Abnormalities of lipid metabolism are considered risk factors for cardiovascular, metabolic, nephrologic diseases amd some malignancies, as well. Nowadays, a lot of effort is devoted to study new risk factors and surrogate markers of conditions mentioned above to improve their prognosis and decrease mortality. The aim of this thesis was to provide a comprehensive survey of lipid metabolism, characteristics of different lipid compounds in health and diseases and of possibilities of utilization of selected lipid parameters in the diagnostics of pathological conditions listed above. Selected lioid parameters were observed in several studies, focused on specific pathological conditions. Besides conventional lipid analytes, the composition of fatty acids in plasma lipid pools was studied in healthy controls, and in the patients suffering from metabolic syndrome, chronic pancreatitis, and pancreatic cancer, as well. Markers of an oxidative stress (oxidatively modified LDL particles and conjugated dienes in precipitated LDL) were assessed in healthy controls, patients with metabolic syndrome, chronic pancreatitis, pancreatic cancer, and in the patients with different concentrations of plasma apoB-48, too. LDL particles subfraction were investigated in healthy controls, in the patients with different...

Das Equine metabolische Syndrom, das Equine Cushing Syndrom und die häufig daraus resultierende Hufrehe stellen den behandelnden Tierarzt noch immer vor Probleme bezüglich Diagnostik und Therapie. Grund hierfür sind fehlende einheitliche endokrinologische Parameter, die eine Einschätzung des Krankheitszustandes des jeweiligen Tieres ermöglichen. Für Ponys fehlt es gänzlich an statistisch validen Referenzbereichen für die, an den Krankheiten beteiligten Hormonen. In der vorliegenden Arbeit wurde die Aktivität von Insulin, sowie die Konzentration von Insulinwachstumsfaktor-1 (IGF-1) und adrenocorticotropem Hormon (ACTH) im Blut von 130 klinisch gesunden, erwachsenen Ponys bestimmt. Damit liegen erstmals Ergebnisse vor, welche auf einer für die Erstellung von Referenzwerten ausreichend großen Fallzahl basieren. Die Analyse fand mittels eines immunometrischen Chemielumineszenz-Assays an drei aufeinander folgenden Tagen statt. Anhand einer Dreifachuntersuchung am ersten Untersuchungstag wurde für jedes Hormon der 95 %-Referenzbereich bestimmt. Für Insulin konnte ein Referenzbereich von 2,0 - 34,3 µU/ml ermittelt werden. Damit liegen die Werte unterhalb den für Großpferde veröffentlichen Werten, wobei ein direkter Vergleich nur bedingt möglich ist. Für Insulinwachstumsfaktor-1 wurden für Pferde noch keine Werte erhoben. Somit ist ein Vergleich zwischen Großpferden und Ponys diesbezüglich noch nicht möglich. Für Ponys liegt der hier ermittelte Referenzbereich zwischen 48,3 und 382,6 ng/ml. Für die Konzentration von adrenocorticotropem Hormon gibt es in der Literatur unterschiedliche Angaben sowohl für Ponys als auch für Großpferde. Mit dieser Studie wurde der 95 %-Referenzbereich für Ponys bei 6,5 bis 23,3 pg/ml ermittelt. Es konnte ein Zusammenhang zwischen dem Alter der Tiere und der ACTH-Konzentration nachgewiesen werden. Der Referenzbereich der Gruppe B (13 bis 32 Jahre) reicht von 7,1 pg/ml bis 27,7 pg/ml und unterscheidet sich damit signifikant von dem Referenzbereich der Gruppe A (drei bis 12 Jahre), welcher zwischen 5,9 pg/ml und 22,2 pg/ml ermittelt wurde. Durch die Bestimmung der Hormonkonzentration an drei aufeinander folgenden Tagen konnte die Empfindlichkeit der Hormone gegenüber enzymatischem Abbau überprüft werden. Die Proben wurden an Tag 1 aufgetaut und anschließend bei 4°C gelagert. Lediglich für adrenocorticotropes Hormon konnte eine signifikante Reduzierung (p< 0,001) der Werte um 5,4 % an Tag 3 im Vergleich zu Tag 1 festgestellt werden. Das Chemielumineszens-Assay-Testverfahren mit den Geräten der IMMULITE 2000-Reihe wurde hinsichtlich seiner Präzisionen überprüft, indem der Variationskoeffizient für die Intra-Assay-Untersuchung und die Inter-Assay-Untersuchung berechnet wurde. Für das Verfahren konnte eine ausreichende (Variationskoeffizienten ACTH: 5,2 % bzw. 5,4%), für die Untersuchung von Insulin und IGF-1 sogar eine hervorragende (Variationskoeffizienten Insulin: 3,9 % bzw. 4,7 %; Variationskoeffizienten IGF-1: 2,6 % bzw.2,9 %) Testgenauigkeit nachgewiesen werden.

