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1.
Diabetes Metab Res Rev ; 30(4): 313-22, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24420974

RESUMEN

BACKGROUND: The FRAX algorithm is a diffuse tool to assess fracture risk, but it has not been clinically applied in European patients with diabetes. We investigated FRAX-estimated fracture risk in patients with type 2 diabetes mellitus (DM), compared with concomitantly enrolled control subjects. METHODS: In our multicentric cross-sectional study, we assessed the FRAX scores of 974 DM and 777 control subjects from three Italian diabetes outpatient clinics, and in DM. We tested the association between parameters and complications of the disease and FRAX scores. RESULTS: DM had significantly lower FRAX-estimated probability of both major osteoporotic fracture (MOF) and hip fracture (HF) than control subjects (6.35 ± 5.07% versus 7.75 ± 6.93%, p < 0.001, and 2.17 ± 3.07% versus 2.91 ± 4.56%, p = 0.023, respectively). When grouping by gender, such differences were found only in men. In DM, the frequency of previous fracture was higher than in control subjects (29.88% versus 20.46%, p < 0.001). In diabetic patients, age, sex, body mass index, HbA1c and hypoglycaemia are significantly associated with FRAX scores; gender-specific regression models differed. Among DM, the tree-based regression (classification and regression tree (CART)) analysis identified groups of patients with different mean FRAX scores. In female DM aged > 65 years with or without obesity, MOF > 20% was found in 5.66% and 13.53% and H > 3% in 40.57% and 63.91% of patients, respectively. CONCLUSIONS: Patients with DM had mean FRAX scores lower than control subjects, despite the higher number of previous fractures. Some features and complications of DM did associate with FRAX scores. Among DM patients, the CART analysis identified subgroups with higher FRAX scores. However, despite its potential utility, concerns still remain for using FRAX in DM patients.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Fracturas de Cadera/complicaciones , Fracturas Osteoporóticas/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento , Algoritmos , Índice de Masa Corporal , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/terapia , Femenino , Fracturas de Cadera/epidemiología , Fracturas de Cadera/etiología , Fracturas de Cadera/prevención & control , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Italia/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/fisiopatología , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/etiología , Fracturas Osteoporóticas/prevención & control , Servicio Ambulatorio en Hospital , Recurrencia , Riesgo , Factores Sexuales
2.
J Asthma ; 46(7): 703-7, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19728209

RESUMEN

BACKGROUND: The correlation between low insulin levels and a decreased sensitivity of the muscarinic receptor has been shown on induced-diabetes animal models. We designed a cohort study with the aim of evaluating the effects of insulin therapy on airway responsiveness (AR) in human patients with type 2 diabetes mellitus. METHODS: We enrolled 92 patients with type 2 diabetes who had switched from oral anti-diabetic therapy to treatment by insulin subcutaneous injection. Patients were administered the methacholine challenge test (MCT) at time 0 (pre-insulin therapy) and at intervals of 15, 30, 90, 180, and 360 days after insulin treatment. The decline of forced expiratory volume in 1 second (FEV(1))% from baseline (Delta FEV(1)) in response to inhaled methacholine (MCH) was determined to assess airway hyper-responsiveness (AHR). RESULTS: A total of 81 patients (18 women and 63 men) completed the study. Their mean age was 58 +/- 7 years and the mean duration of disease was 13.5 +/- 7.7 years. The mean decrease of FEV(1) at pre-insulin assessment was 2.96 +/- 2.6%. Compared with the pre-insulin value, a significant increase of Delta FEV(1) was observed at 15, 30, and 90 days after treatment (6.25%, CI 95% 5.4 to 7.2, p = 0.0005; 7.64%, CI 95% 6.6 to 8.1, p < 0.001; 6.45%, CI 95% 5.5 to 7.3, p = 0.0004, respectively), while after 180 and 360 days AR was similar to pre-insulin values (Delta FEV(1), 3.62%, CI 95% 2.7 to 3.5 and 3.11%, CI 95% 7.9 to 9.3, respectively). CONCLUSIONS: The finding of an increased AR in patients with type 2 diabetes during the first 3 months of insulin therapy may underline the importance of monitoring pulmonary function and respiratory symptoms in patients switching from oral anti-diabetic drugs to insulin therapy, especially in the subset of individuals with respiratory disorders.


