Pascal Brassard

Abnormal in vivo myocardial energy substrate uptake in diet-induced type 2 diabetic cardiomyopathy in rats

The purpose of this study was to determine in vivo myocardial energy metabolism and function in a nutritional model of type 2 diabetes. Wistar rats rendered insulin-resistant and mildly hyperglycemic, hyperinsulinemic, and hypertriglyceridemic with a high-fructose/high-fat diet over a 6-wk period with injection of a small dose of streptozotocin (HFHFS) and control rats were studied using micro-PET (microPET) without or with a euglycemic hyperinsulinemic clamp. During glucose clamp, myocardial metabolic rate of glucose measured with [(18)F]fluorodeoxyglucose ([(18)F]FDG) was reduced by approximately 81% (P < 0.05), whereas myocardial plasma nonesterified fatty acid (NEFA) uptake as determined by [(18)F]fluorothia-6-heptadecanoic acid ([(18)F]FTHA) was not significantly changed in HFHFS vs. control rats. Myocardial oxidative metabolism as assessed by [(11)C]acetate and myocardial perfusion index as assessed by [(13)N]ammonia were similar in both groups, whereas left ventricular ejection fraction as assessed by microPET was reduced by 26% in HFHFS rats (P < 0.05). Without glucose clamp, NEFA uptake was approximately 40% lower in HFHFS rats (P < 0.05). However, myocardial uptake of [(18)F]FTHA administered by gastric gavage was significantly higher in HFHFS rats (P < 0.05). These abnormalities were associated with reduced Glut4 mRNA expression and increased Cd36 mRNA expression and mitochondrial carnitine palmitoyltransferase 1 activity (P < 0.05). HFHFS rats display type 2 diabetes complicated by left ventricular contractile dysfunction with profound reduction in myocardial glucose utilization, activation of fatty acid metabolic pathways, and preserved myocardial oxidative metabolism, suggesting reduced myocardial metabolic efficiency. In this model, increased myocardial fatty acid exposure likely occurs from circulating triglyceride, but not from circulating plasma NEFA.

Dose-Dependent Delay of the Hypoglycemic Effect of Short-Acting Insulin Analogs in Obese Subjects With Type 2 Diabetes A pharmacokinetic and pharmacodynamic study

OBJECTIVE Injected volume and subcutaneous adipose tissue blood flow (ATBF) affect insulin absorption. Pharmacokinetics of short-acting insulin analogs were established by assessing injection of small doses in lean subjects, healthy or with type 1 diabetes. In obese patients, however, daily dosages are larger and ATBF is decreased. This study assessed the kinetics of a short-acting insulin analog in obese subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS Euglycemic clamps after subcutaneous lispro injections were performed. Six healthy control subjects received 10 units. Seven obese (BMI 38.3 ± 7.0 kg/m2) subjects with type 2 diabetes received 10, 30, and 50 units. Plasma lispro was measured by specific radioimmunoassay and ATBF by the 133Xe-washout technique. RESULTS ATBF was 64% lower in subjects with type 2 diabetes than in control subjects. After 10 units injection, time to lispro plasma peak (Tmax) was similar (48.3 vs. 55.7 min; control subjects versus type 2 diabetic subjects), although maximal concentration (Cmax)/dose was 41% lower in subjects with type 2 diabetes, with lower and delayed maximal glucose infusion rate (GIRmax: 9.0 vs. 0.6 mg/kg/min, P < 0.0001, 69 vs. 130 min, P < 0.0001, respectively). After 30- and 50-unit injections, Tmax (88.6 and 130.0 min, respectively) and time to GIRmax (175 and 245 min) were further delayed and dose related (r2 = 0.51, P = 0.0004 and r2 = 0.76, P < 0.0001, respectively). CONCLUSIONS Absorption and hypoglycemic action of increasing dosages of lispro are critically delayed in obese subjects with type 2 diabetes.

Update on adipose tissue blood flow regulation.

According to Ficks principle, any metabolic or hormonal exchange through a given tissue depends on the product of the blood flow to that tissue and the arteriovenous difference. The proper function of adipose tissue relies on adequate adipose tissue blood flow (ATBF), which determines the influx and efflux of metabolites as well as regulatory endocrine signals. Adequate functioning of adipose tissue in intermediary metabolism requires finely tuned perfusion. Because metabolic and vascular processes are so tightly interconnected, any disruption in one will necessarily impact the other. Although altered ATBF is one consequence of expanding fat tissue, it may also aggravate the negative impacts of obesity on the bodys metabolic milieu. This review attempts to summarize the current state of knowledge on adipose tissue vascular bed behavior under physiological conditions and the various factors that contribute to its regulation as well as the possible participation of altered ATBF in the pathophysiology of metabolic syndrome.

