We investigated the relationship between glucose tolerance and birth weight in a group of 7-year-old black South Africans on whom longitudinal anthropometric data were available. Oral glucose tolerance tests (OGTT’s) were carried out on 152 subjects and inverse correlations were found between birth weight and the total amount of insulin secreted during the first 30 minutes (r= -0.19, p=0.04) and the last 90 minutes (r= -0.19, p=0.04) of the oral glucose tolerance test and also between birth weight and the 30 minute glucose concentrations (r= -0.20, p=0.02). Children born with low birth weights but who had high weights at 7 years, had higher insulin concentrations and indices of obesity compared with those with low birth weights and low weights at 7 years of age. There were also positive correlations between weight velocity and BMI (r=0.24, p=0.02) and weight velocity and postprandial insulin levels (r=0.31, p=0.001). Thus low birth weight in conjunction with rapid childhood gains in weight especially as subcutaneous fat, produces poor glucose tolerance in 7-year-old children and may make them susceptible to the development of Type II diabetes later in life.

O íon fluoreto (F) provém do elemento flúor. Sua absorção é inversamente relacionada ao pH e ocorre rapidamente no estômago e posteriormente no intestino delgado. Após sua absorção, o F é distribuído pelos tecidos através da corrente sanguínea e armazenado nos tecidos calcificados e moles. Sua excreção acontece por via renal. Trata-se de um elemento relevante em termos de Saúde Pública, devido às suas propriedades de prevenir ou reverter lesões cariosas em indivíduos de todas as idades. No entanto, sua ingestão excessiva é capaz de afetar o metabolismo ósseo e desenvolvimento do esmalte dentário. Estudos sugerem que o F pode interferir em vias metabólicas, inibindo a ação de diversas enzimas. Entretanto, a literatura é conflitante em relação aos seus efeitos na homeostasia da glicose, o que poderia, talvez, ser explicado pela diferença genética entre as linhagens utilizadas. Sabe-se que camundongos da linhagem A/J são extremamente sensíveis aos efeitos do F, enquanto que os camundongos da linhagem 129P3/J são altamente resistentes ao tratamento com esse íon. Por este motivo, foi investigado se esses animais que sabidamente apresentam uma expressão proteica diferencial em função do F devido ao seu background genético apresentam também respostas diferentes em parâmetros bioquímicos (glicemia jejum, insulinemia, índice de resistência à insulina [HOMA2-IR] e teste de tolerância à insulina) e imunológicos (TNF-&alpha;). Após aprovação da Comissão de ética, 156 animais (78 da linhagem A/J e 78 da linhagem 129P3/J) foram divididos em 3 grupos para cada linhagem, e tratados por um período de 42 dias com doses de 0, 15 ou 50 ppm de F na água e ração com baixo teor de F. Após o término do tratamento, os camundongos foram eutanasiados para a obtenção de amostras de sangue. Os dados foram analisados por ANOVA a 2 critérios e testes de Tukey e Sidak para comparações individuais (p<0,05). Para a glicemia, os animais A/J que receberam água sem F e com a dose de 15 ppm F tiveram glicemia significativamente mais alta que os animais 129P3/J que receberam o mesmo tratamento. Para as dosagens de insulina no plasma, houve diferença significativa apenas entre os camundongos A/J 0 ppm F e 50 ppm F, sendo mais baixa a insulinemia para os animais tratados. O índice HOMA2-IR mostrou diferença significativa somente entre os animais da linhagem A/J, sendo que o grupo que recebeu água contendo 50 ppm F apresentou valores menores quando comparado para os grupos 0 ppm F e 15 ppm F. Quanto ao TNF-&alpha;, não foi observada diferença significativa entre as linhagens e entre os tratamentos. Entretanto, houve uma tendência para seu aumento nos grupos tratados com água contendo 15 ppm F nas duas linhagens. Para o teste de tolerância à insulina, também não foram observadas diferenças significativas entre as linhagens, nem entre os tratamentos. Levando em consideração os resultados, percebe-se que as diferentes concentrações de F alteram os resultados para os parâmetros analisados, e, as linhagens respondem diferentemente a essas alterações. No entanto, é necessário que se analisem outras variáveis para que esse assunto seja melhor elucidado. / Fluoride (F) comes from the element fluorine. Its absorption is inversely related to the pH and occurs quickly in the stomach and later in the small intestine. After absorption, F is distributed to the tissues through the bloodstream and stored in calcified and soft tissues. Excretion occurs via the kidneys. It is an important element in terms of public health, due to its properties to prevent or reverse caries in individuals of all ages. However, its excessive intake can affect bone metabolism