Many elderly undergo cardiac surgery. The prevalence of malnutrition in elderly is high and increases with comorbidity. This thesis aims to clarify some aspects on performing surgery in elderly concerning nutritional status, nutritional treatment and age-related physiology. Study I: 886 patients were assessed preoperatively by body mass index (BMI) and S-albumin and postoperatively for mortality and morbidity.. Low BMI increased the relative hazard for death and low S-albumin increased the risk for infection. BMI and S-albumin are useful in preoperative evaluations Study II: we followed energy intake in 31 patients for five postoperative days. Scheduled and unscheduled surgery did not differ in preoperative resting energy expenditure (REE). REE increased by 10-12% postoperatively, more in unscheduled CABG. Nutritional supplementation increased total energy intake. All patients exhibited postoperative energy deficits, less prominent in the supplemented group. There were no differences in protein synthesis or muscle degradation. Study III: in 16 patients, .we measured stress hormones and insulin resistance before surgery and for five postoperative days Patients were insulin resistant on the first two days. We saw no clearly adverse or beneficial effects of oral carbohydrate on insulin resistance or stress hormone response. Study IV: 73 patients, with early enteral nutrition (EN), were observed until discharge or resumed oral nutrition. EN started within three days in most patients. In a minority, problems occurred (gastric residual volumes, tube dislocation, vomiting, diarrhoea, aspiration pneumonia). In the cardiothoracic ICU individually adjusted early EN is feasible. Study V: in 16 patients, splanchnic blood flow (SBF) enhancing treatments (dopexamine (Dpx) or EN) were compared. Dpx increased systemic blood flow, but had only a transient effect on SBF. EN had no effect on systemic blood flow or SBF. Neither Dpx, EN or the combined treatment, exhibited any difference between groups on systemic or splanchnic VO2 or oxygen extraction ratio.

Obesity is a major health problem in the Western world. Mean birth weight has increased during the last 25 years. One explanation is that the proportion of large for gestational age (LGA) infants has increased. Such infants risk developing obesity, cardiovascular disease and diabetes later in life. Despite the risk of neonatal hypoglycemia, their postnatal metabolic adaptation has not been investigated. Our data, obtained with stable isotope labeled compounds, demonstrate that newborn LGA infants have increased lipolysis and decreased insulin sensitivity. After administration of glucagon, the plasma levels of glucose and the rate of glucose production increased. The simultaneous increase in insulin correlated with the decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants. We also demonstrated an intergenerational effect of being born LGA, since women born LGA, were at higher risk of giving birth to LGA infants than women not born LGA. Further, the LGA infants formed three subgroups: born long only, born heavy only, and born both long and heavy. Infants born LGA of women with high birth weight or adult obesity were at higher risk of being LGA concerning weight alone, predisposing to overweight and obesity at childbearing age. In addition we found that pregnant women with gestational diabetes were at increased risk of giving birth to infants that were heavy alone. This could explain the risk of both perinatal complications and later metabolic disease in infants of this group of women. To identify determinants of fetal growth, 20 pregnant women with a wide range of fetal weights were investigated at 36 weeks of gestation. Maternal fat mass was strongly associated with insulin resistance. Insulin resistance was related to glucose production, which correlated positively with fetal size. The variation in resting energy expenditure, which was closely related to fetal weight, was largely explained by BMI, insulin resistance, and glucose production. Lipolysis was not rate limiting for fetal growth in this group of women. Consequently, high maternal glucose production due to a high fat mass may result in excessive fetal growth.

All living cell functions require an ongoing supply of energy derived from carbohydrates, lipids and proteins with their own pathways of breakdown. All of them end up in the oxidation of reduced coenzymes, yielding chemically-bound energy in the form of adenosine triphosphate (ATP). One broad definition of energy would be the capability to do work and, therefore, the more work that has to be done, the more energy is needed, which may under extreme conditions put the cell into a state of energy metabolic stress. This complex of problems has been examined in the present thesis, where individuals representing different degrees of training status, have been subjected to various types of stressful work-loads as regards intensity and duration. Meanwhile, the energy turnover has been monitored on different levels as whole body (organism)-, single organ/tissue-, cellular and molecular levels. Combined methodologies have been developed and utilized to examine carefully and in some detail energy expenditure and biochemical variables with study subjects under long-term, (outfield) physically and mentally stressful conditions. When the individuals were in a well-controlled energy balance, a diet rich in saturated fatty acids did not elicit any major metabolic stress signs concerning serum lipoproteins and/or insulin/glucose homeostasis during the test period including high volume and low intensity energy turn over. Only a slight decrease in the Apo-B / Apo-A1 ratio was observed, despite a period of totally sedentary life style among the participants. Mental stress combined with a varying energy balance during off-shore sailing races was shown to cause such an energy metabolic stress situation that development of abdominal obesity and signs of a metabolic syndrome in embryo affected the participants who were young, non-obese men and despite their fairly healthy lifestyle concerning the diet they were on and their physical activity habits. Even well-trained young individuals of both sexes, subjected to exhaustive endurance (high intensity exercise session), developed signs of insulin resistance with a deteriorated intracellular glucose availability leading to a supposed ion pump failure and a disturbed osmoregulation on a cellular level. Hence, they presented themselves as having acquired an energy metabolic stress like condition. In conclusion, an energy metabolic stress syndrome has been described, basically due to impaired fuelling of ion pumps with a cluster of signs and symptoms on single organ/tissue-, cellular and molecular levels manifested by muscular intracellular swelling, tendency towards erythrocyte shrinkage as a consequence of a relative insulin resistance concomitant with ion distribution disturbances (Gardos effect), oxidative stress and osmoregulatory taurine leakage.

