Integrated insulin secretion rates calculated from peripheral venous C-peptide measurements by two-compartment kinetic analysis were measured in six young normal subjects after increasing oral glucose loads of 25, 50, and 100 g and respective isoglycemic glucose infusions. The differences in B-cell secretory responses between oral and iv glucose challenges were attributed to factors other than glycemia itself (incretin effect). Both insulin and C-peptide concentrations as well as calculated integrated insulin secretion rates increased with increasing oral glucose loads. Due to the similarity in the glucose profiles after all oral loads, almost identical amounts of iv glucose (approximately 20 g) were infused in all "isoglycemic" infusion experiments, with resulting similar hormone profiles and insulin secretion rates. The percent contribution of incretin factors to total immunoreactive insulin responses after 25, 50, and 100 g glucose (85.6%, 74.9%, and 93.0%; response to oral load, 100%) was significantly higher than their contribution to integrated C-peptide responses (27.6-62.9%) or calculated integrated insulin secretion rates (19.2-61.0%). These findings indicate that the degree of incretin stimulation of insulin secretion depends on the amount of glucose ingested. A discrepancy between the estimates of the incretin effect derived from peripheral venous insulin responses, on the one hand, and C-peptide responses or calculated insulin secretion rates, on the other hand, exists. Inasmuch as peripheral insulin values reflect both insulin secretion and hepatic insulin removal, this discrepancy suggests that elimination kinetics of insulin differ between oral and iv glucose administration. This difference can be related to a significantly reduced fractional hepatic insulin extraction after oral (46.9-54.6%) compared to iv (63.4-76.5%) glucose administration when calculated by a three-compartment kinetic model. This reduction in fractional hepatic insulin extraction could be caused by gastrointestinal factors (hormones or nerves) stimulated in the course of glucose ingestion.
Antivirulence drugs are a new type of therapeutic drug that target virulence factors, potentially revitalising the drug-development pipeline with new targets. As antivirulence drugs disarm the pathogen, rather than kill or halt pathogen growth, it has been hypothesized that they will generate much weaker selection for resistance than traditional antibiotics. However, recent studies have shown that mechanisms of resistance to antivirulence drugs exist, seemingly damaging the 'evolution-proof' claim. In this Opinion article, we highlight a crucial distinction between whether resistance can emerge and whether it will spread to a high frequency under drug selection. We argue that selection for resistance can be reduced, or even reversed, using appropriate combinations of target and treatment environment, opening a path towards the development of evolutionarily robust novel therapeutics.
The prehepatic production of insulin in normal man was evaluated by kinetic analysis of connecting peptide (C-peptide) behavior in the plasma in men and women. Studies were performed during suppression of endogenous insulin secretion (induced by both fasting and exogenous insulin injection) as well as during stimulation of secretion (induced by oral glucose ingestion) and iv glucose injection. Least squares spline fitting of the C-peptide data by interactive computer analysis permitted evaluation of the precursor production of insulin using a two-compartment model for C-peptide removal. Basal prehepatic insulin production averaged 15-4 mU/70 kg.min in 20 subjects and was reduced to 0.9 +/- 2.2 mU/70 kg.min after 84 h of fasting. The injection of exogenous iv insulin resulted in suppression of endogenous production to 0 +/- 2.5 mU/70 kg.min. Maximum prehepatic insulin production induced by a 100-g oral glucose tolerance test was 91 +/- 1.2 mU/70 kg.min, with a cumulative hormone secretion of 11.4 +/- 2.0 U over the 5 h of observation. After the acute iv injection of 25 g glucose, production rose to 465 +/- 108 mU/70 kg.min at 2 min post injection and rapidly returned toward basal. Levels of insulin in the portal vein calculated from this analysis were markedly elevated relative to simultaneous peripheral venous levels. These results quantitate prehepatic insulin production and portal venous insulin concentration from an analysis of the behavior of C-peptide within the plasma in both the steady state and the nonsteady state in man.
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