O remodelamento vascular é uma resposta adaptativa a estímulos específicos, participando da fisiopatologia de diversas doenças cardiovasculares. Devido à intersecção de fatores de risco cardiovasculares relacionados tanto ao remodelamento vascular como à calcificação vascular (CV), propomos a investigação de mecanismos que inter-relacionam tais condições. Postulamos que camundongos ob/ob com obesidade e resistência à insulina têm resposta exacerbada de remodelamento vascular associado à CV quando comparado aos camundongos controles C57BL/6 (C57) após estímulo com vitamina D3 (VD) in vivo. Camundongos C57 e ob/ob (OB) machos foram injetados com 8x103 UI/kg de vitamina D3 intraperitoneal (IP) ou solução fisiológica (CT) durante 14 dias (n=6). Houve aumento da circunferência da lâmina elástica externa da aorta, determinando aumento da área circunferencial do vaso em camundongos OBVD. A hipervitaminose D aumentou o comprimento da lâmina elástica interna da aorta, aumentando o lúmen vascular em camundongos OBVD. Ocorreu também diminuição da espessura da parede do vaso em camundongos OBVD, caracterizando remodelamento vascular positivo hipotrófico. Observamos ainda maior deposição de colágeno na parede do vaso e elastólise em camundongos OBVD. O remodelamento vascular positivo em camundongos OBVD se correlacionou diretamente com o aumento da calcificação na aorta (R2=0,8; p < 0,003). Aortas de camundongos OBVD apresentaram aumento na expressão de espécies reativas de oxigênio (ERO), que foi associado a aumento da atividade de metaloproteinases de matriz (MMP). Estes resultados fornecem evidências que camundongos obesos, insulino-resistentes, e com diabetes tipo 2 desenvolveram remodelamento vascular positivo hipotrófico correlacionado diretamente com calcificação vascular em camundongos OBVD após estímulo com vitamina D3. O desenvolvimento de remodelamento vascular positivo hipotrófico neste modelo murino é possivelmente mediado pela ativação de MMP na parede da aorta e a geração de ERO pode ter contribuído para a ativação de MMP no nosso modelo / Vascular remodeling is a vessel response to mechanical and hemodynamic stimuli, which is a major determinant of changes in vessel lumen caliber. The mechanisms that influence arterial remodeling include calcification. We hypothesized that ob/ob mice develop positive vascular remodeling associated with calcification. We quantify and assess mechanisms of vascular remodeling and vascular calcification in ob/ob mice (OB) after vitamin D3 stimulation (VD) or phosphate buffered saline (CT), compared with (C57BL/6) mice. Both ob/ob (OBVD) and C57BL/6 (C57VD) mice received 8x103 IU/day of (IP) vitamin D3 for 14 days. Control ob/ob (OBCT) and C57BL/6 (C57CT) mice received IP phosphate buffered saline (PBS) for 14 days (n=6). Hypervitaminosis D increased the external and internal elastic length in aortas from OB mice, resulting in increased total vascular area and lumen vascular area respectively, which characterizes positive vascular remodeling. OBVD mice decreased the aortic wall thickness, resulting in hypotrophic vascular remodeling. We demonstrated increases in collagen deposition, elastolysis and calcification in the aortas of OBVD mice. These results showed a positive correlation between expansive vascular remodeling and vascular calcification in OBVD mice (R2=0,8; p < 0,003). Furthermore, aorta from OBVD increased oxidative stress, coincidently with augmented metalloproteinase activity. Our data provide evidence that obese type 2 diabetes mellitus and insulin-resistant mice (ob/ob) developed positive hypotrophic vascular remodeling correlated directly with increased vascular calcification in OBVD mice after chronic vitamin D3 stimulation. The development of positive hypotrophic vascular remodeling in this mouse model is possibly mediated by the activation in the aortic wall of MMP and ROS may have contributed to the activation of MMP in our model

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Diabetes mellitus (DM) is a disorder of the metabolism of carbohydrates, lipids and proteins characterized by hyperglycemia, which in type 2 diabetes (T2DM) involves the production deficiency and / or insulin action. Diabetic subjects exhibit high levels of oxidative stress due to chronic and persistent hyperglycemia, which impairs the activity of the antioxidant defense system and promotes the generation of free radicals. This level of oxidative stress can cause renal, neurological, ocular and cardiovascular complications, such as systemic arterial hypertension (HAS). The enzyme δ-aminolevulinate dehydratase (δ-ALA-D) is a sulfhydryl enzyme, which participates in the synthesis of pyrrole compounds and has been linked to several diseases, including DM. The aim of this study was to evaluate the oxidative status of patients with DM2 and its relationship with the activity of the enzyme δ-ALA-D, lipid profile, body fat distribution besides the role of hypertension in the parameters analyzed. The results showed a decreased activity of the enzyme δ-ALA-D as well as an increase in its reactivation index in patients (n = 63) compared to controls (n = 63). It was also observed, in the T2DM group, an increased level of thiobarbituric acid reactive species (TBARS) and a smaller amount of antioxidants as vitamin C plasma protein thiol groups (P-SH) in plasma and nonprotein (NP-SH) in erythrocytes, as well as a reduction in activity of the enzyme catalase in erythrocytes. Patients who had DM2 plus hypertension (n = 30) showed a more pronounced decrease in the activity of δ-ALA-D than patients with type 2 diabetes only (n = 23) compared to healthy subjects (n = 30), along with an increased rate of reactivation. Also, patients DM2/HAS showed a greater depletion of NP-SH. Correlations among activity of δ-ALA-D and its reactivation index with oxidative stress markers, such as NP-SH and carbonyl groups, as well as lipid profile of patients were also observed. Further, correlations were found between the level of TBARS and triglycerides, as well as between vitamin C, plasma glucose and HbA1c as well as P-SH and body mass index. Therefore, patients with DM2 have changes in lipid profile and body fat distribution, and a situation of oxidative stress that can lead to changes in key molecules as the enzyme δ-ALA-D. This enzyme was effective in reflecting the level of oxidative stress of patients can be considered an interesting biomarker for assessment of damage in chronic metabolic processes such as DM. Furthermore, hypertension appears to be a synergistic factor to the metabolic condition of patients with type 2 diabetes, contributing to the development of its complications. / O Diabetes mellitus (DM) é uma desordem do metabolismo de carboidratos, lipídeos e proteínas caracterizado pela hiperglicemia, que no tipo 2 da doença (DM2) envolve a deficiência da produção e/ou ação da insulina. Indivíduos diabéticos exibem alto nível de estresse oxidativo devido à hiperglicemia crônica e persistente, que prejudica a atividade do sistema de defesa antioxidante e promove a geração de radicais livres. Esse nível de estresse oxidativo pode acarretar complicações renais, neurológicas, oculares e cardiovasculares, como a hipertensão arterial sistêmica (HAS). A enzima δ-Aminolevulinato desidratase (δ-ALA-D) é uma enzima sulfidrílica, que participa da síntese de compostos pirrólicos e vem sendo relacionada a diversas patologias, inclusive o DM. O objetivo deste estudo foi avaliar o status oxidativo de pacientes portadores de DM2 e sua relação com a atividade da enzima δ-ALA-D, perfil lipídico, distribuição de gordura corporal assim como o papel da HAS nos parâmetros analisados. Os resultados demonstraram uma diminuição da atividade da enzima δ-ALA-D assim como um aumento de seu índice de reativação nos pacientes (n=63) em relação aos controles (n=63). Observou-se também, no grupo DM2, um aumentado índice de espécies reativas ao ácido tiobarbitúrico (TBARS) e uma menor quantidade de antioxidantes como vitamina C plasmática, grupamentos tióis protéicos (PSH) em plasma e não protéicos (NP-SH) em eritrócitos, assim como uma redução na atividade da enzima catalase em eritrócitos. Os pacientes que além de DM2 apresentavam HAS (n=30) demonstraram uma diminuição mais pronunciada na atividade da δ-ALA-D do que os pacientes somente com DM2 (n=23) em relação a indivíduos saudáveis (n=30), juntamente com um aumentado índice de reativação. Também, os pacientes DM2/HAS apresentaram uma maior depleção de NP-SH. Correlações entre atividade da δ-ALA-D e seu índice de reativação com marcadores de estresse oxidativo, como NP-SH e grupamentos carbonílicos, bem como com o perfil lipídico dos pacientes também foram observadas. Ainda foram encontradas correlações entre o nível de TBARS e triglicerídeos, bem como entre vitamina C, glicose plasmática e HbA1c além de P-SH e índice de massa corporal. Portanto, os pacientes com DM2 apresentam alterações no perfil lipídico e na distribuição de gordura corporal, além de uma situação de estresse oxidativo que pode levar a alterações de moléculas importantes como a enzima δ-ALA-D. Tal enzima se mostrou efetiva em refletir o nível de estresse oxidativo dos pacientes podendo ser considerada um interessante biomarcador para avaliação de danos em processos metabólicos crônicos como o DM. Ainda a HAS parece ser um fator sinérgico à condição metabólica do paciente com DM2 podendo contribuir para o desenvolvimento de suas complicações.

Abstract The aim of this thesis was to measure patient reported outcomes, such as health related quality of life and general diabetes knowledge of elderly diabetes mellitus type 2 (DMT2) patients in Slovenia. Patient reported outcomes demonstrate patient perspectives when evaluating the delivery of care. In Slovenia, a new, multidisciplinary model of chronic care was introduced in 2011, which yet needs to demonstrate the efficiency, care improvement and cost reduction. Thus, another aim of the study was to research if multidisciplinary teams in diabetes care are economically viable. To achieve the above, the study was divided into 4 subprojects. Firstly, the general level of diabetes knowledge of elderly DMT2 patients (n=179) was measured. Secondly, the reliability and validity of generic, European Quality of Life- 5 Dimensions (EQ-5D), and disease specific, Audit on Diabetes Dependent Quality of Life (ADDQoL ) instruments were examined. Thirdly, health related quality of life of elderly diabetic patients (n=285) was assessed. Fourthly, the systematic literature review on the cost-effectiveness of multidisciplinary teams was conducted. The data were collected during the period 2011–2012. The main contributions of the current thesis can be summarised as follows: This was the first study to measure general diabetes knowledge of elderly DMT2 patients in Slovenia. The results showed that the place of living does not have an impact neither on diabetes knowledge nor the health related quality of life of these patients. Secondly, a pioneering example of measuring health related quality of life (HRQoL) in elderly diabetic patients in Slovenia, using a validated and reliable instrument (ADDQoL) was provided. A study to evaluate the relationships between diabetic and other co-existing chronic medical conditions on health related quality of life was performed. As part of that study, the reliability and validity of the instruments (EQ-5D and ADDQoL) were measured, and the analysis showed that both instruments are reliable. Thirdly, a systematic way of finding evidence for understanding the cost-effectiveness of multidisciplinary teams was applied. The results of the literature review show weak improvements in the economic outcomes. In general, the thesis contributes to the improved understanding of patient reported outcomes in elderly diabetic patients, which can be a measure in assessing diabetes care program in Slovenia, and offers a basis for a national evaluation of the Model Practices. Furthermore, patient reported outcomes of elderly diabetic patients is important to Slovenian decision makers to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the quality of life of diabetes patients. / Tiivistelmä Tutkimuksen tarkoitus oli mitata iäkkäiden tyypin 2 diabetespotilaiden itse ilmoittamia tuloksia, kuten terveyteen liittyvä elämänlaatu ja yleinen diabetekseen liittyvä tietämys Sloveniassa. Tulokset valottavat potilaiden näkökulmaa hoidon arvioinnissa. Sloveniassa otettiin 2011 käyttöön monitieteellinen hoitomalli, jonka tehoa sekä kykyä parantaa hoitoa ja vähentää hoitokustannuksia ei ole osoitettu. Toisena tavoitteena oli selvittää, onko moniammatillisten tiimien käyttö diabeteshoidossa taloudellisesti järkevää. Tutkimus jaettiin neljään osaprojektiin. Ensin mitattiin iäkkäiden tyypin 2 diabetespotilaiden (n=179) yleistä diabetestietämystä. Toiseksi selvitettiin geneerisen European Quality of Life- 5 Dimensions- (EQ-5D) ja diabeteskohtaisen ADDQoL -mittarin luotettavuus ja validiteetti. Kolmanneksi arvioitiin iäkkäiden diabetespotilaiden (n=285) terveyteen liittyvää elämänlaatua. Neljänneksi tehtiin moniammatillisten tiimien kustannus¬tehokkuutta koskeva systemaattinen kirjallisuuskatsaus. Tiedot kerättiin vuosina 2011–2012. Tulokset voidaan tiivistää seuraavasti: Kyseessä oli ensimmäinen tutkimus, jossa mitattiin iäkkäiden tyypin 2 diabetespotilaiden yleistä diabetestietämystä Sloveniassa. Tulosten mukaan asuinpaikka ei vaikuta potilaiden diabetestietämykseen tai terveyteen liittyvään elämänlaatuun. Toiseksi, Sloveniassa toteutettiin pioneerihanke, jossa mitattiin iäkkäiden potilaiden terveyteen liittyvää elämänlaatua (HRQoL) validoidun ja luotettavan instrumentin (ADDQoL) avulla. Tutkimuksessa selvitettiin diabeteksen ja muiden pitkäaikaissairauksien yhteisvaikutusta terveyteen liittyvään elämänlaatuun. Osana tutkimusta selvitettiin instrumenttien (EQ-5D ja ADDQoL) luotettavuus ja validiteetti. Molemmat osoittautuivat luotettaviksi. Kolmanneksi, tutkimuksessa etsittiin systemaattisesti näyttöä moniammatillisten tiimien kustannustehokkuuden arvioimiseksi. Kirjallisuuskatsauksen mukaan taloudellinen tulos paranee vain vähän. Tutkimus lisää tietoa potilaiden ilmoittamista tuloksista iäkkäiden diabetespotilaiden kohdalla, mitä voidaan käyttää diabeteshoito-ohjelman arvioinnissa Sloveniassa sekä mallikäytäntöjen kansallisen arvioinnin perustana. Diabetespotilaiden itse ilmoittava terveystieto on Slovenian päätöksentekijöille tärkeää sopivien interventioiden löytämisessä ja toteuttamisessa, kun halutaan parantaa diabeteshoitoa ja potilaiden elämänlaatua.

