Glucolipotoxicity age-dependently impairs beta cell function in rats despite a marked increase in beta cell mass.

AIMS/HYPOTHESIS: Prolonged exposure of pancreatic beta cells to excessive levels of glucose and fatty acids, referred to as glucolipotoxicity, is postulated to contribute to impaired glucose homeostasis in patients with type 2 diabetes. However, the relative contribution of defective beta cell function vs diminished beta cell mass under glucolipotoxic conditions in vivo remains a subject of debate. We therefore sought to determine whether glucolipotoxicity in rats is due to impaired beta cell function and/or reduced beta cell mass, and whether older animals are more susceptible to glucolipotoxic condition. METHODS: Wistar rats (2 and 6 months old) received a 72 h infusion of glucose + intravenous fat emulsion or saline control. In vivo insulin secretion and sensitivity were assessed by hyperglycaemic clamps. Ex vivo insulin secretion, insulin biosynthesis and gene expression were measured in isolated islets. Beta cell mass and proliferation were examined by immunohistochemistry. RESULTS: A 72 h infusion of glucose + intravenous fat emulsion in 2-month-old Wistar rats did not affect insulin sensitivity, insulin secretion or beta cell mass. In 6-month-old rats by contrast it led to insulin resistance and reduced insulin secretion in vivo, despite an increase in beta cell mass and proliferation. This was associated with: (1) diminished glucose-stimulated second-phase insulin secretion and proinsulin biosynthesis; (2) lower insulin content; and (3) reduced expression of beta cell genes in isolated islets. CONCLUSIONS/INTERPRETATION: In this in vivo model, glucolipotoxicity is characterised by an age-dependent impairment of glucose-regulated beta cell function despite a marked increase in beta cell mass.

Lipid receptors and islet function: therapeutic implications?

G-protein coupled receptors (GPCRs) are targets of approximately 30% of currently marketed drugs. Over the last few years, a number of GPCRs expressed in pancreatic beta-cells and activated by lipids have been discovered. GPR40 was shown to be activated by medium- to long-chain fatty acids (FAs). It has since been shown that GPR40 contributes to FA amplification of glucose-induced insulin secretion. Although some controversy still exists as to whether GPR40 agonists or antagonists should be designed as novel type 2 diabetes drugs, data obtained in our laboratory and others strongly suggest that GPR40 agonism might represent a valuable therapeutic approach. GPR119 is expressed in pancreatic beta-cells and enteroendocrine L-cells, and augments circulating insulin levels both through its direct insulinotropic action on beta-cells and through FA stimulation of glucagon-like peptide 1 (GLP-1) secretion. GPR120 is expressed in L-cells and was also shown to mediate FA-stimulated GLP-1 release. Finally, GPR41 and GPR43 are receptors for short-chain FAs and may indirectly regulate beta-cell function via adipokine secretion. Although the discovery of these various lipid receptors opens new and exciting avenues of research for drug development, a number of questions regarding their mechanisms of action and physiological roles remain to be answered.

Islet beta cell failure in the 60% pancreatectomised obese hyperlipidaemic Zucker fatty rat: severe dysfunction with altered glycerolipid metabolism without steatosis or a falling beta cell mass.

AIMS/HYPOTHESIS: The Zucker fatty (ZF) rat subjected to 60% pancreatectomy (Px) develops moderate diabetes by 3 weeks. We determined whether a progressive fall in beta cell mass and/or beta cell dysfunction contribute to beta cell failure in this type 2 diabetes model. METHODS: Partial (60%) or sham Px was performed in ZF and Zucker lean (ZL) rats. At 3 weeks post-surgery, beta cell mass and proliferation, proinsulin biosynthesis, pancreatic insulin content, insulin secretion, and islet glucose and lipid metabolism were measured. RESULTS: ZL-Px rats maintained normal glycaemia and glucose-stimulated insulin secretion (GSIS) despite incomplete recovery of beta cell mass possibly due to compensatory enhanced islet glucose metabolism and lipolysis. ZF-Px rats developed moderate hyperglycaemia (14 mmol/l), hypertriacylglycerolaemia and relative hypoinsulinaemia. Despite beta cell mass recovery and normal arginine-induced insulin secretion, GSIS and pancreatic insulin content were profoundly lowered in ZF-Px rats. Proinsulin biosynthesis was not reduced. Compensatory increases in islet glucose metabolism above those observed in ZF-Sham rats were not seen in ZF-Px rats. Triacylglycerol content was not increased in ZF-Px islets, possibly due to lipodetoxification by enhanced lipolysis and fatty acid oxidation. Fatty acid accumulation into monoacylglycerol and diacylglycerol was increased in ZF-Px islets together with a 4.5-fold elevation in stearoyl-CoA desaturase mRNA expression. CONCLUSIONS/INTERPRETATION: Falling beta cell mass, reduced proinsulin biosynthesis and islet steatosis are not implicated in early beta cell failure and glucolipotoxicity in ZF-Px rats. Rather, severe beta cell dysfunction with a specific reduction in GSIS and marked depletion of beta cell insulin stores with altered lipid partitioning underlie beta cell failure in this animal model of type 2 diabetes.

