Catechins green tea upregulates the expression of ABCA1, ABCG1, and SRB1 in rats induced atherogenic diet

The efflux of cholesterol from macrophage to liver is known as reverse cholesterol transport (RCT). Impairedcholesterol efflux leads to cholesterol accumulation in macrophages. Therefore, how to increasing cholesterol effluxmay be an effective strategy for atherosclerosis prevention. Key molecules that play a vital role in the efflux ofcholesterol from macrophage are Adenosin Tri Phosphate (ATP)-binding casette transporters A1 and G. This study wasundertaken to clarify the effect of Catechins on the expression of specific transporters such as ATP-binding cassettesub-family A member 1 (ABCA1), ATP-binding cassette sub-family G member 1 (ABCG1) from macrophage to liver,and scavenger receptor class B type I (SRB1). This research was done on Wistar rats induced atherogenic diets. SRB1is one of the transporters to facilitate the delivery of cholesterol from the macrophage to the liver. The SRB1 pathwaymediated the selective uptake of cholesteryl ester. Catechins significantly increased the mRNA expression of ABCA1and ABCG1 in aorta as well as SRB1 of liver also increased. Thus, Catechins decreased the total cholesterol levels inaorta and serum. Catechins can be developed as a potential agent to increase ABCA1 to inhibit atherogenesis process.In conclusion, this study indicates that the potential anti-atherogenic properties of Catechins could be explained, atleast in part, as being due to upregulated expression of ABCA1, ABCG1, and SRB1 through activation liver X receptorsignaling pathway.

PPARγ expression by rambutan peel extract in obesity rat model-induced high-calorie diet

Objective:To monitor the physiological characteristics and genes expression of obesity rat model after rambutan peel extract (RPE) treatment. Methods: Twenty-four 12-week-old male rats were divided into 4 groups: normal, obesity, obesity treated with ellagic acid (O-EA) and obesity treated withRPE30 (O-RPE30). Physiological characteristics were monitored by measuring body weight, calorie intake, size of adipocyte and level of triglyceride. Peroxisome proliferator activated receptorgamma (PPARγ), CCAAT/enhancer-binding proteinsαand fatty acid binding protein 4 (FABP4) expression were observed using immunohistochemistry, western blotting and quantitativeRT-PCR methods. Results: Body weight gain ofO-EA andO-RPE30 rats were lower than obesity group and size of adipocyte cells were smaller than obesity group (P Conclusions:RPE have anti-obesity activity by inhibiting body weight gain, declining size of adipocyte, decreasing triglyceride,PPARγ expression and mRNA level ofFABP4 gene on obesity rat model.

The role of vascular smooth muscle cells on the pathogenesis of atherosclerosis.

Atherosclerosis is the leading cause of death and disability. The lesions of atherosclerosis represent a series of highly specific cellular and molecular responses. The earliest changes that precede the formation of lesions of atherosclerosis take place in the endothelium (EC), with resultant endothelial dysfunction. The EC-induced injury can result in increased lipid permeability, macrophage recruitment, formation of foam cells, and recruitment of T-lymphocytes and platelet. After intimal injury, different cell types,including ECs, platelets, and inflammatory cells release mediators, such as growth factors and cytokines that induce multiple effects including phenotype change of vascular smooth muscle cells (VSMC) from the quiescent "contractile" phenotype state to the active "synthetic" state, that can migrate and proliferate from media to the intima. The inflammatory response simulates migration and proliferation of VSMC that become intermixed with the area of inflammation to form an intermediate lesion. These responses continue uninhibited and is accompanied by accumulation of new extra cellular matrix (ECM). The migratory and proliferative activities of VSMC are regulated by growth promoters such as platelet derived growth factors (PGF), endothelin-1 (ET-1), thrombin, fibroblast growth factor (FGF), interleukin-1 (IL-1) and inhibitors such as, heparin sulfates , nitric oxide (NO), transforming growth factor (TGF)-beta. The matrix metallo proteinases (MMPs) could also participate in the process of VSMC migration. MMPs could catalyze and remove the basement membrane around VSMC and facilitate contacts with the interstitial matrix. This could promote a change from quiescent, contractile VSMC to cells capable of migrating and proliferating to mediate repair. The VSMC regulation is a very complex process, VSMC are stimulated to proliferate and migrate by some kind of cytokines, growth factors, angiotensin II (Ang-II). Together with apoptosis, proliferation and migration of VSMC are vital to the pathogenesis of atherosclerosis and plaque rupture. Rupture of the plaque is associated with increased fibrous cap macrophage, increased VSMC apoptosis, and reduced fibrous cap VSMC. VSMC are the only cells with plaques capable of synthesizing structurally important collagen isoforms, and the apoptosis of VSMC might promote plaque rupture.

The expression and down stream effect of lectin like-oxidized low density lipoprotein 1 (LOX-1) in hyperglycemic state.