Bakgrund: Diabetes Mellitus (DM) är en kronisk sjukdom som kan påverka flera kroppsliga funktioner, vilket i sin tur kan leda till svåra komplikationer. En av dessa är svårläkta sår, vilket är förknippat med en omfattande börda för patienterna. Syfte: Att beskriva patienters upplevelser av att leva med diabetiska fotsår vid DM typ 1 och 2. Metod: Studien genomfördes genom en litteraturöversikt med kvalitativ metod. Studien baserades på elva vetenskapliga artiklar som återfanns genom artikelsökning i databaserna CINAHL och MEDLINE samt manuell sökning. Artiklarna analyserades enligt analys av Friberg i fem steg. Resultat: Litteraturöversikten resulterade i fyra huvudteman; upplevelser av fysisk påverkan, upplevelser av ekonomisk påverkan, upplevelser av social påverkan och upplevelser av emotionell påverkan. Vidare sammanställdes nio subteman. Slutsats: Diabetiska fotsår hos personer med diabetes påverkar psykologiska och sociala aspekter, begränsar rörlighet och orsakar funktionsnedsättning. Brist på stöd leder till ensamhet och börda, medan smärta hindrar social interaktion. Sjuksköterskor kan med kunskap och gott bemötande bidra till ökad kunskap om egenvård och psykosociala effekter och främjar patientens självständighet, hälsa och välbefinnande. / Background: Diabetes Mellitus (DM) is a chronic disease that can affect several bodily functions, which in turn can lead to severe complications. One of these are hard-to-heal wounds, which is associated with an extensive burden for the patients. Aim: To describe patients’ experience of living with diabetic foot ulcers in DM type 1 and 2. Method: The study was conducted through a literature review using a qualitative method. The study was based on eleven scientific articles that were found through an article-search in the databases CINAHL and MEDLINE as well as through manual search. The articles were analyzed according to analysis by Friberg in five steps. Results: The literature review resulted in four main themes; experiences of physical impact, experiences of financial impact, experiences of social influence and experiences of emotional impact. Furthermore, nine subthemes were compiled. Conclusion: Diabetic foot ulcers in people with diabetes affect psychological and social aspects, limits mobility and cause disability. Lack of support leads to loneliness and a feeling of being a burden to others, while pain hinders social interaction. With knowledge and compassion, nurses can contribute to increase the patient’s knowledge about self-care and psychosocial effects which can promote the patient's independence, health, and well-being.

It is controversial whether lifestyle-induced weight loss (LIWL) intervention provides long-term benefit. Here, we investigated whether the degree of weight loss (WL) in a controlled LIWL intervention study determined the risk of prediabetes and recurrence of metabolic syndrome (MetS) during a 5-year follow-up. Following LIWL, 58 male participants (age 45–55 years) were divided into four quartiles based on initial WL: Q1 (WL 0–8.1%, n = 15), Q2 (WL 8.1–12.8%, n = 14), Q3 (WL 12.8–16.0%, n = 14), and Q4 (WL 16.0–27.5%, n = 15). We analyzed changes in BMI, HDL cholesterol, triglycerides (TGs), blood pressure, and fasting plasma glucose (FPG) at annual follow-up visits. With a weight gain after LIWL between 1.2 (Q2) and 2.5 kg/year (Q4), the reduction in BMI was maintained for 4 (Q2, p = 0.03) or 5 (Q3, p = 0.03; Q4, p < 0.01) years, respectively, and an increase in FPG levels above baseline values was prevented in Q2–Q4. Accordingly, there was no increase in prediabetes incidence after LIWL in participants in Q2 (up to 2 years), Q3 and Q4 (up to 5 years). A sustained reduction in MetS was maintained in Q4 during the 5-year follow-up. The present data indicate that a greater initial LIWL reduces the risk of prediabetes and recurrence of MetS for up to 5 years.