Effects of physical training on body composition and organ weights in ovariectomized and hyperestrogenic rats.

OBJECTIVE: To investigate whether regular endurance-type exercise can benefit rats submitted to a model of ovariectomy (OVX)-induced obesity with or without estrogen replacement. SUBJECTS: OVX Sprague-Dawley rats were compared to an ovariectomized-estradiol-treated group (OVXE2) and a Sham-operated (Sham) group. Each of these groups were subdivided into a sedentary and a treadmill-trained (8 wk) group. DESIGN AND MEASUREMENTS: An experimental study in which various parameters, including fat depots, blood lipids and several organ weights were measured. RESULTS: Plasma levels of 17beta-estradiol and uterus weights were significantly (P<0.05) lower in OVX compared to Sham and significantly (P<0.01) higher in OVXE2 (hyperestrogenic) compared to Sham rats. Body weights were significantly (P<0.01) different among groups, in the following decreasing order: OVX, Sham and OVXE2. The average daily food intake and food efficiency were significantly (P<0.01) increased in OVX compared to Sham, whereas estradiol treatment diminished this effect (P<0.01). Exercise training did not alter any of the above-mentioned variables in any of the three estrogen groups. Mesenteric and subcutaneous fat weights were significantly (P<0.01) increased by OVX. This increase was abolished by estrogen replacement or by exercise training. Exercise training also decreased fat weights in OVXE2 and Sham rats. OVX resulted in a decrease in the weights of several other tissues (femur, heart, lungs, liver and adrenal glands) while hyperestrogenic replacement resulted in an increase in weight of all measured tissues. Aside from fat depots, exercise training did not affect any of the tissue weights with the exception for an increase in the weight of the plantaris muscle and adrenal glands and a decrease in lung weight in all three estrogen groups. CONCLUSION: In OVX animals, exercise training may bring about positive changes in body composition (ie reduction in fat weights) despite an ovariectomy-induced increase in body weight.

Metabolic effects of physical training in ovariectomized and hyperestrogenic rats.

This study was undertaken to evaluate the effects of regular endurance-type exercise on glucose tolerance and glucose-stimulated insulin response (GSIR) in ovariectomized (OVX) rats with and without estrogen replacement. To do that, OVX Sprague-Dawley rats were compared with an OVX estradiol-treated group (OVXE2) and a sham-operated (Sham) group. Each of these groups was subdivided into a sedentary and a treadmill-trained (8 wk) group. Intravenous glucose tolerance tests (0.5 g/kg) were conducted in all rats 48 h after the last training session. Plasma levels of 17beta-estradiol and the uterus weight were significantly (P < 0.05) lower in OVX compared with results in Sham and significantly (P < 0.01) higher in OVXE2 (hyperestrogenic) compared with results in Sham. Body weights were significantly (P < 0.01) different among groups, in the following decreasing order: OVX, Sham, and OVXE2. The average daily food intake was significantly (P < 0.01) increased in OVX rats compared with Sham, whereas estradiol treatment diminished this effect (P < 0.01). Exercise training was found to alter none of the above-mentioned variables in all three experimental conditions. Although the mean integrated area under the glucose and insulin curves was not affected by OVX, training induced a significant (P < 0.01) reduction in the mean integrated area under the insulin curve in all three experimental conditions. It is concluded that the positive effects of physical training on improving GSIR in OVX and hyperestrogenic animals are similar to what has been found in Sham.

Evidence that a decrease in liver glycogen content stimulates FFA mobilization during exercise.