Zusammenfassung: Effekte der L-Carnitinsupplementierung auf das metabolische Profil adipöser und insulinre- sistenter Ponys im Verlaufe einer mehrwöchigen Körpergewichtsreduktion Author: Uta Schmengler Institut für Tierernährung, Ernährungsschäden und Diätetik, Veterinärmedizinische Fakultät, Universität Leipzig Eingereicht im September 2012 76 S., 16 Abb., 23 Tab., 169 Lit., Anhang Einleitung: Das ”Equine Metabolische Syndrom” ist gekennzeichnet durch eine regionale oder generalisierte Adipositas, eine periphere Insulinresistenz sowie akute oder chronische Hufreheschübe. Die Ursache ist in einer bedarfsübersteigenden, hochkalorischen Fütterung und einem relativen Bewegungsmangel zu suchen, wobei auch der genetischen Prädisposition spezieller Rassen eine gewisse Bedeutung zukommt. Ziel dieser Studie war die Untersuchung der Effekte einer L-Carnitinsupplementierung in Kombination mit einer restriktiven Füt- terung und täglicher moderater Bewegung auf Körpermasseverlust, Insulinsensitivität und ausgewählte Parameter des Energiestoffwechsels adipöser und insulinresistenter Ponys. Material und Methoden: Für die placebokontrollierte Doppelblindstudie wurden 16 adipöse Ponys per Losverfahren in zwei Gruppen (N=8) eingeteilt. Zu Versuchsbeginn wiesen die Ponys einen mittleren Body Condition Score von 8,0±2,0 (Skala 1-9) und einen mittleren Cresty Neck Score von 4,0±1,0 (Skala 0-5) auf. Während des 14-wöchigen Körpermassere- duktionsprogramms wurden die Ponys restriktiv gefüttert mit 1 - 1,2 kg Heu/100 kg KM/d. Zusätzlich erhielten 8 Ponys eine L-Carnitin-Zulage (1,3 g/100 kg KM/2d) und 8 Tiere ein Placebo in Form einer Kieselsäureverbindung (1,3 g/100 kg KM/ 2d). Die Ergänzungen wur- den in einem Gemisch aus Grünmehl (50 g/2d) und Mineralfutter verabreicht. Über die 14-wöchige Versuchszeit wurde ein Bewegungsprogramm an sechs Tagen in der Woche durch- geführt, das 25 Minuten Schritt und 15 Minuten Trab beinhaltete. Zu Versuchsbeginn und nach Versuchsende wurde mit beiden Versuchsgruppen ein Frequently sampled intravenous glucose tolerance test (FSIGTT) zur Überprüfung der Insulinsensitivität durchgeführt. Über die gesamte Versuchszeit wurden wöchentlich Blutproben gewonnen zur Bestimmung der ba- salen Serum-Insulinaktivität und Plasma-Glucosekonzentration sowie der Konzentration der Freien Fettsäuren (FFS), Triacylglyceride (TAG), Harnstoff und Betahydroxybutyrat (BHB) im Serum. Die Körpermasseverluste wurden über wöchentliche Wägungen sowie Ermittlung von BCS und CNS kontrolliert. Die statistische Überprüfung wurde anhand parametrischer (ANOVA) und nicht-parametrischer Tests (Wilcoxon signed rank test) durchgeführt, die Kal- kulation der Insulinsensitivität erfolgte über das Minimalmodell anhand eines Computerpro- gramms (MINMOD). Ergebnisse: Im Mittel verloren die Ponys über den Versuchszeitraum von 14 Wochen 1- 3% ihrer Körpermasse pro Woche (Zeit: p < 0, 01, Behandlung: p=0,79), was einem totalen Körpermasseverlust von 14,3±% entsprach. Der BCS reduzierte sich in beiden Versuchs- gruppen um eine Differenz von 3 Einheiten, der CNS verringerte sich in der Carnitingrup- pe (GC ) um eine Differenz von 1,4 und in der Placebogruppe (GP ) um eine Differenz von 1,9 Einheiten. Der Körpermasseverlust war von einer signifikanten Verbesserung der Insu- linsensitivität (Zeit p < 0, 01, Behandlung: p=0,39) begleitet. Die Kalkulation der Insulin- sensitivität im Minimalmodell zeigte eine signifikante Erhöhung der SI-Werte am Versuch- sende in beiden Versuchsgruppen (Beginn Studie GC : 0,76±0,88 l/min/μU*10−4 und GP : 1,61±1,31 l/min/μU*10−4 ; Ende Studie GC : 5,45±0,81 l/min/μU*10−4 und GP : 6,08±2,98 l/min/μU*10−4 ). Signifikante, zeitabhängige Veränderungen wurden auch für die metabo- lischen Parameter beobachtet: Plasma-Glucose und Serum-Insulin reagierten mit einem si- gnifikanten Abfall (Glucose GC : 4,5±0,32 mmol/l vs. 4,21±0,61 mmol/l und Glucose GP : 4,34±0,62 mmol/l vs. 3,86±0,34 mmol/l; Insulin GC : 23,71±32,77 μU/ml vs. 3,67±3,94 μU/ml und GP : 13,55±12,67 μU/ml vs. 1,01±1,09 μU/ml). Dabei kam es zu einem signi- fikanten Anstieg des Serum-Harnstoffs (GC : 3,47±0,73 mmol/l vs. 4,31±1,06 mmol/l und GP : 3,71±0,79 mmol/l vs. 4,9±1,23 mmol/l) sowie der Serum-FFS (GC : 157±95 μmol/l vs. 731±138 μmol/l und GP : 113±63 μmol/l vs. 686±142 μmol/l) und Serum-TAG (GC : 0,53±0,28 mmol/l vs. 0,94±0,61 mmol/l und GP : 0,45±0,23 mmol/l vs. 0,64±0,25 mmol/l). Bezüglich der L-Carnitinsupplementierung wurden keine weiteren Effekte verzeichnet. Schlussfolgerungen: Die restriktive Energiezufuhr von 7 MJ DE/100 kg KM entspre- chend einer Heuzulage von 1 kg/100 kg KM führte zu KM-Verlusten von 1-3 %. Eine Kör- permassereduktion zeigte