism. Thus, oxidation to HNA, conjugation with glutathione, and further reduction of the conjugate by aldose reductase appear to be the major pathways of HNE metabolism in erythrocytes. These pathways may be critical determinants of erythrocyte toxicity due to lipid peroxidation-derived aldehydes.

Inhibitory effects of fidarestat on aldose reductase and aldehyde reductase activity evaluated by a new method using HPLC with post-column spectrophotometric detection

A new method to assay the activity of aldose reductase (AR) and aldehyde reductase (AHR) by high-performance liquid chromatography is described. The separation of AR and AHR from tissue extracts using an anion-exchange column was followed by chromatographic measurement of the activity in the elute. AR and AHR activity were expressed as the area under the peak obtained by post-column spectrophotometric detection of the decrease of coenzyme (NADPH) in each enzyme reaction. In the enzyme preparation from rat or human tissues obtained by this method, two active peaks were identified as AR and AHR. The correlation coefficient between the injection volume of the enzyme preparation from each tissue and each peak area was 0.998 or greater. In addition, the within-day preservation rate of AR or AHR activity from each tissue was over 95%. In a comparative study of fidarestat with other AR inhibitors using this method, it was confirmed that the inhibitory effect of fidarestat on AR activity from each rat tissue was more potent than that produced by sorbinil and equipotent to that of epalrestat and zenarestat. Fidarestat was also found to inhibit AR activity more potently than AHR activity in human erythrocytes. Therefore, this method is applicable to studies of the selective inhibition of AR or AHR by test compounds.

[Clinical study on jinmaitong composita on diabetic peripheral neuropathy]

OBJECTIVE

To verify the effect of Jinmaitong composita (JMTC) on red blood cell aldolase reductase activity (RBC-AR), RBC sorbitol (RBC-S) and nerve conductive velocity in diabetic peripheral neuropathy (DN).

METHODS

Sixty-six patients with DN were divided randomly into two groups, 33 patients in treated group treated with JMTC and 33 cases in the control group treated with Jinkui Shenqi (JKSQ), RBC-AR, RBC-S and nerve transmission speed were observed before and after three months treatment.

RESULTS

Level of RBC-AR, RBC-S apparently decreased and nerve conductive velocity increased (P < 0.05, P < 0.01) after TMTC treatment.

CONCLUSION

JMTC was able to improve the nerve conduction significantly with a lowering of RBC-AR and RBC-S and has good result in treating Diabetic peripheral neurophathy.

Increased levels of aldose reductase in peripheral mononuclear cells from type 2 diabetic patients with microangiopathy

Aldose reductase (AR) protein was measured in peripheral mononuclear cells (PMCs) from 55 patients with type 2 diabetes by a two-site ELISA using anti-human AR monoclonal antibody. AR levels did not correlate with age, duration of diabetes, and HbAlc. Furthermore, no significant differences were found in AR levels between the patients and healthy subjects. Thirty seven patients had at least one of diabetic microangiopathy; retinopathy, neuropathy, or nephropathy. AR levels were significantly higher in the patients with microangiopathy than in those without it (52.3 +/- 15.7 vs. 43.0 +/- 15.2 ng/10(6) cells, P < 0.05). The patients with neuropathy had significantly higher AR levels than those without neuropathy (53.7 +/- 15.8 vs. 42.7 +/- 14.3 ng/l0(6) cells, P < 0.05). The same result applied to the patients with retinopathy (54.5 + 15.4 vs. 44.6 +/- 15.3 ng/10(6) cells, P < 0.05). The AR levels in the patients with nephropathy tended to give a higher value than those without it. However, there were no significant differences between the two (53.9 +/- 3.6 vs. 46.4 +/- 2.6 ng/10(6) cells, NS). These results indicate that AR levels in PMCs from type 2 diabetic patients are associated with the presence of microangiopathy. The measurement of AR proteins in PMCs with this ELISA system is a useful tool for the clinical study of diabetic complications, and would increase our understanding of the pathogenesis of the disease.

Inhibition of aldose reductase in human erythrocytes by vitamin C

Ascorbic acid, or vitamin C, has been reported to lower erythrocyte sorbitol concentrations, and present studies were performed to determine the mechanism of this effect. Incubation of erythrocytes with increasing concentrations of glucose (5-40 mM) progressively increased erythrocyte sorbitol contents, reflecting increased flux through aldose reductase. At extracellular concentrations of 90 microM, both ascorbic acid and its oxidized form, dehydroascorbate, decreased intracellular sorbitol by 25 and 45%, respectively. This inhibition was not dependent on the extracellular glucose concentration, or on erythrocyte contents of free NADPH or GSH. To test for a direct effect of ascorbate on aldose reductase, erythrocyte hemolysates were prepared and supplemented with 100 microM NADPH. Hemolysates reduced glucose to sorbitol in a dose-dependent manner that was inhibited with a Ki of 120 microM by the aldose reductase inhibitor tetramethylene glutaric acid. Above 100 microM, ascorbic acid also lowered hemolysate sorbitol generation by about 30%. Studies with ascorbic acid derivatives showed that the reducing capacity of ascorbic acid was not required for inhibition of sorbitol production from glucose in erythrocyte hemolysates. These results show that high, but physiologic, concentrations of ascorbic acid can directly inhibit erythrocyte aldose reductase, and provide a rationale for the use of oral vitamin C supplements in diabetes.

