Journal Club

1
Journal Club
Karatzi K, Karatzis E, Papamichael C, Lekakis J,
Zampelas A. Effects of red wine on endothelial
function Postprandial studies vs clinical
trials. Nutr Metab Cardiovasc Dis. 2009 Jun 29.
Epub ahead of print Monami M, Iacomelli I,
Marchionni N, Mannucci E. Dipeptydil peptidase-4
inhibitors in type 2 diabetes A meta-analysis of
randomized clinical trials. Nutr Metab Cardiovasc
Dis. 2009 Jun 8. Epub ahead of print
2009?8?20? 830-855 8? ??

• ?????? ???????? ????????
• Department of Endocrinology and Diabetes,
• Saitama Medical Center, Saitama Medical
  University
• ?? ??
• Matsuda, Masafumi

2
Journals impact factor 3.56. 
3
(No Transcript)
4
Sirt1 a metabolic master switch that modulates
lifespan
By regulating transcriptional co-regulators such
as PGC-1a or by directly interacting with
transcription factors, Sirt1 can modulate
gene-expression profiles in target tissues such
as brain, liver, fat, pancreatic beta cells and
muscle. By decoding NAD fluctuations in these
tissues, Sirt1 might link the nutritional status
of the cell to the regulation of its metabolism.
Whereas the impact of Sirt1 in tissues such as
liver (increased glucose output via
gluconeogenesis), fat (lipolysis and mobilization
of free fatty acid) and pancreatic beta cells
(increased glucose-stimulated release of insulin)
has been shown, its effect on metabolism in brain
and skeletal muscle is still elusive.
Nature Medicine 12, 34 - 36 (2006)
5
SIRT1 activator SRT1720
Figure 1 Identification of potent SIRT1
activators unrelated to resveratrol. a, Chemical
structures of SIRT1 activators, resveratrol,
SRT1460, SRT2183, and SRT1720.
6
(No Transcript)
7
BACKGROUND
There are several epidemiological studies
suggesting that moderate daily consumption of red
wine may reduce cardiovascular risk.
Additionally, results from a great number of in
vitro studies indicate that constituents found in
red wine are responsible for quite a few
beneficial effects on endothelial cells. However,
comparison of postprandial studies and clinical
trials concerning red wine consumption leads to
controversial results about its effect on
endothelial function and especially flow-mediated
dilatation (FMD). Endothelial function is an
early indicator of atherosclerosis and vessel
damage and at the same time, it is an independent
prognostic factor for cardiovascular risk.
Therefore, it is very important to investigate
the known acute postprandial effects of red wine
consumption, which is highly advised by
dieticians and doctors, especially in high-risk
populations, such as patients with coronary
artery disease (CAD).
8
METHODS
This is a review of studies investigating acute
and short-term effects of red wine on endothelial
function, as well as relevant in vitro studies.
9
FLOW-MEDIATED DILATATION
10
FMD???????FMD???(UNEXEF18G?2?10MHz?????????)
FMD ?????
11
(No Transcript)
12
(No Transcript)
13
CONCLUSIONS
Analysis of all data about the acute effects of
red wine constituents on endothelial function, is
inconclusive and it is obvious that new studies
are necessary in order to elucidate this matter.
Undoubtedly, one should be very careful in
suggesting red wine consumption in high-risk
populations, as its acute postprandial effect is
not yet clear.
14
Message
FMD?????????????? ?)????FMD???? ??
15
(No Transcript)
16
Dipeptidyl peptidase-4 inhibitor/GLP-1??????
Exenatide
Sitagliptin
Liraglutide
Alogliptin
Vildagliptin
17
(No Transcript)
18
BACKGROUND
The role of Dipeptidyl Peptidase-4 (DPP-4)
inhibitors in the treatment of type 2 diabetes is
debated many recent trials, which were not
included in previous meta-analyses, could add
relevant information.
19
METHODS
All available randomized controlled trials
(RCTs), either published or unpublished,
performed in type 2 diabetic patients with DPP-4
inhibitors, with a duration gt12 weeks were
meta-analyzed for HbA1c, BMI, hypoglycemia, and
other adverse events.
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
RESULTS
A total of 41 RCTs (9 of which are unpublished)
was retrieved and included in the analysis.
Gliptins determine a significant improvement of
HbA1c in comparison with a placebo (?0.7
?0.8?0.6), with a low risk of hypoglycemia.
DPP-4 inhibitors show a similar efficacy in
monotherapy and in combination with other agents.
The risk of cardiovascular events and all-cause
death with DPP-4 inhibitors is 0.76 0.46?1.28
and 0.78 0.40?1.51, respectively.
32
CONCLUSIONS
DPP-4 inhibitors reduce HbA1c, although to a
lesser extent than sulphonylureas, with no weight
gain and no hypoglycemic risk further data are
needed to assess their long-term safety.
33
Message
DPP-4?????????????????????????????????????????????
?????????????
34
(No Transcript)