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Biomedical subjects

S Efendic

Publications and source records attributed to S Efendic.

At least 19 recordsLinked to original sources

Molecular cloning of PEC-60 and expression of its mRNA and peptide in the gastrointestinal tract and immune system.

The peptide PEC-60, structurally related to the pancreatic secretory trypsin inhibitor, inhibits glucose-induced insulin secretion. Here we report on the structure of a cDNA clone from pig duodenum encoding PEC-60. The cDNA encodes a 86-amino acid long precursor protein containing a 26-amino acid signal sequence, implying that the mature PEC-60 peptide is secreted from cells. Analysis of porcine duodenum demonstrated a high expression of a 0.6-kilobase long PEC-60 mRNA in this tissue, as well as the presence of strong PEC-60-like immunoreactivity in the cytoplasm of the majority of the goblet cells of the epithelium. High levels of PEC-60 mRNA were also found in the bone marrow and the peripheral blood and moderate levels in the spleen. A strong PEC-60-like immunoreactivity was localized in the monocytes of peripheral blood. Radioimmunoassay revealed high levels of pig PEC-60-like immunoreactivity in pig plasma suggesting that the PEC-60 peptide is efficiently released from cells. These findings imply that the gastrointestinal peptide PEC-60 is formed, stored, and secreted from monocytes present within the bone marrow and in the peripheral blood, indicating a role of the PEC-60 peptide in the immune system in addition to its function as a gastrointestinal peptide.

Amino Acid Sequence

The diabetogenic effects of glucocorticoids are more pronounced in low- than in high-insulin responders.

We investigated in six low- and six high-insulin responders (LIR and HIR) the effect of dexamethasone (Dex, 15 mg orally during 48 hr) on oral glucose tolerance (OGTT), glucose turnover under basal conditions and during glucose infusion of 2 mg.kg-1.min-1, and insulin response during hyperglycemic clamp. Dex increased fasting glucose more in LIR (P less than 0.05). During OGTT, Dex caused a more prominent increment in glucose in LIR, whereas the increment in insulin was less in LIR (P less than 0.05). After Dex, in three LIR but in no HIR, a diabetic OGTT was observed. Dex significantly increased basal hepatic glucose production (turnover measured with [6-3H]glucose), hepatic total glucose output (turnover measured with [2-3H]glucose), and glucose cycling (hepatic total glucose output--hepatic glucose production) only in LIR. Dex decreased basal glucose metabolic clearance to the same extent in LIR and HIR. Hyperglycemic clamp revealed that Dex induced a significant increase (P less than 0.05) in insulin response only in HIR. Dex effects on insulin release during hyperglycemic clamp were negatively correlated with the glucose area during Dex OGTT (P less than 0.01). Thus, the double tracer method provided a new insight into the pathogenesis of the steroid effect on carbohydrate tolerance. Dex increased basal glycemia more in LIR because only in LIR was glucose production increased. During OGTT, the LIR who were not able to counteract the effects of Dex by an appropriate enhancement in insulin secretion developed a decreased OGTT. The evaluation of insulin response after Dex may thus allow differentiation of the subset of LIR that run an increased risk of non-insulin-dependent diabetes mellitus.

Adult

Antidiabetogenic effect of glucagon-like peptide-1 (7-36)amide in normal subjects and patients with diabetes mellitus.