Asunto(s)
Hiperreactividad Bronquial/inducido químicamente , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insulina/farmacología , Anciano , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Hiperreactividad Bronquial/fisiopatología , Pruebas de Provocación Bronquial , Estudios de Cohortes , Diabetes Mellitus Tipo 2/sangre , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Volumen Espiratorio Forzado/fisiología , Hemoglobina Glucada/metabolismo , Humanos , Inmunoglobulina E/sangre , Insulina/administración & dosificación , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad
3.
BMC Genet ; 7: 14, 2006 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-16519809

RESUMEN

BACKGROUND: Among the possible candidate genes for atherosclerosis experimental data point towards the longevity gene p66Shc. The p66Shc gene determines an increase of intracellular reactive oxygen species (ROS), affecting the rate of oxidative damage to nucleic acids. Knock-out p66Shc-/- mice show reduction of systemic oxidative stress, as well as of plasma LDL oxidation, and reduced atherogenic lesions. Thus, p66Shc may play a pivotal role in controlling oxidative stress and vascular dysfunction in vivo. METHODS: We searched for sequence variations in the p66Shc specific region of the Shc gene and its upstream promoter by PCR-SSCP in a selected group of early onset coronary artery disease (CAD) subjects (n. 78, mean age 48.5 +/- 6 years) and in 93 long-living control subjects (mean age 89 +/- 6 years). RESULTS: The analysis revealed two variant bands. Sequencing of these variants showed two SNPs: -354T>C in the regulatory region of p66Shc locus and 92C>T in the p66 specific region (CH2). Both these variants have never been described before. The first substitution partially modifies the binding consensus sequence of the Sp1 transcription factor, and was detected only in two heterozygous carriers (1 CAD subjects and 1 control subject). The 92C>T substitution in the CH2 region consists in an amino acid substitution at codon 31 (proline to leucine, P31L), and was detected in heterozygous status only in one CAD subject. No subjects homozygous for the two newly described SNPs were found. CONCLUSION: Only two sequence variations in the p66Shc gene were observed in a total of 171 subjects, and only in heterozygotes. Our observations, in accordance to other studies, suggest that important variations in the p66Shc gene may be extremely rare and probably this gene is not involved in the genetic susceptibility to CAD.


Asunto(s)
Proteínas Adaptadoras Transductoras de Señales/genética , Enfermedad de la Arteria Coronaria/genética , Polimorfismo de Nucleótido Simple , Edad de Inicio , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/epidemiología , Análisis Mutacional de ADN , Predisposición Genética a la Enfermedad , Humanos , Longevidad/genética , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Polimorfismo Genético , Polimorfismo Conformacional Retorcido-Simple , Regiones Promotoras Genéticas , Proteínas Adaptadoras de la Señalización Shc , Proteína Transformadora 1 que Contiene Dominios de Homología 2 de Src
4.
J Mol Med (Berl) ; 83(9): 711-9, 2005 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15877215

RESUMEN

Adiponectin, an adipocyte-derived protein, is an essential modulator of insulin sensitivity and several studies suggest an important role of adiponectin in the processes leading to atherosclerosis, thus indicating the adiponectin gene as a potential candidate for coronary artery disease (CAD). In the present study we have studied the association between two single nucleotide polymorphisms (SNPs) (+45T>G and +276 G>T) of the adiponectin gene and CAD, looking also into the possible influence of these SNPs on adiponectin plasma levels. The SNPs were analysed in a first cohort of 595 subjects, 325 with CAD and 270 matched controls. We observed a significant association (p<0.001) between the SNP +276G>T in the adiponectin gene and CAD. In multivariate analysis, carriers of the +276G>T SNP had an odds ratio (OR) for CAD of 4.99 (p<0.0007). A strong interaction between the +276G>T SNP and age was also present (OR, 1.03; p<0.0001). The increase in CAD risk was most evident among individuals with early-onset CAD (age T SNP was analysed in a second cohort of CAD and controls. The difference between CAD and controls in the +276G>T SNP frequencies showed a similar trend as before, although not significant. The combination of the two cohorts (1,046 subjects: 580 CAD and 466 controls) showed a statistically significant association, particularly in CAD subjects with early-onset of disease. In addition, we confirmed that in younger CAD subjects the SNP was a significant determinant of lower levels of adiponectin. In view of these results, it could be speculated that the adiponectin gene variant, or a mutation in linkage with it, determines lower adiponectin gene expression, causing in turn an increased risk to develop insulin resistance, atherosclerosis and cardiovascular disease. The significant association of the adiponectin gene in subjects with early-onset CAD also suggests that that genetic factors for late-onset diseases may exert a greater influence in younger persons, when other risk factors are not as prevalent as in older age groups.