This study evaluated a liver glycogen content decrease before exercise on the metabolic responses during exercise. Rats injected with glucagon (20 microg x kg(-1)) were compared to rats with a 50% food restriction (1/2-fast) and normally fed rats. All were studied at rest and during exercise (26 m/min, 0% grade). Resting liver glycogen concentrations were twice as high (P<.01) in normally fed rats, with no significant differences between 1/2-fast and glucagon-injected rats. During exercise, liver glycogen content was significantly reduced in normally fed rats. After exercise, plasma insulin levels were decreased (P<.01) in all groups, and beta-hydroxybutyrate concentrations were similar in normally fed and glucagon-injected rats and significantly (P<.01) lower in 1/2-fast rats. Exercise caused a significant increase in FFA concentrations in all groups (P<.01). No significant differences in FFA concentrations were found between 1/2-fast and glucagon-injected groups (P>0.05).

Effects of supranormal liver glycogen content on hyperglucagonemia-induced liver glycogen breakdown.

The purpose of the present study was to test the hypothesis that a higher hepatic glycogen level is associated with higher glucagon-induced hepatic glycogen depletion. Four groups of anesthetized rats received three injections (at times 0, 30, and 60 min) of glucagon (intravenously, 20 [microg/kg). Among these groups, hepatic glycogen levels had previously been manipulated either by an overloading diet (Fast-refed), a reduction in food intake (1/2-fast), or exercise (75 min of running, 26 m/ min, 0% grade). A fourth group had normal hepatic glycogen levels. A fifth group of rats was injected only with saline (0.9% NaCl). Liver glycogen concentrations were measured every 30 min during the course of the 90-min experiment, using liver samples obtained from the open liver biopsy technique. Plasma glucagon concentrations were significantly higher (P < 0.05) in the glucagon-injected groups than in the saline-injected group. As expected, liver glycogen levels were significantly higher (P < 0.01; 1.6-fold) in the Fast-refed group than in all other groups. Glucagon-induced decreases in liver glycogen concentrations were similar in Fast-refed than in normally fed and exercised rats when the overall 90-min period was considered. However, during the course of the last 30-min period, liver glycogen was significantly (P < 0.01) decreased only in the Fast-refed group. The Fast-refed, normally fed, and exercised groups had a similar glucagon-induced hyperglycemia that was significantly more elevated (P < 0.01) than glucose levels measured in the saline-injected group. Glucagon-induced reactive hyperinsulinemia was observed only in the Fast-refed and normally fed rats, and not in the exercised and 1/2-fast rats. It is concluded that supranormal levels of liver glycogen may be associated with a larger hyperglucagonemia-induced liver glycogen breakdown.

Effects of hepatic portal infusion of hypertonic saline on glucagon response to exercise.

The present study was conducted to evaluate the influence of a hepatic portal infusion of hypertonic saline on the metabolic and hormonal responses to exercise. Adrenodemedullated male rats were studied at rest or after 30 min of treadmill exercise (26 m/min, 0% grade). Three groups of rats were infused continuously at a rate of 52 microL/min with one of the following randomly assigned conditions: hypertonic 3.6% NaCl (P3.6% NaCl) or 1.8% NaCl (P1.8% NaCl) infused into the hepatic portal vein, and hypertonic 3.6% NaCl (J3.6% NaCl) infused into the jugular vein. One group of rats received no infusion (SHAM). The infusions of hypertonic NaCl into the portal or the jugular site resulted in a significant (p < 0.05) increase in peripheral concentration of Na+, Cl-, and osmolality at rest and after exercise. The antidiuretic hormone (ADH) concentration was significantly (p < 0.05) increased by the P3.6% NaCl and J3.6% NaCl infusions at rest and after exercise. Exercise caused a significant (p < 0.05). decrease in liver glycogen content, peripheral and portal plasma glycemia, and insulinemia regardless of the different types and sites of infusions. However, the peripheral glucagon response to exercise was significantly (p < 0.05) increased only when hypertonic saline (1.8 or 3.6%) was infused into the portal vein. Portal and peripheral lactate concentrations at rest and after exercise were significantly (p < 0.01) higher in P3.6% NaCl than in all other groups. It is concluded that a 30-min hypertonic saline infusion into the hepatic portal vein does not specifically influence the insulin response at rest and after exercise, but that glucagon response to exercise is increased by such an infusion.

Effects of acute physical exercise on hepatocyte volume and function in rat.