BACKGROUND: Glucagon-like peptide-1 (7-36) amide (glucagon-like insulinotropic peptide, or GLIP) is a gastrointestinal peptide that potentiates the release of insulin in physiologic concentrations. Its effects in patients with diabetes mellitus are not known. METHODS: We compared the effect of an infusion of GLIP that raised plasma concentrations of GLIP twofold with the effect of an infusion of saline, on the meal-related release of insulin, glucagon, and somatostatin in eight normal subjects, nine obese patients with non-insulin-dependent diabetes mellitus (NIDDM), and eight patients with insulin-dependent diabetes mellitus (IDDM). The blood glucose concentrations in the patients with diabetes were controlled by a closed-loop insulin-infusion system (artificial pancreas) during the infusion of each agent, allowing measurement of the meal-related requirement for exogenous insulin. In the patients with IDDM, normoglycemic-clamp studies were performed during the infusions of GLIP and saline to determine the effect of GLIP on insulin sensitivity. RESULTS: In the normal subjects, the infusion of GLIP significantly lowered the meal-related increases in the blood glucose concentration (P less than 0.01) and the plasma concentrations of insulin and glucagon (P less than 0.05 for both comparisons). The insulinogenic index (the ratio of insulin to glucose) increased almost 10-fold, indicating that GLIP had an insulinotropic effect. In the patients with NIDDM, the infusion of GLIP reduced the mean (+/- SE) calculated isoglycemic meal-related requirement for insulin from 17.4 +/- 2.8 to 2.0 +/- 0.5 U (P less than 0.001), so that the integrated area under the curve for plasma free insulin was decreased (P less than 0.05) in spite of the stimulation of insulin release. In the patients with IDDM, the GLIP infusion decreased the calculated isoglycemic meal-related insulin requirement from 9.4 +/- 1.5 to 4.7 +/- 1.4 U. The peptide decreased glucagon and somatostatin release in both groups of patients. In the normoglycemic-clamp studies in the patients with IDDM, the GLIP infusion significantly increased glucose utilization (saline vs. GLIP, 7.2 +/- 0.5 vs. 8.6 +/- 0.4 mg per kilogram of body weight per minute; P less than 0.01). CONCLUSIONS: GLIP has an antidiabetogenic effect, and it may therefore be useful in the treatment of patients with NIDDM:

Adult

Dexamethasone treatment fails to increase arginine-induced insulin release in healthy subjects with low insulin response.

We have compared insulin responses to L-arginine before and during dexamethasone treatment in healthy subjects, previously classified as subjects with either high or low insulin response according to a standardized glucose infusion test. Arginine stimulation was administered as a 150 mg/kg bolus followed by 10 mg.kg-1.min-1 to six subjects with high insulin response and to seven subjects with low insulin response. Before dexamethasone treatment the incremental insulin level during 0-10 min of arginine was higher in subjects with high (36.5 +/- 6.8 microU/ml) than in subjects with low response (14.5 +/- 2.3 microU/ml), p less than 0.01 for difference. Dexamethasone treatment (6 mg/day for 60 h) markedly enhanced the insulin response to arginine in subjects with high response (+99% 0-30 min) but failed to affect the subjects with low response (+4% 0-30 min). The C-peptide response to arginine exhibited similar differences between groups. Decreased responsiveness to arginine in subjects with low insulin response, especially during dexamethasone treatment, suggests a Beta-cell capacity defect although a decreased potentiating-sensing effect of glucose cannot be completely ruled out.

Adult

The intestinal peptide PEC-60 inhibits insulin secretion in the mouse and the rat.

The newly discovered 60-amino-acid porcine intestinal peptide, PEC-60, shows a structural similarity to pancreatic secretory trypsin inhibitor. PEC-60 was recently demonstrated to inhibit glucose-stimulated insulin secretion from the perfused rat pancreas. We examined in this study whether the peptide affects basal and stimulated insulin secretion in vivo. Purified porcine PEC-60 was injected intravenously in mice at 1 or 8 nmol/kg alone or together with glucose (2.8 mmol/kg) or the cholinergic agonist carbachol (0.16 mumol/kg). PEC-60 was found to inhibit glucose- and carbachol-induced insulin secretion (p less than 0.01 and p less than 0.05, respectively) at 8 nmol/kg, whereas at 1 nmol/kg, the peptide had no effect. In contrast, basal plasma insulin levels were not affected by PEC-60. In a second experimental series, PEC-60 was infused intravenously in rats at 17 or 68 pmol/min alone or together with glucose (56 mumol/min). At 68 pmol/min (p less than 0.01), but not at 17 pmol/min, PEC-60 inhibited glucose-stimulated insulin secretion. The peptide had no influence on basal plasma insulin levels. It is concluded that the newly isolated intestinal peptide, PEC-60, inhibits stimulated insulin secretion under in vivo conditions both in the mouse and in the rat without affecting basal insulin secretion.

