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1.
Int J Mol Sci ; 25(12)2024 Jun 12.
Article in English | MEDLINE | ID: mdl-38928158

ABSTRACT

It has been reported that Mizoribine is an immunosuppressant used to suppress rejection in renal transplantation, nephrotic syndrome, lupus nephritis, and rheumatoid arthritis. The molecular chaperone HSP60 alone induces inflammatory cytokine IL-6 and the co-chaperone HSP10 alone inhibits IL-6 induction. HSP60 and HSP10 form a complex in the presence of ATP. We analyzed the effects of Mizoribine, which is structurally similar to ATP, on the structure and physiological functions of HSP60-HSP10 using Native/PAGE and transmission electron microscopy. At low concentrations of Mizoribine, no complex formation of HSP60-HSP10 was observed, nor was the expression of IL-6 affected. On the other hand, high concentrations of Mizoribine promoted HSP60-HSP10 complex formation and consequently suppressed IL-6 expression. Here, we propose a novel mechanism of immunosuppressive action of Mizoribine.


Subject(s)
Chaperonin 60 , Interleukin-6 , Ribonucleosides , Ribonucleosides/pharmacology , Interleukin-6/metabolism , Chaperonin 60/metabolism , Humans , Immunosuppressive Agents/pharmacology , Animals , Mice
2.
FEBS Lett ; 598(12): 1478-1490, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38605276

ABSTRACT

The aryl hydrocarbon receptor (AhR) forms a complex with the HSP90-XAP2-p23 molecular chaperone when the cells are exposed to toxic compounds. Recently, 1,4-dihydroxy-2-naphthoic acid (DHNA) was reported to be an AhR ligand. Here, we investigated the components of the molecular chaperone complex when DHNA binds to AhR. Proteins eluted from the 3-Methylcolanthrene-affinity column were AhR-HSP90-XAP2-p23 complex. The AhR-molecular chaperone complex did not contain p23 in the eluents from the DHNA-affinity column. In 3-MC-treated cells, AhR formed a complex with HSP90-XAP2-p23 and nuclear translocation occurred within 30 min, while in DHNA-treated cells, AhR formed a complex with AhR-HSP90-XAP2, and translocation was slow from 60 min. Thus, the AhR activation mechanism may differ when DHNA is the ligand compared to toxic ligands.


Subject(s)
HSP90 Heat-Shock Proteins , Receptors, Aryl Hydrocarbon , Receptors, Aryl Hydrocarbon/metabolism , Ligands , HSP90 Heat-Shock Proteins/metabolism , Humans , Molecular Chaperones/metabolism , Protein Binding , Methylcholanthrene/toxicity , Prostaglandin-E Synthases/metabolism , Prostaglandin-E Synthases/genetics , Animals
3.
Intern Emerg Med ; 17(1): 37-42, 2022 Jan.
Article in English | MEDLINE | ID: mdl-33852145

ABSTRACT

Physical restraint is widely used in the intensive care unit (ICU) to ensure patient safety despite its ethical implications. We performed a prospective observational study in six ICUs in Japan to determine the prevalence of and factors associated with physical restraint use in the ICU, a phenomenon that has not yet been reported on in Japan. Data were collected on 10 random days between November 2018 and February 2019. We evaluated physical restraint use in ICU patients aged ≥ 20 years during the data collection days. Among the 787 observations, the prevalence of physical restraint use was 32.9%; however, it was 41.5% in patients receiving invasive mechanical ventilation (IMV). The average age of patients was 68.5 years, and the average Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score was 19.4. Among the included patients, 52.1% received IMV, and 17.2% were diagnosed with delirium. Logistic regression analysis revealed that the independent factors [odds ratio (95% confidence interval)] associated with physical restraint use were age [1.02 (1.00-1.05)], APACHE II score [1.05 (1.01-1.09)], IMV [2.15 (1.16-4.01)], central venous catheter indwelling [2.66 (1.46-4.85)], sedative medication [2.98 (1.72-5.17)], agitation [7.83 (2.96-20.8)], and delirium [4.16 (2.37-7.29)]. Approximately one-third of the ICU patients required physical restraint in Japan. In addition, physical restraint use was influenced by disease severity, mental condition, and the medical apparatus used. Based on these findings, further investigations are imperative to develop strategies to reduce physical restraint use.