Abstract The increasing prevalence of metabolic syndrome and the consequent cardiovascular diseases, including atherosclerotic diseases and type 2 diabetes, are a cause of public concern worldwide. This development has stimulated an active search for novel risk factors and new candidate genes. The hormones regulating energy balance and the polymorphisms associated with them are of special interest as potential risk factors for metabolic syndrome. Ghrelin is a novel peptide hormone from stomach with strong growth hormone releasing activity. It is also able to modify glucose and insulin metabolism, blood pressure levels, cardiac function, adipogenesis and inflammatory processes in experimental conditions. Whether ghrelin and ghrelin gene variations have a role in the development of metabolic syndrome and the associated diseases, is not known. In the present study, the associations between fasting plasma ghrelin concentrations, ghrelin gene mutations (Arg51Gln and Leu72Met), features of metabolic syndrome, type 2 diabetes and carotid artery atherosclerosis were analysed. In addition, the relationship between ghrelin and insulin-like growth factor I (IGF-I) concentrations was studied. The study population consisted of 1045 middle-aged subjects of the hypertensive and the control cohorts of the OPERA project from the City of Oulu, Finland. Low ghrelin concentrations were found to be associated with several components of metabolic syndrome: adiposity, low HDL cholesterol levels, high insulin concentrations and high blood pressure levels. The prevalence of insulin resistance and type 2 diabetes was increased amongst the subjects with low ghrelin concentrations. Out of the individual factors tested, IGF-I concentration was the most significant predictor of ghrelin concentrations. This negative association was strongest in the subjects with insulin resistance and type 2 diabetes, which suggests that changes in ghrelin/IGF-I interactions might be involved in the development of these conditions. The subjects with the Gln51 allele of the ghrelin gene had lower ghrelin concentrations and, consistent with the findings mentioned above, higher prevalence of type 2 diabetes and hypertension compared with the subjects homozygous for the Arg51 allele. No correlation between ghrelin and C-reactive protein concentrations was seen. However, there was a positive association between ghrelin concentrations and carotid artery intima-media thickness. This association was independent of the commonly recognised risk factors of atherosclerosis and was only seen in men, who also had more advanced atherosclerosis than women. These observations call for further studies to clarify the potential causative role of ghrelin in the etiology of metabolic syndrome, type 2 diabetes and atherosclerotic cardiovascular diseases. / Tiivistelmä Metaboliseen oireyhtymään liittyy kohonnut riski sairastua sydän- ja verisuonisairauksiin kuten tyypin 2 diabetekseen ja sepelvaltimotautiin. Metabolisen oireyhtymän nopea esiintyvyyden kasvu on johtanut aktiiviseen uusien riskitekijöiden etsintään. Erityisen kiinnostuksen kohteena ovat olleet energia-aineenvaihduntaa säätelevät hormonit ja niihin liittyvät polymorfiat. Greliini on ensisijaisesti vatsalaukusta erittyvä hormoni, joka lisää voimakkaasti kasvuhormonin eritystä. Koeolosuhteissa sillä on myös vaikutuksia sokeriaineenvaihduntaan, verenpaineeseen, sydämen toimintaan, rasvakudoksen kehittymiseen ja tulehduksellisiin tapahtumiin, minkä perusteella on syytä epäillä greliinillä olevan osuutta metabolisen oireyhtymän ja siihen liittyvien sairauksien synnyssä. Tässä tutkimuksessa selviteltiin greliinin paastoplasmapitoisuuksien ja greliinipolymorfioiden (Arg51Gln ja Leu72Met) yhteyksiä metabolisen oireyhtymän piirteisiin, tyypin 2 diabetekseen ja kaulavaltimoiden ateroskleroosiin. Lisäksi tutkittiin greliinin ja insuliinin kaltaisen kasvutekijän (IGF-I) pitoisuuksien yhteyksiä. Tutkimusväestö koostui 1045 oululaisesta keski-ikäisestä OPERA tutkimukseen kuuluvasta henkilöstä. Tutkimuksessa matalien greliinipitoisuuksien havaittiin olevan yhteydessä useisiin metabolisen oireyhtymän piirteisiin: lihavuuteen, alhaisiin HDL kolesterolin pitoisuuksiin, korkeisiin insuliinipitoisuuksiin ja kohonneeseen verenpaineeseen. Matala greliinipitoisuus yhdistyi myös tyypin 2 diabeteksen ja verenpainetaudin esiintyvyyteen. Tutkituista tekijöistä IGF-I -pitoisuudet selittivät parhaiten greliinipitoisuuksia. Tämä käänteinen yhteys oli erityisen vahva tyypin 2 diabeetikoilla ja insuliiniresistenteillä henkilöillä viitaten greliinin ja IGF-I:n mahdollisen vuorovaikutukseen liittyvän näiden tilojen kehittymiseen. Lisäksi havaittiin, että greliinigeenin Gln51-alleelia kantavien henkilöiden greliinipitoisuudet olivat alhaiset, ja että he sairastivat enemmän diabetesta ja verenpainetautia kuin henkilöt jotka olivat homotsygootteja Arg51-alleelin suhteen. Greliinipitoisuudet ja C-reaktiivisen proteiinin pitoisuudet eivät korreloineet keskenään. Kaulavaltimon seinämäpaksuus korreloi positiivisesti greliinipitoisuuksien kanssa miehillä riippumatta perinteisistä ateroskleroosin riskitekijöistä. Tutkimustulokset tukevat olettamusta, että greliinillä saattaa olla merkitystä metabolisen oireyhtymän, tyypin 2 diabeteksen ja ateroskleroosin kehittymisessä. Jatkotutkimukset ovat tarpeen tämän yhteyden osoittamiseksi.