and the development of tooth enamel. Studies suggest that F can interfere with metabolic pathways, by inhibiting the action of several enzymes. However, there is contradiction in the literature regarding its effects on glucose homeostasis, which could possibly be explained by genetic differences between the strains used. A/J mice are extremely sensitive to the effects of F, whereas 129P3/J mice are highly resistant to treatment with this ion. For this reason, it was investigated whether these animals which are known to exhibit differential protein expression upon exposure to F due to their genetic background also exhibit distinct responses in biochemical (fasting glucose, insulin, insulin resistance index [HOMA2-IR] and insulin tolerance test) and immune (TNF-&alpha;) parameters. After approval by the Ethics Committee, 156 animals (78 of A/J strain and 78 of 129P3/J strain) were obtained, divided into 3 groups for each strain and treated for a period of 42 days with 0, 15 or 50 ppm F in the drinking water. They received low-F diet. After treatment, the mice were euthanized and blood samples were obtained. Data were analyzed by 2-way ANOVA and Tukey and Sidak tests for individual comparisons (p<0.05). For blood glucose analysis, A/J mice treated with water containing no F containing 15 ppm F had significantly higher levels of glucose than 129P3/J animals receiving the same treatment. For plasma insulin, there was significant difference only between A/J mice treated with no F and 50 ppm F, with lower values for the treated animals. HOMA2-IR index showed a significant difference only between A/J animals, where the group received water containing 50 ppm F had lower values when compared to those receiving water containing no F or 15 ppm F. Regarding TNF-&alpha;, no significant differences were observed between the strains or among the treatments. However, there was a trend towards an increase in the groups treated with water containing 15 ppm F for both strains. For insulin tolerance test, also no significant differences between the strains or among treatments were observed. The results suggest that the different F concentrations alter the results of the parameters analyzed, and the strains respond differently to these changes. However, it is necessary to analyze other variables in order to better elucidate these findings.

Many adolescents with type 1 diabetes (T1DM) have suboptimal glycaemic control, increasing the risk of diabetic complications. This thesis explores some of the causes, consequences and therapeutic options for adolescents with T1DM and poor glycaemic control. Insulin resistance occurs in T1DM and normal puberty and contributes to poor glycaemic control. The effect of rosiglitazone, an insulin sensitizer, in addition to insulin on the glycaemic control of adolescents with T1DM was tested using a randomized, double blind placebo controlled trial. Treatment with rosiglitazone did not improve HbA1c, however there was a significant reduction in insulin dose and adiponectin, suggesting improved in insulin sensitivity. Insulin sensitivity by euglycaemic hyperinsulinaemic clamp varied widely between individuals and there was no consistent pattern with rosiglitazone. Potential markers of insulin resistance in T1DM were examined. Total and high molecular weight (HMW) adiponectin levels were lower in children and adolescents with T1DM than controls. HMW adiponectin was significantly associated with other markers of insulin resistance, such as insulin dose, body mass index standard deviation score (BMI-SDS), age, pubertal stage and duration of diabetes. There is increasing evidence that insulin resistance may play a role in T1DM complications. The natural history and risk factors for the development of microalbuminuria was described using a retrospective cohort study of 972 children and adolescents. Most cases of microalbuminuria were transient. Apart from baseline albumin excretion rate, HbA1c and age at diagnosis, other predictors of subsequently developing persistent microalbuminuria included several markers of insulin resistance (higher cholesterol, BMI-SDS, and insulin dose). In addition to insulin resistance, there are many other factors that contribute to glycaemic control. The role of the variability in carbohydrate intake was assessed using questionnaires and food diaries. Although carbohydrate consumption varied by approximately 45grams each day, it had no significant correlation with HbA1c. The impact of socioeconomic status, quality of life and health care delivery is discussed by comparing glycaemic control of children with T1DM in three diabetes centres. A model for the factors associated with poor glycaemic control in adolescents with T1DM is proposed, and the challenges of research and clinical practice in this population are discussed.