Erythrocyte aldose reductase protein: a clue to elucidate risk factors for diabetic neuropathies independent of glycemic control

Prolonged hyperglycemia has been thought to be the primary cause of diabetic complications, however, some diabetic patients develop severe complications early in duration of diabetes, while some patients have no or mild complications even after prolonged hyperglycemia. To investigate the risk factors for diabetic severe neuropathy independent of glycemic control and duration of diabetes, erythrocyte aldose reductase was determined in 43 non-insulin-dependent diabetic patients by a two-site ELISA using recombinant human aldose reductase. Among 20 patients with severe neuropathy which was developed within 5 years of diagnosis, the level of erythrocyte aldose reductase protein was significantly higher than that of 23 patients with no or mild neuropathy who had more than 8 years duration of diabetes and prolonged hyperglycemia (11.9+/-5.7 vs. 8.3+/-1.3 ng/mgHb, P < 0.0001). There was a significant stability of the erythrocyte aldose reductase (AR) in the 40 diabetic patients during 1-4 years. The logistic regression analysis revealed that the maximum body mass index (BMI) in the past minus present BMI and the level of erythrocyte aldose reductase protein were the independent risk factors for diabetic severe neuropathy. The measurement of erythrocyte AR level may be useful for predicting severe neuropathy in non-insulin-dependent diabetes mellitus (NIDDM) patients.

Influence of interindividual variability of aldose reductase protein content on polyol-pathway metabolites and redox state in erythrocytes in diabetic patients

OBJECTIVE

To clarify the influence of interindividual difference in the level of aldose reductase on the polyol pathway-related metabolism in diabetic patients.

RESEARCH DESIGN AND METHODS

The enzyme protein content was determined by a two-site enzyme-linked immunosorbent assay using monoclonal and polyclonal antibodies to recombinant human aldose reductase in erythrocytes from 35 diabetic patients and 11 healthy volunteers. Patients were stratified into two groups by the median of aldose reductase content, and the erythrocyte sorbitol level, the fructose level, and the lactate-to-pyruvate ratio were compared between the two groups. We also examined the correlation of the enzyme content with these metabolic parameters.

RESULTS

The group of patients whose enzyme content was above the median showed a significant increase in the levels of sorbitol (34.7 +/- 4.9 vs. 20.4 +/- 2.0 nmol/g Hb, P < 0.05) and fructose (99.8 +/- 17.2 vs. 45.9 +/- 4.6 nmol/g Hb, P < 0.05), along with an elevated lactate-to-pyruvate ratio (28.6 +/- 6.1 vs. 11.7 +/- 1.2, P < 0.05), compared with patients with low enzyme levels. The aldose reductase content in erythrocytes was well correlated with its activity, and there was a significant correlation between the enzyme content and the erythrocyte sorbitol (r = 0.58, P < 0.001) or fructose (r = 0.57, P < 0.001) levels as well as between the enzyme level and the lactate-to-pyruvate ratio (r = 0.38, P < 0.05).

CONCLUSIONS

These results suggest that the interindividual variability of aldose reductase content may contribute tangibly to the polyol-pathway flux and cytoplasmic redox alteration in diabetic patients.

Determination of minalrestat (an aldose reductase inhibitor) in rat, dog and human plasma by high-performance liquid chromatography

A high-performance liquid chromatographic (HPLC) method was developed for the quantification of minalrestat (a potent aldose reductase inhibitor) in rat, dog and human plasma. Minalrestat and internal standard (I.S.) were extracted from plasma by either solid-phase extraction (SPE) or liquid-liquid extraction (human plasma). Plasma extracts were chromatographed on a Hypersil ODS column with 3-microm packing with a mobile phase of acetonitrile-0.05 M potassium phosphate buffer, pH 3.0 (45:55, v/v) at 0.2 ml/min. The signal in the eluent was enhanced by UV-irradiation when passing through a photochemical reaction unit with a 10-m reaction coil, prior to detection by UV absorbance at 255 nm. The intra-day coefficients of variation was less than 9% in rat, dog and human plasma and the intra-day accuracy (%MRE) was within +/-5% in all matrices tested. The inter-day coefficients of variation were less than 12% in rat and human plasma and the accuracy (%MRE) was within +/-15%. Minalrestat was stable for at least 60 days in rat and human plasma and at least 30 days in dog plasma samples stored at -20 degrees C. In human plasma samples, the analyte was stable for up to 5 cycles of freezing and thawing. This method has been applied successfully for the evaluation of the pharmacokinetics of minalrestat in rats, dogs and humans.

