Comparison of antihyperglycemic effects of creatine and metformin in type II diabetic patients.

PURPOSE: To compare the antihyperglycemic effects of metformin and creatine in recently detected type II diabetics in a short-term clinical study. METHODS: In a 14 day simmetrically randomized crossover study, recently detected type II diabetics received either creatine (2x3 g/day) or metformin (2x500 mg/day) for five days, followed by two days of washout, followed by cross-over to the opposite treatment for the next five days. Fasting and post-prandial (-15, 60, 90, 120, 180 and 240 min) blood glucose, insulin, c-peptide, creatine and lactate were measured every other day for the duration of treatment, and HbA1c only at the begining and at the end of the study. RESULTS: Both creatine and metformin decreased glucose concentrations to similar levels at all time points vs. basal glucose values [-15, 60, 90, 120, 180, and 240 min]: 11.1+/-0.75 vs 9.1+/-0.55a vs 8.8+/-0.59b, 14.4+/-0.6 vs 12.9+/-0.47a vs 13.1+/-0.55a, 14.8+/-0.58 vs 13.0+/-0.46b vs 13.3+/-0.55a, 14.1+/-0.6 vs 11.9+/-0.42b vs 12.5+/-0.51a, 12.2+/-0.6 vs 9.6+/-0.36c vs 9.9+/-0.38c, and 10.1+/-0.47 vs 7.8+/-0.36c vs 8.4+/-0.4b; (aP < 0.05; bP < 0.01; cP < 0.001 vs. basal glucose values). Neither treatment altered insulin, c-peptide, or HbA1c. Lactate varied during the day, but never reached the upper level of the safety reference range. CONCLUSION: Short-term treatment with creatine and metformin elicits similar glucose lowering effects in recently detected type II diabetics. Further studies are necessary to determine the effect of creatine on long-term glucose and insulin regulation.

Effect of creatine on the pancreatic beta-cell.

We report on the stimulatory effect of creatine on insulin secretion and ATP concentration in MIN-6 beta-cells. The addition of creatine (5 mM) to MIN-6 cells in the presence of glucose (1-10 mM) elicited a significant (p<0.001) increase in insulin secretion, but no effect was demonstrated in the absence of glucose. The lack of effect of creatine in the absence of glucose suggests that creatine may act as a potentiator of insulin secretion rather than as an initiator. The potentiatory effect of creatine is specific for glucose since no effect was found in the presence of other known initiators of insulin secretion (K(+), 2-ketoisocaproic acid and tolbutamide). Cellular ATP content was markedly increased by glucose (1-15 mM). Creatine (5 and 10 mM) further increased the ATP level at all glucose concentrations, and the effect was observed even in the absence of glucose. The results from this study demonstrate the ability of creatine to increase insulin secretion only in the presence of glucose, while its effect on increased cellular ATP was independent of the presence of glucose. The mechanism whereby creatine potentiates insulin release is yet to be investigated. However, our data suggest possible unique interactions between creatine and the glucose-dependent insulin secretory pathway.

The influence of season on oxidant-antioxidant status in trained and sedentary subjects.

The association between oxidative stress and cardiovascular diseases is a widely accepted fact today. Generally, men have a higher risk of cardiovascular incidents and mortality from acute myocardial infarction and strokes. We have examined sport-associated circannual rhythms of oxidant and antioxidant processes by measuring plasma LPO, erythrocyte SOD, CAT, Gpx activity and plasma hormonal status in both sedentary and long-term trained men and women. We have shown seasonal variations in both oxidant and antioxidant status in all examined groups. The largest difference was observed in the oxidant status between sedentary men and women during autumn and winter, which is considered a period of high coronary risk for men. Sport decreased LPO in trained men in autumn, while the same effect in trained women was shifted towards summer. These data state that regular, long-term physical exercise training induces adaptive responses that confer protection against oxidative stress, as well as the beneficial effect of exercise with regard to season, particularly in men during a period of high coronary risk (autumn and winter, respectively) and in women during summer.

Beta-cell secretory function and CD25 + lymphocyte subsets in the early stage of type 1 diabetes mellitus.

Cellular immunologic tests have not been used for diagnostic purposes in individuals at risk for autoimmune insulitis or in patients with partial beta-cell destruction because of a lack of studies that show their predictive value. In this study we initially evaluated 43 patients with recent-onset Type 1 diabetes (disease duration

Effect of creatine on erythrocyte rheology in vitro.

