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Researchers discover how to uncouple obesity and type 2 diabetes

MD-FM Thursday April 4, 2013





GENERIQUE
Carillon
 
Sarah:
MD FM — Medical News from around the world with Peter Goodwin.

P1

PETER:
Hello, and with me is Sarah Maxwell. To begin with, for patients with type-2 diabetes, new data adds to the evidence that the immune system plays a big part in causing insulin resistance that’s linked to obesity

SARAH:
Yes, a study — published in Cell Metabolism — showed that obese mice genetically engineered to lack T-Bet — a protein involved in the differentiation and function of immune cells — unexpectedly had improvements in insulin sensitivity.
 
PETER:
Sounds fascinating, because we generally think that obesity and diabetes are often joined at the hip?
 
SARAH:
Yes, but according to these data, that link could be uncoupled by the absence of T-bet. The mice in the study tended to put on more weight than normal mice — especially abdominal fat — and when they were fed a high-fat diet, they put on weight exponentially, but strangely, they also got better insulin sensitivity!
 
Bob-Howard-1: “Usually when you get fatter, particularly if you put fat into the abdominal cavity, that’s usually associated with worsening insulin resistance... And what we found, surprisingly, is even though these mice had this increased visceral fat, these mice, even the young ones, were actually more sensitive to the glucose lowering effects of the insulin --so that’s a very unusual phenotype.”

SARAH:
Lead study author Jane Howard, from King’s College in London, and the team analyzed the composition of fat in the genetically modified mice…

Bob-Howard-2: “In their intra-abdominal fat, these mice had fewer immune cells. So they had the fat there, but the fat had fewer immune cells in it and so was essentially less inflamed, and this might be the reason why they had a better insulin sensitivity”

SARAH:
T-bet lacking immune cells also improved insulin sensitivity in young, lean mice suggesting a possible influence on metabolic physiology and Dr. Howard said, the next step is to identify different molecular pathways through which T-Bet actually works.
 
Bob-Howard-3: “The fact that the immune system is so intrinsically now linked with metabolism --this is really becoming appreciated and if we can understand really the pathways involved in the actions of this particular protein, we may pave the way for the development of a whole new therapies for the treatment of insulin resistance.”

SARAH:
That was Dr. Jane Howard, from London in the UK.


P2

PETER:
Women who secrete lower levels of melatonin, have an increased risk of developing type-2 diabetes. That’s according to a case-control study — published this week in JAMA — that took urine samples from 750 women without diabetes at baseline, and found there was an independent association of developing the disease with lower secretion of the hormone. This is in line with previous findings, suggesting that melatonin may play a role in energy metabolism and the regulation of body weight.


VIRGULE MUSICALE

P3

PETER:
HIV self-testing could be the key to controlling the global AIDS epidemic, according to a major systematic review — reported in PLoS Medicine...
 
SARAH:
Yes, the study showed self-testing was not only effective for detecting cases of HIV, but most of all, it also removed much of the fear and stigma often experienced with going to a clinic to be tested:
 
Bob-Peeling-1: “For the most at risk populations, quite often, they feel stigmatized when they go to a clinic, so self testing is aimed at reaching those people.  So the general idea is that we would like as many people to know their HIV sero-status as possible.”
 
SARAH:
That was senior study author Dr. Rosanna Peeling, from London in the UK who said this could pave the way for early detection and treatment around the world. Patients preferred self-tests performed at home using oral fluid samples, accompanied by counseling on the phone or the internet, compared to self-testing aided by a healthcare professional in person. Currently, self-testing is only used in experimental settings and Dr. Peeling added that more research is still needed before it can be put into practice:
 
Bob-Peeling-2: “Having done this review we feel quite comfortable that self-testing would improve not only case detection but also control of HIV. But we are waiting for the cost-effectiveness of that and in different settings, the linkage to care needs to be worked out, because not everywhere would be as good as in those studies”

SARAH:
Rosanna Peeling, from the London of Hygiene and Tropical Medicine.