Asunto(s)
Enfermedad de la Arteria Coronaria/genética , Polimorfismo de Nucleótido Simple , Adiponectina/sangre , Adiponectina/genética , Adolescente , Factores de Edad , Anciano , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/sangre , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
5.
Dis Markers ; 21(4): 175-80, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16403952

RESUMEN

Among the putative candidate genes for insulin resistance, the peroxisome proliferator-activated receptor gamma coactivator-1alpha (PGC-1alpha) is a transcriptional coactivator of PPARgamma and alpha, regulating a wide range of processes involved in energy production and utilization, such as thermogenesis, liver gluconeogenesis, glucose uptake in muscle. In population studies a Gly482Ser substitution in PGC-1alpha has been reported to be associated with increased risk of type diabetes 2 and insulin resistance. In the present study we have analysed the association between the Gly482Ser missense mutation of the PGC-1alpha gene and insulin sensitivity and glucose tolerance in a population of obese non-diabetic subjects. The Gly482Ser SNPs was detected by PCR-RFLP in a cohort of 358 Caucasian obese subjects (223 with normal glucose tolerance (NGT) and 125 with impaired glucose tolerance (IGT). We observed a significant association (p <0.007) between carriers of the Gly482Ser variant of the PGC-1alpha gene and insulin resistance measured by HOMAIR. Multivariate analysis confirmed that the Gly482Ser SNP was a significant (p < 0.02) determinant of decreased insulin sensitivity, independently from other well-known modulators of insulin action. In conclusion, we have found significant association between the Gly482Ser variant of the PGC-1alpha gene and reduced insulin sensitivity in obese subjects. This association resulted independent from all other known modulators of insulin resistance, and suggests a primary role for the PGC-1alpha gene on the genetic susceptibility to insulin resistance in obesity.


Asunto(s)
Predisposición Genética a la Enfermedad , Intolerancia a la Glucosa/genética , Proteínas de Choque Térmico/genética , Resistencia a la Insulina/genética , Mutación Missense , Obesidad/genética , Factores de Transcripción/genética , Adulto , Sustitución de Aminoácidos/genética , Femenino , Intolerancia a la Glucosa/metabolismo , Glicina/genética , Humanos , Resistencia a la Insulina/fisiología , Masculino , Persona de Mediana Edad , Obesidad/metabolismo , PPAR alfa/metabolismo , PPAR gamma/metabolismo , Coactivador 1-alfa del Receptor Activado por Proliferadores de Peroxisomas gamma , Polimorfismo de Nucleótido Simple/genética , Serina/genética , Transactivadores/genética , Transactivadores/metabolismo
6.
Expert Opin Ther Targets ; 19(12): 1617-22, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26178526