The level of erythrocyte aldose reductase is associated with the severity of diabetic retinopathy

To examine whether the level of erythrocyte aldose reductase is a risk factor for the severity of diabetic retinopathy, the enzyme level in 97 non-insulin-dependent diabetes mellitus (NIDDM) patients was measured by the two-site enzyme-linked immunosorbent assay. Based on the results of fundus photography and biomicroscopy, the severity of retinopathy was classified among NIDDM patients of more than 10 years. The level of erythrocyte aldose reductase was significantly higher in the patients with active proliferative retinopathy than in those with nonproliferative or quiescent proliferative retinopathy. Multivariate logistic regression analysis demonstrated that the level of erythrocyte aldose reductase was an independent risk factor for active proliferative retinopathy (odds ratio, 1.28; 95% confidence interval, 1.01-1.61). The results suggest that a high level of erythrocyte aldose reductase in NIDDM patients may affect the prognosis of diabetic retinopathy. Patients with high enzyme levels would need to be closely followed up in the management of the retinal complication.

The level of erythrocyte aldose reductase: a risk factor for diabetic neuropathy?

The level of erythrocyte aldose reductase protein (AR-p) was determined in diabetic patients as well as in 76 healthy controls by a two-site enzyme-linked immunosorbent assay. No significant difference in the mean AR-p level was demonstrated between the healthy and diabetic individuals. Based on the results of seven nerve function tests, 95 non-insulin-dependent diabetes mellitus (NIDDM) patients were classified into two groups: Group I, without demonstrable neuropathy ( < or = 1 abnormal test results); Group II, overt neuropathy ( > or = 2 abnormal results). The AR-p level was significantly higher in Group II than that in Group I. Multivariate logistic regression analysis identified two independent risk factors for overt neuropathy: longer duration of diabetes after clinical diagnosis (odds ratio, 1.15 per year; 95% confidence interval, 1.05-1.25) and a higher level of AR-p (odds ratio, 1.92 per 1 ng mgHb(-1); 95% confidence interval, 1.39-2.65). On 31 patients the AR-p level was re-assessed after a 12-month follow-up period. Irrespective of improved or stable HbA(1c) levels during the follow-up period, no apparent alteration in the level of AR-p was demonstrated. These results suggest that erythrocyte AR-p level may affect the susceptibility or development of diabetic neuropathy in NIDDM patients.

Sensitive, selective gas chromatographic-mass spectrometric analysis with trifluoroacetyl derivatives and a stable isotope for studying tissue sorbitol-producing activity

One of the major mechanisms involved in diabetic microangiopathy is considered to be an altered polyol pathway. However, clarifying the pathophysiology is difficult due to the lack of a sensitive method for measuring the reduction of glucose to sorbitol in tissue. Here we report a sensitive and selective method for polyol measurement using trifluoroacetyl (TFA) derivatives of polyols and stable isotope-labeled D-sorbitol (U-[13C]sorbitol, 13C6H14O6, 98.7%) as an internal standard. Gas chromatography-mass spectrometry (GC-MS) using an SE-30 capillary column gave elution of TFA derivatives of sugars, polyols and U-[13C]sorbitol within 8 min, with clear separation of sorbitol. In the calibration study, the coefficients of correlation between the amount of sorbitol added and that determined in standard solutions containing 0.1-8.0 nmol sorbitol, erythrocyte mixture and liver cytosol mixture were r = 0.999, r = 0.997 and r = 0.997, respectively. The precision of the GC-MS measurement of standard solution was C.V. = 4.3%. Because glucose is used as a substrate, the method can clarify the polyol pathway under physiological conditions. With this method, Km and Vmax values of the reductase in erythrocytes were 115 +/- 19 mmol/l and 4.42 +/- nmol/min/g of hemoglobin. In human liver, on the other hand, they were 755 +/- 132 mmol/l and 0.773 +/- 0.090 nmol/min/mg of protein, respectively. This difference of Km values suggested that aldehyde reductase rather than aldose reductase is mainly responsible for reducing glucose to sorbitol in the liver. In conclusion, this newly developed method offers a highly sensitive and selective procedure for measuring low concentrations of sorbitol in various tissues and cells and should enable clarification of the kinetics of glucose reduction to sorbitol, which in turn can be used to evaluate the role of an altered polyol pathway in the pathophysiology of diabetic microangiopathy.

