Interaction of ACAT with MTTP in making Lipoprotein B

Blood lipid particles, formally called lipoproteins, are essential for carrying and transporting triglycerides and cholesterol to various body tissues. Lipoproteins that contain B48 and B100 apoproteins are two decisive players. B48-Lipoprotein (Lp B48) is synthesized in the gastrointestinal tract, whereas B100-Lipoprotein (Lp B100) is made in the liver.

In this review article, the authors propose a feasible model of how Lp B48 and Lp B100 are created in the endoplasmic reticulum of enterocytes and hepatocytes. ACAT is responsible for converting free cholesterol into cholesteryl ester (CE), while MTTP is responsible for uploading CE and triglycerides into B48- or B100-Lipoproteins.

Clinician’s knowledge of Lp B48 and Lp B100 physiology is vital as both lipoproteins are – directly or indirectly – involved in all forms of dyslipidemias (Fredrickson classifications I – V)


Diabetic Gastroparesis

Diabetic gastroparesis is a late complication of long-standing uncontrolled diabetes. Pathogenesis is complex as it involves hyperglycemia, vagus neuropathy, and inflammation. Gastroparesis leads to gastric outlet obstruction, delayed gastric emptying, and gastroesophageal reflux. Symptoms are nausea, vomiting, reflux, bloating, weight loss, and improper gastrointestinal absorption.

In this article, the authors provide an in-depth analysis and review of the literature on diabetic gastroparesis. They discuss in detail the pathogenesis, structural anomalies, the role of hyperglycemia, neuropathy, inflammation, and symptoms. They also discuss thoroughly various diagnostic testing, current medications available, and potential future drugs.

Diabetic gastroparesis requires a multidisciplinary approach, including a nutritionist, primary care physician, endocrinologist, gastroenterologist, and surgeon. Tight control of hyperglycemia is paramount in preventing gastroparesis in the first place as well as halting its progression.


Subclinical hypothyroidism in the elderly

Personalized therapy is crucial in good clinical practice, and in the management of older patients with subclinical hypothyroidism, multiple factors must be considered, including age-dependent TSH cutoffs, thyroid autoimmunity, the burden of comorbidities, and the possible presence of frailty. 

Levothyroxine is the drug of choice for the treatment of hypothyroid older people, but the risk of overtreatment, potential adverse drug reactions, and patient compliance should always be considered and thyroid status periodically reassessed.


Obesity and kidney disease

This is a nice review showing how obesity contributes to kidney disease, particularly in the setting of metabolic syndrome, diabetes and hypertension.

The process starts with glomerular hyperfiltration, and made worse by high sodium and animal protein intake. I suspect that inflammation from visceral adiposity plays a major role too.

It appears that the risk for kidney disease accumulates over time, as prognosis is worse in childhood-onset vs. adult-onset obesity.


AHA Scientific Statement: Biomarkers of Heart Failure

“Biomarkers from blood can help detect the presence of Heart Failure, determine its severity, assess risk of future events, and guide therapy. The following discussion focuses on biomarkers that are NOT part of the routine clinical evaluation of patients but rather are obtained specifically to further assess prognosis and possibly direct HF therapy. Individual biomarkers are categorized according to their primary pathophysiological mechanism, although multiple pathways may also be involved.”


Aging, Diabetes and Cardiovascular Illness

Older adults with diabetes are at higher risk for atherosclerotic cardiovascular disease (ASCVD) than younger adults with diabetes and older adults without diabetes. The rationale to implement ASCVD risk–lowering therapies in older adults with diabetes is compelling.

The variability in health status among older adults is pertinent. Those with robust health are more likely to tolerate and derive benefit from many therapies when compared with those who have more complex health including frailty.

Diabetes Care

Obesity 2017

A great review article on the current state of obesity. Increased adiposity or high BMI is a cause or great contributor to multiple of conditions; such as metabolic syndrome, insulin resistance, diabetes, hypertension, high cholesterol, osteoarthritis, impaired renal function, kidney stones, gout and even cancer.