Recent investigations suggest that reducing stearoyl CoA desaturase (SCD) 1 expression confers protection against obesity and insulin resistance, whereas others show that increasing SCD1 expression protects cells from lipotoxicity. The overall aim of this thesis was to establish the role of SCD1 expression in fatty acid metabolism and insulin stimulated glucose disposal in skeletal muscle. In vitro and in vivo studies were conducted to investigate the relationship between fatty acid subtype, SCD1 expression and fuel metabolism. The role of fatty acid subtype on fatty acid metabolite accumulation and insulin resistance was initially examined in rats. Rats were provided with a low fat diet or a high fat diet consisting of predominantly saturated (SAT) or polyunsaturated fatty acids (PUFA). Rats fed a SAT diet were insulin resistant and had increased skeletal muscle diacylglycerol content whereas rats fed a PUFA diet retained insulin sensitivity and accumulated triacylglycerol rather than diacylglycerol. Interestingly, SCD1 mRNA and protein content were elevated in SAT rats compared with PUFA fed and control fed rats, indicating a possible involvement of SCD1 in the aetiology of insulin resistance. Subsequently, SCD1 expression was examined in the skeletal muscle of various rodent models of genetic and diet-induced obesity. SCD1 content was consistently upregulated in the skeletal muscle of obese rodents. To determine whether SCD1 contributes to or protects from fatty-acid induced insulin resistance, SCD1 levels were transiently altered in L6 skeletal muscle myotubes. Short interfering (si) RNA was used to decrease SCD1 content and a pcDNA3.1/HygromSCD1 vector was introduced to increase SCD1 content. Reducing SCD1 protein resulted in marked esterification of exogenous fatty acids into diacylglycerol and ceramide. Insulin-stimulated Akt (acute transforming retrovirus thymoma) phosphorylation and 2-deoxyglucose uptake were reduced with SCD1 siRNA. Exposure of L6 myotubes to palmitate abolished insulin-stimulated glucose uptake in both control and SCD1 siRNA myotubes. Transient overexpression of SCD1 resulted in triacylglycerol esterification but attenuated ceramide and diacylglycerol accumulation and protected myotubes from fatty acid-induced insulin resistance. Further, these changes were associated with reduced phosphorylation of c-Jun Amino-Terminal Kinase (JNK) and the inhibitor of IêB kinase (IKK), both of which impair insulin signalling. These studies indicated that SCD1 protects from cellular toxicity in L6 myotubes by preventing excessive accumulation of bioactive lipid metabolites. Collectively, these experiments indicate that increasing SCD1 expression may be a protective mechanism designed to prevent insulin resistance in obese phenotypes.