Le rôle crucial du tractus gastrointestinal dans la pathogenèse et la pathophysiologie des troubles cardiométaboliques (TCM) et du syndrome métabolique (SM) est actuellement bien établi. Plusieurs facteurs, incluant le stress oxydatif (SOx), l'inflammation et la résistance à l'insuline (RI), perturbent l'homéostasie intestinale et causent des TCM. Les polyphénols (PP) ont des effets biologiques bénéfiques dans la prévention de pathologies métaboliques. Cependant, leurs mécanismes d'actions, surtout au niveau de l'axe intestin-foie, ne sont pas bien compris. Par ailleurs, malgré les nombreuses études sur les effets biologiques et la biodisponibilité des PP, il existe encore des zones d’ombres concernant les interactions entre le microbiote intestinal et les PP et les conséquences subséquentes sur la santé intestinale et métabolique. Dans ce travail de recherche, nous favorisons l’axiome selon lequel les PP, notamment ceux de grande taille moléculaire tels que les proanthocyanidines (PACs), pourraient être utile pour combattre les maladies métaboliques grâce à leurs actions antioxydante et anti-inflammatoire. Toutefois, ces actions précitées des PACs dépendraient d’une régulation en amont du microbiote intestinal. L’objectif central consiste à démontrer les effets bénéfiques des PACs dans la prévention des dérèglements métaboliques dans deux modèles distincts, l’un cellulaire et l’autre animal et d’en étudier les mécanismes. Les effets des PACs sur la RI, les dérangements métaboliques intestinaux grâce à la production de métabolites ont été étudiés. Dans une première étape, nous avons étudié les mécanismes d’actions des PACs et de l’un de leurs métabolites majeurs, le 4,5-dihydroxyphenyl valerolactone (DHPVL), dans la prévention des maladies métaboliques et dans le maintien de l’homéostasie intestinale en utilisant la lignée cellulaire intestinale Caco-2/15. Ces cellules constituent un outil de choix pour l’investigation du SOx, la défense antioxydante et l’inflammation en relation directe avec nos objectifs. Les résultats suggèrent que la capacité des PACs à augmenter la défense antioxydante et anti-inflammatoire et à améliorer l’homéostasie intestinale passeraient en partie probablement par leurs métabolites microbiens. Dans une deuxième étape, en utilisant le modèle murin C57BL6, nous avons déterminé l’impact des PACs sur l’homéostasie métabolique intestinale et hépatique, via l’atténuation du SOx et l’inflammation, le maintien de l’intégrité de la barrière intestinale, la prévention de l’endotoxémie métabolique et les modifications du profil lipidique et de la fonction du microbiote intestinal. Cette partie a évalué les aspects préventifs et thérapeutiques des PACs en spécifiant leurs bénéfices biologiques et voies mécanistiques dans des organes métaboliques clés. Pour étudier ces mécanismes et les comprendre, nous avons utilisé le modèle dysmétabolique de souris C57BL6 soumises à une diète riche en lipides et en sucrose (HFHS), servant à développer le SM et les complications cardio-métaboliques afin d’examiner l’action des PACs. Le développement de l’obésité, de la RI ainsi que la survenue d’autres altérations métaboliques ont été prévenus par l’administration de PACs. Les résultats de cette thèse permettent une meilleure compréhension des mécanismes d’actions qui sous-tendent les effets préventifs et thérapeutiques des PACs dans les désordres métaboliques, en particulier dans l’axe intestin-foie. / The crucial role of the gastrointestinal tract in the pathogenesis and pathophysiology of cardiometabolic disorders (CMD) and metabolic syndrome (MetS) is currently recognized. Several factors, including oxidative stress (OxS), inflammation and insulin resistance (IR), disrupt intestinal homeostasis and cause CMD. Polyphenols (PP) have beneficial biological effects in the prevention of metabolic pathologies. However, their mechanisms of action, especially in the gut-liver axis, are not well understood. Moreover, despite numerous studies on the biological effects and bioavailability of PP, there are still grey areas concerning the interactions between the intestinal microbiota and PP and