The goal of the present experiment was to measure the volume of the different compartments in liver of exercised rats and to get some insights into the appropriate working of the hepatic function following exercise. Hence, livers from male rats were isolated and perfused after treadmill exercise or rest. This procedure was performed on rats that were overnight semifasted (50% food restriction) or well fed. To evaluate the hepatocyte cell volume, the multiple-indicator dilution curve technique was used after 40 min of perfusion. Radioactive tracers for red blood cells, sucrose, and water were used to measure liver vascular space, liver interstitial space, and water cellular space, respectively. The hepatocyte function was assessed by taurocholate and propanolol clearance. Oxygen consumption, intrahepatic resistance, bile secretion, and lactate dehydrogenase release estimated liver viability. Liver viability and hepatocyte function were not changed following exercise either in the fed or in the semifasted animals. As expected, liver glycogen levels were significantly (P < 0.01) reduced in the food-restricted rats. Consequently, liver glycogen levels following exercise were decreased significantly (P < 0.01) only in the fed rats. Despite this, exercise decreased the hepatocyte water space in both food-restricted and fed groups ( approximately 15%; P < 0.01) without altering the sinusoidal and interstitial space. The present data show that acute exercise decreased the hepatocyte volume and that this volume change is not entirely linked to a decrease in hepatic glycogen level.

Effects of portal injection of 2,5-anhydro-D-mannitol on pancreatic hormone responses to exercise in rats.

The fructose analogue 2,5-anhydro-D-mannitol (2,5-AM) has been shown to act specifically in liver by decreasing liver ATP and by blocking glycogenolysis and gluconeogenesis. The present investigation was designed to determine the effects of the administration of 2,5-AM on pancreatic hormone responses during a situation of increased energy demand such as physical exercise, and by comparison to the resting response, to test the possibility that the hormonal effects of 2,5-AM during exercise may be dissociated from a decrease in blood glucose levels. Adrenodemedullated rats were injected intraportally with a dose of 200 mg/kg of 2,5-AM (50 mg/ml) or by an equivalent volume of saline (0.9% NaCl) before being submitted to a 30-min treadmill run (26 m/min, 0% grade). Administration of 2,5-AM at rest resulted in a significant (P < 0.05) decrease of plasma glucose and insulin levels and an increase in beta-hydroxybutyrate concentrations. During exercise, administration of 2,5-AM, as compared to resting values, resulted in a larger decrease in glucose, a similar decrease in insulin, and a much larger increase in glucagon, glucagon/insulin molar ratio, and beta-hydroxybutyrate concentrations. It is concluded that exercise amplifies some of the metabolic and hormonal effects of 2,5-AM, and that these effects cannot all be explained by the decrease in blood glucose levels.

Effects of physical exercise on liver ATP levels in fasted and phosphate-injected rats.

The purpose of the present study was to investigate the effects of exercise (30 min, 23 m/min, 0% grade) on the hepatic levels of ATP in fasted adrenodemedullated rats, with an intraperitoneal injection of sodium phosphate (Na (2) PO (4 ), 0.91 mM) or saline (NaCl). Sodium phosphate was injected to determine if the postulated decrease in liver ATP during exercise may be changed by providing an excess of phosphate. At the end of exercise, a piece of liver was rapidly freeze clamped and used for the enzymatic determination of ATP levels. Liver ATP, in saline-injected rats, was significantly (P < 0.05) decreased by fasting, compared to fed rats (𝒳 +/- SE: 3. 21 +/- 0.2 vs 2.86+/- 0.2 micromol/g). Exercise in fasted rats decreased even more the ATP response in liver (2.58 +/- 0.14 micromol/g). Injection of Na (2) PO (4) did not significantly (P > 0. 05) alter the pattern of ATP response following these 3 conditions (3.35 +/- 0.14 vs 3.0 +/-0.12 vs 2.57 +/- 0.1 micromol/g), ATP levels being significantly (P <0.05) decreased by the fast and the exercise in the fasted state. Fasting and exercise resulted in a significant (P < 0.05) decrease in liver glycogen and plasma glucose concentrations and an increase in free fatty acid levels in both NaCl- and Na (2 )PO (4) -injected groups. In both injection conditions, beta-hydroxybutyrate and peripheral insulin concentrations were respectively, increased and decreased (P < 0.05) by fasting, while norepinephrine and portal glucagon were decreased (P > 0.05) following exercise. The main effect of the injection of Na ( 2) PO (4) was a stimulation (P < 0.05) of peripheral glucagon response following exercise. It is concluded that exercise results in a decrease in liver ATP levels even in fasted rats and that this decrease is not corrected by Na (2 )PO( 4) administration. The decreased liver ATP levels might be involved in the metabolic adaptations to exercise.

