The Insulin Sensitizer KBP-336 Prevents Diabetes-Induced Cognitive decline in ZDF Rats.

BACKGROUND AND OBJECTIVES: Diabetes and especially insulin resistance are associated with an increased risk of developing cognitive dysfunction, making anti-diabetic drugs an interesting therapeutic option for the treatment of neurodegenerative disorders. Dual amylin and calcitonin receptor agonists (DACRAs) elicit beneficial effects on glycemic control and insulin sensitivity. However, whether DACRAs affect cognition is unknown. DESIGN AND INTERVENTION: Zucker Diabetic Fatty rats were treated with either the DACRA KBP-336 (4.5 nmol/kg Q3D), the amylin analog AM1213 (25 nmol/kg QD), or vehicle for 18 weeks. Further, the efficacy of a late KBP-336 intervention was evaluated by including a group starting treatment on day 30. Glucose control and tolerance were evaluated throughout the study and spatial learning and memory were evaluated by Morris Water Maze after 17 weeks of treatment. RESULTS: When evaluating spatial learning, rats receiving KBP-336 throughout the study performed significantly better than AM1213, vehicle, and late intervention KBP-336. Both KBP-336 and AM1213 treatments improved spatial memory compared to the vehicle. The overall performance in the cognitive tests was reflected in the treatment efficacy on glycemic control, where KBP-336 was superior to AM1213. CONCLUSION: In summary, the DACRA KBP-336 ameliorates diabetes-induced spatial learning and memory impairment in diabetic rats. Further, KBP-336 improves long-term glycemic control superior to the amylin analog AM1213. Taken together, KBP-336 is, due to its anti-diabetic and insulin-sensitizing properties, a promising candidate for the treatment of cognitive impairments.

Metabolic flexibility in postmenopausal women: Hormone replacement therapy is associated with higher mitochondrial content, respiratory capacity, and lower total fat mass.

AIM: To investigate effects of hormone replacement therapy in postmenopausal women on factors associated with metabolic flexibility related to whole-body parameters including fat oxidation, resting energy expenditure, body composition and plasma concentrations of fatty acids, glucose, insulin, cortisol, and lipids, and for the mitochondrial level, including mitochondrial content, respiratory capacity, efficiency, and hydrogen peroxide emission. METHODS: 22 postmenopausal women were included. 11 were undergoing estradiol and progestin treatment (HT), and 11 were matched non-treated controls (CONT). Peak oxygen consumption, maximal fat oxidation, glycated hemoglobin, body composition, and resting energy expenditure were measured. Blood samples were collected at rest and during 45 min of ergometer exercise (65% VO2peak). Muscle biopsies were obtained at rest and immediately post-exercise. Mitochondrial respiratory capacity, efficiency, and hydrogen peroxide emission in permeabilized fibers and isolated mitochondria were measured, and citrate synthase (CS) and 3-hydroxyacyl-CoA dehydrogenase (HAD) activity were assessed. RESULTS: HT showed higher absolute mitochondrial respiratory capacity and post-exercise hydrogen peroxide emission in permeabilized fibers and higher CS and HAD activities. All respiration normalized to CS activity showed no significant group differences in permeabilized fibers or isolated mitochondria. There were no differences in resting energy expenditure, maximal, and resting fat oxidation or plasma markers. HT had significantly lower visceral and total fat mass compared to CONT. CONCLUSION: Use of hormone therapy is associated with higher mitochondrial content and respiratory capacity and a lower visceral and total fat mass. Resting energy expenditure and fat oxidation did not differ between HT and CONT.

Where does spinal cord stimulation fit into the international guidelines for refractory painful diabetic neuropathy? a consensus statement.