Em pacientes obesos com diabetes mellitus tipo 2 (DM2), o controle glicêmico pode ser observado em poucos dias após derivação gástrica em Y de Roux (DGYR), antes de ocorrer significativa perda de peso. Dentre os mecanismos propostos para explicar esse benefício metabólico, aqueles que envolvem adaptações gastrintestinais (GI) em resposta às mudanças anatômicas cirúrgicas são os mais consistentes. O presente estudo avaliou a resposta global do transcriptoma gastrintestinal à DGYR em pacientes obesos responsivos à remissão pós-operatória de DM2 e sua correlação com marcadores de homeostase glicêmica. Vinte pacientes adultas obesas com DM2 e candidatas à DGYR foram incluídas, de acordo com critérios específicos. Todas foram submetidas à técnica de DGYR, por laparotomia padronizada e acompanhadas até um ano após DGYR, para classificação dos pacientes responsivos (R) e não responsivos (NR) à remissão de DM2, de acordo com o critério da American Diabetes Association (ADA). Variáveis clínicas e bioquímicas envolvidas na homeostase glicêmica foram avaliadas no pré-operatório e, mensalmente, até 90 dias pós-operatórios. Análises transcriptômicas gastrintestinais foram desenvolvidas por técnica de microarray (Genechip 1.0 ST Array; AffymetrixTM), a partir de RNA obtido de biópsias de estômago corpo alto (ECA), estômago corpo médio (ECM), duodeno, jejuno e íleo, coletadas por enteroscopia de duplo balão (EDB), no período pré-operatório e após 90 dias da DGYR. O método não paramétrico Rank Products (RP) foi utilizado para a seleção dos genes diferencialmente expressos (DEGs). Os DEGs identificados por RP foram submetidos ao programa Ingenuity Pathways Analysis (IPA), para a seleção de genes dentro das seguintes funções relacionadas à fisiopatologia do DM2: 1) Metabolismo dos Carboidratos; 2) Metabolismo Lipídico; 3) Metabolismo dos Aminoácidos, 4) Doenças Metabólicas e 5) Desordem do Sistema Endócrino. DEGs relacionados a essas cinco funções foram submetidos a análises de agrupamento hierárquico de Person, classificação funcional de ontologia gênica (GOslim ontology), análise de enriquecimento funcional (software DAVID, com uso de banco de dados KEGG e Biocarta) e de vias canônicas pelo software IPA. Essas análises foram feitas separadamente em pacientes R e NR. DEGs de interesse foram validados por RT-qPCR usando o sistema de ensaio Taqman® e equipamento 7500 FastTM (Life Technologies). O coeficiente de correlação de Spearman correlacionou variáveis clínicas e bioquímicas com variáveis transcriptômicas. Das 20 pacientes estudadas, 12 foram classificadas como R e 8 como NR. Nas 5 funções de interesse, o número de DEGs encontrado no grupo R foi: 99 (ECA), 26 (ECM), 62 (duodeno), 241 (jejuno) e 63 (íleo). Dentre os DEGs encontrados no duodeno, 8 apresentaram correlação positiva forte a muito forte (coeficiente de Spearman > 0,7) com alterações das concentrações sistêmicas de glicemia ou hemoglobina glicada. Destes, LDLR, MMP1, NPC1L1 e SLC2A5 foram submetidos à análise de RT-qPCR e validados pelo método. De acordo com as análises de enriquecimento funcional e vias canônicas entre grupos (R e NR), apenas a via LXR/RXR, representativa de DEGs encontrados no duodeno de pacientes R, apresentou associação com remissão do DM2. Nos demais segmentos gastrintestinais, essas análises não identificaram vias representativas relacionadas com DM2, embora alguns de seus DEGs estivessem potencialmente envolvidos com marcadores da homeostase glicêmica. Em conclusão, DGYR induziu modificações transcriptômicas gastrintestinais em pacientes obesos com remissão pós-operatória de DM2 e algumas delas foram associadas com marcadores de homeostase glicêmica, principalmente por meio de alterações na via LXR no duodeno / In obese patients with type 2 diabetes mellitus (T2DM), glycemic control is observed within a few days after Roux-en-Y gastric bypass (RYGB), even before significant weight loss. Among the mechanisms proposed to explain this metabolic benefit, those involving gastrointestinal (GI) adaptations in response to surgical anatomical rearreagement are the most consistent. The present study evaluated the global response of the gastrointestinal transcriptome to DGYR in obese patients responsive to postoperative remission of T2DM and its correlation with markers of glycemic homeostasis. Twenty adult obese patients with T2DM diagnosis and candidates to RYGB were included, according to specific criteria. All of them were submitted to standardized laparotomy RYGB surgery and followed until one year after RYGB, for the patients classification as responsive (R) and non-responsive (NR) to T2DM remission according to the American Diabetes Association (ADA) criteria. Clinical and biochemical variables involved in glycemic homeostasis were evaluated at preoperative and monthly up to 90 postoperative days. GI transcriptomic analyzes were performed by microarray technique (Genechip 1.0 ST Array; AffymetrixTM), in RNA samples obtained from biopsies of the stomach cardia (SC), stomach fundus (SF), duodenum, jejunum and ileum, collected by double-balloon enteroscopy (DBE) at pre-postoperative and 90 days after RYGB. The non-parametric Rank Products (RP) method was used for selection of differentially expressed genes (DEGs). DEGs identified by RP were submitted to the Ingenuity Pathways Analysis (IPA) program for its selection within the following functions: 1) Carbohydrate Metabolism; 2) Lipid Metabolism; 3) Amino Acids Metabolism, 4) Metabolic Diseases and 5) Endocrine System Disorder. DEGs related with these five functions were submitted to the analysis of Pearson hierarchical clustering, functional classification of gene ontology (GOslim), functional enrichment (DAVID software, using KEGG and Biocarta database), and canonical pathways (IPA). These analyzes were performed separately in R and NR groups. DEGs of interest were validated by RT-qPCR using Taqman® assays in 7500 FastTM (Life Technologies). The Spearman correlation coefficient correlated clinical and biochemical variables with DEGs. From the 20 patients studied, 12 were classified as R and 8 as NR. In the 5 functions of interest, the number of DEGs found in R group were: 99 (SC), 26 (SF), 62 (duodenum), 241 (jejunum) and 63 (ileum). Among the DEGs found in the duodenum, 8 presented a strong to a very strong positive correlation (Spearman coefficient > 0.7) with systemic concentrations of glycemia or glycated hemoglobin. Of these genes, LDLR, MMP1, NPC1L1 and SLC2A5 were subjected to RT-qPCR analysis and validated by the method. According to the functional enrichment and canonical pathways analyzes between groups (R and NR), only the LXR/RXR pathway, representative of DEGs found in the duodenum of R patients, was associated with T2DM remission. In the other GI segments, these analyzes did not identify representative pathways related to T2DM, although some of their DEGs were potentially involved with markers of glycemic homeostasis. In conclusion, RYGB induced gastrointestinal transcriptomics changes in obese patients with postoperative remission of T2DM and some of these were associated with markers of glycemic homeostasis, mainly by changes in LXR pathway in the duodenum