To evaluate how creatine influences erythrocyte deformability, we determined its effect on erythrocyte filterability in 9 subjects with insulin dependent diabetes (IDDM) without complications, 14 diabetics with uremia and 10 non-diabetic controls. The short-term incubation (15 min at 37 degrees C) of diabetic erythrocytes with 3 mM creatine improved cell filterability (assessed according to the Reid method) from IDDM subjects without complications by 28.4% and that from diabetics with uremia by 18.9%. No rheological effect of creatine was found in erythrocytes from non-diabetic controls. However, a significant protective effect against erythrocyte filterability impairment induced by treatment of red blood cells from non-diabetic controls with hydrogen peroxide was observed with 3 mM (p < 0.04) and 5 mM (p < 0.01) creatine, respectively. Measurement of the thiobarbituric acid (TBA) reactivity was used to assess hydrogen peroxide induced formation of malondialdehyde (MDA). We found that creatine inhibits hydrogen peroxide-induced erythrocyte MDA-formation in a dose dependent manner by 20.4%, 22.3% and 41.4% for 1, 3 and 5 mM creatine, respectively. These results suggest that creatine by its ability to inhibit erythrocyte lipid peroxidation may contribute to the maintenance of normal cell deformability.

Semen quality and reproductive endocrine function in relation to biomarkers of lead, cadmium, zinc, and copper in men.

Blood lead (BPb), activity of delta-aminolevulinic acid dehydratase (ALAD), erythrocyte protoporphyrin (EP), blood cadmium (BCd), serum zinc (SZn), seminal fluid zinc (SfZn), serum copper (SCu), and parameters of semen quality and of reproductive endocrine function were measured in 149 healthy male industrial workers 20-43 years of age. The group contained 98 subjects with slight to moderate occupational exposure to Pb and 51 reference subjects. All of the subjects lived in Zagreb, Croatia. Significant (p < 0.05) correlations of BPb, ALAD, and/or EP with reproductive parameters indicated a Pb-related decrease in sperm density, in counts of total, motile, and viable sperm, in the percentage and count of progressively motile sperm, in parameters of prostate secretory function (SfZn, acid phosphatase, and citric acid in seminal fluid), and an increase in abnormal sperm head morphology, serum testosterone, and estradiol. These associations were confirmed by results of multiple regression, which also showed significant (p < 0. 05) influence of BCd, SZn, SCu, smoking habits, alcohol consumption, or age on certain reproductive parameters. These effects were mainly of lower rank and intensity as compared to Pb-related reproductive effects, whereas BCd contributed to a decrease in sperm motility and an increase in abnormal sperm morphology and serum testosterone. No significant Pb- or Cd-related influence was found on levels of the lactate dehydrogenase isoenzyme LDH-C(4) and fructose in seminal fluid or on follicle-stimulating hormone, luteinizing hormone, and prolactin in serum. The seminal fluid concentrations of Pb (SfPb) and Cd (SfCd) were measured in 118 of the 149 subjects, and a highly significant (p < 0.0001) correlation was found between BPb and SfPb levels (r = 0.571) and between BCd and SfCd levels (r = 0.490). The overall study results indicate that even moderate exposures to Pb (BPb < 400 microg/L) and Cd (BCd < 10 microg/L) can significantly reduce human semen quality without conclusive evidence of impairment of male reproductive endocrine function.

The role of cytokines in MET-enkephalin-modulated nitric oxide release.

In the present study the in vitro and in vivo effect of Met-enkephalin (MENK) on nitric oxide (NO) release by mouse peritoneal macrophages was evaluated. While in vitro MENK was ineffective unless combined with suboptimal concentrations of recombinant murine interferon gamma, in vivo all the doses (2.5, 5 or 10 mg/kg bw) bimodaly modulated NO release. Only the stimulative (2.5 and 10 mg/kg bw) and not the suppressive (5 mg/kg bw) dose of MENK was opioid receptor-mediated as demonstrated by abolishing the effect by naloxone. The stimulative effect of the low (2.5 mg/kg bw) dose, that was observed only if MENK was injected p.m., was associated with the IL production and IFN gamma as demonstrated by abolishing the effect by specific antibodies. The data additionally support the idea that opioid-mediated responses might be to a large degree mediated by the release of cytokines.

Superoxide dismutase activity in lymphocytes and polymorphonuclear cells of diabetic patients.