BACKGROUND: Although pharmacotherapy with anticonvulsants and/or antidepressants can be effective for many people with painful diabetic neuropathy (PDN), albeit with frequent side-effects, a critical juncture occurs when neuropathic pain no longer responds to standard first- and second-step mono- and dual therapy and becomes refractory. Subsequent to these pharmacotherapeutic approaches, third-line treatment options for PDN may include opioids (short-term), capsaicin 8% patches, and spinal cord stimulation (SCS). AIM: This document summarizes consensus recommendations regarding appropriate treatment for refractory peripheral diabetic neuropathy (PDN), based on outcomes from an expert panel convened on December 10, 2022, as part of the Worldwide Initiative for Diabetes Education Virtual Global Summit, "Advances in the Management of Painful Diabetic Neuropathy." PARTICIPANTS: Nine attendees, eminent physicians and academics, comprising six diabetes specialists, two pain specialists, and one health services expert. EVIDENCE: For individuals with refractory PDN, opioids are a high-risk option that do not provide a long-term solution and should not be used. For appropriately selected individuals, SCS is an effective, safe, and durable treatment option. In particular, high-frequency (HF) SCS (10 kHz) shows strong efficacy and improves quality of life. To ensure treatment success, strict screening criteria should be used to prioritize candidates for SCS. CONSENSUS PROCESS: Each participant voiced their opinion after reviewing available data, and a verbal consensus was reached during the meeting. CONCLUSION: Globally, the use of opioids should rarely be recommended for refractory, severe PDN. Based on increasing clinical evidence, SCS, especially HF-SCS, should be considered as a treatment for PDN that is not responsive to first- or second-line monotherapy/dual therapy.

Hantavirus pulmonary syndrome in pregnancy.

This comprehensive case review of hantavirus pulmonary syndrome (HPS) during pregnancy in 5 women characterizes the effect of Sin Nombre virus infection on maternal and fetal outcomes. Histopathologic, serological, and clinical information were evaluated for evidence of vertical transmission. Maternal ages ranged from 20 to 34 years and gestational ages from 13 to 29 weeks. Symptoms, physical findings, and laboratory values other than those related to pregnancy were not noticeably different from those of nonpregnant patients with HPS, although fevers were somewhat lower. One maternal death and 2 fetal losses occurred. Gross, microscopic, and immunohistochemical examination for hantavirus antigen were done on 2 fetal autopsies and 3 placentas showing no evidence of transplacental hantavirus transmission. There was no serological evidence of conversion in the 3 surviving children. Maternal and fetal outcomes of HPS appear similar to those of nonpregnant HPS patients and of pregnant patients with other causes of acute respiratory distress syndrome. No evidence of vertical transmission of Sin Nombre virus was found.

Liposomal amikacin: improved treatment of Mycobacterium avium complex infection in the beige mouse model.

Disseminated Mycobacterium avium complex (MAC) infection has reached epidemic proportions and is a major cause of morbidity and mortality in AIDS patients. We have developed a liposomal preparation of amikacin, VS107, which incorporates the drug in 54-65 nm diameter unilameller phospholipid vesicles and is stable at 4 degrees C for more than 4 months. VS107 exhibits superior microbiological and pharmacological activity over the free amikacin and improves the survival of mice in the established model for MAC infection. The serum half-life of VS107 in mice was 9.1 h and a peak serum level of 730 mg/L was obtained after administering three doses of 160 mg/kg. For the therapeutic study, beige mice infected with 10(7) cfu M. avium complex strain 101 were randomised to be treated with placebo liposomes, buffer, free amikacin or VS107 The drugs were administered via the caudal vein thrice weekly for 1, 3, 5 or 7 weeks beginning 5 days after infection. After 51 days of treatment with VS107, the number of viable M. avium in the liver and spleen was a 100 fold lower than was achieved with conventional amikacin (P < 0.01), and more than six decimal logarithms lower than was found untreated controls (P < 0.001). VS107 was well tolerated and might be a suitable candidate for treating human MAC infections.

Human immunodeficiency virus seroprevalence in an occupational cohort in a South African community.

BACKGROUND: In the early years of the worldwide pandemic, there were no reported cases of acquired immunodeficiency syndrome in Lesotho, a small, mountainous country in South Africa. Since 1986, when the first case of acquired immunodeficiency syndrome was identified, reported diagnoses have risen precipitously. The initiation of the Lesotho Highlands Water Project has resulted in the influx of a migrant workforce of predominantly single males into a relatively isolated, mountainous area where human immunodeficiency virus (HIV) was previously unknown. OBJECTIVE: To ascertain the HIV seroprevalence among a cohort of laborers at the Katse Dam construction site in Bokong, Lesotho. METHODS: During the 5-week study period in late 1992, construction workers (age range, 15 to 59 years) who were first-time clinic users for any chief complaint were randomly selected for serological study. Surveillance complied with the Lesotho National AIDS Control Programme guidelines, which required unlinked, anonymous testing. Serum samples were screened by an enzyme-linked immunosorbent assay; the results were confirmed by the Western blot technique. RESULTS: Unlinked, anonymous HIV testing of 486 persons revealed a seroprevalence of 5.3% (26/486; 95% confidence interval, 3.3% to 7.3%). These data contrasted with a 0.8% seroprevalence in a similar age group in nearby villages that surrounded the construction project. CONCLUSIONS: Lesotho, in the early phase of the HIV/acquired immunodeficiency syndrome epidemic in Africa in the 1980s, was seemingly protected by its relative isolation. Grave concern is now warranted as the country is destined to experience a rapid rise in HIV seroprevalence. Increased surveillance, health education opportunities, and aggressive prevention activities at the Katse Dam construction site are imperative to arrest the spread of HIV from construction workers to nearby villagers.

