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The Effect of Bariatric Operations on the Compensation of Diabetes Mellitus
Horáková, Jitka ; Matoulek, Martin (advisor) ; Haluzík, Martin (referee)
This bachelor thesis deals with the problem of obesity and diabetes mellitus in today's society. The theoretical part brings a closer look at the problem of obesity, the complications resulting from it and the possible ways of therapy. Further it discusses the problem of diabetes mellitus and the influence of obesity on diabetes mellitus type 2 that causes serious health complications. The thesis describes the treatment options of the mentioned diseases, especially focusing on lifestyle changes (dietary regimen, physical activity) and bariatric surgery that significantly contributes to weight reduction and reduction of complications risks. The practical part of the thesis deals with the research in this area, comparing a group of diabetic and non-diabetic patients undergoing the bariatric surgery. Furthermore, it focuses on the impact of the bariatric surgery on the compensation of diabetes mellitus. Keywords: obesity, diabetes mellitus, dietary treatment, bariatric operations
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New regulatory metabolic factors in patients with obesity and type 2 diabetes mellitus
Matějková, Mirka ; Haluzík, Martin (advisor) ; Flachs, Pavel (referee)
Fibroblast growth factors are proteins with diverse biological function in development, tissue repair, and metabolism. The human FGF gene family consists of 22 members. FGF 19 subfamily includes FGF 19, FGF 21, and FGF 23. They act as systemic factors in an endocrine manner. FGF 19 subfamily requires klotho protein as a cofactor for its action. FGF 19 produced by intestine acts mainly in the liver through FGFR4, where it inhibits bile acid and fatty acid synthesis. FGF 21 is produced by the liver and contributes to the regulation of carbohydrate and lipid metabolism through modulation of glucose uptake in adipocytes. Serum FGF 21 levels are increased in patients with obesity and type 2 diabetes mellitus. Serum FGF 19 levels are on the contrary decreased in patients with obesity and type 2 diabetes mellitus and more probably depend on the nutritional status of the organism than on the glucose metabolism and insulin sensitivity. Key words: type 2 diabetes mellitus, FGF 19, FGF 21, obesity, adipose tissue
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The role of adipose tissue in endothelial dysfunction, etherosclerosis and other complications of metabolic syndrome: influence of diet and pharmacotherapy
Doležalová, Radka ; Haluzík, Martin (advisor) ; Šenolt, Ladislav (referee) ; Kábrt, Jan (referee)
The metabolic effects of obesity have made this disease one of the most common risk factors for diabetes, hypertension, and atherosclerosis. Adipose tissue is now recognized as an active secretory and immune organ. Chronic inflammation is a common feature of the obesity, and inflammatory signals may originate within visceral adipose tissue as this fat depot expands in response to chronic positive energy balance. Both adipocytes and macrophages within fat secrete numerous hormones and cytokines that have local effects on WAT physiology but also systemic effects on other organs and may markedly contribute to the development of pathophysiological disorders associated with metabolic syndrome. On the contrary, leanness as well as significant weight reduction in obese patients increases production and circulating levels of metabolically beneficial factors and decreases production of proinflammatory and insulin resistance-inducing factors. Endothelial dysfunction and inflammation are important signs of vascular risk and worsened prognosis in patients with metabolic syndrome and type 2 diabetes. Measures of endothelial function remain invaluable for research into disease mechanism and response to new therapies. An interesting area of ongoing investigation is the role of thiazolidinediones in improving endothelial...