Polyol pathway and NADPH-dependent reductases in dog leukocytes

Recent reports suggest that excess amounts of sugar alcohol are linked to leukocyte dysfunctions associated with diabetes. As the polyol pathway has not been firmly established in leukocytes, we have investigated NADPH-dependent reductases and sugar alcohol formation in dog leukocytes. NADPH-dependent reductase activity was observed with DL-glyceraldehyde as substrate in both mononuclear and polymorphonuclear leukocytes isolated from dog. By chromatofocusing, this activity corresponded primarily to aldehyde reductase rather than aldose reductase. The enzymatic conversion of glucose to the sugar alcohol sorbitol in leukocytes was confirmed in vitro by 19F nuclear magnetic resonance (NMR) spectroscopy using 3-deoxy-3-fluoro-D-glucose as substrate. The NMR spectrum obtained after incubation with 10 Mm 3-deoxy-3-fluoro-D-glucose at 37 degrees C for 24 h displayed newly formed 3-deoxy-3-fluoro-D-sorbitol and 3-deoxy-3-fluoro-D-fructose peaks with both mononuclear and polymorphonuclear leukocytes. Sugar alcohol production in leukocytes from galactose-fed dogs was also observed in vivo. Galactitol accumulation was consistently observed by gas chromatography to occur in mononuclear cells while only trace amounts of galactitol were observed in polymorphonuclear leukocytes. Activation of NADPH oxidase activity in neutrophils isolated from galactose-fed dogs by zymosan was also significantly reduced compared to that of nongalactosemic control dogs. These results indicate that glucose is converted to fructose through sorbitol in both mononuclear and polymorphonuclear leukocytes despite the observations that these cells primarily contain aldehyde reductase rather than aldose reductase. In vivo, sugar alcohol accumulation in mononuclear cells is greater than in polymorphonuclear leukocytes.

Increased levels of methylglyoxal-metabolizing enzymes in mononuclear and polymorphonuclear cells from insulin-dependent diabetic patients with diabetic complications: aldose reductase, glyoxalase I, and glyoxalase II--a clinical research center study

Levels of aldose reductase, glyoxalase I, and glyoxalase II in mononuclear and polymorphonuclear cells from insulin-dependent diabetes mellitus (IDDM) patients with long term diabetic complications were compared to levels in IDDM patients without complications and to those in nondiabetic controls. Cells were isolated from 22 asymptomatic long term IDDM patients, 22 symptomatic IDDM patients, and 16 controls, using a double gradient centrifugation procedure. Aldose reductase was determined by Western blots using polyclonal antiserum to human aldose reductase purified from skeletal muscle. Glyoxalase I and glyoxalase II were determined spectrophotometrically. Aldose reductase in mononuclear cells from symptomatic IDDM patients is significantly elevated compared to that in asymptomatic IDDM patients (mean +/- SEM, 0.96 +/- 0.20 vs. 0.46 +/- 0.08 microgram/mg protein; P < 0.02). Aldose reductase was not detected in polymorphonuclear cells. Glyoxalase I in mononuclear and polymorphonuclear cells from symptomatic IDDM patients is significantly elevated compared to that in controls [mean for mononuclear cells, 0.46 +/- 0.03 vs. 0.37 +/- 0.03 mumol/min.mg (P < 0.05); mean for polymorphonuclear cells, 0.16 +/- 0.01 vs. 0.10 +/- 0.01 mumol/min.mg (P < 0.002)]. Glyoxalase II is significantly elevated only in polymorphonuclear cells from symptomatic IDDM patients compared to controls (mean, 0.13 +/- 0.01 vs. 0.063 +/- 0.016 mumol/min.mg; P < 0.005). Glutathione peroxidase and glutathione S-transferase were not significantly different in these populations. Aldose reductase, glyoxalase I, and glyoxalase II are involved in the metabolism of methylglyoxal, suggesting that methylglyoxal may play a role in the etiology of diabetic complications.

Thermal stress and diabetic complications

Activities of erythrocyte aldose reductase were compared in 34 normal subjects, 45 diabetic patients, and nine young men following immersion in water at 25, 39, and 42 degrees C. Mean basal enzyme activity was 1.11 (SEM 0.12) U/g Hb and 2.07 (SEM 0.14) U/g Hb in normal controls and diabetic patients, respectively (P < 0.0001). Activities of the enzyme showed a good correlation with hemaglobin A1 (HbA1) concentrations (P < 0.01) but not with fasting plasma glucose concentrations. After immersion at 42 degrees C for 10 min, enzyme activity was increased by 37.6% (P < 0.01); however, the activity decreased by 52.2% (P < 0.005) after immersion for 10 min at 39 degrees C and by 47.0% (P < 0.05) at 25 degrees C. These changes suggest that heat stress might aggravate diabetic complications, and body exposure to hot environmental conditions is not recommended for diabetic patients.

