Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In type I (insulin-dependent) diabetic patients, peripheral hyperinsulinemia due to subcutaneous insulin treatment is associated with increased high-density lipoprotein (HDL) cholesterol, and also with an altered surface composition of HDL. Pancreas grafts also release insulin into the systemic rather than into the portal venous system, giving rise to pronounced peripheral hyperinsulinemia. We hypothesized that if peripheral hyperinsulinemia is responsible for high HDL cholesterol and/or altered surface composition of HDL in diabetic subjects, similar changes in the lipid profile should be present in pancreas-kidney transplant recipients (PKT-R). Using zonal ultracentrifugation, we isolated HDL2, HDL3, very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and low-density lipoprotein (LDL) from fasting plasma of 14 type I diabetic PKT-R, eight nondiabetic kidney transplant recipients (KT-R), and 14 healthy control subjects and determined the level and composition of the above lipoproteins. HDL2 cholesterol was increased in PKT-R as compared with KT-R and healthy controls (both P < .05), whereas HDL3 cholesterol was unchanged. However, an altered lipoprotein surface composition was evident in PKT-R: HDL2, HDL3, and LDL were enriched in unesterified cholesterol ([UC] PKT-R v KT-R, P=.13, P < .005, and P < .05, respectively; PKT-R v controls, all P < .005); HDL2 was enriched in phospholipids; and LDL was depleted of phospholipid. KT-R, in contrast, showed no changes in lipoprotein surface composition but a substantial triglyceride enrichment of HDL2 as compared with PKT-R and healthy controls (both P < .05). LDL size as determined by gradient gel electrophoresis was increased in PKT-R compared with controls (P < .005). The plasma concentration of cholesteryl ester (CE) transfer protein (CETP), involved also in phospholipid transfer, was increased in both transplant groups compared with healthy controls (both P < .05). Insulin concentrations in fasting plasma were directly related to CETP levels and to the weight-percentage of UC in HDL3, and inversely to the weight-percentage of phospholipids in LDL (all P < .05). We explain the increase in HDL2 cholesterol and LDL size in PKT-R by their high lipoprotein lipase (LPL) activity conferring an excellent capacity to clear chylomicron triglycerides. Effective handling of postprandial triglycerides, high HDL2 cholesterol, and predominance of LDL pattern A, respectively, are established indicators of a low risk of atherosclerosis. However, it is presently unclear what effects the compositional changes on the surface of HDL and LDL may have on cardiovascular risk in clinically stable PKT-R.
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PMID:Effects of pancreas transplantation on distribution and composition of plasma lipoproteins. 869 21

1. The University of Maryland pancreas transplant program was initiated in July 1991. Through December 1996, 230 pancreas transplants were performed (145 SPK, 64 PAK, 21 PTA). Overall one-year patient and graft survival rates were 95.5% and 78.9%, respectively. 2. The majority of pancreases have been transplanted simultaneously with a kidney. The one-year patient, pancreas and kidney survival rates for SPK transplants were 95.5%, 91.9%, and 82.5%, respectively. 3. Pancreas alone (PA = PAK or PTA) transplants have represented an increasing proportion of the total in recent years. Although the results of PA were previously inferior to SPK transplants, recent developments have made the outcomes equivalent. The advent of FK and MMF have sharply reduced graft losses due to irreversible rejection. Percutaneous pancreas biopsy now provides a safe and effective means to diagnose acute rejection in a timely manner. Anticoagulation protocols have markedly reduced the risk of idiopathic postoperative graft thrombosis. The most recent series of 71 PA cases at our center had a one-year graft survival rate of 75.8% overall, and 88.2% for the 61 technically successful ones. 4. The most widely practiced pancreas transplant technique in the US today includes bladder drainage of exocrine secretions. This results in a high incidence of bladder complications, which can be avoided by enteric exocrine drainage. The most recent series of pancreas transplants at the University of Maryland have been enteric drained, encompassing about half of all cases. Adoption of this technique has eliminated bladder complications, and has not been associated with an increase in anastomotic leaks, infectious complications or graft loss. 5. Most pancreas transplants have had systemic venous drainage via the iliac vein. We recently adopted the portal venous drainage technique, since it eliminates the peripheral hyperinsulinemia associated with systemic drainage, and may therefore improve lipid metabolism and possibly reduce the risk of progression of atherosclerosis. Early results have been favorable. 6. At present the major determinant of pancreas transplant outcome is donor quality. We have emphasized the importance of using pancreases free of fatty or fibrotic transformation, which have been skillfully procured from young, stable, non-obese donors.
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PMID:Pancreas transplantation at the University of Maryland. 928 77