RESUMEN

OBJECTIVE: Endothelial dysfunction (ED) plays a role in diabetic cardiovascular complications. Hyperglycemia increases cytockines involved in vascular inflammation. Inhibition of phosphodiesterase type 5 (PDE5) exerts a relaxation on corpora cavernosa and has cardioprotective properties. The effect of chronic sildenafil treatment, on ED markers and metabolic parameters in a non-randomized study on men with type 2 diabetes (T2DM), was investigated. RESEARCH DESIGN AND METHODS: Twenty-eight T2DM patients (61.2 ± 7.8 years, hemoglobin A1c (HbA1c) 7.9 ± 1.3%, duration of diabetes 11.5 ± 7.8 years) were treated with sildenafil 100 mg/d for 3 months. Baseline and postprandial glycemia, insulin, HbA1c, HOMA index, lipids, glomerular filtration rate, homocysteine were assessed at each visit. P-selectin (CD62P), CD14/42b, CD14/41, ICAM (CD54), PECAM (CD31) and CD11b/CD18, were evaluated, after monocyte isolation with flow-cytometry, before and after treatment. RESULTS: After 3 months, sildenafil decreased P-selectin (p < 0.05), post-prandial glycemia (p < 0.01), HbA1c (p < 0.01), low-density lipoprotein cholesterol (p < 0.01) and increased high-density lipoprotein (p < 0.05). CONCLUSIONS: PDE5 inhibition, in T2DM patients, reduces the endothelial function marker P-selectin and exerts a beneficial effect on glycometabolic control.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Endotelio Vascular/efectos de los fármacos , Citrato de Sildenafil/farmacología , Vasodilatadores/farmacología , Anciano , Biomarcadores/metabolismo , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/complicaciones , Endotelio Vascular/patología , Hemoglobina Glucada , Humanos , Hiperglucemia/tratamiento farmacológico , Insulina/metabolismo , Lípidos/sangre , Masculino , Persona de Mediana Edad , Selectina-P/metabolismo , Inhibidores de Fosfodiesterasa 5/farmacología
7.
Acta Diabetol ; 52(4): 727-32, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25577244

RESUMEN

AIMS: Glucagon-like peptide 1 receptor agonists (GLP-1 RA) induce weight loss and reduction in adipose tissue, but the effects of GLP-1 RA on the distribution of fat deposits have been poorly investigated. METHODS: In 25 patients with type 2 diabetes (16 females and 9 males, mean age 63.5 ± 8.8 years), treated with GLP-1 RA (exenatide, n. 12; liraglutide, n.13), both before and 3 months after starting treatment, an abdominal ultrasonographic scan, with Doppler of renal arteries, and echocardiography were performed. Subcutaneous fat width (peri-umbilical and sub-xiphoid), deep fat deposits (pre-aortic, peri-renal, and epicardial), and renal resistive index (RI) were evaluated. RESULTS: GLP-1 RA induced highly significant (p < 0.001) decrease in BMI and in fat thickness at all the assessed sites, without differences between exenatide and liraglutide treatment. A slight decrease in RI (p = 0.055) was also found. The percent changes of fat thickness was different between sites (p < 0.025), and the changes in subcutaneous deposits showed no significant correlation (p = 0.064) with those of deep fat deposits. CONCLUSIONS: A short course of treatment with GLP-1 RA, besides weight loss, induces a redistribution of adipose tissue deposits, possibly contributing to a better cardiovascular risk profile in patients with type 2 diabetes mellitus.


Asunto(s)
Tejido Adiposo/efectos de los fármacos , Distribución de la Grasa Corporal , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Receptor del Péptido 1 Similar al Glucagón/agonistas , Hipoglucemiantes/farmacología , Liraglutida/farmacología , Péptidos/farmacología , Ponzoñas/farmacología , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/metabolismo , Adulto , Anciano , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/prevención & control , Sistema Cardiovascular/efectos de los fármacos , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Diabetes Mellitus Tipo 2/metabolismo , Ecocardiografía , Exenatida , Femenino , Estudios de Seguimiento , Humanos , Hipoglucemiantes/uso terapéutico , Liraglutida/uso terapéutico , Masculino , Persona de Mediana Edad , Péptidos/uso terapéutico , Factores de Riesgo , Factores de Tiempo , Ultrasonografía , Ponzoñas/uso terapéutico
8.
Thyroid ; 14(5): 355-8, 2004 May.
Artículo en Inglés | MEDLINE | ID: mdl-15186611

RESUMEN

Resistance to thyroid hormone (RTH) is an inherited disease characterized by reduced tissue sensitivity to thyroid hormone. Approximately 90% of subjects with RTH have mutation in the thyroid hormone receptor beta (TRbeta) gene. Approximately 10% of subjects diagnosed as having RTH do not carry mutation in the TRbeta gene. A possible linkage was reported with the retinoid X receptor-gamma (RXR-gamma) gene in two families. The aim of this study is to search for mutation within the RXR-gamma gene in unrelated subjects with diagnosed RTH without mutations in the TRbeta gene. Four subjects with RTH were studied, and sequence variants in the RXR-gamma gene were searched by polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP). Analysis of all the 10 exons of the RXR-gamma gene, including intron-exon boundaries, promoter region and 3' untranslated region (UTR) reveled two variant bands in subjects II and III. Sequencing of these variants showed two single nucleotide polymorphisms (SNPs): 447C > T in exon 3 for patients II and IVS9 + 6A > G for patient III. Both SNPs were also present at high frequency in a group of normal subjects and in nonaffected relatives of subject III. In conclusion, in patients with RTH we have found two SNPs in the RXR-gamma gene; these SNPS are common in the general population, thus excluding a role for the RXR-gamma gene in these patients.