the subsequent consequences for intestinal and metabolic health. In this research work, we promote the axiom that PP, particularly those of large molecular size such as proanthocyanidins (PACs), could be useful in combating metabolic diseases thanks to their antioxidant and anti-inflammatory actions. However, the aforementioned actions of PACs would depend on upstream regulation of the intestinal microbiota. The central objective is to demonstrate the beneficial effects of PACs in preventing metabolic disorders in two distinct models, one cellular and the other animal, and to study the mechanisms involved. The effects of PACs on IR and intestinal metabolic disturbances through metabolite production were studied. In a first step, we investigated the mechanisms of action of PACs and one of their major metabolites, 4,5-dihydroxyphenyl valerolactone (DHPVL), in the prevention of metabolic diseases and in the maintenance of intestinal homeostasis using the Caco-2/15 intestinal cell line. These cells are a tool of choice for investigating OxS, antioxidant defense and inflammation in direct relation to our objectives. The results suggest that the ability of PACs to enhance antioxidant and anti-inflammatory defense and improve intestinal homeostasis is probably partly mediated by their microbial metabolites. In a second step, using the C57BL6 mouse model, we determined the impact of PACs on intestinal and hepatic metabolic homeostasis, via attenuation of OxS and inflammation, maintenance of intestinal barrier integrity, prevention of metabolic endotoxemia and changes in lipid profile and gut microbiota function. This section assessed the preventive and therapeutic aspects of PACs, specifying their biological benefits and mechanistic pathways in key metabolic organs. To investigate and understand these mechanisms, we used the dysmetabolic model of C57BL6 mice subjected to a high-fat, high-sucrose diet (HFHS), used to develop MetS and cardio-metabolic complications to examine the action of PACs. The development of obesity, IR and other metabolic alterations was prevented by the administration of PACs. The results of this thesis provide a better understanding of the mechanisms of action underlying the preventive and therapeutic effects of PACs in metabolic disorders, particularly in the intestine-liver axis.

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Procyanidins (PCs) have been extensively investigated for their potential health protective activities, but the prospective bioactivities are limited by their poor bioavailability. The majority of the ingested dose remains unabsorbed and reaches the colon where extensive microbial metabolism occurs. The objectives of these studies are to better understand the roles and activities of PCs in the lower gastrointestinal tract. First, a new high-throughput Ultra Performance Liquid Chromatography-Tandem Mass Spectrometry method was developed to efficiently analyze PCs and an extensive profile of their microbial metabolites. This method is sufficiently sensitive and effective in simultaneously extracting and measuring native PCs and their microbial metabolites in biological samples. Furthermore, administration of grape seed extract increased the expression of gut junction protein occludin and reduced levels of fecal calprotectin, which suggests an improvement of gut barrier integrity and a potential modulation of endotoxemia. Additionally, chronic supplementation of the diet with flavanols did not increase colonic tissue accumulation of PCs or their microbial metabolites over a 12 week feeding study. This was the first long-term study of its kind, and the results indicate that we still do not fully understand the outcome of ingested flavanols in the colon during chronic exposure rather than acute doses. Lastly, new understanding of the microbial metabolism of PCs in the colon has been reached by studying the colon as 4 segments, rather than as a complete unit as previous studies have done. Data show that a gradient is established along the length of the colon for both PCs and their metabolites, with PCs reaching highest concentrations within 3 h after ingestion, while metabolites reach maximum concentrations anywhere form 3-18 h after ingestion. Moreover, data indicate the progressive, step-wise degradation of PCs into small metabolites throughout the length of the colon. Overall, there is greater understanding of the colonic metabolism of dietary PCs derived from GSE and cocoa, the accumulation of these compounds, and their effect on gut permeability. Future work will build off of these novel studies, and will continue to advance the understanding of the health benefits of dietary PCs. / Ph. D.