Subject(s)
Delirium , Restraint, Physical , Aged , Delirium/diagnosis , Humans , Intensive Care Units , Japan/epidemiology , Prevalence
4.
J Food Biochem ; 45(11): e13958, 2021 11.
Article in English | MEDLINE | ID: mdl-34611901

ABSTRACT

It is known that lactic acid bacteria induce the IL-12. The IL-12 activates NK cells and promotes the production of IFN-γ. The IFN-γ activates macrophages resulting in enhanced phagocytosis and bactericidal activity. We have been investigating fermented foods that activate the immune function. In this study, we investigated the IL-12 inducibility of fermented foods using the specific antibody. Fermented soybean foods such as Tempeh and Natto are attracting attention in terms of nutrition, functionality, and food problems. In this study, Tempeh induced 1,080 µg/ml of IL-12, and IFN-γ associated with the induction of IL-12 was also induced at 682 µg/ml. This was more than twice the induced intensity of PBS. On the contrary, Natto hardly induced IL-12 and IFN-γ. Tempeh also accelerated phagocytosis of the macrophage THP-1 cells. In this study, it was found that the fermented soybean-derived food, Tempeh, has a function of activating the immune function. This is the first report that Tempeh activates innate immunity. PRACTICAL APPLICATIONS: Tempeh, a fermented soybean food induced the IL-12 and IFN-γ production and the increase of macrophage phagocytosis in this study suggested a new function to enhance immunity. Tempeh is also expected to be effective in preventing lifestyle diseases. Fermented soybean products of Tempeh was considered to be a very useful health food for the problems of modern society such as maintaining health by eating, improving immunity, and ingesting vegetable protein due to diversifying food.


Subject(s)
Fermented Foods , Soy Foods , Fermentation , Interleukin-12 , Macrophages , Phagocytosis
5.
RSC Adv ; 9(69): 40368-40377, 2019 Dec 03.
Article in English | MEDLINE | ID: mdl-35542676

ABSTRACT

Annonaceous acetogenins have a wide range of potential biological activities. The development of simple and diversity-oriented approaches to their synthesis is therefore important. We have achieved the first total synthesis of squafosacin F and assigned its absolute configuration. The key steps were an acid-mediated tandem intramolecular double cyclization to build the hydroxy-flanked mono-tetrahydrofuran core and decoration with the desired functionalities of the target natural product via highly stereoselective reactions.

6.
Org Biomol Chem ; 16(16): 3018-3025, 2018 04 25.
Article in English | MEDLINE | ID: mdl-29634057

ABSTRACT

A divergent strategy has been used for the concise and efficient enantioselective formal synthesis of Annonaceous acetogenin cis-solamin. Our synthetic strategy comprises concise preparation of the diepoxyester via an 11-membered silaketal constructed by ring-closing metathesis after the dimerization of chiral epoxides, and uses an acid-catalyzed tandem intramolecular SN2-like reaction to construct the threo-cis-threo configuration of the tetrahydrofuran-diol moiety.

7.
Endocrinology ; 154(1): 537-49, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23221600

ABSTRACT

Stearoyl-CoA desaturase-1 (SCD-1) plays a pivotal role in an increase of triglyceride by an excess of dietary carbohydrate intake. Dietary carbohydrates increase SCD-1 gene expression in liver by sterol response element binding protein (SREBP)-1c-dependent and SREBP-1c -independent pathways. Previous report demonstrated that thyroid hormone (TH) negatively regulates mouse SCD-1 gene promoter before SREBP-1c was revealed. We reported that TH negatively regulates SREBP-1c recently. Therefore, in the current study, we examined whether and how TH regulates human SCD-1 gene expression and evaluated SREBP-1c effect on the negative regulation. Luciferase assays revealed that TH suppresses both mouse and human SCD-1 gene promoter activity. In SREBP-1 knockdown HepG2 cells, TH still suppresses SCD-1 gene promoter activity, and it also exerted the negative regulation under cotransfection of a small amount of SREBP-1c. These data indicated that SREBP-1c does not play the decisive role for the negative regulation by TH. The responsible region for the negative regulation in human SCD-1 gene promoter turned out to be between -124 and -92 bp, referred to as site A. Chromatin immunoprecipitation assays demonstrated that TH receptor-ß is recruited to the region upon T(3) administration, although TR-ß does not bind directly to site A. In conclusion, TH negatively regulates human SCD-1 gene expression in without direct binding of the TH receptor to the SCD-1 gene promoter.


