[Achievement quality evaluation of pretransfusion bedside test]. / Evaluation de la qualité de réalisation des tests de concordance ultime au lit du patient.

As far as transfusions accidents are concerned, immunological causes are frequent. Pretransfusion Bedside Compatibility Tests (PBCT) are the last chance to avoid them. However low data are disponible on the quality their realisation is achieved. The aim of the study is to evaluate the quality level of achievement of these tests, in HIA Laveran Hospital (Marseille Armees, France). During 13 months, from november 2001 to december 2002, we systematically analysed PBCT after use (analysis rate 91%). Three kinds of errors have been noticed: Technical errors, understanding errors and both. Overall mistake rate was 10.4% (1632 tests analysed). In the same time, a complementary formation was dispensed to users responsible of misfits. This formation was successful, decreasing the overall mistake rate from 22.8% (november 2001) to 10.7% (december 2002). This study is an evidence of the importance to evaluate achievement quality of PBCT and shows how efficient can be simple correction methods.

Insulin secretion, inositol phosphate levels, and phospholipase C isozymes in rodent pancreatic islets.

During a dynamic perifusion, 20 mmol/L glucose, 20 mmol/L alpha-ketoisocaproate (KIC) or 20 mmol/L methyl pyruvate (MP) stimulate biphasic insulin secretory responses from collagenase-isolated rat islets. Peak first-phase insulin responses were comparable for all 3 nutrient agonists. The largest second-phase insulin secretory response was evoked by 20 mmol/L glucose (30-fold above basal release rates), and this response was more sustained than that observed with either 20 mmol/L KIC or 20 mmol/L MP. When mouse islets were perifused under similar conditions, KIC stimulated the largest first-phase insulin response, while comparable acute insulin secretion rates were obtained with glucose- or MP-stimulated islets. In contrast to rat islets, the sustained second phase of insulin secretion from mouse islets was minimal regardless of the nutrient secretagogue used. This anomalous response of mouse islets as compared with rat islets could not be ascribed to any obvious difference in the glucose usage rate or insulin content between these 2 species. Glucose, KIC, or MP stimulated significant increases in 3H-inositol phosphates in rat islets. Significantly smaller increases were measured in mouse islets. Comparative Western blot analyses showed pronounced species differences in the expression of phospholipase Cbeta1 (PLCbeta1), PLCbeta2, PLCbeta3, and PLCdelta1 but not PLCgamma1 or protein kinase Calpha (PKCalpha) between rat and mouse islets. PLCbeta4 or PLCdelta2 could not be identified in either species. These findings are consistent with the concept that the underexpression of the nutrient-activated PLC isozyme may account for the minimal inositol phosphate (IP) and second-phase insulin secretory response from mouse islets.

Glucose-induced desensitization of the pancreatic beta-cell is species dependent.

The capacity of 20 mM glucose to desensitize insulin release was determined. A prior exposure to 20 mM glucose impaired the response of rat islets to subsequent restimulation. Compared with control islets, insulin secretory rates measured 25-30 min after the onset of 20 mM glucose stimulation were reduced by 75%. Restimulation of glucose-desensitized islets with 20 mM glucose plus 500 nM forskolin resulted in a dramatic enhancement of both phases of secretion. In contrast to the desensitization of rat islets induced by prior 20 mM glucose exposure, mouse islets were immune to this adverse effect of the hexose. Prior exposure to 20 mM glucose had no adverse effect on glucose usage rates. The activation of phospholipase C in glucose-desensitized rat islets was compromised when compared with control islets. The impairment could not be accounted for by a decrease in immunoreactive content of several major phospholipase C isozymes (beta1 or delta1) or their partitioning between the membrane and cytosolic compartments. In contrast to rat islets, prior exposure of mouse islets to 20 mM glucose for 180 min had no effect on inositol phosphate accumulation. These observations document an additional difference between rat and mouse islets and suggest that the evolution of desensitization is a consequence of the impaired activation of phospholipase C in rat islets.

Chronic exposure to TPA depletes PKC alpha and augments Ca-dependent insulin secretion from cultured rat islets.

The insulin secretory responses of rat islets to glucose (15 mM), 12-O-tetradecanoylphorbol 13-acetate (TPA; 500 nM), and potassium (30 mM) were determined from perifused islets cultured for 22-24 h in CMRL-1066 medium (control cultured) or islets cultured in the additional presence of 500 nM TPA. Islet content of protein kinase C alpha (PKC alpha) and serine and threonine phosphoprotein patterns were also monitored after the culture period. Compared with freshly isolated islets, culturing alone had no adverse effect on the capacity of TPA or 30 mM potassium to stimulate secretion or on the islet content of PKC alpha. In agreement with previous studies, culturing in TPA reduced the islet content of immunoreactive PKC alpha by > 95% and abolished the capacity of the phorbol ester to stimulate secretion during a subsequent dynamic perifusion. Culturing in TPA slightly improved the insulin secretory response to 15 mM glucose compared with control-cultured islets; however, sustained rates of 15 mM glucose-induced secretion from these islets were significantly less than the responses of freshly isolated islets. Islets cultured in TPA responded to 30 mM potassium with a markedly amplified insulin secretory response that was abolished by nitrendipine. Enhanced phosphorylation of several islet proteins was also observed in TPA-cultured islets compared with control-cultured islets. These findings demonstrate that culturing alone impairs glucose-induced secretion, a response that is improved but still subnormal compared with freshly isolated islet responses, if TPA is included in the culture medium. Sustained phosphorylation of several islet proteins in TPA-cultured islets may account, at least in part, for augmented calcium-dependent secretion.

Signal transduction in pancreatic beta-cells: regulation of insulin secretion by information flow in the phospholipase C/protein kinase C pathway.

The physiologic regulation of glucose-induced insulin secretion is dependent upon the activation of information flow in the phospholipase C (PLC)/protein kinase C (PKC) signal transduction system. In both rat and human pancreatic beta-cells, glucose has several time-dependent effects on secretory responsiveness including the regulation of biphasic insulin secretion, time-dependent potentiation and time-dependent suppression. PLC/PKC activation has been implicated in all three response patterns. Islets of Langerhans contain the three major PLC isozyme classes (beta1, gamma1 and delta1) and the available evidence suggests that one class is activated by fuel secretagogues and another by neurohumoral agonists. The expression and activation of PLC is labile. When rat islet are cultured for short periods, the content and activation of PLC in response to glucose decreases and this biochemical defect in signal transduction is paralleled by significant reductions in glucose-induced insulin secretion. Similar defects are observed when human islets are cultured as well. Mouse islet responses to glucose stimulation differ in several major and dramatic ways from rat and human islet responses. When stimulated by 15mM glucose, mouse islets fail to develop a rising second phase secretory response, they fail to exhibit either time-dependent potentiation or time-dependent suppression to the hexose. Biphasic insulin secretion can be evoked and time-dependent potentiation can be induced in mouse islets by carbachol, an agonist that activates an isozyme of PLC distinct from that activated by glucose. These divergent response patterns are attributable to the underexpression in mouse islets, when compared to rat islets, of a fuel-sensitive PLC isozyme. When taken in their entirety, the experimental evidence suggests that the activation of PLC is an essential component in the physiologic regulation of insulin secretion and that disordered activation of the enzyme culminates in disordered insulin release.