Copper-zinc superoxide dismutase (Cu,Zn-superoxide dismutase) activity was evaluated in lymphocytes and polymorphonuclear cells of insulin-dependent (n = 33) and non-insulin-dependent (n = 34) diabetic patients. A commercial method for the measurement of superoxide dismutase activity was adapted for use on a discrete analyser and evaluated for interference by other antioxidants with superoxide anion-scavenging properties. In comparison to healthy control subjects (n = 32), a significantly lower Cu,Zn-superoxide dismutase activity was found in both lymphocytes and polymorphonuclear cells of insulin-dependent (2.08 +/- 0.58 vs. 1.70 +/- 0.46 U/mg protein, p < 0.05, and 1.06 +/- 0.46 vs. 0.64 +/- 0.40 U/mg protein, p < 0.001, respectively) and non-insulin-dependent diabetic patients (2.08 +/- 0.58 vs. 1.61 +/- 0.48 U/mg protein, p < 0.01, and 1.06 +/- 0.46 vs. 0.53 +/- 0.24 U/mg protein, p < 0.001, respectively). There was a week, but significant negative correlation between age and Cu,Zn-superoxide dismutase activity in lymphocytes and polymorphonuclear cells (r = -0.22 and r = -0.28, p < 0.05, respectively), whereas no influence of gender, diabetes duration and glycaemic control was observed. The results indicate that diabetes mellitus could elicit a significant disturbance in superoxide anion-scavenging potential of lymphocytes and polymorphonuclear cells.

Total plasma antioxidants in first-degree relatives of patients with insulin-dependent diabetes.

Insulin-dependent diabetes mellitus (IDDM) is a chronic disorder that results from autoimmune destruction of the pancreatic beta-cells. Recent evidence suggests that oxidative damage, resulting from both cytokine-induced production of toxic free radicals and low antioxidant capacity of the beta-cell plays a significant role in the pathogenesis of IDDM. Islet cell antibodies (ICA) have been the best validated marker of risk for the development of IDDM in predisposed individuals, i.e. first-degree relatives of patients with IDDM. We investigated the total plasma antioxidant status (TAS) in both ICA-positive and ICA-negative first-degree relatives of patients with IDDM, to assess the level of overall protection against oxidative damage. TAS was significantly lowered in ICA-positive when compared to both ICA-negative and healthy subjects (p < 0.001), while no significant difference was found in comparison to recently diagnosed patients with IDDM. TAS values were not significantly influenced by gender, age and smoking habits in all groups, as well as by ICA titers in the group of ICA-positive subjects. Results indicate that prediabetic condition, apart from well-established immunological and metabolic alterations, could be associated with biochemical changes revealing complex disturbances of the antioxidative defence system. Although TAS is a functional rather than specific marker, its measurement is likely to be a valuable tool for understanding the mechanisms of specific beta-cell injury.

Evaluation of ascorbate and urate antioxidant capacity in human semen.

The ascorbate/urate ratio in the seminal plasma was studied in 76 randomly chosen infertile men. The levels of ascorbate and urate were found to vary widely (range: 93-954 mumol l-1 and 127-670 mumol l-1, respectively), while the ascorbate/urate ratio was 1.03 +/- 0.63 (mean +/- SD), indicating almost equimolar concentrations of both compounds in more than 60% of the subjects investigated. No relationship of ascorbate with any biochemical marker of accessory sex gland secretions was observed, whereas an inverse correlation of urate with some prostatic markers, acid phosphatase (-0.37; P < 0.001), zinc (-0.35; P < 0.002) and citric acid (-0.33; P < 0.003), was found. In vitro experiments were conducted on an artificial suspension containing ascorbate and urate at physiological levels and activated polymorphonuclear leukocytes in the normal range (as proposed by WHO) to determine the extent to which the presence of superoxide anion-generating leukocytes contribute to the depletion of ascorbate and urate. The ascorbate level did not change in the presence of 0.2 x 10(6) leukocytes ml-1, while higher amounts of activated polymorphonuclear leukocytes initiated ascorbate oxidation, the intensity of which was in correlation with the extent of leukocyte contamination. After incubation (37 degrees C, 30 min) in the presence of 0.4, 1.0 and 1.5 x 10(6) cells ml-1, the average decline from the initial ascorbic acid level was 24, 43 and 49%, respectively. However, exposure of whole semen, instead of buffer, to oxidants released from the same amount of activated polymorphonuclears led to only 2.6, 11 and 22% decrease of the ascorbic acid, most probably due to the action of other superoxide anion scavenger compounds present in semen. Excessive superoxide anion production due to the presence of activated leukocytes had no influence on urate level either in the artificial suspension or in semen. The ability of ascorbate to afford protection against leukocyte-associated superoxide anions is not hampered in the semen of infertile men, provided that leukocyte contamination does not exceed 1 x 10(6) cells ml-1. The possible role of urate in stabilizing the ascorbate antioxidant activity in seminal plasma should be further investigated.