VIRGULE MUSICALE
 
P4

PETER:
Vaccination in early childhood does NOT trigger autism, according to latest results hammered out — in the Journal of Pediatrics — from the US Centers for Disease Control and Prevention...
 
SARAH:
Yes, there is absolutely no link between vaccination and autism, even when the number of vaccines administered  — both on a single day and cumulatively, over the first two years of life — might seem high to some parents:
 
 Bob-DeStefano-1: “Some parents have concerns or questions that infants and young children are receiving either too many vaccines at one time or too many vaccines early in life --say up to 2 years of age. It’s not really well formulated what the concerns are, but vaguely it has something to do with the infant’s body or immune system not being able to adequately handle that number of vaccines.. It’s like about a quarter to a third of parents who have this concern.”

SARAH:
That was Dr. Frank DeStefano from the CDC in Atlanta, whose team led yet another study to confirm: there’s no association between autism and childhood vaccination. They analyzed data from 250 children with autism spectrum disorder and 750 without, comparing each child’s cumulative exposure to antibody-stimulating proteins and polysac-charides in vaccines, and the maximum number of antigens each child received in a single day:
 
Bob-DeStefano-2: “We found that there really was no relationship, even when we used the older vaccines we didn’t find any association which indicates there’s really no threshold within the balance of the current vaccination schedule”

SARAH:
That was Dr. Frank DeStefano, from Atlanta.


VIRGULE MUSICALE


P5

PETER:  
Patients with newly-diagnosed, metastatic prostate cancer who get continuous anti-androgen therapy, live a bit longer than men on intermittent androgen-therapy…
 
SARAH:
Yes, data from the largest non-inferiority trial to date — reported in the New England Journal of Medicine — show the median survival for men with hormone-sensitive metastatic prostate cancer, who were randomized to continuous treatment with combined androgen deprivation was 5.8 years, compared to 5.1 years for those on an intermittent regimen:

Bob-Hussain-1: “What is clear is that patients on the continuous arm, if you look at the survival curves and such, they did live longer than patients on the intermittent arm. Now having said that, clearly there are patients in the intermittent arm that did just fine. The problem is that there is no way to identify which patients are the ones that are likely to benefit from this treatment and/or not be compromised”
 
SARAH:
That was Dr. Maha Hussain from the University of Michigan in Ann Arbor, who also said that, among the several elements of quality of life they tested for, at seven months: only erectile function and the emotional function were statistically improved for patients on intermittent therapy:

Bob-Hussain-2: The standard of care, based on the level 1 evidence, is that it’s continuous therapy that”s the standard of care. Having said that I think that for some patients, there are certain aspects of quality of life that might be important, and I think it is fair for the practitioner to say that the data that we have today would suggest potential improvements but short-term in certain aspects of quality of life, not all of them, and they are not necessarily sustainable, and this comes in at the price of potentially less survival”  
 
SARAH:
Maha Hussain, from Michigan in the USA.


BREVE 1 Sur fond musical

PETER:
Finally, in brief:

Gastric bypass surgery in mice altered the microbial makeup of their guts, which might — in part — have contributed to the rapid weight loss they had after this surgery. That’s from a study in Science Translational Medicine that showed: when microbes harvested from mice that had surgery were transplanted into mice with no gut bacteria, there was a reduction in fat tissue and they lost up to 5% of body weight.

And …..
 
BREVE 2

For pregnant and postnatal women blood clots have been linked several other medical conditions: having had a stillbirth, having varicose veins, inflammatory bowel disease or heart diseases, being obese, suffering bleeding during pregnancy or labor and having a premature birth or a delivery via caesarean section — these are all factors that increase the risk of venous thrombo-embolism. That’s according to a study — published in Blood — looking at data from the developed world that — the authors suggest — could have implications for how preventative measures for VTE are carried out.

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then from me Peter Goodwin, goodbye!
 
JINGLE FIN     
 

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