[The adolescent psychiatric clientele in a district psychiatric center]. / Det ungdomspsykiatriske klientel i et distriktspsykiatrisk center.

This study is retrospective and based on the charts of 44 adolescents (age 17-22) admitted to a Danish community psychiatric centre during the first 32 months after the opening of the centre. The social status of the adolescents, reasons for admission, previous treatment and need for psychiatric treatment are presented. The adolescents were generally a little older than a typical adolescent psychiatric clientele, and comparatively many of them had rather mild psychiatric conditions. A characteristic feature of these patients was a certain instability in their contact to the centre. Although many of them had long-lasting basic disabilities (e.g. personality disorders), only a few of them achieved a stable treatment alliance with the ward. This indicates difficulties of integrating an adolescent clientele in a community psychiatric centre that primarily takes care of adult patients.

Dose-related activity of stavudine in patients infected with human immunodeficiency virus.

In a multicenter, randomized, open-label, dose-ranging study to determine the relative effects of three dose levels of stavudine on CD4 lymphocyte count, weight gain, and hematologic variables in patients infected with human immunodeficiency virus (HIV), 152 patients with CD4 lymphocyte counts < or = 600/mm3 received stavudine at 0.1 mg/kg/day (n = 51), 0.5 mg/kg/day (n = 53), or 2.0 mg/kg/day (n = 48). The study was designed to evaluate the activity of stavudine after 10 weeks of therapy and permitted extended dosing and follow-up for long-term safety. A significant dose effect on increases in CD4 lymphocyte counts and declines in HIV titer in peripheral blood mononuclear cells was observed. Stavudine was well-tolerated; the only dose-related, dose-limiting adverse event was peripheral neuropathy, which usually was reversible. In this trial, the most favorable therapeutic index was seen at 0.5 mg/kg/day.

Dose response and timing effects in the therapy of the LP-BM5 murine retrovirus-induced lymphoproliferative immunodeficiency disease with diethyldithiocarbamate.

Diethyldithiocarbamate (DTC) was used to treat the murine, retrovirus-induced, immunodeficiency disease (MAIDS). Once-weekly treatment was not effective and 800 mg/kg was toxic. When 200, 400 and 600 mg/kg were given i.p., 5 days per week, starting either on the day of virus inoculation or 14 days later, a dose-response and time-response relationship was noted. Higher doses and a 2-week delayed onset of treatment were generally more effective in reducing the development of lymphadenopathy, hypergammaglobulinemia and in prolonging survival than treatment started on the day of virus inoculation. When treatment was delayed until 10 weeks after virus inoculation existing lymphadenopathy was abrogated (treated node area 0 mm2 compared to control 175 mm2, P < 0.0001) and survival was improved (treated 100% compared to control 12.5%, P < 0.0001). However, when therapy was stopped animals died at the same rate as the untreated controls. These data indicate that DTC is active in MAIDS in a dose-responsive and time-dependent manner.

Effective therapy of the LP-BM5 murine retrovirus-induced lymphoproliferative immunodeficiency disease with diethyldithiocarbamate.

