The intestinal peptides GLP-1 and GIP potentiate glucosemediated insulin release. Agents that increase GLP-1 action are effective therapies in type 2 diabetes mellitus (T2DM). However, GIP action is blunted in T2DM, and GIP-based therapies have not been developed. Thus, it is important to increase our understanding of the mechanisms of GIP action. We developed mice lacking GIP-producing K cells. Like humans with T2DM, "GIP/DT" animals exhibited a normal insulin secretory response to exogenous GLP-1 but a blunted response to GIP. Pharmacologic doses of xenin-25, another peptide produced by K cells, restored the GIP-mediated insulin secretory response and reduced hyperglycemia in GIP/DT mice. Xenin-25 alone had no effect. Studies with islets, insulin-producing cell lines, and perfused pancreata indicated xenin-25 does not enhance GIP-mediated insulin release by acting directly on the ␤-cell. The in vivo effects of xenin-25 to potentiate insulin release were inhibited by atropine sulfate and atropine methyl bromide but not by hexamethonium. Consistent with this, carbachol potentiated GIP-mediated insulin release from in situ perfused pancreata of GIP/DT mice. In vivo, xenin-25 did not activate c-fos expression in the hind brain or paraventricular nucleus of the hypothalamus indicating that central nervous system activation is not required. These data suggest that xenin-25 potentiates GIP-mediated insulin release by activating non-ganglionic cholinergic neurons that innervate the islets, presumably part of an enteric-neuronal-pancreatic pathway. Xenin-25, or molecules that increase acetylcholine receptor signaling in ␤-cells, may represent a novel approach to overcome GIP resistance and therefore treat humans with T2DM.The entero-insulin axis is a physiologic system composed of peptides secreted from the gastrointestinal tract that play an important role in regulating insulin secretion from pancreatic islet ␤-cells (1, 2). To date, attention has focused on two intestinal peptides, glucagon-like peptide-1 (GLP-1) 2 and glucosedependent insulinotropic polypeptide (GIP). GIP is produced predominantly by intestinal K cells located in the proximal small intestine, whereas GLP-1 is produced primarily by intestinal L-cells present in the distal bowel (3-5). Release of GLP-1 and GIP is controlled by nutrient levels in the lumen of the gut rather than the bloodstream. Both hormones are released into the bloodstream immediately after ingestion of a meal and then potentiate glucose-stimulated insulin release. This increase in insulin secretion has been termed the incretin effect. Importantly, the incretin effect occurs only in the presence of elevated blood glucose and does not cause postprandial hypoglycemia.An increase in circulating GLP-1 activity has significant therapeutic benefit in patients with T2DM (1, 2, 6 -10). Two major classes of drugs that accomplish this goal have recently been introduced into the market with substantial success. Long acting analogs of GLP-1 potentiate glucose-stimulated insulin secretion leadin...

The purpose of this study was to determine the accuracy of elevated concentrations of endotoxin in bronchoalveolar lavage (BAL) fluid for the diagnosis of gram-negative pneumonia. Sixty-three hospitalized adults underwent 71 evaluations with BAL using quantitative cultures for suspected lung infection. A cutoff value of > 5 EU/ml for the concentration of endotoxin in BAL fluid yielded the best operating characteristics for the diagnosis of gram-negative pneumonia (sensitivity, 100%; specificity, 75.0%; area under receiver operating characteristic [ROC] curve, 0.88). Good diagnostic agreement was found between elevated concentrations of endotoxin in BAL fluid and microbiologically confirmed gram-negative pneumonia (kappa statistic, 0.64; concordance 83.1%). Gram stain examination of BAL fluid for the presence of gram-negative bacteria yielded inferior operating characteristics (sensitivity, 63.2%; specificity, 75.0%; area under ROC curve, 0.69). Poor diagnostic agreement was observed between BAL fluid Gram stain results and microbiologically confirmed gram-negative pneumonia (kappa statistic, 0.35; concordance, 71.8%). These findings suggest that a concentration of endotoxin in BAL fluid > 5 EU/ml is superior to Gram stain examination for the rapid identification of patients with gram-negative pneumonia.

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Recombinant GST (glutathione transferase) proteins are widely used as immunogens to generate polyclonal antibodies. Advantages of using GST proteins include: commercially available cloning vectors, vast literature for protein expression in Escherichia coli, the ease of protein purification, immunogen can be used as an ELISA standard and GST can be removed in some systems. However, there are disadvantages: GST oligomerization, inclusion body formation and target protein insolubility after GST removal. Perhaps the most detrimental is the significant generation of anti-GST antibodies by the host animal. A two-column procedure using a glutathione-GST column and a glutathione-(GST-protein) column can yield affinity-purified anti-(GST-protein) polyclonal antibody. Several passes over the first column are often required, though, to completely extract the anti-GST antibodies from the immune sera. We reasoned that knowledge of the target protein linear epitope(s) would allow construction of a peptide affinity resin for a single-pass 'one and done' purification termed ETRAP (efficient trapping and purification). In the present paper, we describe our efforts and present data on rabbits and sheep immunized with GST proteins having target protein molecular masses of ~8, 21 and 33 kDa. The titre and purity of the target antibodies using the ETRAP protocol were comparable to the more laborious multi-column purifications but with a considerable saving in time.

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