Novel spirosuccinimide aldose reductase inhibitors derived from isoquinoline-1,3-diones: 2-[(4-bromo-2-fluorophenyl)methyl]-6- fluorospiro[isoquinoline-4(1H),3'-pyrrolidine]-1,2',3,5'(2H)-tetrone and congeners. 1

The high concentrations of plasma glucose formed during diabetic hyperglycemia rapidly translate into high levels of glucose in tissues where glucose uptake is independent of insulin. In these tissues that include the lens, retina, nerve, and kidney, this excess glucose enters the sorbitol (polyol) pathway. The first enzyme in this pathway, aldose reductase, reduces glucose to sorbitol. The diabetes-induced increased flux of glucose through the polyol pathway is believed to play an important role in the development of certain chronic complications of diabetes mellitus. Compounds that inhibit aldose reductase activity and block the flux of glucose through the polyol pathway prevent the development of neuropathy and nephropathy in diabetic animals and interrupt the progression of neuropathy in diabetic patients. Here we describe the preparation and characterization of novel aldose reductase inhibitors. These spiro[isoquinoline-4(1H),3'-pyrrolidine]-1,2',3,5'-(2H)-tetrones, based on the isoquinoline-1,3-dione framework, were evaluated in vitro for their ability to inhibit glyceraldehyde reduction, using a partially purified bovine lens aldose reductase preparation, and in vivo for their ability to inhibit galactitol accumulation in the lens and sciatic nerve of galactose-fed rats. Substitution at the N-2 position of the isoquinoline-1,3-dione framework with diverse structural substituents (i.e., aralkyl, benzothiazolylmethyl, methyl) produced several excellent series of ARIs. Optimization of these new series of spirosuccinimides through structure-activity relationship (SAR) studies, including analogy from other drug series (ponalrestat, zopolrestat), led to the design of the clinical candidate 2-[(4-bromo-2-fluorophenyl)methyl]-6-fluorospiro[isoquinoline-4(1H ),3'- pyrrolidine]-1,2',3,5'(2H)-tetrone (41). Compound 41 exhibited exceptional oral potency in two animal models of diabetic complications, the 14-day galactose-fed and streptozocin-induced diabetic rats, with ED50 values for the sciatic nerve of 0.1 and 0.09 mg/kg/day, respectively. Both enantiomeric forms of 41 exhibited similar inhibitory activity in both in vitro and in vivo assays possibly due to their rapid interconversion. In an ex vivo experiment, the pharmacodynamic effect of 41 in the plasma of rats and dogs, after a single dose, appeared to be comparable to that of tolrestat.

Enzyme immunoassay for erythrocyte aldose reductase

This two-site immunoassay measures erythrocyte aldose reductase by using monoclonal and polyclonal antibodies to recombinant human enzyme. Total incubation time is 2.5 h, and the limit of detection is < 0.05 microgram/L. Analytical recovery tested with blood samples from healthy and diabetic individuals was 101-106%. Average CVs within and between assays were 3.7% and 4.8%, respectively. The enzyme content determined by this system correlated well with the activity of aldose reductase isolated from the same erythrocyte preparations. The amount of erythrocyte aldose reductase per milligram of hemoglobin was higher in women than in men (P < 0.001), but no significant correlation was observed between the amount of enzyme and the age of the individuals. This assay method should provide useful clinical information to optimize administration of aldose reductase inhibitors for effective prevention and treatment of diabetic complications.

High levels of erythrocyte aldose reductase and diabetic retinopathy in NIDDM patients

Erythrocyte aldose reductase was determined in 90 NIDDM patients by a two-site ELISA using recombinant human aldose reductase. The level of aldose reductase did not correlate with age, duration of diabetes, fasting blood glucose and HbA1c of the patients. Among 38 patients with diabetes for more than 10 years, aldose reductase in those with retinopathy (including non-proliferative and proliferative) was significantly higher than in those without, while no difference in the means of the average HbA1c, maximum and minimum blood pressure levels was observed between the two groups. The results indicate that the level of aldose reductase in the erythrocyte of diabetic patients is associated with the presence of retinopathy.

Effect of ageing on erythrocyte aldose reductase and sorbitol dehydrogenase activity

We measured erythrocyte aldose reductase and sorbitol dehydrogenase activity in erythrocytes in healthy individuals aged from 16 to 91 years to determine the mechanism of age-dependent sorbitol accumulation. Erythrocyte aldose reductase activity increased significantly with age but ageing had no effect on sorbitol dehydrogenase activity. Age and the aldose reductase/sorbitol dehydrogenase ratio were positively correlated. These findings suggest that an increase in the ratio of aldose reductase to sorbitol dehydrogenase may contribute to the tissue accumulation of sorbitol in the elderly and may be a mechanism of a disease that is common in elderly individuals.