Subject(s)
Receptors, Thyroid Hormone/metabolism , Stearoyl-CoA Desaturase/genetics , Thyroid Hormones/pharmacology , Animals , Blotting, Western , Chromatin Immunoprecipitation , Cycloheximide/pharmacology , Dactinomycin/pharmacology , Humans , Male , Mice , Mice, Inbred C57BL , Promoter Regions, Genetic/genetics , Protein Binding/drug effects , Real-Time Polymerase Chain Reaction
8.
Endocrinology ; 153(7): 3308-19, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22514047

ABSTRACT

Nucleobindin-2 is a 420-amino-acid EF-hand calcium-binding protein that undergoes proteolytic processing to generate an 82-amino-acid amino-terminal peptide termed nesfatin-1. To determine whether nucleobindin-2 has any biological function, nucleobindin-2 was either overexpressed or knocked down by short hairpin RNA in cultured CHO cells expressing the human insulin and epidermal growth factor (EGF) receptors (CHO/IE) and in 3T3-L1 cells. Reduction in nucleobindin-2 expression inhibited EGF-stimulated MAPK kinase (S217/S221) and Erk phosphorylation (T202/Y204). In contrast, there was no significant effect on EGF-stimulated EGF receptor phosphorylation, EGF receptor internalization, or 52-kDa Shc and c-Raf phosphorylation. Although kinase suppressor of Ras-1 and protein phosphatase 2A expression was not changed, intracellular calcium concentrations and PP2A activity was significantly increased in nucleobindin-2 knocked-down cells. Concomitant with these alterations in EGF-stimulated signaling, cell proliferation was significantly reduced in nucleobindin-2 knocked-down cells. Moreover, reduced nucleobindin-2 expression in 3T3-L1 preadipocytes resulted in a greater extent of 3T3-L1 cell adipocyte differentiation. Taken together, these data indicate that nucleobindin-2 regulates EGF-stimulated MAPK kinase/Erk signaling, cell proliferation, and adipocyte differentiation.


Subject(s)
Adipocytes/cytology , Calcium-Binding Proteins/biosynthesis , DNA-Binding Proteins/biosynthesis , Epidermal Growth Factor/metabolism , ErbB Receptors/metabolism , Nerve Tissue Proteins/biosynthesis , 3T3-L1 Cells , Animals , CHO Cells , Calcium/metabolism , Cell Differentiation , Cell Proliferation , Cricetinae , Electroporation , Humans , Mice , Nucleobindins , Protein Phosphatase 2/metabolism , Receptor, Insulin/metabolism , Signal Transduction
9.
Protein Pept Lett ; 19(9): 997-1004, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22486620

ABSTRACT

Nucleobindin-2 is a 420 amino acid EF-hand Ca²âº binding protein that can be further processed to generate an 82 amino terminal peptide termed Nesfatin-1. To examine the function of secreted Nucleobindin-2 in adipocyte differentiation, cultured 3T3-L1 cells were incubated with either 0 or 100 nM of GST, GST-Nucleobindin-2, prior to and during the initiation of adipocyte differentiation. Nucleobindin-2 treatment decreased neutral lipid accumulation (Oil-Red O staining) and expression of several marker genes for adipocyte differentiation (PPARγ, aP2, and adipsin). When Nucleobindin- 2 was constitutively secreted into cultured medium, cAMP content and insulin stimulated CREB phosphorylation were significantly reduced. On the other hand, intracellularly overexpressed Nucleobindin-2 failed to affect cAMP content and CREB phosphorylation. Taken together, these data indicate that secreted Nucleobindin-2 is a suppressor of adipocyte differentiation through inhibition of cAMP production and insulin signal.


Subject(s)
Adipocytes/cytology , Adipogenesis , Calcium-Binding Proteins/metabolism , DNA-Binding Proteins/metabolism , Nerve Tissue Proteins/metabolism , 3T3-L1 Cells , Adipocytes/metabolism , Animals , Calcium-Binding Proteins/blood , Calcium-Binding Proteins/chemistry , Cyclic AMP/metabolism , DNA-Binding Proteins/blood , DNA-Binding Proteins/chemistry , Humans , Insulin/metabolism , Mice , Nerve Tissue Proteins/blood , Nerve Tissue Proteins/chemistry , Nucleobindins , Rats
10.
Neurosci Lett ; 494(1): 34-7, 2011 Apr 20.
Article in English | MEDLINE | ID: mdl-21356276