deutliche Auswirkungen auf den Glucose- und Lipidmetabolismus und führte zu einer signifikanten Verbesserung der Insulinsensitivität, wohingegen die L- Carnitinsupplementierung keine weiteren Effekte auf den Glucosestoffwechsel herbeiführte. Eine bedarfsdeckende Eigensynthese von L-Carnitin ist beim Pony offensichtlich auch im Zu- stand der Insulinresistenz gewährleistet und reicht aus um die obligatorischen Funktionen L-Carnitins im Energiestoffwechsel zu erfüllen. / Summary: The effects of L-carnitine supplementation on body weight losses and metabolic profile in obese and insulin resistant ponies during a several weeks lasting bodyweight reduction pro- gramme Author: Uta Schmengler Institute of Animal Nutrition, Nutrition Diseases and Dietetics, Faculty of Veterinary Medi- cine, University of Leipzig Submitted in September 2012 76 p., 16 fig., 23 tab., 169 ref., appendix Introduction: Insulin resistance, local or general adiposity and the predisposition towards acute or chronical laminitis are components of the equine metabolic syndrome. Contributing factors for this syndrome are the intake and the quality of a high caloric feed by a lack of physical exersice. Howewer, the genetically predisposition of so called ”easy keepers” seems to play a role in pathogenesis. The objective of this study was to investigate the effects of L- carnitine supplementation in combination with a body weight reduction programme (BWRP) on body weight (BW) losses, insulin sensitivity and selected metabolic parameters in obese and insulin resistant ponies. Material und methods: 16 obese ponies (mean BCS = 8.0±2.0, mean CNS = 4.0±1.0) were assigned to a randomized double blind, placebo-controlled study. The ponies werde di- vided into two equal groups (N=8). During a 14 weeks lasting BWRP the ponies were fed 1.0-1.2 kg hay/100 kg BW daily. Additionally, 8 ponies were supplemented with L-carnitine (1.3g/100 kg BW) and 8 ponies were supplemented with a placebo (1.3g/100 kg BW). The supplements were offered in a mixture of 50 g grass meal and 50 g of a commercial mineral mixture, twice a day. During BWRP ponies were exercised a low-intensity protocol 6 days a week (daily 25 min walk and 15 min trot across the countryside). A frequently sampled intravenous glucose tolerance test (FSIGTT) was undertaken in order to assess insulin sen- sitivity at the beginning and the end of the study. Routine blood samples were collected for analysis of plasma glucose, serum insulin, free fatty acids (FFA), triglycerides (TG), urea and beta-hydroxybutyrate (BHB). Ponies were weighed weekly after 12 h of feed restriction by using an electronic scale for large animals. BCS and CNS were recorded weekly by the same 2 observers throughout the study. The statistical analysis was performed by parametric and non-parametric tests (ANOVA and Wilcoxon ranked test). The minimal modell calcu- lation of insulin sensitivity (SI) from FSIGTT was calculated by the computer programme (MINMOD). Results: Ponies lost 1-3% BW per week over the BWRP (time P<0.01, L-carnitine supple- mentation P=0.79), meaning a total body weight loss of 14.3%. BCS decreased in both groups with a difference of three points and CNS was reduced with a difference of 1.4-1.9 points. BW losses were accompanied by a significant improvement in insulin sensitivity (Time: P<0.01, L-carnitine supplementation: P=0.39). The calculation for SI-values by the minimalmodell showed a significant increase in L-carnitine group (GC ) and placebo group (GP ) in the end of the study. (GC : 0.76±0.88 L/min/μU*10−4 to 5.45±0.81 L/min/μU*10−4 , GP : 1.61±1.31 L/min/μU*10−4 to 6.08±2.98 L/min/μU*10−4 ). Significant time related decreases were observed for plasma glucose (GC : 4.5±0.32 mmol/L to 4.21±0.61 mmol/L, GP : 4.34±0.62 mmol/L to 3.86±0.34 mmol/L) and serum insulin (GC : 23.71±32.77 μU/mL to 3.67±3.94 μU/mL, GP : 13.55±12.67 μU/mL to 1.01±1.09 μU/mL). A significant increase was observed for serum urea (GC : 3.47±0.73 mmol/L to 4.31±1.06 mmol/L, GP : 3.71±0.79 mmol/L to 4.9±1.23 mmol/L), FFA (GC : 157±95 μmol/L to 731±138 μmol/L und GP : 113±63 μmol/L to 686±142 μmol/L) and TG (GC : 0.53±0.28 mmol/L to 0.94±0.61 mmol/L, GP : 0.45±0.23 mmol/L to 0.64±0.25 mmol/L) during BWRP. There was no further improvement in metabolic responses by L-carnitine supplementation. Conclusions: Energy intake of 7 MJ DE/100 kg BW leads to bodyweight losses of 1- 3%, herby improving insulin sensitivity and glucose metabolism. L-carnitine supplementation does not further improve glucose or fat metabolism, suggesting that endogenous L-carnitine synthesis was sufficient to facilitate energy metabolism in obese and insulin resistant ponies.