Association of erythrocyte aldose reductase activity with diabetic complications in type 1 diabetes mellitus

Erythrocyte aldose reductase was isolated and its activity measured in 72 Type 1 (insulin dependent) diabetic patients and 21 age and sex matched non-diabetic subjects. The diabetic patients were categorized into two groups in terms of presence (n = 29) or absence (n = 43) of severe diabetic complications. Age, sex, duration of diabetes and HbA1c levels were matched between the diabetic groups. Erythrocyte aldose reductase (mean +/- SEM) was increased in patients with Type 1 diabetes compared to the non-diabetic subjects (7.22 +/- 0.24 vs 5.66 +/- 0.19 Ul-erythrocytes-1, < 0.0001). There was a four-fold variation in its activity among the diabetic patients (3.38-12.23 Ul-erythrocytes-1). The enzyme activity was significantly higher in patients with complications than those without (8.17 +/- 0.39 vs 6.58 +/- 0.26 Ul-erythrocytes-1, p < 0.002). When the patients were stratified by duration of the disease, the enzyme activity was highest in patients who had developed complications with a duration of less than 20 years and lowest in those without complications for 20 years or longer (8.54 +/- 0.48 vs 6.46 +/- p +/- 0.33 Ul-erythrocytes-1, p < 0.002). Patients who had an aldose reductase activity greater than the mean +/- 2SD of that seen in non-diabetic controls were four times more likely to have diabetic complications than those whose enzyme activity fell within 2SD of non-diabetic individuals (p < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation between erythrocyte aldose reductase activity and the width of skeletal-muscle capillary basement membrane in insulin-dependent diabetes mellitus

Thickening of capillary basement membrane has been demonstrated in diabetic subjects, and it is considered to be the characteristic pathological lesion of diabetic microvascular disease. There are studies reporting the effects of inhibitors of aldose reductase, the first enzyme of the polyol pathway, on the thickening of the capillary basement membrane. These observations indicate a significant role of the polyol pathway in the development of microvascular disease. However, it is unknown whether or not there is any correlation between the thickness of the capillary basement membrane and the activity of aldose reductase in diabetic patients. To clarify this issue, we measured the width of skeletal-muscle basement membrane and erythrocyte aldose reductase activity in 27 insulin-dependent diabetic and 8 nondiabetic individuals. The results showed that both the aldose reductase activity and the width of capillary basement membrane were increased in diabetic patients as compared to nondiabetic individuals (6.89 +/- 0.38 versus 5.15 +/- 0.60 mL/mU erythrocytes, p < 0.05 and 2257 +/- 166 versus 1136 +/- 69 A, p < 0.0001, respectively) (mean +/- SE), but marked variability was observed in both the enzyme activity and the basement membrane thickness among the diabetic patients. There was a significant correlation between the capillary basement membrane thickness and the activity of erythrocyte aldose reductase (r = 0.51, p < 0.01) in diabetic patients. Our data suggest that the polyol pathway plays an important role in thickening of capillary basement membrane in diabetic individuals, and the variability in aldose reductase activity seen among diabetic patients may result in the varying susceptibility to the development of diabetic microvascular disease.

No correlation between glycemic control and an increase in erythrocyte aldose reductase activity in type I and type II diabetic patients

Aldose reductase, the first enzyme of the polyol pathway, has been related to the pathogenesis of diabetic complications. The regulation of the enzyme in diabetes patients, however, has not yet been clarified. We recently reported that the activity of aldose reductase was increased in erythrocytes of insulin-dependent diabetes mellitus patients but short-term hyperglycemia did not affect the enzyme activity. It is still unclear, however, whether or not the increase in the enzyme activity is caused by long-term hyperglycemia and thus would be seen equally in both type I (insulin-dependent diabetes mellitus) and type 2 (non-insulin-dependent diabetes mellitus) individuals. To further clarify these issues we measured erythrocyte aldose reductase activity in 46 type I patients and 30 type II patients who had variable glucose control and in 16 nondiabetic subjects. We compared the enzyme activity with plasma glucose levels and hemoglobin A1c levels. The results show that erythrocyte aldose reductase activity is increased in both type I and type II patients as compared with nondiabetic subjects (7.1 +/- 0.3 U/L and 6.8 +/- 0.4 U/L erythrocytes versus 5.6 +/- 0.2 U/L erythrocytes, p less than 0.001 and p less than 0.01, respectively), but there were no significant differences between the two groups of diabetic patients. The enzyme activity varied by approximately four times among the diabetic individuals but there was no correlation between the enzyme activity and plasma glucose or hemoglobin A1c levels. We conclude that the increased activity of erythrocyte aldose reductase seen in diabetes is not related to hyperglycemia.