ABSTRACT

The liver X receptors (LXR-α and -ß) are nuclear oxysterol receptors that play pivotal roles in regulating the expression of genes involved in cholesterol transport and metabolism. Recently, several groups have reported that the LXRs also regulate adrenal steroidogenesis. In the previous report, we demonstrated that LXR-α is dominantly expressed in the pituitary and that LXR-α positively regulates the proopiomelanocortin (POMC) gene promoter at the transcriptional level. In this report, we evaluated the expression levels of LXR-α and -ß gene in the human pituitary tumor. Even though LXR-α mRNA levels are not significantly increased in ACTH-secreting adenomas, LXR-α/ß expression ratio is significantly higher than other pituitary tumors including normal pituitaries. Furthermore, in At-T20 cells, which express POMC gene, overexpression of LXR-ß decreased POMC gene promoter activities. Thus, we concluded that LXR-α/ß gene expression ratio is a critical factor to activate POMC gene expression in ACTH-secreting pituitary adenomas.


Subject(s)
ACTH-Secreting Pituitary Adenoma/metabolism , Adenoma/metabolism , Adrenocorticotropic Hormone/metabolism , Orphan Nuclear Receptors/metabolism , ACTH-Secreting Pituitary Adenoma/genetics , Adenoma/genetics , Adult , Female , Humans , Liver X Receptors , Male , Middle Aged , Orphan Nuclear Receptors/genetics , Pro-Opiomelanocortin/genetics , Pro-Opiomelanocortin/metabolism , RNA, Messenger/genetics , RNA, Messenger/metabolism
11.
Biochem Biophys Res Commun ; 394(3): 548-52, 2010 Apr 09.
Article in English | MEDLINE | ID: mdl-20211147

ABSTRACT

We have recently reported that an alternative splicing variant of liver X receptor (LXR)-beta acts as an RNA co-activator, which is referred to as LXRBSV. The in vivo role of LXRBSV is yet to be clarified. The LXRBSV gene is expressed in various tissues including the liver and brain. We evaluated the gene expression of LXRBSV in various regions of the brain using real-time quantitative PCR assays in the current study and found that LXRBSV is abundantly expressed in the pituitary. 5'-rapid amplification of cDNA ends (5'-RACE) revealed that the transcriptional start site (TSS) of LXRBSV is located 40 base pairs (bp) downstream of LXR-beta. We prepared two promoter constructs: -1598/+35 bp and -1598/+75 bp in pGL4 for LXR-beta and LXRBSV, respectively. The latter promoter construct demonstrated significantly higher activity than the former construct in GH3 cells derived from the rat pituitary. On the contrary, the promoter activities of these two constructs were indistinguishable in Hepa1-6 cells derived from mouse hepatocytes. Furthermore, the promoter region specific for LXRBSV itself exerted promoter activity in GH3 cells but not in Hepa1-6 cells. Taken together, we have concluded that LXRBSV is preferentially transcribed and expressed in the pituitary, indicating that LXRBSV plays a role in regulating pituitary gene expression. These data provide clues to elucidating the physiological relevance of LXRBSV.


Subject(s)
Alternative Splicing , Orphan Nuclear Receptors/genetics , Pituitary Gland/metabolism , Transcriptional Activation , Animals , Cell Line , Gene Expression , Hepatocytes/metabolism , Humans , Liver X Receptors , Mice , Promoter Regions, Genetic , Rats , Transcription Initiation Site
12.
Endocr J ; 55(1): 205-12, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18270432

ABSTRACT

Visfatin is a novel adipocytokine that is expressed by the visceral fat cells. We investigated the role of genetic variation in the visfatin gene in the pathophysiology of type 2 diabetes and clinical variables in Japanese subjects. The 11 exons, and the promoter region of the visfatin gene were screened for single nucleotide polymorphisms (SNPs) by PCR-direct sequencing. We found SNPs in the promoter region (SNP - 1535T>C), exon 2 (SNP + 131C>G, Thr44Arg), and exon 7 (SNP + 903G>A). The allele and genotype frequencies of these SNPs showed no significant differences between 200-448 diabetic and 200-333 control subjects. However, the -1535T/T genotype was associated with lower serum triglyceride levels (T/T vs. T/C + C/C (p = 0.015) and T/T vs. C/C (p = 0.043)) and higher HDL-cholesterol levels (T/T vs. C/C, p = 0.0496) in the nondiabetic subjects. Reporter gene assay of 3T3-L1 adipocytes revealed that the promoter activity of -1535T and -1535C was similar, suggesting that the observed association may reflect linkage disequilibrium between -1535T>C and causative variations of the visfatin gene.