The lesions of atherosclerosis represent a series of highly specific cellular and molecular responses. Low density lipoprotein (LDL), which may be modified by oxidation, glycation, aggregation, association with proteoglycans, or incorporation into immune complexes, is a major cause of injury to the endothelium and vascular smooth muscle cells (VSMC).The major major cell types involved in atherogenesis, macrophages and VSMC, are activated by pro-inflammatory stimuli including modified LDL. Modified LDL induces inflammatory responses in macrophages, migration and proliferation of SMC, and triggers foam cell formation. Scavenger receptors, including LOX-1, play a key role in foam cell formation by mediating the uptake of modified LDL. LOX-1 expression is detected in endothelial cells of early atherosclerosis lesions of human carotid arteries. Advanced lesions showed LOX-1 expression not only in endothelial cells but also in macrophages and more frequently in VSMC, and may be involved in foam cell transformation in macrophages and VSMC. The metabolic abnormalities that characterize diabetes, particularly hyperglycemia, free fatty acids, and insulin resistance, provoke molecular mechanisms that alter the function and structure of blood vessels. These include increased oxidative stress, intracellular signal transduction disturbances, and activation of the receptor for advanced glycation end products (R-AGE). Data showed that LOX-1 expression is enhanced by proatherogenic factors relevant to human diabetes, including high glucose, oxLDL, advance glycation end products, and C-reactive protein. LOX-1 expression increased also through oxygen species (ROS), endothelin-1 (ET-1), tumor necrosis factor-alpha (TNF-alpha), shear stress, activation of protein kinase-C (PKC), angiotensin-II (ANG-II), and through inflammatory pathways.

Hypertension: diagnostic problem, challenge and dilemmas.

An elevated arterial pressure is probably the most important public health problem. The prevalence of hypertension depends on both the racial composition of the population studied and the criteria used to define the condition. Patients with hypertension die prematurely, the most common cause of death is heart disease, stroke, and renal failure. The JNC-7 report has introduced a new classification that includes term "pre-hypertension". The new classification may make a new dilemma in the management since the main treatment of pre-hypertension is the lifestyle changes. What do we recommend to lean patients with pre-hypertension who are already following a prudent lifestyle? The ultimate public health goal of antihypertensive therapy is the reduction of cardiovascular and renal morbidity and mortality. The question is, what should the blood pressure goal be? For patients without any compiling condition, it was assumed that 140/90 mmHg was desired treatment target level. For diabetic patient, it is reasonable to target a blood pressure well within the normal range, at most 130/80 mmHg. Some newer studies suggest that the target of treatment may force the recommended goal even lower, even for the patient without any compiling condition. For elderly individuals, a goal of 140/90 mmHg is appropriate. Hypertension during pregnancy is one of important aspects, since blood pressure during pregnancy may change related to the gestational age. This is always subject of discussion because there is no evidence that pharmacologic treatment results in improved neonatal outcomes, lower blood pressure may, in fact uteroplacental perfusion and thereby jeopardize fetal development. It means that more attention is needed for hypertensive patients not only for treatment regimens choice but also the blood pressure target. The accurate measurement of blood pressure is the sine qua non for successful management of hypertension. The operator should be trained and regularly retrained in the standardized technique, to avoid the chance of mismanagement.

The competency of internists in holistic global care to support healthy Indonesia 2010.

All patients are entitled to good standards of practice and care from their doctors. The improved health of all peoples is the main goal of medical education, including for the education of internal medicine registrars. The future development of the direction and goal of education, the level of competence of internal medicine specialists, and the process of learning will be related to preparing the internal medicine specialist to have global competitive advantage. Identification of general competencies is the first step in a long-term effort designed to emphasize educational outcome, for assessment in residency programs, and in the accreditation process. To achieve that competence, a variety of learning opportunities need to be provided in order that the resident can achieve the necessary knowledge, skills, attitude, and behaviors. Identification of the role and function of internal medicine specialists is needed prior to the development of the general competencies. As educational objectives, the competencies fall into two main categories: knowledge-based and performance-based. Knowledge-based competency has two components, medical knowledge (bio-science and clinical medicine) and contextual knowledge (epidemiology, health service organization, and human behavior). The performance base has two components, intellectual skills and the interpersonal skills. Besides the two main categories of educational objectives, there are behavioral objectives that residents must achieve through the educational program, to ensure that residents are able to deal with a range of prescribed clinical situations effectively, safely, humanely, and economically. The achievement of behavioral objectives will ensure, at least in part, that the doctor will implement good medical practice. The index clinical/community situations (ICS) on which the educational objectives will be based are taken from diseases and illnesses that occur in clinical and community settings. No resident can master all medicine there is to know, as there are no limits to what can be known about medicine. It is important to make choices in selecting what residents should learn by analyzing the ICS.

The Petai China study: metabolic syndrome among obese Indonesian Chinese adolescents (preliminary report).

AIM: We examined 251 boys and 259 young girls of chinese offspring, age of 12 to 18 years old from 5 schools around North Jakarta and West of Jakarta. The variables observed are Body Mass Index, waist circumference, fasting sugar level, fasting HDL-cholesterol, tryglyceride and insulin level (fasting). METHODS: Cross-sectional epidemiology survey. RESULTS: We found 125 youngsters as obese which are 82 young boys and 43 young girls. 47 of the 510 students observed anthropometrically agreed to continue the examination for blood test. The prevalence of the obesity is 4,9% of the population observed and the prevalence of the metabolic syndrome found higher among male students (19,14%) of 10,63% among female students. For the obese population, the criterion of metabolic syndrome is found higher (35,71%). CONCLUSION: We determined the existence of metabolic syndrome among the youth in Jakarta that the prevalence of the metabolic syndrome is higher among the obese population.