Fatty acids differentially regulate insulin resistance through endoplasm reticulum stress-mediated induction of tribbles homologue 3: a potential link between dietary fat composition and the pathophysiological outcomes of obesity.

AIMS/HYPOTHESIS: Previous studies have shown that saturated fatty acids cause insulin resistance (IR) that is prevented by unsaturated fatty acids. Tribbles homologue 3 (TRIB3) is a putative endogenous inhibitor of insulin signalling, but its role in insulin signalling is controversial. This study aimed to determine whether fatty acids regulate IR via TRIB3. METHODS: We treated HepG2 cells with saturated and unsaturated fatty acids and evaluated TRIB3 expression. We then tested whether regulation of TRIB3 occurred through endoplasmic reticulum (ER) stress, and whether modulating TRIB3 and ER stress marker genes was necessary and/or sufficient for regulation of insulin signalling. To test the in vivo significance of this mechanism, we fed mice obesogenic diets with different fatty acid profiles and assessed physiological variables of diabetes, ER stress markers and Trib3 expression in the liver. RESULTS: Our data show that fatty acids differentially regulate IR through ER stress-mediated induction of TRIB3. Intriguingly, a standard and widely used obesogenic diet high in unsaturated fats failed to induce ER stress, TRIB3 or IR. However, an alternative obesogenic diet with lower unsaturated fat recapitulated the cell studies by causing ER stress, TRIB3 induction and IR. CONCLUSIONS/INTERPRETATION: This study revealed a novel mechanism linking dietary fat composition to IR. Given the emerging roles for ER stress in non-alcoholic liver disease, we conclude that dietary fat composition rather than total amount may mediate hepatic pathology associated with obesity.

Transcatheter closure of a patent foramen ovale following mitral valve replacement.

We report the successful closure of a postoperative patent foramen ovale in a patient who underwent coronary artery bypass grafting and mitral valve replacement for severe mitral insufficiency. The postoperative course was complicated by severe hypoxemia due to a large patent foramen ovale. The patient underwent transcatheter closure with the Das Angel Wings transcatheter occluder (Microvena Corporation, White Bear Lake, MN) with immediate improvement.

Lobar pulmonary edema due to mitral regurgitation: diagnosis by echocardiography.

One etiology of unilateral lobar pulmonary edema is mitral regurgitation. Echocardiography is able to demonstrate the retrograde flow of blood into the pulmonary veins and allows timely diagnosis and treatment planning. Correction of mitral regurgitation is followed by resolution of the radiographic abnormality.

c-erbB-2/p185-directed therapy in human lung adenocarcinoma.

BACKGROUND: These experiments were conducted to determine whether p185 can be therapeutically targeted in adenocarcinoma of the lung using an anti-p185-gelonin conjugate. c-erbB-2/p185 is overexpressed in up to one third of non-small cell lung cancers. CALU-3 is a human lung adenocarcinoma cell line that overexpresses p185. muMoAb-4D5 is a murine anti-p185 monoclonal immunoglobulin G1. Gelonin is a potent type 1 ribosomal inhibitory protein. METHODS: 4D5 and gelonin were covalently modified and linked. Purification was confirmed by SDS-polyacrylamide gel electrophoresis. Dose-dependent cytotoxicity was quantified using 3H-thymidine uptake by CALU-3 cells after incubation with 4D5-gelonin conjugate or with control substances (4D5, gelonin, unconjugated 4D5 + gelonin, or control antibody MOPC-21). RESULTS: The 4D5-gelonin conjugate showed a 50% inhibitory concentration of 3.5 x 10(-10) mol/L, but 4D5 alone demonstrated no cytotoxic effect. Gelonin and the unconjugated 4D5-gelonin mixture had one tenth the cytotoxicity of the 4D5-gelonin conjugate (inhibitory concentration = 6.5 x 10(-9) mol/L and 8.5 x 10(-9) mol/L, respectively). The conjugate exhibited minimal toxicity against a p185-negative cell line (NIH3T3). CONCLUSIONS: Selective and efficient killing of human lung adenocarcinoma cells can be achieved in vitro using c-erbB-2/p185-directed therapy.

Salmonella mediastinal abscess.

Salmonella is a rare cause of a mediastinal infection. This report describes the 14-year natural history of a mediastinal mass with eventual abscess formation. Computed tomography provided excellent visualization, and surgical drainage afforded prompt diagnosis and treatment.

Necrotizing fasciitis secondary to discoid lupus erythematosus.