Amino Acid Sequence

Glucocorticoid increases glucose cycling and inhibits insulin release in pancreatic islets of ob/ob mice.

Normoglycemic ob/ob mice were treated for 24 or 48 h with either 25 micrograms/day of dexamethasone or saline. After an overnight fast, the animals were killed and pancreatic islets were incubated with 3H2O or [U-14C]glucose or [5-3H]glucose at 5.5 and 16.7 mM glucose. Incorporation of 3H from 3H2O into carbon 2 of medium glucose and the yield of 14CO2 from [U-14C]glucose and 3H2O from [5-3H]glucose were measured. Dexamethasone treatment for 48 h significantly increased the rate of dephosphorylation of glucose in islets both at 5.5 mM (24 vs. 16%) and 16.7 mM (56 vs. 36%) glucose, whereas glucose oxidation and utilization were unaffected. Dexamethasone treatment also inhibited insulin release by approximately 60% at 5.5 and 16.7 mM glucose, either in the presence or absence of 10 mM arginine, but had no effect when insulin release was stimulated by 1 mM 3-isobutyl-1-methylxanthine. Moreover, 24-h treatment with dexamethasone significantly increased glucose cycling at low and high glucose concentrations in the medium and inhibited insulin responsiveness to glucose and arginine. In conclusion, short-term dexamethasone treatment increases glucose flux through glucose-6-phosphatase in islets from ob/ob mice. This effect may contribute to the decreased insulin response to glucose and arginine found in animals treated with dexamethasone.

1-Methyl-3-isobutylxanthine

Long-term stability of low insulin responses to glucose in non-diabetic subjects.

We investigated the stability of the insulin response to glucose in healthy subjects by making retrospective comparisons of insulin responses after two 60 min glucose infusion tests performed many years apart. The subjects (N = 49) were divided into two lower and two higher quartiles as assessed by the incremental 0-10 min insulin area during the initial glucose infusion test. Ages were initially 32.3 +/- 2.8 years in lower quartiles and 26.6 +/- 1.1 in higher quartiles and body mass indexes 21.6 +/- 0.6 kg/m2 and 21.8 +/- 0.5, respectively. The interval between the first and second glucose infusion tests was 8.1 +/- 2.8 years for lower quartiles and 10.4 +/- 1.3 for higher quartiles. In lower quartiles, the 0-10 min insulin area at first testing was 157.1 +/- 15.9 mU/l x 10 min and at follow-up 202.2 +/- 26.6 (+29%, NS). In higher quartiles, the insulin area decreased from 654.8 +/- 70.6 mU/l x 10 min at first testing to 489.8 +/- 53.6 at follow-up (-25%, p less than 0.05). The 0-60 min glucose area did not change significantly between glucose infusion tests in lower quartiles (+5%), but did increase by 12% (p less than 0.005) in higher quartiles. Only one subject of the lowest quartile at first testing changed to higher quartiles at follow-up. Predictable "regression toward the mean" at follow-up was moderate, hence the individual insulin response to glucose was relatively stable with time. This finding is compatible with the hypothesis that genetic factors are of major importance for the insulin response to glucose.

Adult

Effects of nicotinic acid on glucose tolerance and glucose incorporation into adipose tissue in hypertriglyceridaemia.