We evaluated, from 96 postmortem angiographs, the main feeding arteries and degree of vascularity of the pancreas to discover to what extent atherosclerosis affects pancreatic blood supply in subjects with and without non-insulin-dependent diabetes mellitus (NIDDM). Patients with NIDDM more often showed intrapancreatic arteries with irregularities in the body-tail of the pancreas (p = 0.050) and more frequently demonstrated decreased vascularity in both the body-tail and the head of the pancreas (p < 0.001) than did the controls. When the arterial system from the aorta to the intrapancreatic branches was examined as a whole, 26 (58%) of the NIDDM patients and 10 (20%) of the controls (p = 0.0001) showed one or more of the following: >50% stenosis in the celiac or splenic artery, two or more irregular intrapancreatic branches, or a distinctly decreased degree of vascularity in the body-tail portion of the pancreas, the region responsible for most insulin secretion. Only 1 NIDDM patient, compared to 10 controls, showed a totally normal angiogram. In conclusion, vascular disease in the feeding arteries of the pancreas is more common in NIDDM patients than age- and gender-matched controls.
Pancreas 1998 Jan
PMID:Postmortem pancreatic angiography in 45 subjects with non-insulin-dependent diabetes mellitus and 51 controls. 943 64

Pancreas-kidney transplantation with enteric drainage has become a standard treatment in diabetic patients with renal failure. Leaks of the graft duodenum (DL) remain a significant complication after transplantation. We studied incidence and predisposing factors of DLs in both simultaneous pancreas-kidney (SPK) and pancreas after kidney (PAK) transplantation. Between January 2002 and April 2013, 284 pancreas transplantations were performed including 191 SPK (67.3%) and 93 PAK (32.7%). Patient data were analyzed for occurrence of DLs, risk factors, leak etiology, and graft survival. Of 18 DLs (incidence 6.3%), 12 (67%) occurred within the first 100 days after transplantation. Six grafts (33%) were rescued by duodenal segment resection. Risk factors for a DL were PAK transplantation sequence (odds ratio 3.526, P = 0.008) and preoperative immunosuppression (odds ratio 3.328, P = 0.012). In the SPK subgroup, postoperative peak amylase as marker of preservation/reperfusion injury and recipient pretransplantation cardiovascular interventions as marker of atherosclerosis severity were associated with an increased incidence of DLs. CMV-mismatch constellations showed an increased incidence in the SPK subgroup, however without significance probability. Long-term immunosuppression in PAK transplantation is a major risk factor for DLs. Early surgical revision offers the chance of graft rescue.
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PMID:Duodenal leaks after pancreas transplantation with enteric drainage - characteristics and risk factors. 2564 50

Theses reviewed in this issue include "Characterization and Purification of Putative Stem Cells from the Adult Murine Pancreas," "Inhibition of TLR4 Minimizes Islet Damage due to Sterile Inflammation and Improves Islet Transplant Outcomes," "Liquefaction of the Brain Following Stroke Shares Multiple Characteristics with Atherosclerosis and Mediates Secondary Neurodegeneration in an Osteopontin-Dependent Mechanism," "Manipulating the Segregation of Human Mitochondrial DNA," "Role of Mitochondria in Plasma Membrane Repair and Pathogenesis of Muscular Dystrophy," and "The Role of Cytosolic Accumulation of Nuclear DNA in Retinal-Pigment Epithelium Dysfunction and Age-Related Macular Degeneration."
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PMID:Commentary on Some Recent Theses Relevant to Combating Aging: August 2020. 3271 30