The influence of aldose reductase on the oxidative burst in diabetic neutrophils

Lucigenin-enhanced chemiluminescence was examined as an index of neutrophil superoxide production in four groups of 20 subjects: controls with/without infection and type 1 diabetics with/without infection. At 5 mM glucose there was no significant difference in chemiluminescence output between neutrophils from the four groups (P greater than 0.01). Increasing the in vitro glucose concentration from 5 to 20 mM produced an 8.75% reduction in superoxide in the combined control groups, compared with a 21.45% reduction in the diabetic subjects (P less than 0.01). With the addition of an aldose reductase inhibitor (Statil, ICI) to neutrophils from diabetic subjects, the suppression caused by an increase in glucose concentration to 20 mM was reduced to 4.5%. This value was similar to the controls (P greater than 0.01). Neutrophil aldose reductase activity, measured in 28 diabetic subjects was 0.024 +/- 0.003 U/10(8) cells (mean +/- SE). There was a significant correlation between aldose reductase activity and superoxide suppression (P less than 0.01, r = 0.64). These results suggest that aldose reductase is responsible for reduced superoxide production in diabetic patients and the addition of an aldose reductase inhibitor to the diabetic neutrophil restores superoxide output to control values.

Aldose reductase inhibitors and diabetic complications

Aldose reductase inhibitors impede flux of glucose through the sorbitol pathway in diabetes mellitus. They therefore reduce the accumulation of the pathway metabolites, sorbitol and fructose, reduce the impact of the flux on the cofactors used by the pathway and reduce other derived phenomena, such as osmotic stress and myo-inositol depletion. As drugs, their targets are the chronic complications of diabetes--neuropathy, retinopathy, nephropathy and vasculopathy. In experimental models there is proof of activity against biochemical, functional and structural defects in all of the involved tissues, but we await full clinical verification of this potential.

Neutrophil aldose reductase activity as a potential marker for neuropathy and cataract in diabetes

Aldose reductase activity can be measured in the neutrophil and it has been proposed that this may be a marker for risk of complications in diabetes. We have studied aldose reductase activity in neutrophil, nerve, and lens in diabetic patients undergoing sural nerve biopsy or cataract extraction. A correlation was demonstrated between lens and neutrophil aldose reductase activity (r = 0.53, p = 0.01) but no correlations were demonstrated between nerve aldose reductase activities and nerve morphometry, nerve function or neutrophil aldose reductase activity. No significant difference was found between neutrophil aldose reductase activities in groups of patients with severe neuropathy, or cataract, or no complications (24 (interquartile range 16-32) vs 24 (16-40) vs 24 (16-40) nmol NADPH min-1 10(8)-cells-1). In a group of 56 Type 1 diabetic patients screened within 6 years of diagnosis, multiple regression analysis failed to show any relationship between neutrophil aldose reductase activity and abnormalities of neurophysiological function. These results suggest that neutrophil aldose reductase activity cannot be used as a marker for the development of cataract or neuropathy in diabetes.

Activation of erythrocyte aldose reductase in man in response to glycaemic challenge

Flux via the polyol pathway, which comprises the enzymes aldose reductase (AR) and sorbitol dehydrogenase (SDH), has been implicated in the debilitating complications of diabetes. Previous studies in this laboratory have indicated that erythrocyte AR activities are increased (by 72%) in insulin-dependent diabetic patients. To investigate the mechanism underlying this activation, the response of AR activity to oral glucose challenge was investigated in eight overnight-fasted human volunteers. Glucose consumption led to a transient activation (by 76%: P less than 0.01) of erythrocyte AR, which paralleled the rise and subsequent fall in blood glucose concentrations. It is concluded that erythrocyte AR activity is acutely modulated in response to hyperglycaemia by an as yet unknown mechanism.

Crucial role of aldose reductase activity and plasma glucose level in sorbitol accumulation in erythrocytes from diabetic patients

Increased sorbitol levels have been demonstrated in tissues of diabetic patients. Although tissue sorbitol levels correlate with plasma glucose levels, a large variability in sorbitol levels has been observed among diabetic patients with similar plasma glucose levels. This variability in tissue sorbitol levels may be due to differences in the activity of aldose reductase, the enzyme that converts glucose to sorbitol. In this study, we isolated aldose reductase from erythrocytes of 31 diabetic patients and 6 nondiabetic control subjects, measured its activity, and compared it to simultaneously measured erythrocyte sorbitol levels. The activity of erythrocyte aldose reductase was increased in diabetic patients compared with control subjects (28.1 +/- 1.4 vs. 22.4 +/- 1.7 nmol.min-1.g-1 Hb, P less than 0.05), but there was an approximately threefold variation in aldose reductase activity among diabetic patients. Erythrocyte aldose reductase activity and fasting plasma glucose levels significantly correlated with the erythrocyte sorbitol level in all individuals (r = 0.48, P less than 0.005 and r = 0.63, P less than 0.005, respectively). The sorbitol level was higher in patients with high aldose reductase activity than in those who had low enzyme activity for any given level of glycemia. The sorbitol production rate calculated from Km and Vmax values showed a better correlation with the erythrocyte sorbitol level (r = 0.80, P less than 0.005), and there was also a good correlation between the erythrocyte sorbitol level and the product of aldose reductase activity by plasma glucose level (r = 0.70, P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of aldose reductase, ATPases, and nucleotide concentrations of erythrocytes in patients with type 2 (non-insulin-dependent) diabetes mellitus