Relationship between Total and High Molecular Weight Adiponectin Levels and Plasma Nonesterified Fatty Acid Tolerance during Enhanced Intravascular Triacylglycerol Lipolysis in Men

CONTEXT Increased plasma nonesterified fatty acid (NEFA) appearance during enhanced intravascular triacylglycerol (TG) lipolysis is a marker of metabolic adipose tissue dysfunction and may lead to the development of insulin resistance. The relationship between total and high molecular weight (HMW) adiponectin levels, NEFA appearance, and total TG lipolytic capacity has not been previously studied in humans. OBJECTIVES Our objective was to determine whether total and HMW adiponectin plasma levels are associated with plasma NEFA level and appearance, and with total TG lipolytic rate during enhanced intravascular TG lipolysis in men. DESIGN This was a cross-sectional metabolic study. SETTING The study was performed at an academic clinical research center. PARTICIPANTS There were 15 healthy men (mean +/- sd body mass index 25.5 +/- 4.7 kg/m(2)) aged 21-50 yr (mean +/- sd 31.1 +/- 10.2) without first-degree relatives with type 2 diabetes included in the study. INTERVENTIONS Pancreatic clamps and iv infusion of stable isotopic tracers ([1,1,2,3,3-(2)H(5)]glycerol and [U-(13)C]palmitate) were performed, whereas intravascular TG lipolysis was clamped by iv infusion of heparin plus Intralipid at low (fasting) and high insulin levels. Total and HMW adiponectin levels were measured using an ELISA. MAIN OUTCOME MEASURES Levels of total and HMW adiponectin, palmitate appearance (plasma palmitate appearance rate), and glycerol appearance (plasma glycerol appearance rate) were calculated. RESULTS During heparin plus Intralipid infusion, total and HMW adiponectin was inversely correlated with plasma palmitate appearance rate (r = -0.65; P = 0.01), but this association was lost when expressed per nonlean weight. Adiponectin levels were positively associated with plasma glycerol appearance rate per nonlean weight (r = 0.71 and r = 0.66, respectively; P < or = 0.01). CONCLUSIONS Increased adipose tissue mass likely explains the association between low adiponectin and reduced NEFA tolerance. Adiponectin level is a marker of total TG lipolytic rate per adipose tissue mass in men.

Regulation of blood flow in adipose tissue: involvement of the cholinergic system

Acetylcholine (Ach) has vasodilatory actions. However, data are conflicting about the role of Ach in regulating blood flow in subcutaneous adipose tissue (ATBF). This may be related to inaccurate ATBF recording or to the responder/nonresponder (R/NR) phenomenon. We showed previously that healthy individuals are R (ATBF increases postprandially by >50% of baseline BF) or NR (ATBF increases ≤50% postprandially). Our objective was to assess the role of the cholinergic system on ATBF in R and NR subjects. ATBF was manipulated by in situ microinfusion of vasoactive agents (VA) in AT and monitored by the (133)Xenon washout technique (both recognized methods) at the VA site and at the control site. We tested incrementally increasing doses of Ach (10(-5), 10(-3), and 10(-1) mol/l; n = 15) and Ach receptor antagonists (Ra) before and after oral administration of 75-g glucose using atropine (muscarinic Ra; 10(-4) mol/l, n = 13; 10(-5) mol/l, n = 22) and mecamylamine (nicotinic Ra; 10(-3) mol/l, n = 15; 10(-4) mol/l, n = 10). Compared with baseline [2.41 (1.36-2.83) ml·100 g(-1)·min(-1)], Ach increased ATBF dose dependently [3.32 (2.80-5.09), 6.46 (4.36-9.51), and 10.31 (7.98-11.52), P < 0.0001], with no difference between R and NR. Compared with control side, atropine (both concentrations) had no effect on fasting ATBF; only atropine 10(-4) mol/l decreased post-glucose ATBF [iAUC: 1.25 (0.32-2.91) vs. 1.98 (0.64-2.94); P = 0.04]. This effect was further apparent in R. Mecamylamine had no impact on fasting and postglucose ATBF in R and NR. Our results suggest that the cholinergic system is implicated in ATBF regulation, although it has no role in the blunting of ATBF response in NR.

Restoring ATBF: Dreaming the impossible dream?

Dear Sir: Knowledge of the longterm effect of weight loss on adipose tissue blood flow (ATBF) is scarce. We read with great interest the paper by Rossi et al. [3], reporting the results of a study using laser-Doppler flowmetry (LDF), where baseline thigh ATBF was lower in morbidly obese subjects compared to ageand sex-matched controls (4.8 vs. 79.9 perfusion units /PU). These results confirm several previous studies [4]. After one-year follow-up subsequent to Roux-en Y gastric bypass (RYGB) in obese patients, they observed a meaningful weight loss (−40 kg, e.g.−28%). This weight loss was associated with a slight but nevertheless significant increase in ATBF (up to 10.0 PU) although patients remained obese. The main limitations of the Rossi et al. study are linked to the inherent drawbacks of the LDF method, relating mainly to calibration, multiple Doppler shifts, tissue optical properties, motion artefacts, biological zero and impossibility to express the results in absolute values [2]. The gold-standard for ATBF measurement is the 133 xenon wash-out method, which should be combined with LDF in order to validate data obtained therewith [1]. Anemia, a frequent complication of RYGB, and antihypertensive drugs, which may influence adipose tissue perfusion [4], could also interfere with LDF measurements. However, no indication relating to these specific issues was provided in the paper. Additionally, the chosen site of measurement stands out as another scientific issue, because subcutaneous adipose tissue in the thigh is known to be much less active than in abdomen [4]. Rossi et al.’s conclusion to the effect that the slight increase in ATBF, observed one year after RYGB, is rather negligible, is sustained by another study [5] reporting on ATBF following a very low-calorie diet