The effects of therapy with the immunomodulator diethyldithiocarbamate (DTC) on the manifestation and natural history of LP-BM5 murine retrovirus infection in adult C57 Black 6 mice was investigated. DTC itself, had limited effects on the spleen weight, serum IgM, or mitogen responses of the non-virus-infected control mice when evaluated over a 9-week period. The virus inoculum administered was such that there was approximately a twofold increase in serum IgM and a halving of phytohemagglutinin (PHA) and lipopolysaccharide (LPS) responses in about two weeks and death of all animals by about 26 weeks postinfection. Doses of DTC of 20 and 200 mg/kg weekly or 5 days per week (intraperitoneally) in mice with LP-BM5 infection did not alter the manifestations or course of the disease. Doses of 400 or 600 mg/kg given 5 days per week, starting either 2 weeks before or the day of virus inoculation significantly reduced hypergammaglobulinemia, spleen weight, lymphadenopathy, and also prolonged survival. A dose of 400 mg/kg started 2 weeks after virus inoculation resulted in partial prevention of hypergammaglobulinemia, splenomegaly, and lymphadenopathy as well as 100% survival compared with 12.5% in non-drug-treated controls at 23 weeks after virus inoculation. The 9 surviving animals in the treated group were then allocated to continue treatment or stop treatment. In the animals without further treatment, lymphadenopathy and mortality occurred starting within 6 weeks after cessation of therapy while the animals with continued treatment remained in good condition for 40 weeks. There was only a very limited and transient effect of DTC therapy on the decline of the proliferative responses to phytohemagglutinin or lipopolysaccharide in any of the treated groups in the above described experiments.(ABSTRACT TRUNCATED AT 250 WORDS)

Visceral leishmaniasis in Sudan. Clinical features.

Kala azar is a disease endemic to the Sudan and a cause of major morbidity and mortality to affected patients when the diagnosis or treatment has been delayed. In this report we described the clinical features of 99 parasite proven patients with visceral leishmaniasis. The Sudanese kala azar patient is young in age (teens to 20's), has marked weight loss despite a continuous, excellent appetite and suffers from insomnia, epistaxis and abdominal pain. Hepatosplenomegaly is universally present. Generalized lymphadenopathy is a prominent feature (72%). The high prevalence of lymphadenopathy has a wide range of implications: for diagnosis, i.e., the use of lymph node aspiration; for response to treatment, i.e., the resolution of lymphadenopathy; and for studies of immunoregulation in this systemic infection.

Biological activity of diethyldithiocarbamate (Ditiocarb, Imuthiol) in an animal model of retrovirus-induced immunodeficiency disease and in clinical trials in patients with HIV infection. The Ditiocarb Study Group.

Diethyldithiocarbamate (Ditiocarb) is a drug with diverse biological activities suggesting that it may have multiple, clinical uses. Thus, it is an inhibitor of such enzymes as cytochrome P450, it is a chelating agent for nickel and cadmium, it is a free-radical scavenger and finally, it is an immunomodulator. As such, it can restore the immune responses of immunosuppressed mice. In the murine retrovirus-induced immunodeficiency disease (LP-BM5 in C57 black 10 mice), it can prevent the development of disease when given from the day of virus inoculation until 2 weeks after virus inoculation. In addition, it can reverse disease manifestations including lymphadenopathy when started as late as 10 weeks after virus inoculation. Associated with these effects is a reduction in mortality from 100 percent to between 0 and 10 percent. When drug is stopped however, disease progression resumes. In man, Ditiocarb has been used in a series of open, non-randomized as well as randomized prospectively-controlled clinical trials in patients with HIV infection. Three randomized placebo-controlled studies have been conducted. In the largest of these, involving 389 patients, Ditiocarb was shown to be safe, non-toxic and effective. Thus, there was a 62 percent reduction in new opportunistic infections (OI) in all of the treated patients, a 50 percent reduction in ARC patients and an 82 percent reduction in AIDS patients. When new and recurrent OI and other events indicating progression were taken together, there were 17 events in 193 treated patients and 42 events in 196 placebo control patients. Statistically significant reductions in these events were seen in ARC patients, AIDS patients and all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastrointestinal cytomegalovirus infection in heart and heart-lung transplant recipients.

Cytomegalovirus (CMV) causes major morbidity in organ transplant recipients. Gastrointestinal disease was the most prominent manifestation of CMV infection in a population of heart and heart-lung transplant patients, with an incidence of 9.9%, compared with pneumonitis (4.0%) and retinitis (0%), and occurred most frequently in CMV-seronegative recipients of organs from CMV-seropositive donors. Clinical manifestations included gastritis (nine patients), gastric ulceration (four patients), duodenitis (three patients), esophagitis (one patient), pyloric perforation (one patient), and colonic hemorrhage (one patient). Patients with gastrointestinal CMV infection were treated with intravenous ganciclovir sodium therapy, 5 mg/kg twice daily, for 2 to 8 weeks, with positive clinical, endoscopic, histologic, and virologic responses. Relapses occurred in four of nine patients who were followed up for a median period of 18 months. Retreatment resulted in healing of endoscopic lesions and in viral clearing. We conclude that early endoscopic evaluation for CMV is indicated in heart and heart-lung transplant patients with gastrointestinal symptoms. This study further suggests that intravenous ganciclovir therapy is effective for the treatment of gastrointestinal CMV in these patients.