Background: A number of conditions are associated with laminitis in horses, such as corticosteroid administration, equine Cushing’s syndrome and equine metabolic syndrome. In common to these conditions are disturbed glucose and insulin metabolism and importantly, the development of insulin resistance. Insulin resistance is seen when the insulin-responsive glucose transport proteins (GLUTs) that are largely responsible for glucose disposal in tissues such as skeletal muscle begin to fail. Aims: 1. The aim of this thesis was to determine the relationship between disturbed carbohydrate metabolism and laminitis in horses and test the hypothesis that impaired glucose uptake in the hoof lamellae is involved in the pathogenesis of laminitis, by investigating the mechanisms that control glucose uptake in hoof lamellae. 2. Having determined that glucose uptake in the hoof occurs independently of insulin, the hypothesis was re-examined, with the aim of determining the effects of hyperinsulinaemia, in the absence of cortisol manipulation, dietary modification, or hyperglycaemia on lamellar integrity in the hooves of healthy ponies. Methods: 1. An in vitro lamellar explant model was used to investigate the effects of insulin on glucose uptake in hoof lamellae. The β-adrenoceptor (β-AR) populations in equine lamellae were characterised using the radioligand binding technique and the glucose uptake response to stimulation with a potent β-AR agonist (l-isoprenaline) in the hoof was investigated. Further, the mRNA expression of both GLUT1 and GLUT4 in lamellar tissue was determined via PCR analysis. 2. Clinically healthy ponies were randomly allocated to either treatment (n = 5) or control (n = 4) groups. Treatment involved a prolonged (72 h) euglycaemic-hyperinsulinaemic clamp technique while control ponies received an equivalent volume infusion of 0.9% saline. Ponies were euthanased at the onset of Obel grade 2 laminitis (treatment) or at 72 hours (controls). Lamellar tissue was obtained from all ponies and analysed via gelatin zymography, histopathology and immunohistochemistry. Results: 1. The predominant β-AR subtype in lamellae was the β2-AR (90%), with β1-AR expression less abundant (10%). Furthermore, stimulation with l-isoprenaline inhibited glucose uptake by up to 30% in lamellae. This is consistent with the known effects of isoprenaline in other species and tissues, and supports the hypothesis that stimulation with adrenaline could result in reduced glucose uptake in hoof lamellae, suggesting a possible mechanism by which impaired glucose metabolism may be involved in laminitis. Glucose uptake in lamellar explants was not affected by either acute (10-120 min) or long-term (24 h) stimulation with porcine insulin. These results do not support a glucose deprivation model for laminitis, in which reduced insulin sensitivity results in impaired glucose uptake in the hoof. Further, exposing lamellar explants to increasing concentrations of glucose resulted in a GLUT saturation point indicative of predominantly insulin-independent GLUT1 proteins. GLUT1 mRNA expression was strong in brain, coronary band and lamellar tissue and weak in skeletal muscle in control animals and was similar in ponies with insulin-induced laminitis. In contrast, mRNA expression of the insulin-dependent GLUT4 was strong in skeletal muscle and was either absent or barely detectable in coronary band and lamellar tissue. These results are consistent with a predominantly GLUT1-mediated glucose transport system, and suggest that it is unlikely that the GLUT4 gene plays a substantial role in glucose uptake in the hoof. 2. Treated ponies all developed laminitis within 55.4  5.5 hours, while no laminitis occurred in control ponies. Insulin-induced laminitis indicated elongated, collapsed secondary epidermal lamellae (SEL), as well as enlarged and increased numbers of basal cell nuclei, mitotic figures and increased keratinisation in SELs. However, in contrast to the histological appearance of tissue obtained from oligofructose-induced laminitis, basement membrane disintegration was not a major finding. There was no increase in either active or latent forms of MMP-2 or -9 in lamellar homogenates obtained from ponies with insulin-induced laminitis compared with controls, except in one pony that demonstrated increased MMP-2 activity, which was euthanased five days after developing laminitis. Conclusions: Collectively, the research outlined in this thesis indicates that glucose uptake in the equine hoof is independent of insulin, utilising a predominantly GLUT1-mediated glucose transport system. However, a more complete understanding of the metabolic processes within equine hoof lamellae would involve further characterising the effects of other hormones, such as cortisol and IGF-1 on glucose transport, as these results indicate a possible role for adrenaline in reducing glucose uptake in lamellar tissue. Nevertheless, the results presented in this thesis do not support a glucose deprivation model for laminitis, in which reduced insulin sensitivity results in impaired uptake of glucose into hoof lamellar tissue. This research demonstrates that prolonged hyperinsulinaemia induces laminitis in normal ponies, independent of changes in blood glucose concentration. Preliminary studies investigating the pathophysiology of insulin-induced laminitis suggest the possible involvement of increased cellular proliferation and inflammation, rather than MMP activation. However, the exact mechanism by which hyperinsulinaemia induces laminitis awaits further investigation.