Subject(s)
Cholesterol, HDL/blood , Cholesterol, HDL/genetics , Cytokines/genetics , Nicotinamide Phosphoribosyltransferase/genetics , Polymorphism, Single Nucleotide , Promoter Regions, Genetic , Triglycerides/blood , Triglycerides/genetics , 3T3-L1 Cells , Aged , Animals , DNA Mutational Analysis , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/genetics , Female , Gene Frequency , Genes, Reporter , Genetic Linkage , Genotype , Humans , Japan , Male , Mice , Middle Aged , Transfection
13.
J Biol Chem ; 281(8): 5246-57, 2006 Feb 24.
Article in English | MEDLINE | ID: mdl-16377800

ABSTRACT

Mutations in the hepatocyte nuclear factor (HNF)-4alpha gene cause a form of maturity-onset diabetes of the young (MODY1) that is characterized by impairment of glucose-stimulated insulin secretion by pancreatic beta-cells. HNF-4alpha, a transcription factor belonging to the nuclear receptor superfamily, is expressed in pancreatic islets as well as in the liver, kidney, and intestine. However, the role of HNF-4alpha in pancreatic beta-cell is unclear. To clarify the role of HNF-4alpha in beta-cells, we generated beta-cell-specific HNF-4alpha knock-out (betaHNF-4alphaKO) mice using the Cre-LoxP system. The betaHNF-4alphaKO mice exhibited impairment of glucose-stimulated insulin secretion, which is a characteristic of MODY1. Pancreatic islet morphology, beta-cell mass, and insulin content were normal in the HNF-4alpha mutant mice. Insulin secretion by betaHNF-4alphaKO islets and the intracellular calcium response were impaired after stimulation by glucose or sulfonylurea but were normal after stimulation with KCl or arginine. Both NAD(P)H generation and ATP content at high glucose concentrations were normal in the betaHNF-4alphaKO mice. Expression levels of Kir6.2 and SUR1 proteins in the betaHNF-4alphaKO mice were unchanged as compared with control mice. Patch clamp experiments revealed that the current density was significantly increased in betaHNF-4alphaKO mice compared with control mice. These results are suggestive of the dysfunction of K(ATP) channel activity in the pancreatic beta-cells of HNF-4alpha-deficient mice. Because the K(ATP) channel is important for proper insulin secretion in beta-cells, altered K(ATP) channel activity could be related to the impaired insulin secretion in the betaHNF-4alphaKO mice.


Subject(s)
Glucose/metabolism , Hepatocyte Nuclear Factor 4/physiology , Insulin-Secreting Cells/metabolism , Insulin/metabolism , ATP-Binding Cassette Transporters/metabolism , Adenosine Triphosphate/chemistry , Animals , Arginine/chemistry , Blood Glucose/metabolism , Blotting, Western , Calcium/metabolism , Cytosol/metabolism , Exons , Female , Genotype , Hepatocyte Nuclear Factor 4/metabolism , Heterozygote , Immunohistochemistry , Insulin Secretion , Islets of Langerhans/metabolism , Male , Mice , Mice, Inbred C57BL , Mice, Knockout , Microscopy, Fluorescence , Models, Genetic , Multidrug Resistance-Associated Proteins/metabolism , Patch-Clamp Techniques , Polymerase Chain Reaction , Potassium/chemistry , Potassium Channels, Inwardly Rectifying/metabolism , Potassium Chloride/chemistry , RNA, Messenger/metabolism , Receptors, Drug , Reverse Transcriptase Polymerase Chain Reaction , Sulfonylurea Compounds/chemistry , Sulfonylurea Receptors , Tissue Distribution , Transgenes
14.
J Antibiot (Tokyo) ; 58(3): 185-91, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15895526

ABSTRACT

Peribysins E-G (1-3) have been isolated from a strain of Periconia byssoides originally separated from the sea hare Aplysia kurodai. Their absolute stereostructures have been elucidated on the basis of spectroscopic analyses using 1D and 2D NMR techniques and some chemical transformations. In addition, the absolute configuration of peribysin A (4), previously undetermined, has been established by conversion to 2 and 3. All these metabolites inhibited the adhesion of human-leukemia HL-60 cells to HUVEC.


