Liver and Muscle in Morbid Obesity: The Interplay of Fatty Liver and Insulin Resistance

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) can be seen as a manifestation of overnutrition. The muscle is a central player in the adaptation to energy overload, and there is an association between fatty-muscle and -liver. We aimed to correlate muscle morphology, mitochondrial function and insulin signaling with NAFLD severity in morbid obese patients. METHODS: Liver and deltoid muscle biopsies were collected during bariatric surgery in NAFLD patients. NAFLD Activity Score and Younossi's classification for nonalcoholic steatohepatitis (NASH) were applied to liver histology. Muscle evaluation included morphology studies, respiratory chain complex I to IV enzyme assays, and analysis of the insulin signaling cascade. A healthy lean control group was included for muscle morphology and mitochondrial function analyses. RESULTS: Fifty one NAFLD patients were included of whom 43% had NASH. Intramyocellular lipids (IMCL) were associated with the presence of NASH (OR 12.5, p<0.001), progressive hepatic inflammation (p = 0.029) and fibrosis severity (p = 0.010). There was a trend to an association between IMCL and decreased Akt phosphorylation (p = 0.059), despite no association with insulin resistance. In turn, hepatic steatosis (p = 0.015) and inflammation (p = 0.013) were associated with decreased Akt phosphoryation. Citrate synthase activity was lower in obese patients (p = 0.047) whereas complex I (p = 0.040) and III (p = 0.036) activities were higher, compared with controls. Finally, in obese patients, complex I activity increased with progressive steatosis (p = 0.049) and with a trend with fibrosis severity (p = 0.056). CONCLUSIONS: In morbid obese patients, presence of IMCL associates with NASH and advanced fibrosis. Muscle mitochondrial dysfunction does not appear to be a major driving force contributing to muscle fat accumulation, insulin resistance or liver disease. Importantly, insulin resistance in muscle might occur at a late point in the insulin signaling cascade and be associated with IMCL and NAFLD severity

Pemphigus autoimmunity: Hypotheses and realities

The goal of contemporary research in pemphigus vulgaris and pemphigus foliaceus is to achieve and maintain clinical remission without corticosteroids. Recent advances of knowledge on pemphigus autoimmunity scrutinize old dogmas, resolve controversies, and open novel perspectives for treatment. Elucidation of intimate mechanisms of keratinocyte detachment and death in pemphigus has challenged the monopathogenic explanation of disease immunopathology. Over 50 organ-specific and non-organ-specific antigens can be targeted by pemphigus autoimmunity, including desmosomal cadherins and other adhesion molecules, PERP cholinergic and other cell membrane (CM) receptors, and mitochondrial proteins. The initial insult is sustained by the autoantibodies to the cell membrane receptor antigens triggering the intracellular signaling by Src, epidermal growth factor receptor kinase, protein kinases A and C, phospholipase C, mTOR, p38 MAPK, JNK, other tyrosine kinases, and calmodulin that cause basal cell shrinkage and ripping desmosomes off the CM. Autoantibodies synergize with effectors of apoptotic and oncotic pathways, serine proteases, and inflammatory cytokines to overcome the natural resistance and activate the cell death program in keratinocytes. The process of keratinocyte shrinkage/detachment and death via apoptosis/oncosis has been termed apoptolysis to emphasize that it is triggered by the same signal effectors and mediated by the same cell death enzymes. The natural course of pemphigus has improved due to a substantial progress in developing of the steroid-sparing therapies combining the immunosuppressive and direct anti-acantholytic effects. Further elucidation of the molecular mechanisms mediating immune dysregulation and apoptolysis in pemphigus should improve our understanding of disease pathogenesis and facilitate development of steroid-free treatment of patients

Microhabitat associations and seedling bank dynamics in a neotropical forest

We conducted a rigorous test of tropical tree seedling microhabitat differentiation by examining microhabitat associations, survival and growth of established seedlings of ten tropical tree species representing a four-factor gradient in seed size. Eight microhabitat variables describing soil and light conditions were measured directly adjacent to each of 588 seedlings within twelve 10×100 m belt transects at Paracou, French Guiana, and at 264 reference points along the transects. From these measurements, we defined three principal components describing soil richness, soil softness and canopy openness. Six of ten species (in 9 of 30 total cases) were distributed non-randomly with respect to microhabitat along at least one principal component. However, few species demonstrated clear microhabitat specialization. All shifts in distribution relative to reference points were in the same direction (richer, softer soil). Furthermore, of 135 pairwise comparisons among the species, only 7 were significantly different. More than three-fourths of all seedlings (75.3%) survived over the 2-year monitoring period, but survival rates varied widely among species. In no case was the probability of survival influenced by any microhabitat parameter. Relative height growth rates for the seedlings over 2 years varied from −0.031 cm cm −1  year −1 ( Dicorynia guianensis , Caesalpiniaceae) to 0.088 cm cm −1  year −1 ( Virola michelii , Myristicaceae). In only 4 of 30 cases was height growth significantly associated with one of the three principal components. Because the conditions in this study were designed to maximize the chance of finding microhabitat differentiation among a group of species differing greatly in life history traits, the lack of microhabitat specialization it uncovered suggests that microhabitat partitioning among tropical tree species at the established seedling stage is unlikely to contribute greatly to coexistence among these species.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47708/1/442_2004_Article_1691.pd