Nicotinic acid 4 g daily was given to 28 weight-stable hypertriglyceridaemic patients. The aim was to study its effects on serum lipoprotein lipid levels, intravenous glucose tolerance (k-values) and glucose incorporation into subcutaneous adipose tissue (GLIAT) in vitro. The investigations were performed prior to the nicotinic acid therapy, after 6 weeks, and 6 months of drug treatment. Fasting blood glucose levels increased by 13%, whereas k-values fell by 26% after the nicotinic acid treatment. Decrease in k-values was predicted from the initial k-values (R2-value = 0.76). GLIAT increased by 76%, while in the subgroup of eight patients, treated for 6 months with nicotinic acid, GLIAT increased by 331%. The changes in k-values and GLIAT were not significantly interrelated. Serum triglyceride levels were strongly decreased. The most likely explanation for the decrease in intravenous glucose tolerance is that nicotinic acid stimulates glucose output from the liver and that this effect outweighs the stimulating effects of the drug on glucose utilization in extrahepatic tissues. The latter is reflected by the increased uptake of glucose in adipose tissue. A stimulated GLIAT, reflecting formation of alpha-glycerophosphate in adipose tissue, might contribute to the reduction of serum triglyceride levels induced by nicotinic acid, since alpha-glycerophosphate is the acceptor of fatty acids assumed to be liberated from circulating triglycerides by lipoprotein lipase.

Adipose Tissue

Can somatostatin prevent injection pancreatitis after ERCP?

In a double-blind randomized study, 30 patients received somatostatin infusion during ERCP and 30 patients placebo with the aim of evaluating whether somatostatin can reduce the incidence of injection pancreatitis. S-amylase, U-amylase and S-lipase were evaluated before, during and after (up to 48 hours) ERCP. C-peptide was also determined as a marker of the function of the endocrine pancreas. While no statistically significant effect of somatostatin in terms of amylase and lipase was to be found, somatostatin did significantly decrease c-peptide levels in plasma, indicating that the peptide inhibited beta-cell secretion. About 40% of patients in the somatostatin group and about 50% in the placebo group showed signs of injection pancreatitis (elevated levels of enzymes) and in both groups there are patients with clinically apparent pancreatitis.

Aged

Pancreatic secretory trypsin inhibitor (PSTI) isolated from pig intestine. Influence on insulin and somatostatin release.

Upon investigation of pig intestinal peptides for effects on the release of endocrine hormones from the isolated perfused rat pancreas, we reported earlier that glucose-stimulated insulin release was inhibited by PEC-60, a peptide with marked sequence similarity to PSTI (pancreatic secretory trypsin inhibitor). Continuing this study we found a polypeptide, which inhibited glucose-induced insulin release but enhanced glucose-induced somatostatin secretion. Determination of the amino acid sequence of this polypeptide revealed that it is identical to that of PSTI. Thus, PSTI modulates islet hormone release.

Amino Acids

Immunohistochemical localization of porcine diazepam-binding inhibitor (DBI) to rat endocrine pancreas.

The occurrence of diazepam-binding inhibitor (DBI), isolated and characterized from porcine upper intestine, was examined in the pancreas of Sprague-Dawley albino rats using indirect immunofluorescence. The polypeptide was found in the endocrine Langerhans islets and, utilizing double-labelling controls, it was shown to be present within the peripherally located glucagon-containing cells. Regulation of islet hormone production may therefore be under DBI control.

Animals

Somatostatin promotes accumulation of phospholipids in regenerating liver tissue of rats.

Effects of somatostatin (SOM) on tissue contents of proteins, total lipids and phospholipids were investigated in regenerating and intact liver tissue of Y-59 rats. Whereas SOM inhibited protein accumulation in regenerating liver, the hormone evoked an increase in total lipids, and specially in phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine (PS) and phosphatidylinositol (PI). Since the same effects were not seen when intact liver was analyzed, it is assumed that SOM acts primarily on tissue stimulated to rapid growth. The increase of PS + PI fractions indicates a specific effect of SOM on the metabolism of phosphatidylinositides. Such an effect might result from the interference of the hormone with the action of growth factors that accelerate phosphatidylinositol breakdown.

Animals

Phylogenetic aspects of pancreastatin- and chromogranin-like immunoreactive cells in the gastro-entero-pancreatic neuroendocrine system of vertebrates.