Aldose reductase (EC 1.1.1.21) is implicated in the pathophysiology of diabetic complications. In this paper we determined the activities of aldose reductase and ATPases of the erythrocytes in 17 patients with Type 2 (non-insulin-dependent) diabetes mellitus (NIDDM). In the aldose reductase assay we used fluorometric method to avoid the disturbance of hemoglobin. With dihydronicotinamide adenine dinucleotide (NADH), we verified it was aldose reductase but not aldehyde reductase II that was activated in the erythrocytes of the patients with NIDDM. The aldose reductase activity of the erythrocytes in the patients was significantly higher (P less than 0.01) than that in the controls. The activity of Na+/K(+)-ATPase of the patients was significantly lower (P less than 0.01) than that of the controls. The activities of Ca(2+)-ATPase and Mg(2+)-ATPase on the erythrocyte membranes of the patients were similar to those of the controls. At the same time we measured the seven nucleotide concentrations in the erythrocytes of the patients. In this experiment we used ultrafiltration method, instead of acid precipitation to make it possible to determine dihydronicotinamide adenine dinucleotide phosphate (NADPH) and NADH. The concentrations of ATP, ADP and AMP were similar to those of the controls. The concentrations of NADPH, NAD+ and NADH in the erythrocytes of the patients were significantly lower (P less than 0.01, 0.05 and 0.05 respectively) than those of controls. The concentration of nicotinamide adenine dinucleotide phosphate (NADP+) in the patients was significantly higher (P less than 0.01) than that of controls.

Neutrophil aldose reductase activity and its association with established diabetic microvascular complications

Direct investigation of the polyol pathway is rarely possible in studies of human diabetes. A spectrophotometric assay has been developed for the measurement of aldose reductase and sorbitol dehydrogenase activity in the neutrophil. Neutrophil aldose reductase activity was increased in patients with Type 1 diabetes with complications (median 40 (interquartile range 28-48) u, where 1 unit of enzyme activity = nmol NADPH min-1 10(8)-cells-1) compared with those without complications (20 (16-36) u, p less than 0.01) and normal control subjects (20 (8-36) u, p less than 0.01). In Type 2 diabetes, patients with complications also had higher aldose reductase activity (40 (28-52) u) than those without complications (24 (16-36) u, p less than 0.01). There were no differences between patients without complications and normal control subjects. Sorbitol dehydrogenase activity was decreased in diabetic patients (p less than 0.02) but not significantly different between diabetic patients with and without complications.

[EEG sleep patterns and biogenic amine metabolizing enzymes in patients with endogenous depression]

Polygraphic sleep patterns as well as monoamine oxidase (MAO) and aldehyde reductase (AR) activity in blood platelets were assessed in 16 patients with endogenous depression. Results subjected to factor analysis revealed four essential factors. One of the factors was significantly loaded with MAO and AR activity as well as with REM latency and phasic REM percentage.

Increased erythrocyte aldose reductase activity in type 1 diabetic patients

Elevated erythrocyte sorbitol levels have been demonstrated in diabetic patients. In order to explain the enhanced sorbitol formation, it has been suggested that aldose reductase might be activated by hyperglycaemia. Although aldose reductase activity has been reported to be increased in some tissues of diabetic patients, the effects of varying concentrations of glucose on the enzyme activity in vivo are unknown. To determine whether or not erythrocyte aldose reductase activity is increased in diabetic patients and is affected by glucose levels, we collected blood samples from 10 Type 1 diabetic patients while fasting and 2 h after a standard meal. We measured the activity of erythrocyte aldose reductase after partial purification by column chromatography. The results showed that erythrocyte aldose reductase activity was significantly increased in diabetic patients as compared with non-diabetic subjects (7.3 +/- 0.7 (+/- SE) vs 5.2 +/- 0.3 u l-erythrocytes-1, p less than 0.05). No correlation, however, was observed between fasting plasma glucose levels and the enzyme activity, and acute elevation of the blood glucose level did not affect the enzyme activity.