Introdução: Acredita-se que o diabetes mellitus possa alterar mecanismos celulares do miocárdio tornando-o mais sensível a um insulto isquêmico, e que esta menor resistência do miocárdio isquêmico induzido pelo diabetes possa ser um dos motivos para o pior prognóstico observado em pacientes com doença arterial coronariana e diabetes. Um dos principais mecanismos adaptativos protetores do miocárdio é o precondicionamento isquêmico, sendo este desencadeado por curtos períodos de isquemia seguidos por reperfusão e que tornam o tecido mais resistente a um insulto isquêmico grave e prolongado. Em humanos, o precondicionamento isquêmico pode ser observado durante testes ergométricos sequenciais, nos quais a melhora em parâmetros isquêmicos no segundo teste ergométrico quando comparado ao primeiro é uma metodologia consagrada para o estudo clínico deste fenômeno. Estudos experimentais demonstram resultados controversos em relação à interferência do diabetes sobre o fenômeno do precondicionamento, e estudos com humanos são escassos e inconclusivos. Assim, ainda é incerto se o diabetes pode afetar a expressão do precondicionamento isquêmico em pacientes com doença arterial coronariana. Objetivos: Identificar se o diabetes mellitus interfere no fenômeno do precondicionamento isquêmico em pacientes com doença arterial coronariana. Métodos: Pacientes com doença arterial coronariana comprovada por cineangiocoronariografia diagnóstica, função ventricular sistólica preservada e com angina ou teste ergométrico positivo para isquemia miocárdica foram submetidos a dois testes ergométricos sequenciais com intervalo de 30 minutos. Parâmetros isquêmicos foram comparados entre pacientes com e sem diabetes mellitus. O precondicionamento isquêmico foi considerado presente quando o tempo para a depressão em 1,0 mm do segmento ST (T-1mm) foi maior no segundo teste sequencial comparado ao primeiro. Também se mensurou o duplo-produto (frequência cardíaca multiplicada pela pressão arterial sistólica) no momento do T- 1mm. Os testes foram analisados por dois cardiologistas experientes, independentes. Resultados: De 2.140 pacientes consecutivos com doença arterial coronariana, 361 apresentavam critérios para inclusão nesse estudo. Destes, 174 pacientes (64,2 ± 7,6 anos) foram submetidos aos testes ergométricos sequenciais para identificação e caracterização do precondicionamento isquêmico; 86 apresentavam diabetes mellitus (grupo 1) e 88 não apresentavam diabetes mellitus (grupo 2). Os dois grupos foram semelhantes em relação às principais características demográficas, com exceção de infarto do miocárdio prévio e perfil lipídico. No primeiro grupo, 62 pacientes (72,1%) manifestaram o precondicionamento isquêmico e no segundo, 60 (68,2%) manifestaram o precondicionamento isquêmico (P=0,62). Analisando-se os pacientes que expressaram o fenômeno, a melhora do T-1mm foi similar entre os dois grupos (média da melhora do tempo entre os testes 1 e 2: 79,4 ± 47,6 x 65,5 ± 36,4 segundos, respectivamente para os grupos 1 e 2, P=0,12). Em relação ao duploproduto no momento do T-1mm, os pacientes com diabetes apresentaram melhora expressiva em relação aos pacientes sem diabetes (média da melhora do duploproduto 3011 ± 2430 x 2081 ± 2139 bpm x mmHg, respectivamente para os grupos 1 e 2, P=0,01). A análise da melhora das arritmias e da morfologia da depressão do segmento ST nos testes ergométricos sequenciais não mostrou diferenças entre os dois grupos de pacientes. Conclusão: Neste estudo, o diabetes mellitus tipo 2 não impediu o surgimento do PI. Além disso, o diabetes esteve associado à melhora significativa do esforço cardíaco e do consumo miocárdico de oxigênio, caracterizados pelo duplo-produto . / Background: It\'s postulated that diabetes mellitus may impair myocardial cellular mechanisms turning it more sensitive to ischemic injuries, and that this lower resistance of the ischemic myocardium induced by diabetes may be one reason for the poor prognosis observed in patients with both coronary artery disease and diabetes. One major adaptive myocardial protective mechanism is ischemic preconditioning, which is triggered by brief ischemia followed by reperfusion that turns the myocardium more resistant to a prolonged ischemic insult. In humans, ischemic preconditioning can be observed during sequential exercise tests, in which the improvement in ischemic parameters in the second exercise test compared to the first is a methodology devoted to the clinical study of the phenomenon. However, experimental studies have shown conflicting results about the interference of diabetes on ischemic preconditioning, and the few human studies are scarce and inconclusive. Thus, it\'s still uncertain whether diabetes may affect ischemic preconditioning in coronary artery disease patients. Objectives: Identify whether type 2 diabetes mellitus intervenes on myocardial ischemic preconditioning in symptomatic coronary artery disease patients. Methods: Symptomatic multivessel coronary artery disease patients with preserved systolic ventricular function and a positive exercise test underwent two sequential exercise tests to demonstrate ischemic preconditioning. Tests were performed with a 30 minutes interval between them. Ischemic parameters were compared among patients with and without type 2 diabetes mellitus. Ischemic preconditioning was considered present when the time to 1.0 mm ST deviation (T-1mm) was greater in the second of 2 exercise tests. Rate pressure-product (heart rate multiplied by systolic arterial pressure) at T-1mm was also assessed. Sequential exercise tests were analyzed by 2 independent cardiologists. Results: Of the 2,140 consecutive coronary artery disease patients screened, 361 met inclusion criteria, and 174 patients (64.2 ± 7.6 years) completed the study protocol. Of these, 86 had the diagnosis of type 2 diabetes. The 2 groups were similar regarding the main demographic characteristics, except for the rate of previous myocardial infarction and lipid profile. Among diabetic patients, 62 (72.1%) manifested an improvement in ischemic parameters consistent with ischemic preconditioning, whereas among nondiabetic patients, 60 (68.2%) manifested ischemic preconditioning (P=0.62). The analysis of patients who demonstrated ischemic preconditioning showed similar improvement in the time to 1.0 mm ST deviation between diabetic and nondiabetic groups (79.4 ± 47.6 vs 65.5 ± 36.4 sec, respectively, P=0.12). Regarding rate pressure-product, the improvement was greater in diabetic compared to nondiabetic patients (3011 ± 2430 vs 2081 ± 2139 bpm x mmHg, respectively, P=0.01). The analysis of arrhythmias and ST-segment deviation morphology during sequential exercise tests did not show differences between the 2 groups of patients. Conclusion: In this study, type 2 diabetes mellitus did not prevent the occurrence of ischemic preconditioning. In addition, diabetes was associated with significant improvement in cardiac stress and myocardial oxygen consumption, characterized by rate pressure-product