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / Este trabalho teve como objetivo investigar os efeitos da telmisartana (agonista PPAR-gama parcial), losartana (puro bloqueador do receptor AT1 da angiotensina II) e rosiglitazona (agonista PPAR-gama) em modelo experimental de síndrome metabólica. Os alvos do estudo foram a pressão arterial, metabolismo de carboidratos, resistência insulínica, inflamação, tecido adiposo e fígado. Camundongos C57BL/6 (a partir de 3 meses de idade) foram alimentados com dieta padrão (SC, n = 10) ou dieta hiperlipídica rica em sal (HFHS, n = 40) por 12 semanas. Após esse tempo, os animais do grupo HFHS foram subdivididos em 4 grupos (n = 10): HFHS (sem tratamento), ROSI (HFHS tratado com rosiglitazona), TELM (HFHS tratado com telmisartana) e LOS (HFHS tratado com losartana) por 5 semanas. O grupo HFHS apresentou um significante ganho de peso e aumento da pressão arterial sistólica, hiperinsulinemia com resistência insulínica, hiperleptinemia, hipertrofia de adipócitos bem como um quadro de esteatose hepática e níveis aumentados da citocina inflamatória interleucina-6 (IL-6). Os animais tratados com telmisartana chegou ao final do experimento com massa corporal similar ao grupo SC, com reversão do quadro de resistência insulínica, com pressão arterial normal, adipócitos de tamanho normal e sem apresentar esteatose hepática. Além disso, o tratamento com telmisartana aumentou a expressão de PPAR&#947; e adiponectina no tecido adiposo epididimal. A expressão da proteína desacopladora-1 (UCP-1) no tecido adiposo branco (TAB) também foi aumentada. O tratamento com losartana diminuiu a pressão arterial para valores normais, porém com menores efeitos nos parâmetros metabólicos dos animais. O presente modelo experimental de ganho de peso e hipertensão induzidos por dieta mimetiza a síndrome metabólica humana. Neste modelo, a telmisartana aumentou a expressão de UCP-1 no TAB, preveniu o ganho de peso e melhorou a sensibilidade à insulina e a esteatose hepática dos camundongos C57BL/6, provavelmente devido à ativação PPAR-gama. / The study aimed to investigate the effects of telmisartan (a partial PPAR gamma agonist), losartan (a pure angiotensin II receptor blocker) and rosiglitazone (PPAR gamma agonist) in a mice model of metabolic syndrome (MetS). The targets of this study were blood pressure (BP), carbohydrate metabolism, insulin resistance, inflammation, white adipose tissue (WAT) and liver. Male C57BL/6 mice were studied over 17 weeks after being separated into two major groups according to diet: standard chow (SC, 10% fat, n = 10) or high-fat high-salt chow (HFHS, 60% fat, 7% salt, n = 40). In the last 5 weeks of the experiment, the HFHS group was divided into four groups (n = 10): untreated HFHS, ROSI (HFHS plus rosiglitazone), TELM (HFHS plus telmisartan), and LOS (HFHS plus losartan). The HFHS group had significantly greater body mass and BP, in addition to hyperinsulinemia with insulin resistance, hyperleptinemia, adipocyte hypertrophy and hepatic steatosis as well as increased inflammatory cytokine levels. Animals treated with telmisartan had body weights similar to the SC group, in addition to reversed insulin resistance, reduced hypertension, reduced adipocyte hypertrophy, ameliorates hepatic steatosis and decreased IL-6. Telmisartan increased PPAR&#947; and adiponectin expression in white adipose tissue. Interestingly, the expression of UCP-1 in white adipose tissue was also increased by treatment with telmisartan. Losartan decreased BP but had smaller effects on metabolic parameters. The present model of diet-induced weight gain and hypertension in mice mimics human features of MetS. In this model, telmisartan enhances UCP-1 expression in WAT, prevented weight gain and ameliorates insulin sensitivity and hepatic steatosis in C57Bl/6 mice, probably due to PPAR gamma activation.