Influence of methionine-enkephalin on stress-induced parameters.

This study examines the influence of methionine-enkephalin (MENK) on stress-induced oxidative damage (lipid peroxidation; LPO) in mice liver homogenate, plasma corticosterone concentration (CS) and phagocytic activity of mouse splenocytes. The LPO value increased in the mice subjected to restraint stress and had no correlation to stress duration, while MENK had no effect. The CS concentration was enhanced after 6 h of stress and 6 h after injection of a low (2.5 mg/kg bw) dose of MENK. However, MENK and stress are adjunct modulators of LPO and corticosterone in vivo. LPO was additionally elevated when MENK (10 mg/kg bw) proceeded for 2 h after the onset of stress. However, corticosterone concentration seems to be regulated differently by the same dose of MENK depending on the duration of stress i.e. elevated in cases involving short periods of stress (2 h) and decreased in cases involving prolonged periods of stress (6 h). This modulation of LPO and corticosterone by 10 mg/kg bw of MENK and 2 h of restraint stress was paralleled with elevated phagocytosis.

Relationship of sperm superoxide dismutase-like activity with other sperm-specific enzymes and experimentally induced lipid peroxidation in infertile men.

Superoxide dismutase-like activity (SOD-like), isoenzyme lactate dehydrogenase-C4 (LDH-C4) and NADH-diaphorase activities in spermatozoa have been investigated from 58 normozoospermic and 27 oligozoospermic men. Significantly higher SOD-like, LDH-C4 and diaphorase activities (P < 0.01, P < 0.005 and P < 0.0001, respectively) were detected in spermatozoa from oligozoospermic men, compared to the activities found in normozoospermic samples. SOD-like activity (mean +/- SE) in oligozoospermic samples amounted to 8.3 +/- 1.6 U 10(-8) spermatozoa, while in spermatozoa in normozoospermic men with a sperm concentration above 20 million of spermatozoa per ml amounted to 4.2 +/- 0.5 U 10(-8). There was a close correlation between the SOD-like activity and biochemical indicators of the presence of residual cytoplasm i.e. isoenzyme LDH-C4 and NADH-diaphorase (r = 0.53 and r = 0.66 in normozoospermic and r = 0.63 and r = 0.54 in oligozoospermic men, respectively). A positive relationship between SOD-like activity and experimentally-induced lipid peroxidation was detected in 54 infertile men (r = 0.30; P < 0.05). These findings suggest that a higher level of superoxide dismutase-like activity may reflect a defect in the development or maturation of spermatozoa and, thereby, a decreased fertility potential. Hence, determination of SOD-like activity may give information on the state of maturity of human spermatozoa, while its role in the antioxidative protection remains to be determined.

Met-enkephalin modulates stress-induced alterations of the immune response in mice.

Overnight restraint stress of mice decreased ConA-driven lymphocyte proliferation, plaque-forming cell response to sheep red blood cells (SRBC), and NK activity in the spleen, but the phagocytic activity was enhanced. Injection of methionine-enkephalin (MENK), 10 mg/kg, i.p., 30 min before restraint, abolished these changes (except for the NK activity) and attenuated the stress-induced elevation of glucocorticoids. However, MENK itself affected the immune responses like stress: It decreased NK activity and the PFC response and enhanced phagocytic activity. Contrary to results with stress, MENK had no effect on cell proliferation. The opioid-receptor antagonist naloxone given before restraint reversed the stress-induced enhancement of phagocytosis and the decrease of T-cell proliferation. Alterations of the immune responses induced by restraint stress seem to be mediated by at least two mechanisms: activation of the hypothalamus-pituitary-adrenal (HPA) axis and the secretion of opioid peptides. MENK injected before stress may interfere with either or both mechanisms. T or B lymphocytes seem to be affected by the activation of the HPA axis, and phagocytes by a direct opioid action, whereas NK cells seem to be under the influence of another control mechanism.

