ABSTRACT
BACKGROUND: Dipeptidyl peptidase 4 (DPP4) is a serine exopeptidase able to inactivate various oligopeptides, and also a hepatokine. Hepatocyte-specific overexpression of DPP4 is associated with hepatic insulin resistance and liver steatosis. METHOD: We examined whether weekly DPP4 inhibitor omarigliptin (OMG) can improve liver function as well as levels of inflammation and insulin resistance in type 2 diabetic patients with non-alcoholic fatty liver disease (NAFLD). Further, we investigated the effects of OMG in a diabetic patient with biopsy-confirmed nonalcoholic steatohepatitis (NASH). RESULTS: In NAFLD patients, OMG significantly decreased levels of aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, homeostatic model assessment of insulin resistance (HOMA-IR), and high-sensitivity C-reactive protein (hsCRP), while no significant change was seen in hemoglobin A1c or body mass index. In the NASH patient, liver function improved markedly, and levels of the hepatic fibrosis marker FIB-4 decreased in parallel with HOMA-IR and hsCRP. Slight but clear improvements in intrahepatic fat deposition and fibrosis appeared to be seen on diagnostic ultrasonography. CONCLUSION: Weekly administration of the DPP4 inhibitor OMG in ameliorating hepatic insulin resistance may cause beneficial effects in liver with NAFLD/NASH.
ABSTRACT
BACKGROUND: Intracranial artery calcification has been reported to be an independent risk factor for ischemic stroke. Also, existence of a positive correlation has been reported between the presence of arterial calcification and that of ischemic changes in the area supplied by such arteries. While intracranial artery calcification has frequently been observed on computed tomographic (CT) images of the brain in hemodialysis patients, its prevalence has not been reported previously. We investigated our hemodialysis outpatients to determine the prevalence of intracranial artery calcification in these patients in comparison with that in healthy controls. METHODS: Brain CT examinations were performed in 107 patients under maintenance hemodialysis therapy. For comparison, 43 representatives of the general population who underwent a brain CT examination as part of a health checkup were also studied as control subjects. RESULTS: Intracranial calcifications were more frequently found among hemodialysis patients (87.9%) than among control subjects (53.5%, P = 0.0003), and the prevalences of calcification in each of the intracranial arteries in the two groups were as follows: vertebral artery (65.5% vs. 25.6%, P = 0.0002), internal carotid artery (62.1% vs. 18.6%, P < 0.0001), basilar artery (34.5% vs. 34.9%, ns), anterior cerebral artery (0 vs. 2.3%, ns), middle cerebral artery (24.1% vs. 20.9%, ns), and posterior cerebral artery (5.2% vs. 4.7%, ns). CONCLUSIONS: A much higher rate of intracranial artery calcification was observed in hemodialysis patients than in the general population, and the most frequently involved sites of calcification in these patients were the relatively large intracranial arteries.