Effect of hepatic portal injection of ouabain on the hepato-sympathoadrenal reflex.

The purpose of the present investigation was to evaluate the effects of an intraportal injection of ouabain (2 mg/kg), an inhibitor of the sodium-potassium pump, on plasma catecholamine response in unrestrained normally fed rats with and without an intact hepatic vagus nerve. Three groups of rats were submitted to two injection conditions each. Hepatic vagotomized (HV) rats were randomly injected with ouabain or saline (0.9%) in the portal vein. Sham-operated rats were either injected with ouabain or saline in the portal or jugular vein. Ouabain or saline were injected at 0 min and again at 20 min. Plasma catecholamines were measured before the first injection and 15 min after each injection. Blood glucose concentrations were significantly (p < 0.01) increased by the ouabain injection as compared with basal values and saline-injected groups. The hyperglycemic effect of ouabain was not affected by the hepatic vagotomy or the site of infusion. The injection of ouabain, either into the portal or the jugular vein and either after HV or the sham operation, resulted in a significant (p < 0.01) increase in epinephrine levels as compared with saline-infused rats. Plasma norepinephrine levels were significantly (p < 0.05) increased after the second intraportal injection of ouabain in both HV and sham-operated groups. However, the injection of ouabain into the jugular vein did not change the plasma norepinephrine levels. The latter observation indicates a specific action of ouabain in the liver on the sympathetic activity.

Effects of hepatic portal infusion of deionized water on metabolic and hormonal responses to exercise in rats.

The present study was conducted to investigate the in vivo effects of an intrahepatic infusion of deionized water during exercise in rats. Adrenodemedullated male Sprague-Dawley rats were continuously infused for 30 min either at rest or during treadmill exercise (26 m/min, 0% grade). Rats were randomly assigned to one of three infusion conditions (52 micro ul/min) with either deionized water (PW) or saline (PS; NaCl; 0.9%) via the hepatic portal vein or deionized water through the jugular vein (JW). The exercise period caused a significant (P < 0.05) decrease in liver glycogen and relative liver water content and peripheral and portal blood glucose and insulin while increasing peripheral and portal glucagon and K+ plasma concentrations. These responses, with the exception of K+, were not influenced by the different types of infusions. The increase in K+ during exercise was significantly (P < 0.05) higher in JW rats than in the PW and PS groups. Both the infusion and exercise protocols did not significantly alter the liver weight-to-body weight ratio, plasma osmolality, free fatty acids, beta-hydroxybutyrate, Na+, Cl-, vasopressin, and catecholamine concentrations. It is concluded that an hepatic portal infusion of deionized water does not specifically alter the metabolic and hormonal responses to exercise in rats.

Metabolic and hormonal responses to exercise in partially hepatectomised rats.

To characterise how the liver affects metabolic and hormonal exercise responses, hepatectomised (70%; HX) rats were submitted to a 30- or 50-min treadmill exercise (26 m/min, 0% slope) 48 hr or 7 days after surgery (reduced or normal liver mass, respectively). To determine whether metabolic effects of liver mass reduction during exercise were caused by reduced capacity of the liver to produce glucose, metabolic and hormonal responses to the same exercise protocol were measured in 48-hr HX rats. Euglycemia, maintained by exogenous glucose infusion, produced attenuated lactate, insulin, and glucagon values in 48-hr HX rats but did not affect FFA, glycerol, and plasma catecholamine responses. Results indicate that metabolic and hormonal exercise responses are amplified in 48-hr HX rats. Maintaining euglycemia in 48-hr HX rats during exercise does not reduce all responses. Intrahepatic events, similar to those in a short-term (48-hr) HX liver, may influence metabolic and hormonal exercise responses.

Lack of effects of an acute hepatic vagotomy on insulin and catecholamine responses in rats following exercise.