Apolipoprotein B100 (apoB), the structural protein component of triglyceride-rich very low density lipoprotein (VLDL) and atherogenic low density lipoprotein, is considered an important risk indicator of atherosclerosis. In insulin resistant states, hepatic overproduction of apoB leads to metabolic dyslipidemia, characterized by high circulating VLDL and hypertriglyceridemia. Since the mitogen-activated protein kinases (MAPKs) and the inhibitor of NFkappaB kinase (IKK)-NFkappaB cascades are perturbed in insulin resistance, we hypothesized that the MAPKs (ERK, p38 and JNK) and the IKK-NFkappaB pathways regulate hepatic apoB output. We modulated these pathways in HepG2, a human hepatoma cell line, and primary hamster hepatocytes using chemical inhibitors and protein overexpression. ApoB synthesis and secretion were examined by metabolic pulse labeling. HepG2 is typically defective in secreting apoB as large VLDL particles and secretes smaller triglyceride-poor apoB-particles. Under continuous pulse labeling, ERK inhibition not only increased apoB secretion, it enabled HepG2 to secrete VLDL-sized particles in the presence of exogenous fatty acid (oleate). Concomitant with the increased apoB-particle size, ERK inhibition raised intracellular triglyceride level and diacylglycerol acyltransferase (DGAT) 1 and DGAT2 mRNA levels. Conversely, ERK activation decreased VLDL-apoB secretion from primary hepatocytes. In contrast to ERK, p38 or JNK inhibition decreased apoB secretion without affecting apoB-particle size from oleate-treated HepG2 cells. JNK inhibition also modulated apoB levels in primary hamster hepatocytes. Interestingly, the development of diet-induced hepatic insulin resistance was associated with decreased ERK, and enhanced p38 and NFkappaB activities. Thus we investigated the role of the NFkappaB pathway in regulating hepatic apoB production. IKK inhibition decreased and IKK overexpression increased apoB levels by modulating apoB mRNA translation and protein stability. IKK inhibition also suppressed hepatic apoB overproduction in an insulin resistance model, the fructose-fed hamster. Altogether, our results suggest that among the MAPK cascades, the MEK-ERK pathway is crucial in regulating apoB-lipoprotein assembly, possibly by modulating lipid availability to newly-synthesized apoB. The inflammatory IKK-NFkappaB cascade is also involved in regulating apoB synthesis and secretion. We postulate that dysregulation in the MAPK or NFkappaB cascades in insulin resistant and inflammatory states may contribute to hepatic apoB overproduction, and the common phenotype of hypertriglyceridemia and dyslipidemia.