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / Este trabalho teve como objetivo investigar os efeitos da telmisartana (agonista PPAR-gama parcial), losartana (puro bloqueador do receptor AT1 da angiotensina II) e rosiglitazona (agonista PPAR-gama) em modelo experimental de síndrome metabólica. Os alvos do estudo foram a pressão arterial, metabolismo de carboidratos, resistência insulínica, inflamação, tecido adiposo e fígado. Camundongos C57BL/6 (a partir de 3 meses de idade) foram alimentados com dieta padrão (SC, n = 10) ou dieta hiperlipídica rica em sal (HFHS, n = 40) por 12 semanas. Após esse tempo, os animais do grupo HFHS foram subdivididos em 4 grupos (n = 10): HFHS (sem tratamento), ROSI (HFHS tratado com rosiglitazona), TELM (HFHS tratado com telmisartana) e LOS (HFHS tratado com losartana) por 5 semanas. O grupo HFHS apresentou um significante ganho de peso e aumento da pressão arterial sistólica, hiperinsulinemia com resistência insulínica, hiperleptinemia, hipertrofia de adipócitos bem como um quadro de esteatose hepática e níveis aumentados da citocina inflamatória interleucina-6 (IL-6). Os animais tratados com telmisartana chegou ao final do experimento com massa corporal similar ao grupo SC, com reversão do quadro de resistência insulínica, com pressão arterial normal, adipócitos de tamanho normal e sem apresentar esteatose hepática. Além disso, o tratamento com telmisartana aumentou a expressão de PPAR&#947; e adiponectina no tecido adiposo epididimal. A expressão da proteína desacopladora-1 (UCP-1) no tecido adiposo branco (TAB) também foi aumentada. O tratamento com losartana diminuiu a pressão arterial para valores normais, porém com menores efeitos nos parâmetros metabólicos dos animais. O presente modelo experimental de ganho de peso e hipertensão induzidos por dieta mimetiza a síndrome metabólica humana. Neste modelo, a telmisartana aumentou a expressão de UCP-1 no TAB, preveniu o ganho de peso e melhorou a sensibilidade à insulina e a esteatose hepática dos camundongos C57BL/6, provavelmente devido à ativação PPAR-gama. / The study aimed to investigate the effects of telmisartan (a partial PPAR gamma agonist), losartan (a pure angiotensin II receptor blocker) and rosiglitazone (PPAR gamma agonist) in a mice model of metabolic syndrome (MetS). The targets of this study were blood pressure (BP), carbohydrate metabolism, insulin resistance, inflammation, white adipose tissue (WAT) and liver. Male C57BL/6 mice were studied over 17 weeks after being separated into two major groups according to diet: standard chow (SC, 10% fat, n = 10) or high-fat high-salt chow (HFHS, 60% fat, 7% salt, n = 40). In the last 5 weeks of the experiment, the HFHS group was divided into four groups (n = 10): untreated HFHS, ROSI (HFHS plus rosiglitazone), TELM (HFHS plus telmisartan), and LOS (HFHS plus losartan). The HFHS group had significantly greater body mass and BP, in addition to hyperinsulinemia with insulin resistance, hyperleptinemia, adipocyte hypertrophy and hepatic steatosis as well as increased inflammatory cytokine levels. Animals treated with telmisartan had body weights similar to the SC group, in addition to reversed insulin resistance, reduced hypertension, reduced adipocyte hypertrophy, ameliorates hepatic steatosis and decreased IL-6. Telmisartan increased PPAR&#947; and adiponectin expression in white adipose tissue. Interestingly, the expression of UCP-1 in white adipose tissue was also increased by treatment with telmisartan. Losartan decreased BP but had smaller effects on metabolic parameters. The present model of diet-induced weight gain and hypertension in mice mimics human features of MetS. In this model, telmisartan enhances UCP-1 expression in WAT, prevented weight gain and ameliorates insulin sensitivity and hepatic steatosis in C57Bl/6 mice, probably due to PPAR gamma activation.