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The role of endothelial progenitor cells in the pathogenesis of anti - neutrophil cytoplasmatic antibody - associated vasculitis
Závada, Jakub ; Tesař, Vladimír (advisor) ; Haluzík, Martin (referee) ; Monhart, Václav (referee)
Summary: Introduction: Circulating endothelial progenitor cells (EPC) may provide an endogenous repair mechanism to counteract ongoing endothelial damage. Antineutrophil cytoplasmic antibody - associated vasculitis (AAV) is an inflammatory disorder of small- to medium-sized vessels with relapsing/remitting progression and endothelial injury is a major feature of AAV. EPC thus may play and an important role in the pathogenesis of AAV, or serve as a useful marker for monitoring and/or prediction of outcomes in patients with AAV. Hypotheses: EPC number in patients with AAV could be altered. The decreased capacity for endothelial regeneration paralleled by low EPC numbers could increase the risk of relapse in patients with AAV. Patients and methods: We have measured EPC in healthy volunteers, patients with AAV, chronic kidney failure (CKD) and atherosclerosis by a colony-forming assay. We have investigated the relation between the numbers of EPC, clinical and laboratory characteristics of the patients, and long-term outcomes of patients with AAV. Results: Patients with AAV had a significantly lower number of EPC than healthy subjects, but not than patients with CKD or atherosclerosis. The cumulative relapse-free survival increased stepwise across three increasing baseline levels of endothelial progenitor cells....
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Local metabolism of glucocorticoids in female Prague hereditary hypertriglyceridemic rats
Klusoňová, Petra ; Pácha, Jiří (advisor) ; Kopecký, Jan (referee) ; Haluzík, Martin (referee)
11-hydroxysteroid dehydrogenase (11HSD1) is an oxidoreductase which catalyzes conversion of inactive 11-oxo steroid derivatives into active 11-hydroxy forms. 11HSD1 elevates intracellular level of active glucocorticoid (GC) hormones: cortisol in human tissues and corticosterone in rodents, therefore local level of active GCs can be set independently from systemic secretion driven by hypothalamo-pituitary-adrenal axis (HPA axis). Chronic systemic excess of GCs results in development of Cushing's syndrome which is characterised by central obesity and other metabolic disturbances. Despite normal serum levels of GCs, the patients with idiopathic obesity also develop metabolic syndrome. It was suggested that GCs could be elevated locally in target tissues due to enhanced 11HSD1 activity. This hypothesis was confirmed in transgenic rodent models. Prague hereditary hypertriglyceridemic (HHTg) rats represent a non-obese model of metabolic syndrome without genetic manipulations or specific mutations. The strain was bred by cross-mating of Wistar rat individuals with elevated serum levels of triglycerides (TGs). The strain exhibit hypertriglyceridemia and hypertension. When kept on high carbohydrate diet HHTg rats exhibit alterations in glucose homeostasis. Since there are no data that would describe...
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The importance of biosynthetic and catabolic pathway of cholesterol in inflammatory and tumor diseases
Leníček, Martin ; Vítek, Libor (advisor) ; Haluzík, Martin (referee) ; Mareček, Zdeněk (referee)
This thesis focuses on the importance of intermediate products of biosynthetic and catabolic pathway of cholesterol. The aim of the first part of the thesis is mainly to investigate, whether statins (HMG- CoA reductase inhibitors) possess antitumor properties and to compare the differences in antitumor potential of individual statins. The other part of the thesis aims at the utilization of 7α-hydroxycholest-4-en-3-one (C4), a promising marker of cholesterol 7α-monooxygenase (CYP7A1) activity and bile acid malabsorption. We demonstrated antitumor effect of statins on an experimental model of pancreatic cancer. Individual statins, however, differed significantly in their efficacy, depending on their physico-chemical properties. Our data suggests, that the most likely (but not the only) mechanism of antitumor effect of statins is decreased prenylation of signaling proteins, especially Ras protooncogene. We set up a reliable method for measurement of C4, which facilitated our research in CYP7A1 regulation. We demonstrated, that promoter polymorphism -203A>C might affect CYP7A1 activity, that diurnal variability of CYP7A1 activity might be triggered by insulin, and that insulin resistance in patients with non-alcoholic fatty liver disease impedes the feedback regulation of CYP7A1, which may lead to disease...
