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Pathology Role of insulin -produced in the beta cells of the pancreas -initially synthesised as a single chain 86 amino acid polypeptide (pre-proinsulin) -post-translational modification removes the amino terminal signal peptide what is a signal peptide?
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Nutrition 101 tutorTUTOR REQUIRED FOR NUTRITION 101 -CONTACT DR. BARRE IF YOU OR SOMEONE ELSE ARE INTERESTED.A student tutoring for the Jennifer Keeping Centre is paid $15 per hour. Students typically get tutored 2 hours a week. They can be tutored right up until the end of the term or sooner depending on the student's needs.
Lecture 4a 31 January 2011 Diabetes
Type IType II
Pathology-4aNutritional Intervention-4bFunctional Food/Nutraceutical Approaches-4c
Pathology Role of insulin
-produced in the beta cells of the pancreas
-initially synthesised as a single chain 86 amino acid polypeptide (pre-proinsulin)
-post-translational modification removes the amino terminal signal peptide
what is a signal peptide?
Role of insulin
-this give rise to proinsulin -insulin is created via the cleavage of an internal peptide (31mer) and the A (21mer) and B(30 mer) chains of insulin are then linked together by a disulphide linkage (enzyme responsible?)
Causes of Type I-genetic-concordance is 30-70 % in identical twins
-polymorphisms in HLA complex appear to account for 40-50 % of type I
-HLA complex contains genes for the class II MHC molecules which present antigen to
helper T cells and are thus involved in initiating the immune response
-ability of class II MHC molecules to present antigen is dependent on the amino acid
composition of their antigen binding sites
Genetic
-amino acid substitutions may influence the specificity of the immune response by altering the binding affinity of
different antigens for the class II molecules
-10 % of genetic risk due to
polymorphisms in the promoter region of the insulin gene
Causes of Type I-autoimmune- beta cells produced proteins that mediate draw lymphocytes into pancreas where they infiltrate islets (insulitis) and selectively attack beta cells- inflammation leads to atrophy of -cells -immunological markers-islet cell autoantibodies-these antibodies are directed at a series of -cell proteins -environmental-viruses-coxsackie and rubella
-bovine milk-nitrosamines
Type II-no longer adult NIDDM - affects children and insulin can be used
-genetic factors
-concordance of 70-90 % in identical twins- question this
-40 % if both parents have it-question this as well
-polymorphisms or mutations in insulin receptor and enzymes involved in glucose homeostasis (candidates?)
-pathophysiology
-increased hepatic glucose synthesis because as insulin sensitivity drops the ability of
insulin to promote glycogen synthesis and suppress gluconeogenesis drops
-impaired insulin sensitivity
Pathophysiology continued
-impaired insulin production-reason is unknown-though glucose toxicity while undefined cripples beta cell-suggestions
-increased free fatty acids impair -cell function
Metabolic syndrome-obesity
-kick-off via increased free fatty acids
-measures-BMI
-percentage fat-skinfolds underwater weighing
-height-weight tables
-free fatty acids regulate insulin sensitivity
Metabolic syndrome
-free fatty acids regulate insulin sensitivity
-free fatty acids decrease glucose utilisation and increase hepatic glucose production
-lipids-including decreased anti-oxidation
capacity
-increased free fatty acids
-decreased HDLc, increased CETP, decreased LPL
-increased cholesterol, LDLc
-increased triglycerides
Metabolic syndrome
-blood pressure-elevated
-platelet aggregation- Trip- epidemiology slide
PLATELET HYPERREACTIVITY AND MYOCARDIAL INFARCTION*
SPA STATUS MORTALITY CARDIAC AND NUMBER EVENTSOF PATIENTS
TOTAL 149 18 33SPA NEG. 94 6 (6.4 %) 14 (14.9 %)
SPA INT. 29 3 (10.3 %) 7 (24.1 %)
SPA POS. 26 9 (34.6 %) 12 (46.2 %)
12 MOS. DATA OF Trip et al. NEJM 322:1549 (1990)SPA = SPONTANEOUS PLATELET AGGREGATION
Metabolic syndrome
-insulin sensitivity-receptor binding efficiency
-right shift in insulin dose response curve and downward shift in maximal impact
-as insulin sensitivity goes down the lipids are further perturbed
-ultimately may get pancreatic failure with requirement for insulin injections