Necrotizing fasciitis (NF) is an uncommon, but devastating, disease with a significant morbidity and mortality, unchanged in the last several decades. This case report is the first successful management of a patient with NF secondary to discoid lupus erythematosus. A review of the literature describes current concepts of etiology, pathophysiology, diagnosis, and treatment of NF. This case report represents a growing class of patients at increased risk of NF due to iatrogenic immune compromise.

The influence of heme-binding proteins in heme-catalyzed oxidations.

We show here that heme-binding proteins may enhance, decrease, or completely inhibit heme-catalyzed oxidations and that in doing so the proteins themselves may be oxidized depending upon their relative affinities for heme and the nature of their interactions with this metalloporphyrin. That release of iron from heme was not responsible for the catalytic effect is indicated by the observation that heme induced more peroxidation of rat liver microsomal lipid in the presence of H2O2 than iron and that iron release is very low under the conditions employed. Hemopexin, which binds heme with high affinity, completely inhibited heme-catalyzed lipid peroxidation at concentrations slightly higher than that of heme, suggesting a unique role for this acute phase protein in antioxidant defense mechanisms. The protein itself was not oxidized, presumably because the putative bis-histidyl heme-hemopexin complex cannot interact with H2O2. Rat and human albumin and rat glutathione S-transferases (GST), proteins with moderate affinities for heme, decreased heme-catalyzed lipid peroxidation in a dose-dependent manner but were subject to oxidation. The GST were crosslinked forming a nondisulfide covalently linked subunit dimer as well as products of higher molecular weight whereas the oxidation products of the albumins had molecular weights only slightly higher than those of the native proteins. The changes in the electrophoretic patterns of GST and albumin were accompanied by a decrease in their tryptophan fluorescence and the formation of bityrosine-like products. Proteins with lower affinities for heme, such as bovine albumin and rat liver fatty acid-binding protein (L-FABP), enhanced lipid peroxidation at all concentrations tested. While bovine albumin was modified, L-FABP was not crosslinked nor were its tyrosine residues oxidized. Thus, the susceptibility of a protein to heme-mediated oxidative damage would appear to be determined by factors such as its affinity for heme, the nature of the amino acids in the vicinity of the bound catalyst and the availability of a free coordination site on the iron.

Early diagnosis of pancreatic infection by computed tomography-guided aspiration.

We performed 92 computed tomography-guided percutaneous needle aspirations of pancreatic inflammatory masses in 60 patients suspected of harboring pancreatic infection. Thirty-six patients (60%) were found by Gram stain and culture to have a total of 41 separate episodes of pancreatic infection. Among 42 aspirates judged to be infected by computed tomography-guided aspiration, all but one were confirmed by surgery or indwelling catheter drainage. Among 50 aspirates judged to be sterile, no subsequent evidence of infection was found. All patients tolerated the procedure well and no complications were noted. As a result of this technique, we observed that pancreatic infection occurs earlier than has been previously appreciated (within 14 days of the onset of pancreatitis in 20 of the 36 patients) and that infection may recur during prolonged bouts of pancreatitis. We conclude that guided aspiration is a safe, accurate method for identifying infection of the pancreas at an early stage.

Activation of serotonin2 (5-HT2) receptors by quipazine increases arterial pressure and renin secretion in conscious rats.

Quipazine, a nonselective serotonin (5-HT) agonist, has been shown to increase plasma renin activity (PRA). The present study examined the effects of quipazine on mean arterial pressure (MAP), heart rate (HR) and PRA in conscious, chronically catheterized male rats. Quipazine caused dose (0.3-3.0 mg/kg i.v.)-and time (up to 30 min)-dependent increases in MAP and PRA. The maximum increases in MAP (control = 94 +/- 2 mm Hg, 3 mg/kg = 155 +/- 1 mm Hg) and PRA (nanograms of angiotensin 1 per milliliter per hour; control = 2.5 +/- 0.2, 3 mg/kg = 25.2 +/- 5.9) were observed 5 min after quipazine. HR tended to decrease, but a significant bradycardia was observed only 15 min after 3 mg/kg. The selective 5-HT2 antagonist LY 53857 (1 mg/kg i.v.) did not affect MAP, HR or PRA per se, but at 0.03 to 1.0 mg/kg totally abolished the pressor response to quipazine (3 mg/kg). At 0.01 mg/kg, LY 53857 attenuated quipazine-induced hypertension, whereas 0.003 mg/kg was ineffective. Total blockade of quipazine-induced renin secretion was produced by LY 53857 at 0.003 mg/kg, and the response was still reduced by 50% at 0.001 mg/kg. In summary, although quipazine increases arterial pressure and renin secretion, endogenous 5-HT does not tonically control MAP or PRA in conscious, unrestrained, normotensive rats through 5-HT2 receptors. The 10-fold difference in the dose of LY 53857 necessary to block the pressor and renin responses may be due to subtle differences in receptor subtypes, or to pharmacokinetic properties favoring antagonism of quipazine-induced renin secretion.