Subject(s)
Furans/chemistry , Indans/chemistry , Naphthols/chemistry , Animals , Aplysia/microbiology , Ascomycota/isolation & purification , Ascomycota/metabolism , Cell Adhesion/drug effects , Chemical Phenomena , Chemistry, Physical , Crystallography, X-Ray , Furans/metabolism , Furans/pharmacology , Indans/metabolism , Indans/pharmacology , Magnetic Resonance Spectroscopy , Molecular Structure , Naphthols/metabolism , Naphthols/pharmacology , Spectrometry, Mass, Electrospray Ionization , Spectrophotometry, Ultraviolet , Spectroscopy, Fourier Transform Infrared , Stereoisomerism
15.
Biochem Biophys Res Commun ; 329(3): 984-90, 2005 Apr 15.
Article in English | MEDLINE | ID: mdl-15752752

ABSTRACT

Mutations in the hepatocyte nuclear factor (HNF) 4alpha gene cause a form of maturity-onset diabetes of the young (MODY1), which is a monogenic form of type 2 diabetes characterized by impaired insulin secretion by pancreatic beta-cells. HNF4alpha is a transcription factor expressed in the liver, kidney, intestine, and pancreatic islet. Multiple splice variants of the HNF4alpha gene have been identified and an isoform of HNF4alpha8, an N-terminal splice variant, is expressed in pancreatic beta-cells. However, expression levels of HNF4alpha protein in pancreatic beta-cells and the transcriptional activity of HNF4alpha8 are not yet understood. In the present study, we investigated the expression of HNF4alpha in beta-cells and examined its functional properties. Western blotting and immunohistochemical analysis revealed that the expression of HNF4alpha protein in pancreatic islets and INS-1 cells was much lower than in the liver. A reporter gene assay showed that the transactivation potential of HNF4alpha8 was significantly weaker than that of HNF4alpha2, which is a major isoform in the liver, suggesting that the total level of HNF4alpha activity is very weak in pancreatic beta-cells. We also showed that the N-terminal A/B region of HNF4alpha8 possessed no activation function and C-terminal F region negatively regulated the transcriptional activity of HNF4alpha8. The information presented here would be helpful for the better understanding of MODY1/HNF4alpha diabetes.


Subject(s)
DNA-Binding Proteins/metabolism , Islets of Langerhans/metabolism , Phosphoproteins/metabolism , Transcription Factors/metabolism , Amino Acid Substitution , Animals , Cell Line , DNA-Binding Proteins/genetics , Hepatocyte Nuclear Factor 4 , Humans , Mice , Mutagenesis, Site-Directed , Phosphoproteins/genetics , Protein Isoforms/metabolism , Rats , Structure-Activity Relationship , Transcription Factors/genetics
16.
Rinsho Shinkeigaku ; 42(1): 32-4, 2002 Jan.
Article in Japanese | MEDLINE | ID: mdl-12355849

ABSTRACT

A 64 year-old man began to feel numbness on his bilateral feet in 1990. He was diagnosed as diabetes mellitus with a high fasting glucose level of 580 mg/dl in 1993 and he received oral hypoglycemic agents. Since then, his blood glucose levels had been in good control under diet therapy and medication. However, his numbness worsened and progressive weakness of bilateral lower legs occurred in 1997. Bilateral anterior tibial muscles were atrophic and deep tendon reflexes were decreased on bilateral upper and lower limbs. Protein level of his cerebrospinal fluid was 63 mg/dl. Nerve conduction study fulfilled the electrophysiological diagnostic criteria of CIDP. Superficial peroneal nerve biopsy showed loss of myelinated fibers, small amount of onion bulbs and thickening of the basement membrane of arterioles. Demyelination was predominant in teased fiber study. These findings were compatible with CIDP combined with diabetes mellitus (DM-CIDP). His numbness and leg weakness improved after intravenous high dose immune globulin therapy. DM-CIDP must be distinguished from diabetic peripheral polyneuropathy because immunological therapy may be effective in DM-CIDP patients.


Subject(s)
Diabetic Neuropathies/therapy , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/therapy , gamma-Globulins/therapeutic use , Humans , Male , Middle Aged
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