Type 2 diabetes mellitus (T2DM) ensues from diminished insulin sensitivity and abated compensatory insulin secretion. While diminished insulin secretion has a strong genetic origin, environmental factors are central in the development of insulin resistance; these include hyperinsulinemia and lipotoxicity. Insulin resistance results in the dysregulation of hypothalamic neurons that mediate its central actions: a key intermediary neuron is the neuropeptide Y/agouti-related peptide (NPY/AgRP) neuron. The hypothesis therefore was generated that insulin directly regulates NPY/AgRP neurons, and that prolonged insulin or palmitate, a prevalent free fatty acid (FFA), exposure inhibits neuronal insulin signaling. Using well characterized hypothalamic cell lines, mHypoE-46 or mHypoE-44, which express NPY, AgRP and insulin receptor signaling machinery, this hypothesis was examined in three studies. Correspondingly, insulin decreased NPY and AgRP mRNA expression in the mHypoE-46 cells, through an extracellular signal-regulated kinase (ERK) dependent mechanism; whereas prolonged exposure of NPY/AgRP cells to insulin or palmitate attenuated insulin signaling, determined by analysis of phosphorylated Akt. Insulin induced insulin receptor substrate-1 (IRS-1) serine 1101 phosphorylation in mHypoE-46 cells, utilizing the mTOR-S6K1 pathway, as the mTOR inhibitor rapamycin prevented IRS-1 serine phosphorylation. Insulin also decreased insulin receptor and IRS-1 protein levels; this was prevented by lysosomal and proteasomal pathway inhibitors, 3-methyladenine and epoxomicin, respectively. Importantly, rapamycin, epoxomicin or 3-methyladenine pre-treatment decreased the attenuation of insulin signaling during long-term insulin exposure. On the other hand, palmitate activated c-Jun N-terminal kinase (JNK), the apoptosis effector caspase 3, and induced endoplasmic reticulum (ER) stress in mHypoE-44 cells: JNK inhibition prevented ER stress. In an attempt to avert the deleterious effects of palmitate, the neuronal cells were treated with the 5`AMP-activated protein kinase (AMPK) activator AICAR, a possible insulin sensitizer. Interestingly, AICAR attenuated JNK and caspase 3 activation, and restored insulin signaling. These findings demonstrate that insulin directly regulates NPY/AgRP neuronal cells, and that insulin and palmitate provoke neuronal insulin resistance through different mechanisms. These findings substantiate the idea that environmental factors known to trigger peripheral insulin resistance may have consequences at the level of the individual hypothalamic neuron, which may ultimately contribute to the resulting pathophysiological states of obesity and T2DM.

Type 2 diabetes mellitus (T2DM) ensues from diminished insulin sensitivity and abated compensatory insulin secretion. While diminished insulin secretion has a strong genetic origin, environmental factors are central in the development of insulin resistance; these include hyperinsulinemia and lipotoxicity. Insulin resistance results in the dysregulation of hypothalamic neurons that mediate its central actions: a key intermediary neuron is the neuropeptide Y/agouti-related peptide (NPY/AgRP) neuron. The hypothesis therefore was generated that insulin directly regulates NPY/AgRP neurons, and that prolonged insulin or palmitate, a prevalent free fatty acid (FFA), exposure inhibits neuronal insulin signaling. Using well characterized hypothalamic cell lines, mHypoE-46 or mHypoE-44, which express NPY, AgRP and insulin receptor signaling machinery, this hypothesis was examined in three studies. Correspondingly, insulin decreased NPY and AgRP mRNA expression in the mHypoE-46 cells, through an extracellular signal-regulated kinase (ERK) dependent mechanism; whereas prolonged exposure of NPY/AgRP cells to insulin or palmitate attenuated insulin signaling, determined by analysis of phosphorylated Akt. Insulin induced insulin receptor substrate-1 (IRS-1) serine 1101 phosphorylation in mHypoE-46 cells, utilizing the mTOR-S6K1 pathway, as the mTOR inhibitor rapamycin prevented IRS-1 serine phosphorylation. Insulin also decreased insulin receptor and IRS-1 protein levels; this was prevented by lysosomal and proteasomal pathway inhibitors, 3-methyladenine and epoxomicin, respectively. Importantly, rapamycin, epoxomicin or 3-methyladenine pre-treatment decreased the attenuation of insulin signaling during long-term insulin exposure. On the other hand, palmitate activated c-Jun N-terminal kinase (JNK), the apoptosis effector caspase 3, and induced endoplasmic reticulum (ER) stress in mHypoE-44 cells: JNK inhibition prevented ER stress. In an attempt to avert the deleterious effects of palmitate, the neuronal cells were treated with the 5`AMP-activated protein kinase (AMPK) activator AICAR, a possible insulin sensitizer. Interestingly, AICAR attenuated JNK and caspase 3 activation, and restored insulin signaling. These findings demonstrate that insulin directly regulates NPY/AgRP neuronal cells, and that insulin and palmitate provoke neuronal insulin resistance through different mechanisms. These findings substantiate the idea that environmental factors known to trigger peripheral insulin resistance may have consequences at the level of the individual hypothalamic neuron, which may ultimately contribute to the resulting pathophysiological states of obesity and T2DM.