Introdução: A sitagliptina, inibidor da dipeptidil-peptidase IV, impede a degradação do GLP-1 (peptídeo-1 semelhante ao glucagon), um dos principais hormônios incretínicos. A dieta interfere na secreção de GLP-1, no entanto, a interação das drogas que aumentam o GLP-1 e os macronutrientes da dieta é pouco estudada. Objetivo e Métodos: Determinar o efeito da sitagliptina, na secreção de GLP-1, glucagon, insulina, peptídeo-C, ácidos graxos livres e na glicemia após três dietas, isocalóricas, de diferentes composições nutricionais em pacientes diabéticos tipo 2, recém-diagnosticados, virgens de tratamento, quando comparado a uso de placebo. Dezesseis indivíduos nessas condições foram submetidos a dietas hiperglicídica, hiperprotêica e hiperlipídica, isocalóricas entre si. Dosaram-se nos tempos 0, 30, 60, 120 e 180 minutos os parâmetros: glicose, insulina, peptídeo C, GLP-1, glucagon e AGL. Foi calculada média de área sob a curva e cálculo da área incremental, além de análise de variância para medidas repetidas. Resultados: Durante o teste de dieta hiperglicídica a glicemia foi maior em todos os tempos quando comparado aos testes com PTN e LPD independentemente do uso de sitagliptina (p<0,05). Sitagliptina diminuiu a glicemia em todos os tempos, quando comparado ao uso de placebo (p<0,05). Durante a dieta CHO, a secreção de glucagon foi menor que nas dietas LPD e PTN (p<0,05). Já a concentração de insulina foi maior com a dieta CHO em relação à dieta LPD (p<0,05). A concentração de insulina e peptídeo C foi maior em todos os tempos na dieta CHO (p<0,05). A concentração de GLP-1 foi significativamente maior durante o teste hiperlipídico em relação à dieta CHO. Durante a dieta LPD, a medida de GLP-1 foi maior em todos os tempos. A dieta CHO apresentou medida de GLP-1 menor em todos os tempos do que as outras dietas (p<0,05). A medida de GLP-1 no tempo foi maior (até 120\') com o uso de sitagliptina do que com o uso do placebo, apesar de não estatisticamente significativa. Os níveis de AGL no tempo foram maiores com o uso do placebo do que com o uso da sitagliptina, apesar de não estatisticamente significativo. Conclusão: Houve diminuição da glicemia em todos os tempos com sitagliptina, independentemente da dieta testada. Houve diminuição do efeito da sitagliptina durante o uso da dieta hiperglicídica / Background: Sitagliptin, a dipeptidil-peptidase IV inhibitor, prevents the degradation of GLP-1 (glucagon-like peptide 1), one of the incretin hormones. It is well-known that diet interferes in the GLP-1 secretion; however, the interaction between drugs that stimulates the release of GLP-1 and the macronutrients from diet is hardly studied. Objective and Methods: To demonstrate the effect of sitagliptin on glycemia, and on the secretion of GLP-1, glucagon, insulin, C-peptide, and free fatty acids after three isocaloric diets with different nutritional compositions, in drug-naïve patients, newly diagnosed with type 2 diabetes, when compared to the use of placebo. Sixteen individuals were subjected to a high-carbohydrate diet, a high-protein diet, and a high-fat diet, all of which with similar caloric values. At 0, 30, 60, 120 and180 minutes after the diet, glucose, insulin, C-peptide, GLP-1, glucagon, and AGL were measured. The mean area under the curve, the incremental area, and the variance for repeated measures were calculated. Results: During high-carbohydrate diet, glycemia was higher for all time points, when compared to the PTN and LPD diets, independently of sitagliptin (p<0,05). Sitagliptin reduced glycemia during three diets when compared to placebo (p<0,05). During CHO diet, secretion of glucagon was smaller than it was during the LDP and PTN diets (p<0,05). On the other hand, insulin concentration was higher than during the LPD diet (p<0,05). Concentrations of insulin and C-peptide were higher for all the time points during the CHO diet (p<0,05). GLP-1 concentration was significantly higher during the high-fat diet than during the high-carbohydrate diet. During the LPD diet, the quantity of the GLP-1 was larger for all time points. The CHO diet presented lower GLP-1 level, for all the time points, than the other diets (p<0,05). The GLP-1 level (up to 120min) with the use of sitagliptin was higher with LPD and PTN diet than it was with the CHO diet. The AGL levels for all time points were higher with placebo than with sitagliptin, although not statistically significant. Conclusion: There was a reduction in glycemia with sitagliptin, independently of the diet tested, for all time points. There was a reduction in sitagliptin effect during the use of the high-carbohydrate diet

Le surpoids et l’obésité touchent plus de 1,9 milliard d’adultes à travers le monde et pourraient atteindre 3,3 milliards de personnes dans une dizaine d’année. L’obésité est associée à une inflammation tissulaire et systémique chronique de bas grade, qui contribuent à l’apparition de la résistance à l’insuline. Récemment, notre laboratoire a mis en évidence des anomalies d’une nouvelle population de lymphocytes T innés, les cellules MAIT (Mucosal Associated Invariant T) chez des patients obèses et/ou ayant un diabète de type 2 (T2D). Les cellules MAIT sont des lymphocytes T non conventionnels, qui expriment un récepteur des cellules T (TCR) avec une chaîne alpha invariante. Leur TCR reconnait la molécule d’histocompatibilité de classe 1 non classique MR1, présentant des métabolites dérivés de la voie de biosynthèse des vitamines B, notamment les vitamines B2 et B9. Dans cette étude, nous utilisons les modèles murins pour analyser le rôle des cellules MAIT dans le developpement du T2D. Au cours de l’obésité induite par un régime riche en graisse, les cellules MAIT du tissu adipeux viscéral (TA) et de l’iléon sont activées de façon précoce et anormale et produisent plus de cytokines pro-inflammatoires (i.e. IL-17, TNFa et l’IFN?). De plus, l’augmentation de la fréquence tissulaire des MAIT chez des souris Va19 transgéniques conduit à l’apparition de la résistance à l’insuline et à une intolérance au glucose, au cours de l’obésité. A l’inverse, les souris obèses déficientes en MAIT, MR1-/-, sont protégées contre ces anomalies métaboliques. Une fréquence élevée de MAIT est associée au changement de macrophages M2 (anti-inflammatoires) en M1 (inflammatoires) et à une infiltration des cellules NK et des LTaß-CD8 au niveau du TA. Par ailleurs, les MAIT contrôlent la fréquence des Treg, ILC2 et ILC3 dans l’iléon et des Treg, ILC2 et éosinophiles dans le tissu adipeux. La modification de la fréquence des ILC2 et ILC3 est associée à la production intestinale d’IL-33 et d’IL-25. De plus, nous montrons que le rôle délétère des MAIT dans le développement du T2D est associé à une dysbiose intestinale. Finalement, des expériences de transfert de flores intestinales montrent que cette dysbiose intestinale est en partie responsable des anomalies immunitaires et métaboliques. / Obesity and type 2 diabetes are associated with low-grade chronic inflammation. Immune cells are recruited and activated in several tissues, including adipose tissue, thereby contributing to insulin-resistance and diabetes. Recent studies described gut microbiota dysbiosis as a consequence as well as a driver of obesity and type 2 diabetes. Mucosaassociated invariant T cells (MAIT) are innate-like T cells expressing a semi-invariant T-cell receptor restricted by the non-classical MHC class I molecule MR1 presenting bacterial ligands. In obese/T2D patients MAIT cells in blood and adipose tissue exhibit a pro-inflammatory profile. In the present study, we show that during high fat diet-induced obesity MAIT cells produce inflammatory cytokines in adipose tissue and the ileum and induce inflammation in these tissues by modifying other immune cell populations (i.e. macrophages, CD8 Taß cells, NK cells, LTreg, eosinophils and ILC2 in the adipose tissue and ILC2, ILC3 and LTreg in the ileum). These changes impair the function of both tissues leading to insulin resistance, glucose intolerance, impaired lipid metabolism and increased gut permeability. MAIT cells also impact gut microbiota dysbiosis during obesity and microbiota transfer experiments highlight a bidirectional crosstalk between MAIT cells and the gut microbiota leading to inflammation and gut leakage. Altogether these results reveal the major role of MAIT cells in promoting the development of type 2 diabetes during obesity.