Concanavalin A binding glycoproteins of epidermal cells.

The Concanavalin A reactive glycoproteins of epidermal cells were analyzed by the application of the iodinated lectin to molecules separated by SDS-PAGE. Normal epidermal cells were maintained as undifferentiated or differentiated by controlling the Ca++ concentration of the growth medium. Some 20 labeled bands could be resolved. Their relative intensities changed dramatically with the stage of differentiation. Fresh tissue gave a radioactive profile similar to that for cultured differentiated cells, except for evidence of damage from the techniques used to separate the epidermis from the dermis (the damage being progressively more severe going from heat to ammonium chloride to trypsin separation). The labeling patterns for three carcinogen-transformed cell lines were markedly different from those of the normal cells. The least tumorigenic cell line had a profile in many respects intermediate between those of the normal differentiated and undifferentiated cells, while the other 2 lines showed greater deviation.

CT appearance of afferent loop obstruction.

Obstruction of the afferent loop may develop in patients who have had a Billroth type II gastrojejunostomy. This obstructed loop has a characteristic but initially confusing computed tomographic appearance that might be mistaken for multiple peripancreatic cystic masses. Three cases of afferent loop obstruction due to gastric carcinoma are reported. In each case, the length of the jejunal segment incorporated into the afferent loop determined the number of cystic masses evident at each scan level. Recognition of the typical anatomic configuration and uniform size of these cystic masses is key to the correct diagnosis.

The effect of the state of differentiation on labeling of epidermal cell surface glycoproteins.

Epidermal cells were grown in a medium in which the Ca++ concentration controlled the stage of differentiation. Cell surface molecules of differentiated and undifferentiated cells were compared by lactoperoxidase-catalyzed iodination, by the interaction with 125I-lectins, and by the metabolic incorporation of L-(3H)-fucose. Molecular weights of the labeled components were determined by SDS-PAGE and autoradiography. After lactoperoxidase iodination, most of the radioactivity was found in polypeptide bands of 79,000, 65,000 and 56,000 daltons. The 79,000 band is the most intense for undifferentiated cells (and also for neoplastic cells) but disappears as differentiation proceeds. The 56,000 band is present in normal cells at all stages of differentiation but is absent from neoplastic cells. Glycoproteins reacted with 125I-lectins were found at 180,000, 130,000 and 85,000 daltons. The 130,000 band was the most prominent for differentiated cells labeled with wheat germ agglutinin but was essentially absent from the undifferentiated cells. With Ricinus communis agglutinin, this band was weaker for undifferentiated than for differentiated cells but was the most intense for both. After metabolic incorporation of tritiated fucose, radioactive glycoproteins were found at 130,000 and 85,000 daltons, with comparable intensities for differentiated and undifferentiated cells.

Lactoperoxidase-catalyzed iodination of membrane proteins in normal and neoplastic epidermal cells.

Cell surface proteins of normal human, mouse, and rat cells in primary culture, of human basal cell carcinoma, and of carcinogen-transformed cell lines were examined by lactoperoxidase-catalyzed iodination. Autoradiography was used to record the distribution of label in the polypeptide subunits separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis. There was no significant difference in the results for normal cells of human, mouse, and rat. On the other hand, carcinogen-transformed mouse cells had many more labeled polypeptide bands of widely distributed molecular weights. The iodination profiles from human basal cell carcinoma cells were much more akin to those from normal cells than to those from carcinogen-transformed cells. Treatment of iodinated cells with proteolytic enzymes visibly altered the polypeptide bands.

Separation of newborn rat epidermal cells on discontinuous isokinetic gradients of PERCOLL.

A one-step procedure has been developed for the separation of epidermal cells using PERCOLL (a new colloidal silica medium of low viscosity, osmolarity, and toxicity) for density gradient centrifugation. Newborn rat epidermal cells were dispersed with trypsin-EDTA and separated into 4 fractions in discontinuous isokinetic gradients. The cell fractions were characterized by their appearance in photomicrographs and their distribution by number and size. Preferential incorporation of 3H-thymidine and 14C-glycine, by basal and granular cells respectively, confirmed the identification of cell types. The basal cells, which were collected in the densest fraction (1.090), were the most homogeneous population with a mean diameter between 7-8 mum and showed 98% viability. The granular cells predominated in the least dense fraction (1.023). The intermediate fractions contained spinous cells admixed with the other cell types.