Methylglyoxal (MG) is a reactive metabolite presents in all biological systems. The accumulation of MG in diabetic patients and animals has been long recognized. Recently, studies have shown that MG levels are elevated in hypertensive rats. However, the pathological effects of MG in diabetes and related insulin resistance syndrome such as obesity are currently unknown. In the present study, the role of MG in the pathogenesis of insulin resistance was investigated.<p> First, it was observed that MG induced structural and functional changes of insulin. Incubation of human insulin with MG in vitro yielded MG-insulin adducts, as evidenced by additional peaks observed upon mass spectrometric (MS) analysis. Tandem MS analysis of insulin B-chain adducts confirmed attachment of MG at an arginine residue. [3H]-2-deoxyglucose uptake ([3H]-2-DOG) by 3T3-L1 adipocytes was significantly and concentration-dependently decreased after treatment with MG-insulin adducts, in comparison with the effect of native insulin at the same concentration. A significant decrease of glucose uptake induced by MG-insulin adducts was also observed in L8 skeletal muscle cells. Unlike native insulin, MG-insulin adducts did not inhibit insulin release from pancreatic â-cells. The degradation of MG-insulin by cultured liver cells was also decreased. In conclusion, MG modifies insulin by attaching to internal arginine residue in the â-chain of insulin. The formation of this MG-insulin adduct decreases insulin-mediated glucose uptake, impairs autocrine control of insulin secretion, and decreases insulin clearance. These structural and functional abnormalities of the insulin molecule may contribute to the pathogenesis of insulin resistance.<p> Second, the effects of MG on the insulin signaling pathway were investigated. After 9 weeks of fructose treatment, an insulin resistant state was developed in Sprague-Dawley (SD) rats, demonstrated as increased triglyceride and insulin levels, elevated blood pressure, and decreased insulin-stimulated glucose uptake by adipose tissue. A close correlation between insulin resistance and the elevated MG accumulation in adipose and skeletal muscle tissues was observed. The insulin resistant state and the elevated MG level were reversed by the MG scavenger, N-acetyl cysteine (NAC) and metformin. In cultured adipose cells, MG treatment impaired insulin signaling as measured by decreased tyrosine phosphorylation of insulin-receptor substrate-1 (IRS-1) and the decreased kinase activity of phosphatidylinositol 3-kinase (PI3K). The ability of NAC to block MG-impairment of PI3K activity and IRS-1 phosphorylation further confirmed the role of MG in the development of insulin resistance. In cultured skeletal muscle cells, MG treatment significantly reduced the expression of IRS-1 and PI3K at the mRNA level. Similar to adipose cells, MG also decreased tyrosine phosphorylation of IRS-1 and PI3K activity. We also examined the mechanism of metformin to inhibit AGEs. Using mass spectrometry, stable metformin-MG adducts were identified.<p> In addition, we investigated the causative effect of MG in the pathogenesis of obesity, another form of insulin resistance. This study revealed a previously unrecognized effect of MG in stimulating adipogenesis by up-regulating Akt signaling. In Zucker fatty rats, dramatically increased MG accumulations in serum and different tissues were identified. The serum MG level increased age. In 10 and 12 week-old obese rats, MG was 144±50% and 171±15% of the age-matched control Zucker rats; this value increased to 241±7 % and 329±10% by 14 and 16 weeks (P<0.05, n=4). Further study suggested that MG accumulation stimulates the phosphorylation of Akt and its effectors p21 and p27. The activated Akt pathway then increased the activity of Cdk2 and accelerates the cell cycle progression and proliferation of pre-adipocytes. The effects of MG were efficiently reversed by both alagebrium, and Akt inhibitor SH-6.<p> Overall, the current study investigated the effect of MG during the pathogenesis of insulin resistance syndrome. MG, as the most potent precursor of AGEs, impairs the activity of insulin signaling pathway by glycating the insulin molecule and other insulin signaling proteins. Moreover, this study observed a previously unrecognized causative effect of MG in the proliferation of adipocytes by up-regulating the Akt signaling pathway. The results from this study offer new mechanisms to explain the development of insulin resistance and to prevent the related diseases.