To gain insight in the relationship between innate immune system and metabolic disease, we aimed to investigate the effects of lactoferrin in obesity-related metabolic disturbances. Circulating lactoferrin concentration was significantly decreased in subjects with altered glucose tolerance (AGT) and associated negatively with obesity-related metabolic disturbances. The SNPs-induced aminoacidic changes in lactoferrin N-terminus region were associated with a low atherogenic lipid profile. Lactoferrin production in neutrophils decreased significatively in aging, chronic low-grade inflammation and type 2 diabetes. In vitro, lactoferrin increased insulin signaling pathway, even under insulin resistance conditions and displayed dual effects on adipogenesis (antiadipogenic in 3T3-L1 and adipogenic in human adipocytes). In conclusion, lactoferrin might play a potential protective role against insulin resistance and obesity related metabolic disturbances. / Per aprofundir en la relació entre el sistema immunològic innat i els trastorns metabólics, s’investiga l’efecte de la lactoferrina en els desordres metabòlics associats a l’obesitat. Els nivells circulants de lactoferrina es trobaven significativament disminuits en subjetes amb la tolerància a la glucosa alterada (AGT), i aquests es correlacionaven negativament amb trastorns metabòlics associats a obesitat i resistència a la insulina. Els canvis aminoacídics en la seva regió N-Terminal s’associaven a un perfil lipídic menys aterogènic. La producció de lactoferrina es troba reduïda en condicions d’envelliment, inflamació crònica i diabetes tipus 2. In vitro, la lactoferrina incrementava la via de senyalització de la insulina, inclús en condicions de resistència a la insulina i presentava efectes dual en la adipogenesis (antiadipogenic en 3T3-L1 i adipogenic en adipòcits humans). En conclusió, la lactoferrina podria tenir un potencial efecte protector enfront les enfermetats metabòliques associades a obesitat i resistència a la insulina.

Problemstellung: Die Tiergesundheit hat sich bei Milchkühen in den letzten Jahren weltweit negativ entwickelt. Wichtigster Ausdruck dafür ist die auf ca. 2,4 Jahre verkürzte Nutzungsdauer. Dabei spielt das Fettmobilisationssyndrom eine dominante Rolle. Das Fettgewebe ist nicht nur als reiner Energiespeicher, sondern als endokrines stoffwechselaktives Organ anzusehen. Untersuchungen an Menschen und Mäusen haben gezeigt, dass das Fettgewebe in Abhängigkeit von seiner Lokalisation im Körper unterschiedlich auf metabolische und hormonelle Stimuli reagiert. Es gibt Hinweise, dass auch für das Rind ähnliche Differenzen angenommen werden können. Zielstellung: Um die Eigenschaften des bovinen Fettgewebes und seine Rolle im Energiestoffwechsel besser charakterisieren zu können, war das Ziel der vorliegenden Untersuchung, die mRNA-Expressionen ausgewählter für den Fettstoffwechsel relevante Gene im bovinen Fettgewebe an verschiedenen Lokalisationen grundlegend in gesunden Rindern zu untersuchen. Material und Methoden: Die Probenentnahme erfolgte an 12 gesunden Schlachtkühen direkt nach der Tötung, die aufgrund Schwermelkbarkeit oder Unfruchtbarkeit geschlachtet wurden. Das Fettgewebe wurde aus dem Omentum majus, dem Depotfett der Niere, im kaudalen Beckendrittel (retroperitoneales Fett), dem Hüftbereich (subkutanes Fett) und dem Fett an der Herzbasis entnommen. Die Proben wurden in Flüssigstickstoff tiefgefroren, auf Trockeneis transportiert und bis zur Untersuchung bei -70°C gelagert. Die mRNA-Expression für die verschiedenen Gene (Hormonsensitive Lipase (HSL), Lipoproteinlipase (LPL), Fettsäuresynthase (FASN), Leptin, Adiponektin, Retinolbindungsprotein 4 (RBP4), Tumornekrosefaktor  (TNF) und Interleukin 6 (IL-6), Fettsäurebindungsproteine (FABP3, 4 und 5) und Glukosetransporter 4 (GLUT4)) , wurden mit einer quantitativen real time (RT)-PCR gemessen. Ergebnisse: Die mRNA-Expressionen der verschiedenen oben genannten Gene, ausgenommen IL-6 und FABP3, sind im bovinen Fettgewebe nachweisbar. Die mRNA-Expressionen unterschieden sich in den einzelnen Fettdepots nicht signifikant. Ausnahme hierbei bildete RBP4, dessen mRNA im pericardialen Fett signifikant höher exprimiert war als im subkutanen und omentalen Depot. Die mRNA-Expression des subkutanen, omentalen, perirenalen und pericardialen Fettdepots