Asunto(s)
Variación Genética , Polimorfismo de Nucleótido Simple , Receptores de Hormona Tiroidea/genética , Receptor gamma X Retinoide/genética , Síndrome de Resistencia a Hormonas Tiroideas/genética , Hormonas Tiroideas/farmacología , Adulto , Cartilla de ADN , Exones/genética , Femenino , Bocio/genética , Humanos , Intrones/genética , Masculino , Persona de Mediana Edad , Mutación , Reacción en Cadena de la Polimerasa/métodos , Receptores beta de Hormona Tiroidea , Tirotropina/sangre , Triyodotironina/sangre
9.
J Atheroscler Thromb ; 17(6): 539-45, 2010 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-20134099

RESUMEN

AIM: Type 2 diabetes increases the risk for cardiovascular disease, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) reduce cardiovascular events in these patients. The benefits of statin therapy cannot be explained only by the lipid-lowering effect. The aim of this study was to test the effect of atorvastatin therapy on CD36 scavenger receptor expression, nuclear factor-kappaB (NFkappaB) levels and markers of inflammation (C-reactive protein, CRP, Tumor Necrosis Factor-alpha, TNF-alpha) in circulating monocytes from diabetic patients. METHODS: Twenty-two type 2 diabetic patients were treated for 8 weeks with atorvastatin (20 mg/day). At baseline and after treatment a blood sample was collected for measurement of glucose, lipid profile (total cholesterol, HDL, LDL cholesterol, triglycerides), glycated hemoglobin (HbA1c), CRP and for isolation of monocytes. RESULTS: Atorvastatin decreased total (p<0.0001) and LDL (p<0.01), and incresased HDL choles-terol (p<0.02). CD36 surface protein expression (anti-CD36 fluorescein isothiocyanate-FITC) was reduced in circulating monocytes after atorvastatin therapy (p<0.02) while immunoblot analysis showed reduced nuclear and increased cytoplasm NFkappaB levels (p<0.05). Finally, TNFalpha production in lipopolysaccharide-activated monocytes from patients treated with atorvastatin was reduced (p<0.05). CONCLUSION: These results suggest that atorvastatin therapy, beside lowering serum cholesterol levels, could exert anti-atherogenic and anti-inflammatory effects in type 2 diabetic patients.


Asunto(s)
Antígenos CD36/análisis , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Ácidos Heptanoicos/farmacología , Monocitos/metabolismo , Proteínas Serina-Treonina Quinasas/análisis , Pirroles/farmacología , Factor de Necrosis Tumoral alfa/análisis , Anciano , Anticolesterolemiantes , Atorvastatina , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Células Cultivadas , Diabetes Mellitus Tipo 2/complicaciones , Regulación hacia Abajo/efectos de los fármacos , Femenino , Humanos , Inflamación/tratamiento farmacológico , Inflamación/prevención & control , Masculino , Persona de Mediana Edad , Monocitos/citología , Monocitos/efectos de los fármacos , Quinasa de Factor Nuclear kappa B
10.
Diabetes Care ; 32(8): 1550-2, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19487641

RESUMEN

OBJECTIVE To determine whether the association observed between poor glycemic control and low HDL cholesterol in type 2 diabetes is dependent on obesity and/or hypertriglyceridemia. RESEARCH DESIGN AND METHODS We performed a cross-sectional study of 1,819 patients with type 2 diabetes and triglycerides <400 mg/dl enrolled at three diabetes centers in Italy. The risk for low HDL cholesterol was analyzed as a function of A1C levels. Odds ratios (ORs) were calculated after adjustment for confounding factors. RESULTS A 1% increase in A1C significantly increased the risk for low HDL cholesterol (OR 1.17 [95% CI 1.1-1.2], P = 0.00072); no changes were observed when age, sex, smoking, and lipid-lowering therapy were included in the model (1.17 [1.1-1.2], P = 0.00044). The association remained strong after adjustments for obesity and hypertriglyceridemia in multivariate analysis (1.12 [1.05-1.18], P = 0.00017). CONCLUSIONS Poor glycemic control appears to be an independent risk factor for low HDL cholesterol in type 2 diabetes.


