本帖最後由 lsc0019 於 2009-6-22 23:41 編輯
作者：Samuel I. Beard, Jr.
出處：WebMD醫學新聞
June 3, 2009 (德州休士頓) — 根據Vishnupriya Rao Paturi醫師等人在美國臨床內分泌醫師協會第18屆年會暨臨床研討會中發表的研究，辨識人類唾液中的多數蛋白質，有助於發展一種非侵犯性的唾液檢測，來診斷糖尿病與糖尿病前期。不過，一名專家表示，需要更多研究以對這些發現有更多的瞭解。
Paturi醫師是印度Hyderabad科學大學Nizam醫學研究中心內分泌與代謝科主任。
Paturi醫師研究團隊成員之一、Srinivasa R. Nagalla醫師向Medscape Diabetes & Endocrinology 表示，我們嘗試辨識一種非侵犯性的方法來偵測糖尿病前期/糖尿病，利用唾液作為非侵犯性介質。我們已經對第2型糖尿病進行抗唾液蛋白質體定序，辨識唾液中的各種蛋白質，共約有600種左右，之後檢視它們在對照組與糖尿病及糖尿病前期病患之間是否不同。
該團隊在這三組研究對象中辨識出多種蛋白質。
對40名病患的唾液進行前溯觀察性研究，分析其蛋白質。這些人被分成四組、各有10人。一組之前診斷有第2型糖尿病，接受治療中，第二組葡萄糖耐受不佳(IGT)，第三組有IGT以及空腹血糖耐受不良(IFG)。第四組是臨床健康者組成的對照組。使用多維液相層析/串聯式質譜儀分析唾液特徵。
該分析發現總共487種獨特的蛋白質，幾乎有33%是之前未曾在人類唾液中發現的。研究團隊在摘要中寫道，這些之中，有65種的數量在對照組與第2型糖尿病組之間有兩倍大的差異。
大多數病患有調節新陳代謝與免疫反應。第2型糖尿病患的多種生物標記在單純IGT病患與IGT合併IFG病患的唾液之間大有不同。使用西方免疫印漬法與酵素免疫吸附分析對蛋白質體進行個別確效。
研究者表示，研究終點朝向研發一種非侵犯性唾液量尺檢測，確認病患是否為糖尿病前期或糖尿病。他們發表一個看起來像壓舌板的原型裝置。
Nagalla醫師表示，多數糖尿病前期並未診斷，因為他們不需要健康照護。我們的目標是提供一種很簡單的裝置，例如像驗孕棒一樣簡單，讓你不必驗血檢測空腹血糖，就可以判斷自己有無糖尿病或糖尿病前期。這是糖尿病領域的最大障礙，希望加以改變得更有可近性。
不過，紐約Stony Brook大學醫學中心助理醫學教授、壁報展覽評審Harmeet Singh Narula醫師向Medscape Diabetes & Endocrinology表示，需要對這些蛋白質有更進一步的瞭解，因為其中有三分之一未曾在人類唾液發現過。至少需要三至五年才可能取代現有的驗血方式。需要有更大型、更堅實的研究來評估反瞻— 這些蛋白質表現類型的預測力。
Narula醫師同意，還無法推測它未來是否會改變糖尿病治療。這相當引人注意且有趣，但是需要以更大型的樣本加以探討。
美國臨床內分泌醫師協會(AACE)第18屆年會暨臨床研討會：摘要239。發表於2009年5月16日。
AACE 2009: Certain Proteins in Saliva May Indicate Type 2 Diabetes
By Samuel I. Beard, Jr.
Medscape Medical News
June 3, 2009 (Houston, Texas) — The identification of a large number of proteins in human saliva might help in the development of a noninvasive saliva test to diagnose diabetes and prediabetes, according to a study presented by Vishnupriya Rao Paturi, MD, PhD, FACE, and his team here at the American Association of Clinical Endocrinologists 18th Annual Meeting and Clinical Congress. However, more research is needed to better understand the findings, one expert says.
Dr. Paturi is head of the Department of Endocrinology and Metabolism at the Nizam Institute of Medical Sciences University in Hyderabad, India.
Srinivasa R. Nagalla, MD, a member of Dr. Paturi's team, told Medscape Diabetes & Endocrinology that "we are trying to identify a way to detect prediabetes/diabetes noninvasively, using saliva as a noninvasive vehicle. We have sequenced the antisalivary proteomes in type?2 diabetes and identified all of the proteins in saliva, which is about 600 or so proteins, and then examined if they are different in controls vs [patients with] diabetes and prediabetes."
The team identified several proteins that are different in all 3 groups.
The prospective observational study involved 40 subjects in whom saliva was analyzed for proteins. The cohort was divided into 4 groups of 10. One group had previously diagnosed type?2 diabetes and were receiving treatment, the second group had impaired glucose tolerance (IGT), and the third group had IGT with impaired fasting tolerance (IFG). The fourth group was a control group of clinically healthy individuals. Saliva was characterized using multidimensional liquid chromatography/tandem mass spectrometry.
The analysis revealed a total of 487 unique proteins, approximately 33% of which were previously unidentified in human saliva. "Of these, 65 demonstrated a greater than 2-fold difference in abundance between control and type?2 diabetes samples," the team wrote in their abstract.
The majority of these proteins are involved in regulating metabolism and immune response. Several of the biomarkers in patients with type?2 diabetes were "differentially abundant in the saliva of patients with IGT alone and IGT and IFG." The proteomes were independently validated using Western immunoblotting and enzyme-linked immunosorbent assay.
The researchers say the study points toward the development of a noninvasive dipstick test of saliva that will determine if a patient is prediabetic or diabetic. They presented a prototype device that resembled a tongue depressor.
Dr. Nagalla said: "The majority of prediabetics are not diagnosed because [they don't have] access to healthcare. Our main objective is to provide a very simple device, just like a pregnancy [test]?.?.?. so that you don't have to go get blood drawn to test for fasting plasma and glucose to know whether you're diabetic or prediabetic. That's the biggest hurdle we see in the diabetes area and [something we] would like to change to get more accessibility."
However, Harmeet Singh Narula, MD, FACP, FACE, assistant professor of medicine at Stony Brook University Medical Center in New York and judge of the poster session, told Medscape Diabetes & Endocrinology that "there needs to be a better understanding of all these proteins, with one third of them having never been described in human saliva before. It'll be at least 3 to 5 years before there is any replacement of the standard blood test. There needs to be a much larger, much more rigorous study to evaluate the reverse — the predictability of these patterns of protein expression."
Dr. Narula agreed: "It's too speculative to say if, over time, it could change diabetes therapy. It's intriguing and interesting,?.?.?. but it's something we'd like to see in a larger group of people."
American Association of Clinical Endocrinologists (AACE) 18th Annual Meeting and Clinical Congress: Abstract 239. Presented May 16, 2009. |
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