korrelierten signifikant positive untereinander. Schlussfolgerung: Die mRNA-Expressionen der in den Fettstoffwechsel involvierten und untersuchten Gene gesunder Rinder waren nachweisbar, unterschieden sich jedoch nicht signifikant von einander mit Ausnahme der RBP4 mRNA. Die positiven signifikanten Korrelationen zwischen dem subkutanen, omentalen, perirenalen und pericardialen Fettlokalisationen und gleichmäßigen Expressionen innerhalb der Gewebe deuten auf eine einheitliche Fettmetabolismus des gesamten Körpers. Verglichen mit Ergebnissen der Humanmedizin sind nur wenige Übereinstimmungen (HSL, LPL, GLUT4,TNF) zu eruieren. Weitere Studien mit gesunden Tieren im Vergleich zu erkrankten Rindern müssen klären, ob eine mögliche Verschiebung der mRNA-Konzentrationen auf das Fettmobilisationssyndrom hinweisen. / Purpose: Over the last years, the situation of animal health concerning dairy cows has developed worldwide in an adverse way. Most important indicator is the shortened useful life of approx. 2.4 years. The fat mobilization syndrome plays a dominant role in this process. Apparently, fatty tissue does not only serve as a mere energy reservoir, but also as an endocrin organ with metabolic activity. Researches on humans and mice have shown fatty tissue to react on metabolic and hormonal stimuli in different ways, depending on its body localization. There are dues to anticipate, similar differences in cattle. Objectives: In order to better characterize the attributes of bovine fatty tissue and its purpose in metabolism, the present study aims examine basically the expression of mRNA in selected genes which are important for lipid metabolism in bovine fatty tissue of different localizations in healthy cattle. Methods and material: Samples where taken from twelve carcasses of healthy dairy cows slaughtered for reason of difficult milking or infertility directly after killing. Fatty tissue was taken from omentum major, kidney capsula, caudal pelvis area (retroperiteonal fat), hip area (subcutaneous fat), and cardiac base. It was instantly quick-freezed in liquid nitrogen, put on dry ice while transporting, and stored at -70°C until analysis. The expression of mRNA of different genes (hormone-sensitive lipase (HSL), lipoproteine lipase (LPL), fatty acid synthase (FASN), fatty acid binding proteine (FABP3,4 and 5), retinol binding proteine 4 (RBP4), adiponectine, glucose transporter 4 (GLUT4), leptin, interleukin-6 (IL-6), and tumor necrosis factor a (TNFα) was measured by means of a quantitative real-time (RT)-PCR. Results: The mRNA-expressions of all these different genes except IL-6 and FABP3 were detected in bovine fatty tissue. The differences of mRNA-expression between sample localization were not statistically significant. RBP4 was excepted, which mRNA showed a significantly higher expression in pericardial fat than in subcutaneous and omental fat, respectively. The correlation between mRNA-expressions of subcutaneous, omental, pericardial and perirenal fat was significant. Conclusions: The mRNA-expression of examined genes being involved in fatty tissue metabolism, were detected in healthy cattle, but were not significantly different, except RBP4. Significantly positive correlations between subcutaneous, omental, perirenal and pericardial localization and consistent expression indicate an integrative metabolism of the whole body. Compared to results of the human medicine only few analogies (HSL, LPL, GLUT4, TNF) were found. Further studies comparing healthy and diseased cattle will have to prove, if possible displacements of the mRNA-level can indicate the fat mobilization syndrome being present.

Το σύνδρομο των πολυκυστικών ωοθηκών (PCOS) είναι ίσως η συχνότερη διαταραχή των γυναικών αναπαραγωγικής ηλικίας. Οι κύριες κλινικές εκδηλώσεις του συνδρόμου είναι η υπερανδρογοναιμία και η χρόνια ανωοθυλακιορρηξία, ενώ σχετίζεται σε μεγάλο βαθμό με την παχυσαρκία και την αντίσταση στην ινσουλίνη. Η αντίσταση στην ινσουλίνη έχει ένα σημαντικό ρόλο τόσο ως αίτιο όσο και ως αποτέλεσμα του συνδρόμου. Στις γυναίκες τόσο η υπερινσουλιναιμία όσο και η υπερανδρογοναιμία σχετίζεται με αυξημένο καρδιοαγγειακό κίνδυνο. Το PCOS σχετίζεται με αυξημένο καρδιοαγγειακό κίνδυνο, ενώ τόσο η αλλαγή τρόπου ζωής και η φαρμακολογική παρέμβαση έχει δειχθεί ότι βελτιώνει την υπερανδρογοναιμία