Using a battery of region-specific antisera raised against different amino acid sequences of pancreastatin (Pst) (Pst-1-6, Pst-1-17, Pst-14-49, Pst-33-49) as well as two antisera raised against chromogranin (Cg) A and CgA/B and the biotin-avidin technique, the phylogenetic distribution of Pst-immunoreactive (-IR) and Cg-IR cells was studied in the gastroentero-pancreatic (GEP) neuroendocrine system. The investigation was carried out with representatives of all vertebrate classes as well as with the protochordates Branchiostoma lanceolatum and Ciona intestinalis. The study revealed the presence of Pst-IR and Cg-IR cells in the gastro-intestinal mucosal epithelium as well as in the islet parenchyma of all vertebrates studied with the only exception found in rat. In the rat GEP system unequivocal immunoreactions were obtained only by the use of antiserum CgA/B. In the gastro-intestinal tract of the deuterostomian invertebrates no Pst-IR or Cg-IR cells could be observed with any of our antisera. Whether this might indicate that Pst-like or Cg-like peptides are characteristic for vertebrates or, more likely, whether similar proteins/peptides might be present in the alimentary tract of protochordates which do not react with the antisera at hand, remains to be clarified. Thouh pronounced interspecies and some intraspecies differences were found, several general conclusions can be drawn. In all vertebrate species, the Pst-IR and Cg-IR cells observed in the mucosal epithelium of the gastro-intestinal tract showed an endocrine structure and were of the so-called open type. The Pst and the Cg antisera which gave immunoreactions with parenchymal cells in the islets of Langerhans also reacted with cells in the epithelium of the pancreatic ducts. Comparative analysis of the reaction properties of the region-specific antisera used indicated that the Pst-like material in the islet cells of the cartilaginous fish species studied seems to be "mammalian-like," whereas it appears to be different in the other (phylogenetically younger) submammalian vertebrates. In addition, the Pst-like peptides in the gastro-intestinal mucosal epithelium and in those in the islets seem to differ in most submammalians. Finally, in the pyloric-duodenal junction of the quail (Coturnix c. japonica) the presence of a so far unknown peptide of the Cg family is presumed. In general, our results seem to indicate that the phylogeny of Pst-like and Cg-like peptides is not as "straight" as those which have been demonstrated for several other neurohormonal peptides.(ABSTRACT TRUNCATED AT 400 WORDS)

Amino Acid Sequence

Quantitation of glycogen/glucose-1-P cycling in liver.

A method is introduced for quantitating cycling between hepatic glycogen and glucose-1-P in humans. It depends on the administration of trace [2-3H,6-14C]galactose, a glucose load, and acetaminophen. The ratio of 3H to 14C in the glucuronide of the acetaminophen excreted in urine to that in the administered galactose provides the measure of the fraction of glycogen synthesized that is synthesized from glucose-1-P formed from glycogen. The quantity of glucose-1-P formed from glycogen that is not reconverted to glycogen is not measured. It is assumed that the glucuronide samples the UDP-glucose pool in liver from which glycogen is formed, the last glucosyl units formed from UDP-glucose in glycogen synthesis are the first broken down, and the equilibration of [2-3H]glucose-1-P with fructose-6-P is rapid relative to its conversion to UDP-glucose. During a 5-hour period, while three normal subjects and three non-insulin-dependent diabetics, who had fasted overnight, were infused with 4 mg/kg/min of glucose, the rate of glycogen breakdown, as measured using the method, was only a small percentage of the rate of glycogen synthesis.

Adult

The insulin-like growth factor binding protein-1 in low and high insulin responders before and during dexamethasone treatment.

