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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
High-dose insulin therapy reduces postoperative liver dysfunction and complications in liver resection patients through reduced apoptosis and altered inflammation
Journal of Clinical Endocrinology and Metabolism, Volume 97, No. 1, Year 2012
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Description
Context: An exaggerated inflammatory response in patients undergoing major liver resection coupled with poor nutrition diminishes liver regenerative capacity and increases the risk of postoperative complications. Objectives: Our objective was to evaluate the biological context leading to better clinical outcomes in patients undergoing liver resection coupled with hyperinsulinemic-normoglycemic clamp vs. standard care (insulin sliding care). Design and Setting: This study was a fundamental research analysis of a patient subset from a randomized-controlled study at the McGill University Health Center. Patients and Intervention: Thirty consenting patients participating in a randomized clinical trial for liver resection received either hyperinsulinemic-normoglycemic clamp technique with 24-h preoperative carbohydrate load (intervention) or standard glucose control through insulin sliding scale treatment (control). Main Outcome Measures: Liver biopsies and plasma samples were taken at various time points before and after surgery. Primary measures included mRNA quantitation for genes related to insulin signaling, inflammation, and proliferation; proinflammatory cytokines at various time points; and liver function markers. These measurements were associated with clinical outcomes. Results: The hyperinsulinemic-normoglycemic clamp technique reduced postoperative liver dysfunction, infections, and complications. Markers of energy stores indicated higher substrate availability. Cytokine expression pattern was altered (TNF-α, IL-8,monocyte chemoattractant protein-1, IL-6, IL-10, and C-reactive protein). Apoptosis was markedly reduced, whereas the complement system was unaltered. Conclusion: The hyperinsulinemic-normoglycemic clamp technique reduced postoperative negative outcomes by suppressing apoptosis. This phenomenon appears to be linked with higher substrate availability and altered cytokine secretion profile and may provide a long-term benefit of this therapy on liver resection patients. Copyright © 2012 by The Endocrine Society.
Authors & Co-Authors
Fisette, Alexandre
Canada, Quebec
Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval
Hassanain, Mazen M.
Canada, Montreal
Centre Universitaire de Santé Mcgill
Saudi Arabia, Riyadh
College of Medicine
Metrakos, Peter P.
Canada, Montreal
Centre Universitaire de Santé Mcgill
Saudi Arabia, Riyadh
College of Medicine
Doi, Suhail A.
Australia, Brisbane
The University of Queensland
Salman, Ayat
Saudi Arabia, Riyadh
College of Medicine
Schricker, Thomas P.S.
Canada, Montreal
Centre Universitaire de Santé Mcgill
Lattermann, Ralph B.
Canada, Montreal
Centre Universitaire de Santé Mcgill
Wykes, Linda J.
Canada, Montreal
Centre Universitaire de Santé Mcgill
Nitschmann, Evan
Canada, Montreal
Centre Universitaire de Santé Mcgill
Smith, Jessica D.
Canada, Quebec
Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval
Cianflone, Katherine M.
Canada, Quebec
Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval
Statistics
Citations: 24
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1210/jc.2011-1598
ISSN:
0021972X
e-ISSN:
19457197
Research Areas
Cancer
Food Security
Health System And Policy
Study Design
Randomised Control Trial