και την υπογονιμότητα και ελαττώνει τον καρδιοαγγειακό κίνδυνο. Μαζί με τους κλασικούς καρδιοαγγειακούς παράγοντες κινδύνου, αιμοδυναμικές και αιματολογικές μεταβλητές παίζουν σημαντικό ρόλο στην παθογένεση της αθηρωσκλήρυνσης. Η γλοιότητα του πλάσματος είναι σημαντική αιματολογική μεταβλητή και εξαρτάται απο μακρομόρια όπως το ινωδογόνο, οι ανοσοσφαιρίνες και οι λιποπρωτεϊνες. Ο σκοπός της παρούσης μελέτης ήταν να ερευνήσει τις μεταβολές της γλοιότητας του πλάσματος σε γυναίκες με PCOS και την συσχέτιση τους με την υπερανδρογοναιμία, την παχυσαρκία και την αντίσταση στην ινσουλίνη. Η μελέτη συμπεριέλαβε 96 ασθενείς με PCOS και 72 γυναίκες με φυσιολογική έμμηνο ρύση ως ομάδα ελέγχου. Η γλοιότητα πλάσματος ήταν 1.243±0.670 mm2/s στην ομάδα ελέγχου (n=72), και 1.250±0.079 στιν γυναίκες με PCOS (n=96) (p=0.524). Η γλοιότητα του πλάσματος εμφάνισε σημαντική συσχέτιση με BMI (b=0.315, p=0.013), Ολικές Πρωτείνες (b=0.348, p=0.005), AUCIns (b=0.320, p=0.011). Στις γυναίκες με PCOS με αντίσταση στην ινσουλίνη (PCOS-IR) η γλοιότητα του πλάσματος ήταν 1.300 ± 0.055 mm2/s, ενώ στις γυναίκες με PCOS χωρίς αντίσταση στην ινσουλίνη (PCOS-ΝIR) η γλοιότητα του πλάσματος ήταν 1.231± 0.49 mm2/s (p=0.004). Στη συνέχεια χωρίσαμε όλες τις γυναίκες με PCOS σε 2 υποομάδες: αυτές με BMI<25 και αυτές με BMI>25. Η γλοιότητα πλάσματος ήταν 1.235±0.786mm2/s στις γυναίκες με PCOS και BMI<25, και 1.273±0.756mm2/s στις γυναίκες με PCOS και BMI>25 (p=0.024). Σε νέες γυναίκες με PCOS η αύξηση της γλοιότητας του πλάσματος συσχετίσθηκε με την παχυσαρκία και την αντίσταση στην ινσουλίνη. Συμπερασματικά στις νέες γυναίκες με PCOS η γλοιότητα του πλάσματος επιδεινώθηκε από την αντίσταση στην ινσουλίνη. Καθώς η αυξημένη γλοιότητα του πλάσματος είναι ένας πρώιμος παράγοντας κινδύνου για καρδιοαγγειακή νόσο, ο κλινικός χειρισμός των νέων υπέρβαρων γυναικών με PCOS θα πρέπει πάντα να περιλαμβάνει μία μείωση του σωματικού τους βάρους και τη λελογισμένη και με προσοχή χρήση των αντισυλληπτικών δισκίων ως θεραπευτική προσέγγιση. / Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility in women. PCOS is characterized by hirsutism, anovulation, hyperandrogenemia and is also highly associated with obesity and insulin resistance. Insulin resistance plays a significant role, both as a cause and as a result of the syndrome. Both hyperinsulinemia and androgen excess in women is associated with increased cardiovascular risk. PCOS is linked to cardiovascular disease, while, altering lifestyle or pharmacological intervention has been shown to improve hyperandrogenism and infertility and reduce cardiovascular risk. Along with classic cardiovascular risk factors, hemodynamic and hemorheologic variables play an important role in the pathogenesis of atherosclerosis. Plasma viscosity is an important hemorheologic variable and is mainly determined by several macromolecules, including fibrinogen, immunoglobulins, and large lipoproteins. Our objective was to investigate plasma viscosity in women with PCOS. The acquired data were tested for association with hyperandrogenemia, obesity and insulin resistance in PCOS patients. The study included 96 young PCOS women and 72 healthy controls. Plasma viscosity was 1.243±0.670 mm2/s in the control group and 1.250±0.079 in PCOS women (p=0.524). Total protein (B=0.348, p=0.005), AUC for Insulin (B=0.320, p=0.011) and BMI (B=0.315, p=0.013) were proven to be significantly correlated to plasma viscosity. Plasma viscosity was significantly increased in PCOS women with Insulin Resistance (IR) compared to matched for age and BMI PCOS women without IR (1.300±0.055 mm2/s versus 1.231±0.049 mm2/s) (p=0.004). Then we divided all PCOS women in two separate groups, lean PCOS with BMI<25 and obese PCOS with BMI>25. Plasma viscosity was 1.235±0.786mm2/s in PCOS women with BMI<25, in the group of women was and 1.273±0.756mm2/s in PCOS women with BMI>25 (p=0.024). Young PCOS women presented a plasma viscosity which was increased by obesity and IR. In conclusion, young PCOS women presented a plasma viscosity which was deteriorated by IR. As increased plasma viscosity is an early risk factor for cardiovascular disease, clinical management of young overweight PCOS women with IR should always include a serious reduction in body weight and the use of oral contraceptive treatment with cautious.

