Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups

Background: Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovascular disease (primary prevention). Methods: In CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), 4401 participants with type 2 diabetes mellitus and chronic kidney disease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care. Results: Primary prevention participants (n=2181, 49.6%) were younger (61 versus 65 years), were more often female (37% versus 31%), and had shorter duration of diabetes mellitus (15 years versus 16 years) compared with secondary prevention participants (n=2220, 50.4%). Canagliflozin reduced the risk of major cardiovascular events overall (hazard ratio [HR], 0.80 [95% CI, 0.67-0.95]; P=0.01), with consistent reductions in both the primary (HR, 0.68 [95% CI, 0.49-0.94]) and secondary (HR, 0.85 [95% CI, 0.69-1.06]) prevention groups (P for interaction=0.25). Effects were also similar for the components of the composite including cardiovascular death (HR, 0.78 [95% CI, 0.61-1.00]), nonfatal myocardial infarction (HR, 0.81 [95% CI, 0.59-1.10]), and nonfatal stroke (HR, 0.80 [95% CI, 0.56-1.15]). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P for interaction >0.5 for each outcome). Conclusions: Canagliflozin significantly reduced major cardiovascular events and kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, including in participants who did not have previous cardiovascular disease

Study of expression of PTEN and Akt protein in OSCC cell lines submitted to in vitro assay method.

PTEN é um gene supressor de tumor, que resulta na proteína citoplasmática de mesmo nome, e possui a capacidade de modular a apoptose e o ciclo celular, assim como de inibir a migração celular. Por outro lado, o oncogene Akt promove a sobrevida celular e impede a apoptose. A ativação de Akt é inversamente relacionada com a ausência de PTEN em uma variedade de neoplasias malignas. Neste estudo, linhagens celulares derivadas de carcinoma epidermóide bucal (HN6, HN30, HN31 e uma linhagem de células controle, HaCat) foram submetidas ao método de invasão in vitro e clones celulares altamente invasivos foram isolados. Através das técnicas de imunofluorescência e Western blot foi verificada a expressão de ambas as proteínas nos novos clones (denominados HN6.1, HN30.1, HN31.1 e HaCat.1) e comparada às linhagens controle. A técnica da zimografia também foi realizada, desde que várias metaloproteinases (MMPs) têm demonstrado possuir papel importante no processo de invasão e metástase dos CEB. Nossos resultados revelaram que todas as linhagens celulares e seus respectivos clones invasivos mostraram marcação citoplasmática e nuclear para PTEN e pAkt, respectivamente. A exceção foi a HaCat.1 que apresentou marcação predominantemente citoplasmática para pAkt. A análise do Western blot revelou que os clones invasivos expressam menor quantidade de PTEN, não significantes estatisticamente. Essa diminuição foi expressiva somente na linhagem HaCat.1 (p<0.05). Em relação ao pAkt, foi observado uma discreta superexpressão dessa proteína nas linhagens invasivas de CEB. Contrariamente, a linhagem HaCat.1 sofreu uma significante diminuição de pAkt (p<0,05). Finalmente, a zimografia mostrou um discreto aumento de MMP-2 latente e/ou um significante aumento de MMP-9 ativa em todos os clo nes invasivos. Nossos resultados sugerem que não há uma relação inversa consistente e significativa entre as proteínas PTEN e Akt no processo de invasão in vitro com células derivadas de CEB. Não há somente um padrão de sinalização PTEN-PI3K-Akt no processo de carcinogênese desta neoplasia. A linhagem celular HaCat.1 se comportou diferente das linhagens derivadas de CEB e provavelmente sofreu diferenciação. Um aumento estatisticamente significante de secreção de MMP-9 ativa foi observado em 2 das 3 linhagens de CEB estudadasPTEN is a tumor suppressor gene that encodes a dual phosphates protein capable to modulate apoptosis and cell cycle and prevent cellular migration. On the other hand, Akt oncogene promotes both cell cycle progression and inhibits apoptosis. Akt activation is inversely correlated with PTEN lost in a variety of cancers. In this study, highly invasive clones of OSCC cell lines (HN6, HN30, HN31 and a control cell line, HaCat) were isolated using an in vitro assay method. The expression of both proteins in these cells was compared by immunofluorescence and western blot technique. The metalloproteinase activation was analyzed by gelatin zimography, since several MMPs have been shown to play an important role in the invasion and metastasis of OSCC. All OSCC cell lines and its new clones showed cytoplasmatic and nuclear staining for PTEN and pAkt, respectively. The western blot analysis revealed no significant decrease of PTEN expression in the most invasive clones (named HN6.1, HN30.1 and HN31.1). Only HaCat.1 had a significant decrease (p<0,05). However, there was no significant increase of Akt in the invasiveness clones and oppositely the expression of Akt was strongly reduced (p<0,05) in the HaCat.1. Finally, the zimography showed a discrete increase of inactive MMP-2 and/or a significant increase of active MMP-9 in all the most invasive cell lines. In conclusion, no correlation was seen between PTEN and pAkt in the process of invasion in vitro. There is not only a linear PTEN-PI3K-Akt pathway in OSCC. The HaCat.1 had a different behavior in relation to OSCC cell lines and probably allowed cellular differentiation. In addition, a significant increase of active MMP-9 was seen in 2 of 3 lines of cells derived from OSC