Asunto(s)
Glucemia/metabolismo , HDL-Colesterol/sangre , Diabetes Mellitus Tipo 2/sangre , Edad de Inicio , Anciano , Colesterol/sangre , Estudios Transversales , Angiopatías Diabéticas/epidemiología , Angiopatías Diabéticas/mortalidad , Dislipidemias/complicaciones , Dislipidemias/epidemiología , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Lipoproteínas HDL/sangre , Lipoproteínas HDL/deficiencia , Masculino , Persona de Mediana Edad , Análisis de Regresión , Factores de Riesgo , Triglicéridos/sangre
11.
Obesity (Silver Spring) ; 16(4): 899-901, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18239564

RESUMEN

OBJECTIVE: To investigate whether insulin resistance (IR) and the metabolic syndrome (MS) are associated with kidney dysfunction in obese non-diabetic (OND) subjects. METHODS AND PROCEDURES: Three-hundred and eighty (113M/267F; age = 41 +/- 14 years) OND subjects (BMI > or = 30 kg/m(2); range = 43 +/- 8 kg/m(2)) were studied. Anthropometric measures, blood pressure, fasting glucose, insulin, lipid profile, and serum creatinine were evaluated. Glomerular filtration rate (GFR) was estimated (e-GFR) with the Modification of Diet in Renal Disease equation. Chronic kidney disease (CKD) was defined as e-GFR <60 ml/min/1.73 m(2). RESULTS: e-GFR was associated with gender (being lower in women) (P = 0.001) and age (P < 0.0001). CKD was present in 32 subjects (8.4%), who were older (P < 0.0001) and more frequently affected by hypertension (P = 0.04) as compared to subjects without CKD. MS was present in 212 (55.8%) subjects. They were older (P< 0.001), had lower e-GFR (P = 0.02) and were more frequently affected by CKD (odds ratio (OR), 95% confidence interval (CI) = 2.3, 1.1-5.1) than those without MS. However, differences in e-GFR values and in the risk of CKD were no longer statistically significant after adjusting for age (P = 0.99 for e-GFR and OR, 95% CI = 1.2, 0.5-2.8 for the risk of CKD, respectively). Homeostasis model assessment of IR (HOMA(IR)) index was neither higher in subject with CKD (P = 0.1) nor inversely correlated with e-GFR (r = 0.1, P = 0.1). DISCUSSION: In OND individuals the risk of CKD is independent of the MS and related abnormalities. This suggests that these individuals are not susceptible to a further deleterious role on kidney function on the top of that played by obesity itself.


Asunto(s)
Nefropatías Diabéticas/epidemiología , Síndrome Metabólico/epidemiología , Obesidad/epidemiología , Insuficiencia Renal Crónica/epidemiología , Grasa Abdominal , Adulto , Nefropatías Diabéticas/diagnóstico , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión Renal/diagnóstico , Hipertensión Renal/epidemiología , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/diagnóstico , Factores de Riesgo , Distribución por Sexo
12.
J Urol ; 177(2): 655-9, 2007 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-17222652