Ο Σακχαρώδης Διαβήτης (ΣΔ) είναι μια μεταβολική διαταραχή, που χαρακτηρίζεται από χρόνια υπεργλυκαιμία ως αποτέλεσμα διαταραχής στην έκκριση της ινσουλίνης ή τη δράση της ή και στα δύο αυτά χαρακτηριστικά. Οι μακροπρόθεσμες επιπτώσεις της χρόνιας υπεργλυκαιμίας στον ΣΔ διακρίνονται σε μικροαγγειακές και μακροαγγειακές επιπλοκές. Η μικροαγγειακή νόσος οδηγεί σε αμφιβληστροειδοπάθεια, νεφρική ανεπάρκεια και νευροπάθεια, ενώ η σχετιζόμενη με τον ΣΔ μακροαγγειακή νόσος προκαλεί αυξημένο κίνδυνο για έμφραγμα μυοκαρδίου, αγγειακά εγκεφαλικά επεισόδια και ακρωτηριασμούς των άκρων. Έχει βρεθεί ότι η υπεργλυκαιμία είναι η κύρια αιτία της μικροαγγειακής νόσου, ενώ στην παθογένεια της μακροαγγειακής νόσου συμμετέχει η υπεργλυκαιμία, αλλά και η αντίσταση στην ινσουλίνη. Ο σύνδεσμος ανάμεσα στην χρόνια υπεργλυκαιμία και την αγγειακή βλάβη έχει αποδοθεί σε τέσσερα ανεξάρτητα βιοχημικά μονοπάτια: 1. Αυξημένη δραστηριότητα του μονοπατιού της πολυόλης 2. Συσσώρευση τελικών προϊόντων προχωρημένης γλυκοζυλίωσης (Advanced Glycation Endproducts: AGEs) 3. Ενεργοποίηση της πρωτεϊνικής κινάσης C (PKC) και 4. Αυξημένη δραστηριότητα του μονοπατιού της εξοζαμίνης. Αυτά τα φαινομενικά μη σχετιζόμενα μεταξύ τους μοριακά μονοπάτια έχουν έναν υποκείμενο κοινό μηχανισμό : την υπερπαραγωγή ριζών υπεροξειδίου από τη μιτοχονδριακή αλυσίδα μεταφοράς ηλεκτρονίων. Οι μιτοχονδριακές ελεύθερες ρίζες οξυγόνου, μέσω ενεργοποίησης της πολυμεράσης της πολυ-ADP-ριβόζης, μερικώς αναστέλλουν το γλυκολυτικό ένζυμο αφυδρογονάση της 3-φωσφορικής γλυκεραλδεΰδης, με αποτέλεσμα τη συσσώρευση των γλυκολυτικών ενδιάμεσων προϊόντων, όπως της 3-φωσφορικής γλυκεραλδεΰδης και της 6-φωσφορικής φρουκτόζης, που αποτελούν υποστρώματα για τα τέσσερα παραπάνω βιοχημικά μονοπάτια. Το αποτέλεσμα της αντίστασης στην ινσουλίνη, όσον αφορά τις μακροαγγειακές επιπλοκές, είναι η αυξημένη ροή των ελεύθερων λιπαρών οξέων από τα λιποκύτταρα προς τα αρτηριακά ενδοθηλιακά κύτταρα. Η αυξημένη οξείδωση των ελεύθερων λιπαρών οξέων στα μιτοχόνδρια και η μιτοχονδριακή υπερπαραγωγή ελευθέρων ριζών οξυγόνου οδηγούν στην ενίσχυση των τεσσάρων μοριακών μονοπατιών με τον ίδιο ακριβώς μηχανισμό που έχει περιγραφεί παραπάνω για την υπεργλυκαιμία. Στην αντίσταση στην ινσουλίνη έχει παρατηρηθεί, επίσης, η μερική αναστολή του μονοπατιού της κινάσης της 3-φωσφατιδυλινοσιτόλης, που τελικά προάγει την ενίσχυση των αθηρογόνων και την καταστολή των αντι-αθηρογόνων ιδιοτήτων της ινσουλίνης. Ο κύριος στόχος αυτής της βιβλιογραφικής εργασίας είναι η περιγραφή των μονοπατιών που οδηγούν στη δημιουργία των, επαγόμενων από την υπεργλυκαιμία αλλά και την αντίσταση στην ινσουλίνη, διαβητικών αγγειακών επιπλοκών, καθώς και του κοινού μηχανισμού (παραγωγής ελευθέρων ριζών οξυγόνου) που βρίσκεται πίσω από αυτά τα μονοπάτια, παρέχοντας πλέον μια καινούρια βάση για μελλοντική έρευνα και ανακάλυψη φαρμάκων, προληπτικών και θεραπευτικών της διαβητικής αγγειοπάθειας. / Diabetes Mellitus is a metabolic disorder characterized by chronic hyperglycemia, due to decreased secretion of insulin and/ or decreased tissue sensitivity to insulin. The sequelae of chronic hyperglycemia in diabetes of all phenotypes are divided into microvascular and macrovascular complications. Microvascular disease causes blindness, renal failure, and neuropathy, and diabetes-accelerated macrovascular disease causes excessive risk for myocardial infarction, stroke, and lower limb amputation. Strict glycemic control has been shown to reduce both microvascular and macrovascular complications of diabetes. However, in contrast to diabetic microvascular disease, it is believed that hyperglycemia is not the major determinant of diabetic macrovascular disease : a large part of cardiovascular disease risk is due to insulin resistance. The link between chronic hyperglycemia and vascular damage has been established by four independent biochemical abnormalities : increased polyol pathway flux, increased formation of Advanced Glycation End-products (AGEs), activation of Protein Kinase C (PKC), and increased hexosamine pathway flux. These seemingly unrelated pathways have an underlying common denominator : overproduction of superoxide by the mitochondrial electron transport chain. Mitochondrial reactive oxygen species (ROS) partially inhibit the glycolytic enzymes glyceraldehyde-3-phosphate dehydrogenase, which diverts increased substrate flux from glycolysis to pathways of glucose overutilization. As for insulin resistance, it causes increased free fatty acid flux from adipocytes into endothelial cells and increased free fatty acid oxidation in macrovascular endothelial cells, resulting in mitochondrial overproduction of ROS by exactly the same mechanism described above about hyperglycemia. Furthermore, metabolic insulin resistance is characterized by pathway-specific impairment in phosphatidylinositol 3-kinase-dependent signaling, which also causes endothelial dysfunction. Preliminary experimental evidence in vivo suggests that these mechanisms leading to diabetic microvascular and macrovascular complications offer a novel basis for research and drug development, targeting to prevention and treatment of angiopathy in Diabetes Mellitus.