To investigate the influence of normal insulin levels on levels of the insulin-like growth factor binding protein-1 (IGFBP-1) we measured this peptide postabsorptively and during hyperglycemic clamp in 17 healthy subjects, nine with low insulin response (LIR) and eight with high insulin response (HIR). The study was performed before and after 60 hours of treatment with dexamethasone 6 mg/d. The fasting levels of IGFBP-1 were significantly higher in LIR, 36 +/- 2.5 micrograms/L, than in HIR, 22 +/- 2.6 micrograms/L (P less than .01), while no differences in glucose, insulin, and C-peptide concentrations were found. Dexamethasone induced an increase in basal concentrations of insulin, while IGFBP-1 levels decreased to 18.8 +/- 2 micrograms/L in LIR (P less than .01) and to 14.0 +/- 0.9 micrograms/L in HIR (P less than .05). There was no correlation between the individual basal IGFBP-1 concentrations and basal insulin levels. In contrast, basal levels of IGFBP-1 were inversely correlated to the integrated insulin or C-peptide concentrations during the hyperglycemic clamp both before (r = -.67, P less than .01) and during dexamethasone (r = -.79, P less than .001). Dexamethasone, which increased the insulin resistance, did not change the relationship between basal IGFBP-1 and the glucose-induced insulin release. In conclusion, the morning levels of IGFBP-1 in healthy subjects reflect the acute beta-cell responsiveness to glucose, which may correspond to integrated diurnal insulin levels. The inhibitory effects of dexamethasone on the morning levels of IGFBP-1 can be explained by attendant hyperinsulinemia.

Adult

Effects of cholecystokinin (CCK)-8, CCK-33, and gastric inhibitory polypeptide (GIP) on basal and meal-stimulated pancreatic hormone secretion in man.

Gastrointestinal hormones with insulinotropic effects, like cholecystokinin (CCK) and gastric inhibitory polypeptide (GIP) might tentatively be used in the treatment of non-insulin-dependent diabetes mellitus. We therefore examined the effects of intravenous injection of pharmacological dose levels of CCK-8 (100 and 300 pmol/kg), CCK-33 (100 pmol/kg), GIP (100 pmol/kg), and CCK-8 plus GIP (100 pmol/kg of each) on plasma levels of glucose, insulin, somatostatin, glucagon, and pancreatic polypeptide (PP) in healthy human volunteers. The peptides were given under basal conditions or in combination with a mixed meal. CCK-8, CCK-33, and GIP were all found to increase the basal plasma levels of insulin, somatostatin, and PP; the increases were observed already in samples taken at 2 min after the injection. In contrast, the plasma glucagon levels were unaffected by the peptides. CCK-8, CCK-33, and GIP (100 pmol/kg) all potentiated the meal-induced plasma responses of insulin and PP, whereas plasma levels of glucagon after the meal were not affected. Plasma somatostatin levels after the meal were increased by GIP but not affected by CCK-8 or CCK-33. CCK-8 and GIP together (100 pmol/kg for both) increased plasma levels of insulin, PP and somatostatin as much as each of the peptides given alone, both under basal conditions and after the meal intake. Plasma levels of glucagon were not affected by CCK-8 and GIP together. We conclude that in man, both CCK-8, CCK-33, and GIP moderately stimulate basal and meal related insulin release without any synergistic effects and that the peptides do not inhibit the secretion of glucagon.

Adult

Metabolic effects and clinical value of beet fiber treatment in NIDDM patients.

In the present study a randomized cross-over design was used to determine the clinical usefulness of adding 16 g of beet fiber to the ordinary diet of non-insulin dependent diabetic (NIDDM) out-patients. In addition, fiber effects on the gastrointestinal hormone responses to a standardized test meal were evaluated. The study included five patients treated with diet alone and eight patients treated with diet and sulphonylurea (SU). Beet fiber supplementation resulted in a 10% reduction (P less than 0.01) of serum cholesterol in SU-treated patients. No differences were found for fasting blood glucose, glycated hemoglobin, serum triglycerides or body weight. In the diet-treated patients, fasting plasma somatostatin was elevated during the fiber period. However, postprandial responses of insulin, C-peptide, glucagon, gastric inhibitory peptide and somatostatin were not influenced by an increased fiber intake in any group. All patients experienced mild gastrointestinal discomfort during the fiber period. In view of the limited metabolic benefit of beet fiber treatment we conclude that there is little use for this type of dietary fiber in the routine treatment of patients with NIDDM.

Blood Glucose