The number of people having diabetes mellitus is increasing worldwide at an alarming rate. An unbalanced diet rich in carbohydrates and saturated fats, obesity and lack of physical activity, are being blamed. The worldwide prevalence of diabetes for all age-groups has been estimated to be 2.8% in 2000 and projected to be 4.4% by the year 2030. The pathogenesis of diabetes, especially the recent epidemic increase in type 2 diabetes, is still far from clear. Endothelial dysfunction, commonly defined as reduced endothelium-dependent relaxation due to reduced availability of the vasodilator mediator nitric oxide (NO), is a hallmark of diabetes mellitus. Methylglyoxal (MG) is a highly reactive dicarbonyl compound mainly formed as an intermediate during glycolysis. MG is also formed to a lesser extent from protein and amino acid metabolism. However, the relative contribution of various metabolic precursors to MG formation is not known. Levels of MG have been found to be elevated in diabetic and hypertensive conditions but it is not known whether MG is the cause or the effect of these pathological conditions. The aim of my project was (i) to quantify the amount of MG and oxidative stress produced from various substrates in cultured A10 vascular smooth muscle cells (VSMCs), (ii) to investigate the acute in vivo effects of a single dose of MG on glucose tolerance in male Sprague-Dawley (SD) rats, (iii) to investigate the effects of MG on endothelial function and (iv) to investigate the effects, and the underlying molecular mechanisms, of chronic administration of MG on glucose homeostasis in male SD rats. The results show that aminoacetone, a protein metabolism intermediate, is the most potent substrate for MG formation on a molar basis, whereas D-glucose and fructose are equipotent. I also established optimum sample preparation protocols for reproducible measurement of MG in biological samples by high performance liquid chromatography (HPLC). In normal SD rats a single acute dose of MG induced glucose intolerance, reduced adipose tissue glucose uptake and impaired the insulin signalling pathway, which was prevented by the MG scavenger and advanced glycation end product (AGE) breaking compound, alagebrium (ALT-711). MG and high glucose (25 mM) induced endothelial dysfunction in rat aortic rings and cultured endothelial cells by reducing endothelial nitric oxide synthase (eNOS) phosphorylation at Ser-1177, activity and NO production. MG and high glucose also increased oxidative stress and further reduced NO availability in rat aortic rings and cultured endothelial cells. Chronic administration of MG in normal SD rats by continuous infusion with a subcutaneously implanted minipump for 28 days (60 mg/kg/day), induced metabolic and biochemical abnormalities of glucose homeostasis and insulin regulation that are characteristic of type II diabetes. In MG treated rats, insulin stimulated glucose uptake in adipose tissue, and glucose stimulated insulin release from freshly isolated pancreas, were significantly reduced as compared to saline treated control rats. At a molecular level, insulin gene transcription was significantly impaired and apoptosis and DNA fragmentation were more prevalent in the pancreas of MG treated rats as compared to untreated control rats. All of these in vivo effects of MG were attenuated by the MG scavenger, alagebrium. Our data strongly indicate that MG is a causative factor in the pathogenesis of endothelial dysfunction and type 2 diabetes mellitus.

The number of people having diabetes mellitus is increasing worldwide at an alarming rate. An unbalanced diet rich in carbohydrates and saturated fats, obesity and lack of physical activity, are being blamed. The worldwide prevalence of diabetes for all age-groups has been estimated to be 2.8% in 2000 and projected to be 4.4% by the year 2030. The pathogenesis of diabetes, especially the recent epidemic increase in type 2 diabetes, is still far from clear. Endothelial dysfunction, commonly defined as reduced endothelium-dependent relaxation due to reduced availability of the vasodilator mediator nitric oxide (NO), is a hallmark of diabetes mellitus. Methylglyoxal (MG) is a highly reactive dicarbonyl compound mainly formed as an intermediate during glycolysis. MG is also formed to a lesser extent from protein and amino acid metabolism. However, the relative contribution of various metabolic precursors to MG formation is not known. Levels of MG have been found to be elevated in diabetic and hypertensive conditions but it is not known whether MG is the cause or the effect of these pathological conditions. The aim of my project was (i) to quantify the amount of MG and oxidative stress produced from various substrates in cultured A10 vascular smooth muscle cells (VSMCs), (ii) to investigate the acute in vivo