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Signalling of protein kinase B and expression of cyclooxygenase in early phases of diabetic nephropathy
Ždychová, Jana ; Komers, Radko (advisor) ; Haluzík, Martin (referee) ; Matoušovic, Karel (referee) ; Škrha, Jan (referee)
Introduction: Renal hypertrophy, extracellular matrix accumulation, aItered apoptosis as well as changes in regional hemodynamics have been implicated in the pathophysiology of nephropathy in diabetes mellitus (DM). On the molecular level the detailed mechanisms for development of diabetic nephropathy (DN) have becn intensively studied. Insulin induces a variety of biologicaI effects in a number of cell types via phosphatidylinositol-3 kinase (PI3K)/Akt kinase signaling pathway. Considering multiple function of Akt that incIude potentiaIly hannful pro-growth effects mediated by mTOR and cyclooxygenas-2 (COX-2), as well as protective effects mediated by endotheliaI nitric oxide synthase (eNOS), it is possible that aIterations in activities of Akt may play role in the pathophysiology ofDN. Renal corticaI activity and expression of Akt, its down-strearn effectors mTOR, eNOS, and "C<JIX-:Z. as well as PTEN, an endogenous Akt inhibitor, were investigated in streptozotocin (STZ): diabetic rats as a model of Type 1 DM with different levels of glycenůc control, and in Zucker ~d.iabetic fatty rats, a model ofDM2, and in nondiabetic rats as controls. Methods: Akt activity was measured by kinase assay. Protein expressions were measured by .immunoblotting and immunohistochemistry in renal cortex of 4- and 12- week old...
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Novel approaches to diagnosis and treatment of selected endocrine disorders
Ježková, Jana ; Marek, Josef (advisor) ; Haluzík, Martin (referee) ; Vladyka, Vilibald (referee)
Je známou zkušeností, že hyperkortizolismus urychluje aterosklerotické děje. Ty je možné sledovat ultrazvukovým vyšetřováním karotid a nověji též vyšetřováním cévní mikrocirkulace laser-Dopplerovskou metodou. Pro urychlení aterosklerotických změn u nemocných s Cushingovým syndromem jsou nesporně důležité známé faktory: hypertenze, obezita a hyperlipidemie. К nim se počítá zvýšená inzulínová rezistence, ale nemocní s floridním hyperkortizolismem mají normální hladiny glykemie a imunoreaktivního inzulínu. К aterogenezi u floridního hyperkortizolismu může přispívat zvýšená tvorba volných kyslíkových radikálů vznikajících při oxidaci lipidů a zvýšené hladiny pozitivního proteinu akutní fáze-orosomukoidu. Imunosupresivní charakter se projevuje snížením hladin autoprotilátek a snížením hladiny intercelulární adhezivní molekuly-1 (ICAM-1). К urychlení aterogeních dějů dochází i u nemocných, kteří jsou již dlouhou dobu po úspěšné normalizaci hyperkortizolemie. I když čerstvě operovaní a normalizovaní nemocní ztrácí do jednoho roku svou Cushingovskou obezitu, dochází později u operovaných nemocných opět к nadváze. Ta je spojena s poruchami lipidového spektra a u čtvrtiny nemocných i s hypertenzí. Nemocné po operaci pro Cushingův syndrom je nutné pravidelně sledovat, i když jsou dlouhodobě normalizováni. Je třeba u...
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The influence of pharmacology and reduction diet on metabolism of adipose tissue in obese patients with diabetes type 2
Anderlová, Kateřina ; Haluzík, Martin (advisor) ; Vítek, Libor (referee) ; Stárka, Luboslav (referee)
Insulin resistance, obesity, type 2 diabetes mellitus and their complications are linked together under definition called Metabolic or Reaven Syndrome. The presence of Metabolic Syndrome increases the risk of atherosclerosis and consequently cardiovascular morbidity and mortality. Metabolic Syndrome belongs among civilization diseases and due to changes in our life styles becomes major health and social-economic issue. The insulin resistance is considered primary pathology that may induce other components of Metabolic Syndrome. Research conducted within last decade brought significant results and showed how important is the adipose tissue in the development of insulin resistance especially in the context of discovery of endocrine function of adipose tissue. The existence of nuclear receptors PPAR (peroxisome proliferator activated receptor) could explain the interaction between particular tissues and hormonal factors which may induce insulin resistance. When the PPAR receptors are bound by lipophilic ligands they directly affect transcriptional processes in cell nucleus and induce expression of genes involved in metabolism of lipids and carbohydrates, in the regulation of inflammation, in tumor growth regulation, in immune response, in cell differentiation and etc. In current medical practice...
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