A randomized, controlled dose response study of intravenous sodium diethyldithiocarbamate in patients with advanced human immunodeficiency virus infection.

Sodium diethyldithiocarbamate (Imuthiol, DTC) has previously been observed to promote T-cell maturation in animal models and to reduce lymphadenopathy and improve survival in a murine AIDS model. In addition, several clinical studies have suggested that one dosage regimen may be active in patients with HIV infection. We conducted a randomized, controlled dose response study of intravenous DTC in patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC). Drug associated toxicities included gastrointestinal upset, burning at the infusion site, metallic taste, sneezing, confusional states, hyperactivity, delusional thinking, and myoclonus. Toxicity was ameliorated by dose reduction. The maximally tolerated dose varied for individual patients from 200 mg/m2 weekly to 800 mg/m2 twice weekly. No myelosuppression was observed. In patients with greater than 200 CD4+ cells/uL, a statistically significant reduction of lymphadenopathy occurred; whereas no beneficial effects were observed in patients with less than 200 CD4+ cells/uL. Improvement in symptom score and stabilization of CD4+ count also occurred in the treated group, although these trends did not reach statistical significance. Further controlled clinical trials of DTC in earlier HIV infection are warranted.

A hybridoma producing human monoclonal antibody specific for glycoprotein 120 kDa of human immunodeficiency virus (HIV-1.

A stable hybridoma producing anti-HIV human monoclonal antibody (HMCA) was generated by fusing CD3-depleted human splenic lymphocytes from an HIV sero-positive donor with the mouse myeloma cell line P3x63AgU1. The resultant hybridoma has been secreting IgG1, lambda chain for over nine months at a rate of 2.5 micrograms/10(6)cells/day. The HMCA shows specific reactivity in ELISA using HIV-infected cell lysates. Immunofluorescence tests have indicated that this HMCA binds specifically to the surface of H9 and C3 HIV/HTLVIIIb infected cells, HIV/N1T infected CEM cells and to MoT cells infected with an HIV clinical isolate. Western blotting revealed recognition of glycoproteins 120 and 160 kDa of HIV by the HMCA. Although this HMCA demonstrated no neutralizing activity, the production of an anti-HIV HMCA specific for glycoprotein 120 kDa indicates the possibility that a neutralizing HMCA can be developed as further fusions with lymph nodes and spleens from HIV positive donors are performed.

Human monoclonal antibody against glycoproteins of human immunodeficiency virus.

We have established a program to make human monoclonal antibodies to the human immunodeficiency virus (HIV). Lymphocytes of lymph nodes from patients with the acquired immunodeficiency syndrome (AIDS) related complex (ARC) spontaneously produced antibodies to HIV in vitro and their antibody production was suppressed by culturing them in the presence of HIV antigens. Therefore, in vitro stimulation with HIV antigens was not done but rather, donor lymph node or spleen lymphocytes were directly fused with mouse myeloma cells. One of the hybridomas thus generated has been stably producing human monoclonal antibody (MAb) of the IgG1 isotype with a kappa chain. This antibody, MAb86, bound to the surface membrane of HIV-infected cells but not to that of uninfected cells at all. MAb86 reacted in Western blot with both viral glycoproteins of 120,000 daltons (gp120) and 41,000 daltons (gp41). While not neutralizing alone, a combination of MAb86 with another human IgG1 MAb against gp120 showed viral neutralization. Based on these data it seems likely that this approach will result in human MAbs capable of viral neutralization and antibody-dependent cytotoxicity. These may have value for the prevention and/or treatment of AIDS.

Visceral leishmaniasis in the Sudan: comparative parasitological methods of diagnosis.

Patients with suspected kala-azar had aspirations of spleen, lymph node and bone marrow performed to compare the relative merit of each procedure. Splenic aspiration remains the method most likely to provide microscopic proof of leishmanial infection (18 of 19 samples) and was the only site positive in 5 patients. Lymph node aspirates contained parasites in 20 of 29 patients, whereas bone marrow aspirates provided the diagnosis in 18 of 28. Therefore, lymph node aspiration, with its minimal morbidity, is indicated as the primary diagnostic method in patients in the Sudan with suspected kala-azar. If negative, splenic aspiration should be performed.