effects of a single dose of MG on glucose tolerance in male Sprague-Dawley (SD) rats, (iii) to investigate the effects of MG on endothelial function and (iv) to investigate the effects, and the underlying molecular mechanisms, of chronic administration of MG on glucose homeostasis in male SD rats. The results show that aminoacetone, a protein metabolism intermediate, is the most potent substrate for MG formation on a molar basis, whereas D-glucose and fructose are equipotent. I also established optimum sample preparation protocols for reproducible measurement of MG in biological samples by high performance liquid chromatography (HPLC). In normal SD rats a single acute dose of MG induced glucose intolerance, reduced adipose tissue glucose uptake and impaired the insulin signalling pathway, which was prevented by the MG scavenger and advanced glycation end product (AGE) breaking compound, alagebrium (ALT-711). MG and high glucose (25 mM) induced endothelial dysfunction in rat aortic rings and cultured endothelial cells by reducing endothelial nitric oxide synthase (eNOS) phosphorylation at Ser-1177, activity and NO production. MG and high glucose also increased oxidative stress and further reduced NO availability in rat aortic rings and cultured endothelial cells. Chronic administration of MG in normal SD rats by continuous infusion with a subcutaneously implanted minipump for 28 days (60 mg/kg/day), induced metabolic and biochemical abnormalities of glucose homeostasis and insulin regulation that are characteristic of type II diabetes. In MG treated rats, insulin stimulated glucose uptake in adipose tissue, and glucose stimulated insulin release from freshly isolated pancreas, were significantly reduced as compared to saline treated control rats. At a molecular level, insulin gene transcription was significantly impaired and apoptosis and DNA fragmentation were more prevalent in the pancreas of MG treated rats as compared to untreated control rats. All of these in vivo effects of MG were attenuated by the MG scavenger, alagebrium. Our data strongly indicate that MG is a causative factor in the pathogenesis of endothelial dysfunction and type 2 diabetes mellitus.

Apolipoprotein B100 (apoB), the structural protein component of triglyceride-rich very low density lipoprotein (VLDL) and atherogenic low density lipoprotein, is considered an important risk indicator of atherosclerosis. In insulin resistant states, hepatic overproduction of apoB leads to metabolic dyslipidemia, characterized by high circulating VLDL and hypertriglyceridemia. Since the mitogen-activated protein kinases (MAPKs) and the inhibitor of NFkappaB kinase (IKK)-NFkappaB cascades are perturbed in insulin resistance, we hypothesized that the MAPKs (ERK, p38 and JNK) and the IKK-NFkappaB pathways regulate hepatic apoB output. We modulated these pathways in HepG2, a human hepatoma cell line, and primary hamster hepatocytes using chemical inhibitors and protein overexpression. ApoB synthesis and secretion were examined by metabolic pulse labeling. HepG2 is typically defective in secreting apoB as large VLDL particles and secretes smaller triglyceride-poor apoB-particles. Under continuous pulse labeling, ERK inhibition not only increased apoB secretion, it enabled HepG2 to secrete VLDL-sized particles in the presence of exogenous fatty acid (oleate). Concomitant with the increased apoB-particle size, ERK inhibition raised intracellular triglyceride level and diacylglycerol acyltransferase (DGAT) 1 and DGAT2 mRNA levels. Conversely, ERK activation decreased VLDL-apoB secretion from primary hepatocytes. In contrast to ERK, p38 or JNK inhibition decreased apoB secretion without affecting apoB-particle size from oleate-treated HepG2 cells. JNK inhibition also modulated apoB levels in primary hamster hepatocytes. Interestingly, the development of diet-induced hepatic insulin resistance was associated with decreased ERK, and enhanced p38 and NFkappaB activities. Thus we investigated the role of the NFkappaB pathway in regulating hepatic apoB production. IKK inhibition decreased and IKK overexpression increased apoB levels by modulating apoB mRNA translation and protein stability. IKK inhibition also suppressed hepatic apoB overproduction in an insulin resistance model, the fructose-fed hamster. Altogether, our results suggest that among the MAPK cascades, the MEK-ERK pathway is crucial in regulating apoB-lipoprotein assembly, possibly by modulating lipid availability to newly-synthesized apoB. The inflammatory IKK-NFkappaB cascade is also involved in regulating apoB synthesis and secretion. We postulate that dysregulation in the MAPK or NFkappaB cascades in insulin resistant and inflammatory states may contribute to hepatic apoB overproduction, and the common phenotype of hypertriglyceridemia and dyslipidemia.