RESUMEN

PURPOSE: We investigated the relationship between oxidative stress and diabetic erectile dysfunction. MATERIALS AND METHODS: A total of 23 patients with a mean +/- SD age of 56.7 +/- 5.6 years, a history of type 2 diabetes for 10.0 +/- 8.3 years and erectile dysfunction, as tested by the International Index of Erectile Function questionnaire, but without vascular and neurological complications, and 15 age matched patients with diabetes without erectile dysfunction were recruited. Circulating monocyte oxidative activity by cytofluorometry, and endothelin-1, intercellular adhesion molecule-1, plasminogen activator inhibitor-1 by enzyme linked immunosorbent assay were evaluated in all patients in the study. RESULTS: Monocyte free radical production, and total and low density lipoprotein cholesterol were higher in patients with than in those without erectile dysfunction (p <0.03, <0.02 and <0.05, respectively). In all patients the International Index of Erectile Function score inversely correlated with low density lipoprotein (p <0.05), while in patients with erectile dysfunction it negatively correlated with age (p <0.03), body mass index (p <0.02), endothelin-1 (p <0.02) and intercellular adhesion molecule-1 (p <0.05). Endothelin-1, intercellular adhesion molecule-1 and plasminogen activator inhibitor-1 were not different in patients with diabetes with and without erectile dysfunction. CONCLUSIONS: In men with type 2 diabetes who have erectile dysfunction but are asymptomatic for cardiovascular disease oxidative activation of monocytes is increased and it is related to other risk factors of endothelial dysfunction.


Asunto(s)
Complicaciones de la Diabetes/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Disfunción Eréctil/metabolismo , Monocitos/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Complicaciones de la Diabetes/sangre , Diabetes Mellitus Tipo 2/sangre , Endotelina-1/sangre , Endotelio Vascular , Disfunción Eréctil/sangre , Humanos , Molécula 1 de Adhesión Intercelular/sangre , Masculino , Persona de Mediana Edad , Inhibidor 1 de Activador Plasminogénico/sangre
13.
Eur Urol ; 52(6): 1768-74, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-17478034

RESUMEN

OBJECTIVE: To investigate the synergic effect of propionyl L-carnitine (PLC) plus sildenafil in reducing monocyte oxidative activity and endothelial dysfunction markers in diabetic patients with erectile dysfunction (ED). METHODS: Thirty-two type 2 diabetic patients with ED (according to the International Index of Erectile Function-5 [IIEF-5]) were randomized to receive PLC (2 g/d) alone (n=8) or combined with sildenafil (50 mg/d twice weekly) (n=8), sildenafil alone (50 mg/d twice weekly) (n=8), or placebo (n=8) in a double-blind, fixed-dose study. Monocyte oxidative activity (stimulation index [SI]), intercellular adhesion molecule-1 [ICAM-1], P-selectin, advanced glycation end product (AGE) levels, Doppler sonography (recording peak systolic velocity [PSV]; end diastolic velocity [EDV]; systolic wave time [SWT]; resistive index [RI]), and IIEF score were evaluated before and after 12 wk of treatment; IIEF-5 was evaluated again 4 wk posttreatment. RESULTS: SI was reduced by treatment with PLC alone or combined with sildenafil (p<0.05). In patients treated with PLC plus sildenafil, a decrease in ICAM-1, P-selectin, and EDV values was observed compared with patients treated with sildenafil alone (p<0.05, p<0.01, p<0.001, respectively). IIEF-5 improved in all patients treated with PLC plus sildenafil or sildenafil alone (p<0.03, p<0.05, respectively). Four weeks posttreatment, patients treated with PLC plus sildenafil maintained the improvement of the IIEF-5 compared with patients on sildenafil alone (p=0.05). In patients on PLC treatment (with or without sildenafil), SI was correlated with IIEF-5 (p<0.001), glycemia with STW (p<0.03), and AGEs with IIEF-5 (p<0.01). CONCLUSION: PLC plus sildenafil was more effective in reducing SI and endothelial dysfunction markers in patients with type 2 diabetes and ED.


Asunto(s)
Antioxidantes/administración & dosificación , Carnitina/análogos & derivados , Diabetes Mellitus Tipo 2/complicaciones , Endotelio Vascular/efectos de los fármacos , Disfunción Eréctil/tratamiento farmacológico , Monocitos/efectos de los fármacos , Inhibidores de Fosfodiesterasa/administración & dosificación , Piperazinas/administración & dosificación , Sulfonas/administración & dosificación , Anciano , Biomarcadores , Carnitina/administración & dosificación , Método Doble Ciego , Quimioterapia Combinada , Disfunción Eréctil/fisiopatología , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Monocitos/metabolismo , Purinas/administración & dosificación , Especies Reactivas de Oxígeno/metabolismo , Citrato de Sildenafil
14.
Horm Res ; 65(3): 120-5, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16479142