Superoxide anion scavenging capacity of human seminal plasma.

This study has investigated the antioxidant capacity of human seminal plasma due to the presence of both high and low molecular weight antioxidant factors. Methods for the measurement of superoxide dismutase-like activity (SOD-like) and total antioxidant status (TAS) were automated, and had a within-run coefficient of variation of 7.3% for SOD-like activity and 4.8% for TAS. In 69 semen samples from unselected infertile men, SOD-like activity in seminal plasma ranged from 2 to 16 U/ml, with a mean of 6.9 +/- 2.8 U/ml. As SOD-like activity was correlated positively with levels of citric acid (p < 0.0001), zinc (p < 0.0002) and acid phosphatase activity (p < 0.0005), and there was no correlation with fructose levels, our results suggest that prostatic secretions are an important source of superoxide anion scavengers. Evaluation of SOD-like activity in infertile men with accessory sex gland infections (n = 12) showed significantly lower activity (p < 0.003) compared to values found in 12 infertile men without signs of infection. The values obtained for total antioxidant status (equivalent to the antioxidant capacity of alpha-tocopherol analogue) ranged from 1.7 to 2.3 mmol/L, with a mean of 2.1 +/- 0.1 (n = 40), reflecting the protective activity of ascorbate, urate and albumin, and to a very low extent of glutathione and taurine. The data obtained by TAS assay correlated with fructose, a major marker of vesicular secretion (p < 0.005), suggesting that low molecular weight components with antioxidant capacity derive partly from the seminal vesicles. The results indicate that the relative contribution of antioxidant defence systems capable of counteracting the deleterious action of superoxide anions, depends on the secretory activity of accessory sex glands and is independent of excessive ROS production due to increased oxidative stress.

Concentration of sialic acid in alloxan diabetic rat islets of Langerhans.

A microanalytical procedure for the determination of total and surface sialic acid concentrations was employed to establish their changes in relation to the length of alloxan diabetes in rat islets of Langerhans. 14 and 60 days after alloxan administration (65 mg/kg), the number of Langerhans islets was significantly decreased (p < 0.001) compared to the control. According to their size, the distribution of islets displayed no significant difference in diabetic and control animals 14 days after alloxan administration, while after 60 days no large islets (dia > or = 128 microns) were found in diabetic animals. The surface sialic acid was significantly increased in the small islets (p < 0.001), whereas no change was found in the large islets 14 days after alloxan administration. After 60 days, the surface sialic acid of both small and large islets was significantly decreased (p < 0.001). These results demonstrate that chronic beta-cell destruction induces a decrease in the sialic acid content in the pancreatic islet cells, suggesting that sialic acid might play a role in insulin secretory regulation regarding chronic effects of alloxan beta-cytotoxicity.

Interaction of Met-enkephalin and corticosteroids in immunomodulation.

The effect of Met-enkephalin (MENK) on several immune functions, corticosterone (CS) and adrenocorticotropin (ACTH) levels in the plasma was studied in adrenalectomized (ADX) and sham-adrenalectomized (SADX) mice. Multiple Met-enkephalin injections (10 mg/kg per day in two injections 12 h apart, for 4 days) increased the plaque-forming cell response to sheep erythrocytes in the spleen and enhanced the proliferation of spleen cells in vitro. These effects were comparable in sham-adrenalectomized and adrenalectomized mice. However, spleen cells of mice immunized with sheep red blood cells and injected with Met-enkephalin, showed suppressed blastogeneic transformation with Con A. The effect was equal in adrenalectomized and sham-adrenalectomized mice. In the absence of Con A in spleen cell cultures, MENK treatment of donor mice resulted in a significant mitogenic effect. NK activity of the spleen cells was suppressed in MENK-treated adrenalectomized mice. Injection of MENK decreased corticosterone levels and increased ACTH levels in the plasma of sham-adrenalectomized mice. In adrenalectomized mice plasma levels of ACTH were decreased by MENK. It seems that corticosteroid secretion, although changed by adrenalectomy and influenced by treatment with MENK, does not influence the modulatory effect of MENK on the PFC response and blastogeneic transformation of mouse spleen cells. However, NK activity of the spleen cells treated with MENK seems to the reflect joint action of MENK and corticosteroids.