The purpose of the present investigation was to evaluate the effects of an acute hepatic vagotomy on hormonal responses to hyperglycemic and hypoglycemic challenges in rats previously submitted to an exercise protocol. Two experiments were conducted. In a first experiment, 8-week trained (TR) and untrained (UNTR) rats, subdivided into acutely hepatic vagotomized (HV) and sham-operated (SHM) groups, were submitted to an intraperitoneal glucose tolerance test (0.5 g/kg) under anesthesia. Training was associated with a tendency (P = 0.07) for blood glucose levels to be less elevated (at time point 10 min), and with a significant (P < 0.01) lower glucose/insulin ratio following the glucose injection. The HV did not have any effects on these responses. In a second experiment, non-exercised rats and a group of rats submitted to an acute bout of exercise (treadmill, 60 min, 26 m/min, 5% slope) 24 h before the experiment, each one of these two groups being subdivided into acutely HV and SHM groups, were submitted to an insulin-induced hypoglycemia protocol, under anesthesia. Blood glucose concentrations were decreased significantly (P < 0.01) to approximately 40 mg/dl in all groups 60 and 80 min after the insulin injection. Plasma adrenaline and noradrenaline levels were increased significantly (P < 0.01) in all groups. The catecholamine increase was not influenced by the HV or the acute exercise bout. The present results do not indicate an implication of the hepatic vagus nerve on hormonal responses to hyper and hypoglycemia following exercise.

Effect of hepatic vagotomy on plasma catecholamines during exercise-induced hypoglycemia.

The existence of a hepatosympathetic reflex active during insulin-induced hypoglycemia has recently been reported. The purpose of the present investigation was to test the hypothesis that the liver, through the afferent innervation of the vagus nerve, contributes to plasma epinephrine and norepinephrine responses during exercise-induced hypoglycemia. Hepatic vagotomized and sham-operated rats were killed at rest or after 30, 60, and 120 min of running exercise (26 m/min, 0% grade). At the end of the 120-min exercise period, liver glycogen, glucose, and insulin levels measured in the portal and peripheral plasma were all significantly reduced (P < 0.05) while epinephrine and norepinephrine concentrations, beta-hydroxybutyrate, lactate, and portal and peripheral glucagon plasma levels were all significantly increased (P < 0.05). However, no significant differences were observed between hepatic vagotomized and sham-operated rats at rest and after exercise for the metabolic and hormonal responses. These results suggest that if a hepatosympathetic reflex is active during an exercise-induced hypoglycemia situation, then this contribution is probably hidden by more important regulatory mechanisms.

Adaptation of maximal aerobic and anaerobic tests for disabled swimmers.

The purpose of the present study was to submit disabled swimmers to two maximal swimming tests, and by comparing the physiological and performance responses of disabled and normal swimmers to determine if these adapted tests can be used to design training programmes for this particular class of swimmer. Two groups of disabled (n = 8 and 6) and two groups of normal competitive swimmers (n = 9 and 13) were respectively submitted to a functional maximal aerobic power test (FMAPT) and a maximal anaerobic lactic test (MANLT). For the disabled, the FMAPT included a slower initial speed and a slower increase in swimming speeds. In the maximal aerobic test, exercise duration, peak heart rate, and the maximal speed relative to the respective best time of a 100-m race [55.5 (SD 3.9) compared to 56.5 (SD 2.8)%] were not significantly different between the disabled and normal swimmers. Peak lactate concentration was, however, higher in the disabled swimmers [10.8 (SD 3.5) compared to 6.8 (SD 1.6)mmol.l-1]. In the MNALT, peak lactate concentration [14.3 (SD 4) compared to 16.8 (SD 1.9)mmol.l-1], and the maximal speed relative to the respective best time in a 100-m race [99.1 (SD 3.2) compared to 98.3 (SD 2.5)%] were not significantly different between the disabled and normal swimmers. These results would seem to indicate that functional maximal aerobic and anaerobic field tests could be used to evaluate and design training programmes for disabled competitive swimmers.

Multiple coarctations of the pulmonary artery: scintigraphic appearance.

A case of angiography-proven multiple coarctations of the pulmonary arteries is presented. The patient had a history of long-standing exertional dyspnea and intranasal cocaine use. A chest radiograph suggested oligemia in the left lung and enlargement of the right pulmonary artery, prompting ventilation and perfusion radionuclide lung imaging. The combined scintigraphic and radiographic findings were indistinguishable from those caused by pulmonary emboli. Although rare, this entity should be included in the differential diagnosis of multiple unmatched perfusion defects on pulmonary ventilation-perfusion studies.