When to treat a diabetic patient using an external insulin pump. Expert consensus. Société francophone du diabète (ex ALFEDIAM) 2009.

For years, external insulin pumps have enjoyed proven efficacy as an intensive diabetes treatment to improve glycaemic control and reduce hypoglycaemia. Since the last ALFEDIAM guidelines in 1995, however, basal-bolus treatment using a combination of long- and short-acting insulin analogues have emerged and could challenge, at a lower cost, the efficacy of pumps using rapid-acting insulin analogues, considered the 'gold standard' of insulin treatment. Nevertheless, given its theoretical and practical advantages, some patients will derive more benefit from pump treatment. These cases have been carefully evaluated in the literature by a panel of experts appointed by ALFEDIAM to determine the indications for pump treatment. In patients with type 1 diabetes, persistent elevated HbA(1c) despite multiple daily injections (MDI), and repeated hypoglycaemia and high glycaemic variability, represent the most validated indications. In patients with type 2 diabetes, pump treatment may be indicated in cases of MDI failure to achieve HbA(1c) targets. Absolute contraindications are rare, and comprise severe psychiatric disorders, rapidly progressing ischaemic or proliferative retinopathy before laser treatment and exposure to high magnetic fields. Relative contraindications are mostly related to the patient's lack of compliance or inability to cope with the treatment, and need to be evaluated individually to clearly assess the benefit/risk ratio for the given patient. However, as these conditions are progressive, there should also be annual reassessment of the appropriateness of pump treatment. Specific education on pump treatment initially and throughout the follow-up, delivered by experienced medical and paramedical teams, are the best guarantees of treatment efficacy and safety.

The novel Akt inhibitor, perifosine, induces caspase-dependent apoptosis and downregulates P-glycoprotein expression in multidrug-resistant human T-acute leukemia cells by a JNK-dependent mechanism.

A significant impediment to the success of cancer chemotherapy is the occurrence of multidrug resistance, which, in many cases, is attributable to overexpression of membrane transport proteins, such as the 170-kDa P-glycoprotein (P-gp). Also, upregulation of the phosphatidylinositol 3-kinase (PI3K)/Akt-signaling pathway is known to play an important role in drug resistance, and has been implicated in the aggressiveness of a number of different cancers, including T-acute lymphoblastic leukemia (T-ALL). We have investigated the therapeutic potential of the novel Akt inhibitor, perifosine (a synthetic alkylphospholipid), on human T-ALL CEM cells (CEM-R), characterized by both overexpression of P-gp and constitutive upregulation of the PI3K/Akt network. Perifosine treatment induced death by apoptosis in CEM-R cells. Apoptosis was characterized by caspase activation, Bid cleavage and cytochrome c release from mitochondria. The proapoptotic effect of perifosine was in part dependent on the Fas/FasL interactions and c-Jun NH(2)-terminal kinase (JNK) activation, as well as on the integrity of lipid rafts. Perifosine downregulated the expression of P-gp mRNA and protein and this effect required JNK activity. Our findings indicate that perifosine is a promising therapeutic agent for treatment of T-ALL cases characterized by both upregulation of the PI3K/Akt survival pathway and overexpression of P-gp.

Antiapoptotic role of p38 mitogen activated protein kinase in Jurkat T cells and normal human T lymphocytes treated with 8-methoxypsoralen and ultraviolet-A radiation.

A combination of 8-methoxypsoralen and ultraviolet-A radiation (320-400 nm) (PUVA) is used for the treatment of T cell-mediated disorders, including chronic graft-versus-host disease, autoimmune disorders, and cutaneous T-cell lymphomas. The mechanisms of action of this therapy, referred to as extracorporeal phototherapy, have not been fully elucidated. PUVA is known to induce apoptosis in T lymphocytes collected by apheresis, however no information is available concerning the underlying signaling pathways which are activated by PUVA. In this study, we found that PUVA treatment of Jurkat cells and human T lymphocytes up-regulates the p38 MAPK pathway but not the p42/44 MAPK or the SAPK/JNK signaling networks. The use of a pharmacological inhibitor selective for the p38 MAPK pathway, SB203580, allowed us to demonstrate that this network exerts an antiapoptotic effect in PUVA-treated Jurkat cells and T lymphocytes from healthy donors. Moreover, the effect of SB203580 was not due to a down-regulation of the Akt survival pathway which was not activated in response to PUVA. These results may suggest that p38 MAPK-dependent signaling is very important for the regulation of survival genes after exposure to PUVA. Since the therapeutic effect of PUVA seems to depend, at least in part, on apoptosis, further studies on the apoptosis signaling networks activated by this treatment might lead to the use of signal transduction modulators in combination with PUVA, to increase the efficacy of this form of therapy.

