Twelve subjects with insulin-dependent diabetes mellitus were treated using continuous subcutaneous insulin infusion (CSII) and intraportal insulin infusion (IPII) via the umbilical vein for 4 mo. Glucose control improved in both CSII and IPII groups, but a decrease in glucose and HbAIc was more rapid and more significant in the IPII group than in CSII, even though insulin requirement was lower during IPII than CSII (40 +/- 2 vs. 50 +/- 2 U/day, P less than 0.05). The insulin plasma fasting levels were different (88 +/- 10.7 in the IPII group vs. 263 +/- 23 pM in CSII, P less than 0.001). High plasma levels of lactate, pyruvate, alanine, cortisol, and growth hormone were decreased in both groups, with their full normalization only in the IPII group. Glucagon concentrations were low in both groups at the beginning of the study (30.0 +/- 4.1 in the CSII group and 32.3 +/- 1.8 ng/L in IPII); they were equalized to control values in the IPII group and were low in the CSII group at the study's end (46.0 +/- 3.7 in IPII vs. 31.7 +/- 3.1 ng/L in CSII, P less than 0.05. We conclude that intraportal administration of insulin via the umbilical vein at rates of 0.01-0.05 U.kg-1.hr-1 reduces plasma levels of glucose, three carbon precursors, cortisol, and growth hormone by a direct action on the liver, and the hepatic action of peripherally administered insulin is manifested only when the infusion rate is increased to 0.1-0.3 U.kg-1.hr-1.(ABSTRACT TRUNCATED AT 250 WORDS)
The autoimmune nature of insulin-dependent diabetes mellitus (IDDM) is currently undeniable. In the 80s, some features of its pathogenesis were determined: on beta cells of patients with newly diagnosed IDDM, overexpression of class I HLA antigens was detected; on beta and alpha cells of isolated islets of Langerhans, expression of class II HLA antigens in combination with tumor necrosis factor (TNF-alpha) and gamma-interferon (gamma-IF) was detected; the presence or absence of Asp-57 in the N-end of the beta1 domain of the HLADQ beta chain has been shown to be positively associated with IDDM in humans and NOD mice; it was revealed that macrophage interleukin-1 (IL-1) and TNF-alpha have a damaging effect on beta cells: IL-1 exhibits selective beta-cell cytotoxicity in low molar concentrations, and the effect of IL-1 is potentiated by TNF-alpha; it was determined that early infiltration during the development of inflammation of pancreas in BB rats is caused by macrophages and monocytes; destruction of beta cells is performed by T-helpers and natural killers. Thus, the autoimmune concept of the disease necessitates the use of immunotherapy to slow the development of IDDM.
The authors present data- on the protective effect of newborn rabbits pancreatic islet cell culture xenotransplantation of Langerhans islets P-cells of rats with alloxan diabetes. This effect was the most marked in rats fed diets with normal or increased protein content. The authors discuss a possible stimulating effect of rabbit islet cell culture xenooransplantation on regeneration processes in recipient rat pancreatic islets. This effect was better pronounced in rats kept on rations with increased protein content. Further experiments will help more accuretaly define the indications for therapy of insulindependent diabetes mellitus by xenokansplantations of islet cell cultures.
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