<p>Zastupljenost deficita vitamina D3 je mnogo veći kod bolesnika sa dijabetesnom bolesti tipa 2 nego u populaciji zdravih osoba. Bolesnici sa DM tipa 2 i deficitom vitamina D3 imaju veći rizik za razvoj dijabetesne nefropatije. Eksperimenti na životinjama i neka klinička istraživanja ukazuju da bi primena nižih doza vitamina D3 mogla imati renoproktektivno delovanje. Cilj istraživanja je bio da se utvrdi zastupljenost deficita vitamina D3 u populaciji bolesnika sa dijabetesnom nefropatijom koja je definisana proteinurijom ˃0,150 g/du. Drugi cilj je bio da se utvrdi da li primena holekaciferola u dozi koja predstavlja razliku između utvrđenog i optimalnog nivoa vitamina D3 dovodi do statistički značajnog smanjenja proteinurije. Bolesnici sa dijabetesom tipa 2 i proteinurijom ˃0,150 g/du su uključivani u skrining na nivo vitamina D3 (25(OH)D) nakon čega su svrstavani u grupe sa deficitom i normalnim nivoom vitamina D3. Granična vrednost za utvrđivanje deficita vitamina D3 je odreĎivana na osnovu tabele koja defini&scaron;e ove vrednosti za svaki mesec tokom godine, posebno za mu&scaron;karce i žene. Bolesnici sa deficitom vitamina D3 su podeljeni u 2 grupe od po 45 ispitanika. Studijska grupa je primala holekaciferol u dozi koja je izračunata na osnovu razlike između izmerene vrednosti i određenog optimalnog nivoa vitamina D3 od 90-100 nmol/L. Kontrolna grupa bolesnika je uzimala svoju uobičajenu terapiju. Istraživanje je trajalo 24 nedelje tokom koje su na drugi mesec praćeni parametri bubrežne funkcije, parametri inflamacije i ko&scaron;tanog metabolizma. Na početku i kraju istraživanja su odreĎeni nivo vitamina D3 u studijskoj grupi, dok su u obe grupe određivani vrednost HbA1c i lipidni profil. Analizom dobijenih podataka je utvrđeno da je zastupljenost deficita vitamina D3 kod bolesnika sa dijabetesnom nefropatijom, uzimajući u obzir sezonske varijacije u nivou ovog vitamina, bila veća od vrednosti od 30-50% koje su postavljene u radnoj hipotezi. Učestalost bolesnika sa nedostakom vitamina D3 je u ispitivanom uzorku je bila 82,56% , dok je normalne vrednosti vitamina D3 imalo 17,43% ispitanika, od toga je bilo 10 (52,63%) mu&scaron;karaca i 9 (47,36%) žena. Sniženje vrednosti vitamina D3 u odnosu na donje granične vrednosti je bilo izraženije u letnjem periodu i bilo je statistički značajno kod svih ispitanika zajedno, potom u studijskoj grupi, dok je utvrđeno i u kontrolnoj grupi ali je u njoj bilo bez statisičke značajnosti. Utvrđen je porast HbA1c koji je bio veći u kontrolnoj grupi ispitanika. Suplementacija vitaminom D3 je imala povoljan efekat na lipidni profil. Registrovan je porast vrednosti ukupnog holesterola koji je bio izraženiji u kontrolnoj grupi, pad vrednosti triglicerida u grupi bolesnika koji su uzimali vitamin D3 i njihov porast u kontrolnoj grupi ispitanika. U studijskoj grupi je registrovan porast vrednosti HDL-holesterola koji je bio na granici statističke značajnosti dok je istovremeno nađeno njegovo smanjenje u kontrolnoj grupi. Vrednost LDL-holesterola je ostala bez promene pod delovanjem vitamina D3, dok je u kontrolnoj grupi do&scaron;lo do njegovog porasta. Utvrđeno je snižavanje vrednosti sedimentije, CRP-a i fibrinogena koje je bilo bez statističke značajnosti. Bezbednosni profil vrednosti kalcijuma u serumu i urinu tokom dugotrajnije primene je dobar. Primenom vitamina D3 je do&scaron;lo do signifikatnog smanjenja proteinurije u grupi bolesnika koji su primali holekaciferol čime je ujedno i potvrđena radna hipoteza.</p> / <p>The prevalence of vitamin D3 deficiency is much higher in patients with type 2 diabetes than in the healthy population. Patients with type 2 DM and vitamin D3 deficiency are at increased risk for developing diabetic nephropathy. Animal experiments and some clinical studies suggest that administration of lower doses of vitamin D3 could have renoprotective effect. The aim of the study was to determine the prevalence of vitamin D3 deficiency in the population of patients with diabetic nephropathy defined by proteinuria ˃0.150 g / du. The second goal was to determine whether the use of cholecaciferol in a dose that represents the difference between the established and optimal levels of vitamin D3 leads to a statistically significant reduction in proteinuria. Patients with type 2 diabetes and proteinuria ˃0.150 g / du were screened for vitamin D3 (25 (OH) D) levels and then classified as deficient and normal vitamin D3. The limit value for determining vitamin D3 deficiency was set on the basis of a table defining these values for each month during the year, separately for men and women. Patients with vitamin D3 deficiency were divided into 2 groups of 45 subjects each. The study group received cholecaciferol at a dose calculated on the basis of the difference between the measured value and the set optimal vitamin D 3 level of 90-100 nmol/L. The control group of patients was taking their usual therapy. The study lasted 24 weeks during which the parameters of renal function, parameters of inflammation and bone metabolism were monitored every second month. At the beginning and end of the study, the levels of vitamin D3 in the study group were determined, while in both groups HbA1c and lipid profile were determined. The analysis of the obtained data showed that the prevalence of vitamin D3 deficiency in patients with diabetic nephropathy, taking into account seasonal variations in the level of this vitamin, was higher than the values of 30-50%, which were set in the working hypothesis. The frequency of patients with vitamin D3 deficiency in the study sample was 82.56%, while the normal values of vitamin D3 were in 17.43% of the subjects, of which 10 (52.63%) were men and 9 (47.36%) woman. The decrease in vitamin D3 compared to the lower limit values was more pronounced in the summer and was statistically significant in all subjects together, as well in the study group, while it was also found in the control group but was not statistically significant. An increase in HbA1c was found to be higher in the control group. Vitamin D3 