Ação de extratos do açaí (Euterpe oleracea Mart. ) sobre a produção de óxido nítrico em células RAW 264.7

Açaí (Euterpe oleracea Mart.), é uma palmeira tropical muito apreciada por sua beleza e valor nutricional. Estudos químicos revelaram a presença de ácidos graxos e esteróides. No presente trabalho foi avaliada a ação de extratos obtidos dos frutos e flores sobre a produção de óxido nítrico (ON), molécula que apresenta várias atividades fisiológicas, tais como vasodilatação, neurotransmissão, além de atividades tumoricidas e citotóxicas. Células Raw 264,7 estimuladas com lipopolissacarídeo bacteriano (LPS, 100 ng/ml) e interferon-alfa (IFN-alfa, 10 U/ml) produziram grande quantidade de óxido nítrico (35 μM) quando comparadas com as células não estimuladas (3 μM). Os extratos com hexano, diclorometano, acetato de etila e n-butanol apresentaram alta capacidade de inibição em células ativadas com LPS e IFN-alfa, de acordo com a concentração, sendo que na concentração mais alta ocorreu uma inibição de quase 100 por cento. Também avaliamos se o efeito inibitório seria devido a seqüestro do radical livre (ON), através do uso do SNAP (um doador de ON). Somente o extrato em acetato de etila mostrou atividade sequestrante. Esforços estão sendo empregados na tentativa de compreender os possíveis mecanismos associados ao efeito inibitório destes extratos.

Açaí (Euterpe oleracea Mart.) is a tropical palm tree appreciated for its attractive beauty and for nutritional purposes. Chemical studies have revealed the presence of fatty acids and steroids. In the present work, it has been tested the action of the extracts obtained from the fruits and flowers on the nitric oxide (NO) production, a very important molecule with a lot of physiological rules such as vasodilatation, neurotransmission, tumoricidal and cytotoxic activity. Cells RAW 264.7 stimulated with bacterial lipopolysaccharide (LPS, 100 ng/ml) and interferonalpha (IFN-alpha, 10 U/ml) produce large amounts of nitric oxide (35 μM) when compared with non-stimulated cells (3μM). The hexane, dichloromethane, ethyl acetate and n-butanol extracts have shown high inhibition capacity, concentration-dependent in the cells activated with LPS and IFN-alpha, and the highest concentration has promoted almost 100 percent of inhibition. We also have tested if the inhibitory effect was due to a scavenger action using a NO donor, the SNAP. Only the ethyl acetate extract has shown significant scavenger action. At this moment an effort is going on to try to understand the possible mechanisms associated to the inhibition of those extracts.

Constituintes apolares do fruto do açaí (Euterpe oleracea M. - Arecaceae)

Euterpe oleracea M. (açaí) é uma palmeira economicamente importante encontrada em vários locais do Brasil. O palmito é uma iguaria bastante apreciada em todo o mundo enquanto o fruto é apenas consumido no Brasil. Esse estudo enfocou a composição química do extrato hexânico obtido de diferentes partes do fruto: o pericarpo, o endocarpo e o fruto na íntegra. Ficou comprovado não haver diferença química significativa na análise cromatográfica dos três extratos.

Euterpe oleracea M. (açaí) is an economically important palm found in many places throughout Brazil. The heart of palm is a well known delicacy all around the world while the fruit of this palm is eaten only in Brazil. This study deals with the chemical composition of the hexanic extract obtained from the different parts of the fruit: the pericarp, the endocarp and the whole fruit. It has been comproved no chemical difference regarding fatty acids when these three extracts were analysed.

Complex associates of plasmid DNA and a novel class of block copolymers with PEG and cationic segments as new vectors for gene delivery.

Cationic block copolymers, consisting of a poly(ethylene glycol) block and a block deriving from the poly(dimethylamino)ethyl methacrylate were prepared via a two-step procedure, based on the use of macroinitiators. By appropriately changing the experimental conditions and reacting the poly(dimethylamino)ethyl methacrylate block with iodo- or bromo-alkyl derivatives, a variety of ionic block copolymers with tuned physicochemical properties were prepared. These block copolymers are able to spontaneously self-assemble with plasmid DNA to produce oriented and shielded vectors, with physicochemical properties appropriate for in vivo applications. In addition, the formation of a complex between the cationic block copolymer and the plasmid DNA results in a nuclease resistance increase due to the stable nature of the complex.

Characterization of HIV-1 Tat proteins mutated in the transactivation domain for prophylactic and therapeutic application.

Previous work from our group showed that genetic immunization of mice with HIV-1 tat genes (tat22 and tat22/37), encoding Tat proteins mutated in the transactivation domain and lacking Tat-transactivating activity, evoke an immune response to wild-type Tat, both humoral and cellular. In the present work we report that the mutated Tat proteins localize within the cells, are released and taken up by the cells in a fashion similar to wild-type Tat. Moreover, the exogenous mutated Tat proteins interfere with the transactivating function of extracellular wild-type Tat. These results support the notion that tat22 and tat22/37 genes may represent good candidates for the development of an anti-HIV-1 vaccine, especially for HIV-1 infected patients.