RESUMEN

Insulinoma is the most common pancreatic endocrine tumor, accounting for 40% of all pancreatic functional neoplasm, and is characterized by hypersecretion of insulin and hypoglycemia. Elective treatment for insulinomas is surgical enucleation. Medical therapy with diazoxide, followed by somatostatin analogues in some cases, may be necessary to treat the hypoglycemic symptoms. We report a case of a patient affected by metastatic insulinoma with severe hypoglycemia. After surgery, histopathology confirmed the presence of a malignant insulinoma with multiple metastases in the liver. Due to the persistence of hypoglycemia, the patient was started on octreotide LAR treatment, which determined a complete clinical remission with regression of the metastatic lesions in the liver after one year. Repeated CT scans 2 and 3 years after surgery confirmed the remission. To our knowledge, the complete regression of the disease in insulinomas treated with long-standing somatostatin analogue therapy has never been reported. Immunohistochemical analysis in tissue specimens showed a strong membrane immunoreactivity for somatostatin receptors type 2 (SSTR2) in both the primary nodule and the metastases. The capacity of somatostatin analogues to negatively regulate cell proliferation through indirect and direct mechanisms has been experimentally demonstrated. Furthermore, SSTR2 activation may exert pro-apoptotic effects in neoplastic cells. Thus, both mechanisms may have been responsible of the remission of the disease in this patient. This case underlies the potential impact of the treatment of pancreatic insulinomas with somatostatin analogues, and, if confirmed, the usefulness of SSTR determination in these neoplastic specimens.


Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Insulinoma/secundario , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Octreótido/uso terapéutico , Neoplasias Pancreáticas/química , Receptores de Somatostatina/análisis , Adulto , Apoptosis , Proliferación Celular , Femenino , Humanos , Inmunohistoquímica , Insulinoma/química , Insulinoma/tratamiento farmacológico , Insulinoma/patología , Neoplasias Hepáticas/química , Neoplasias Hepáticas/diagnóstico , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/patología , Inducción de Remisión , Tomografía Computarizada por Rayos X
15.
Nutr Metab Cardiovasc Dis ; 16(5): 345-52, 2006 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-16829343

RESUMEN

BACKGROUND AND AIM: Oxidized low-density lipoproteins (OxLDLs) play a critical role in endothelial dysfunction, which is implicated in the pathogenesis of atherosclerosis. Vascular endothelial cells internalize and degrade oxLDL through the endothelial lectin-like oxidized LDL receptor 1 (OLR1). OLR1 is up-regulated in several pathological conditions, including hypertension, hyperlipidemia, diabetes, atherosclerosis and inflammation, and represents therefore a good candidate for coronary artery disease (CAD). Recently, a 3'-UTR (188 C>T) SNP in the OLR1 gene has been reported to be associated with coronary artery stenosis and myocardial infarction. In the present study we investigated whether the OLR1 gene 188 C>T SNP is a genetic risk marker for CAD in Italian patients with angiographically defined coronary atherosclerosis, and assessed its relation with clinical and metabolic abnormalities, including severity of disease (classified as restenosis, single- or multiple coronary vessels disease, and MI). METHODS: The 3'-UTR C>T SNP was detected in real-time PCR in 351 subjects with CAD and in 215 control subjects. RESULTS: The OLR1-T allele frequencies were 48.9% in the CAD subjects and 47.7% in controls, with no significant difference between the two groups. Also, the 3'-UTR C>T SNP did not associate with any of the parameters of severity of disease. Furthermore, none of the other clinical and metabolic parameters were associated with the OLR1 gene SNP. CONCLUSIONS: Our observations suggest that, in our population, the 3'-UTR C>T polymorphism of the OLR1 gene is unlikely to play a role in the pathogenesis of coronary artery disease.


Asunto(s)
Regiones no Traducidas 3'/genética , Enfermedad de la Arteria Coronaria/genética , Polimorfismo Genético , Receptores de LDL/genética , Estudios de Casos y Controles , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/patología , Femenino , Frecuencia de los Genes , Marcadores Genéticos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oxidación-Reducción , Reacción en Cadena de la Polimerasa , Receptores de LDL/metabolismo , Receptores de LDL Oxidadas , Receptores Depuradores de Clase E , Índice de Severidad de la Enfermedad
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