supplementation had a beneficial effect on the lipid profile. An increase in the total cholesterol level that was more pronounced in the control group, a decrease in triglyceride values in the group of patients taking vitamin D3 and its increase in the control group of subjects were registered. An increase in HDL-cholesterol was reported in the study group, which was at the limit of statistical significance, while at the same time a decrease was found in the control group. LDL-cholesterol levels remained unchanged under the influence of vitamin D3, while in the control group it increased. The decrease in sedimentation, CRP and fibrinogen values was found to be of no statistical significance. The safety profile of serum and urine calcium during long-term administration is good. The use of vitamin D3 resulted in a significant decrease in proteinuria in the group of patients receiving cholecaciferol, which also confirmed the working hypothesis.</p>

<p>Doktorsku disertaciju čine tri celine kojima je zajednički element ispitivanje fenola, u pogledu njihovog sadržaja i dostupnosti u dijetetskim suplementima na bazi grožđa i japanskog troskota, ispitivanja uticaja suplementacije kod eksperimentalnih životinja, odnosno mogućnosti ekstrakcije fenolnih jedinjenja iz komine grožđa. Osnovni ciljevi prvog dela bili su ispitivanje bezbednosti i kvaliteta 14 suplemenata na bazi grožđa i japanskog troskota u pogledu ujednačenosti mase, sadržaja i brzine rastvorljivosti. U drugom delu je radi provere terapijske delotvornosti suplementa koji sadrži čist resveratrol ispitan njegov uticaj na glikemiju i lipidni status eksperimentalnih životinja. Treći deo je obuhvatio analizu pet različitih komina grožđa i razvoj metode ekstrakcije fenola iz odabrane komine kako bi se dobili ekstrakti sa &scaron;to je moguće većim prinosom, koristeći rastvarače koji su bezbedni po ljudsko zdravlje. Rezultati su pokazali da dva od četrnaest suplemenata nisu ispunila zahteve farmakopeje za lekove u pogledu ujednačenosti mase i sadržaja aktivne komponente, dok ni jedan suplement nije ispunio zahteve u pogledu brzine rastvorljivosti aktivne supstance, zbog čega se postavlja pitanje delotvornosti ispitanih suplemenata. Ni kod jednog suplementa nisu kvantifikovani ostaci pesticida ni toksični metali, čime je potvrđena njihova bezbednost. Farmakodinamska ispitivanja na pacovima pokazala su antioksidantna, anti-dijabetska i hipolipidemijska svojstva dijetetskog suplementa na bazi resveratrola, čime je potvrđena njegova delotvornost. Za potvrdu delotvornosti suplementa na ljudima neophodno je sprovesti dobro dizajnirano kliničko ispitivanje na dovoljnom broju ispitanika. Analiza pet različitih komina grožđa pokazala je da ovaj nusprodukt proizvodnje vina sadrži različite fenole, od kojih je samo katehin bio prisutan u značajnoj količini. Kvalitativan i kvantitativan sastav komine značajno varira zavisno od sorte i berbe grožđa, kao i od primenjenog tehnolo&scaron;kog procesa proizvodnje vina. Imajući u vidu sveobuhvatne kriterijume u pogledu efikasnosti ekstrakcije, zaključeno je da su 55% etanol, odnos uzorak / rastvarač 1:40, pH 4,5, T 55&deg;C i vreme od 30 min optimalni eksperimentalni uslovi za ekstrakciju fenola iz komine grožđa. U zavisnosti od osnovnog cilja procesa ekstrakcije ovi parametri se mogu lako modifikovati. Vi&scaron;estruke su mogućnosti za iskori&scaron;ćenje komine grožđa, a jedan od njih bi mogla biti i da se koristi kao sirovina za izradu dijetetskih suplemenata.</p> / <p>The dissertation consists of three parts with a common element &ndash; testing phenols in terms of content and availability in grape and Polygonum cuspidatum-based dietary supplements, testing the supplement&rsquo;s impact on experimental animals and the possibility to extract phenolic compounds from grape pomace. The primary objectives of the first part were testing safety and quality of fourteen grape and Polygonum cuspidatum-based supplements in terms of uniformity of mass, content and dissolution profile. In the second part, to test the therapeutic efficacy of a supplement containing pure resveratrol, its effect on the glycemia and lipid profile of experimental animals was examined. The third part covers the analysis of five different grape pomaces and the development of a phenol extraction method from the selected grape pomace to obtain extracts with the highest possible yield, using solvents that are safe for human health. The results showed that two out of fourteen supplements have not met the Pharmacopoeia requirements in terms of uniformity of mass and active substance content, while no supplement has met requirements in terms of dissolution test of the active substance, which raises the question of the effectiveness of the tested supplements. No pesticide or heavy metal residues were quantified in any of the supplements which confirms their safety. Pharmacodynamic testing on rats has shown antioxidant, antidiabetic and hypolipidemic properties of the resveratrol-based dietary supplement which confirms its efficacy. In order to confirm the supplement efficacy on people, it is necessary to conduct a well-designed clinical trial on a sufficient number of human participants. The analysis of five different grape pomaces revealed that this byproduct of vine production contains different phenols, and only catechin was present in significant amounts. The qualitative and quantitative composition of grape pomace varies significantly depending on grape variety and harvesting as well as on the technological process that was applied in vine production. Considering the comprehensive criteria in terms of extraction efficacy, it was concluded that optimal experimental conditions for the extraction of phenol from grape pomace include 55% ethanol, sample/solvent ratio 1:40, pH 4.5, T 55&deg;C for 30 minutes. Depending on the primary objective in the extraction process, these parameters can be easily modified. There are multiple possibilities for utilizing grape pomace and one of them could be as raw material in production of dietary supplements.</p>