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A. V. Greco, L. Altomonte, G. Ghirlanda, L. M. D'Anna, R. Manna, S. Caputo and L. Uccioli

Abstract. The present study was undertaken in order to establish the significance of glucagon in glucose intolerance in liver cirrhosis. The plasma glucose response to an oral glucose load (75 g) was determined in 10 control subjects and in 10 cirrhotic patients, after infusions of: glucagon (3 ng·kg−1·min−1) or saline (154 mmol/l); somatostatin (SRIH) (500 μg/h); and SRIH plus glucagon (3 ng·kg−1·min−1). Glucagon infusion did not impair glucose tolerance, neither in normal subjects nor in patients with cirrhosis. On the other hand, in both groups glucose tolerance was impaired by SRIH infusion, presumably owing to an absolute insulin deficiency. Both in normal subjects and in cirrhotic patients, SRIH plus glucagon infusion further impaired glucose tolerance, presumably as a result of excess glucagon and concomitant insulin deficiency. In conclusion, our data show that hyperglucagonemia is not an important factor in the development of the glucose intolerance in patients with hepatic cirrhosis.

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Maria Regina R Gasparin, Felipe Crispim, Sílvia L Paula, Maria Beatriz S Freire, Ivaldir S Dalbosco, Thais Della Manna, João Eduardo N Salles, Fábio Gasparin, Aléxis Guedes, João M Marcantonio, Márcio Gambini, Camila P Salim and Regina S Moisés

Objective

Wolfram syndrome (WS) is a rare, progressive, neurodegenerative disorder with an autosomal recessive pattern of inheritance. The gene for WS, WFS1, was identified on chromosome 4p16 and most WS patients carry mutations in this gene. However, some studies have provided evidence for genetic heterogeneity and the genotype–phenotype relationships are not clear. Our aim was to ascertain the spectrum of WFS1 mutations in Brazilian patients with WS and to examine the phenotype–genotype relationships in these patients.

Design and methods

Clinical characterization and analyses of the WFS1 gene were performed in 27 Brazilian patients with WS from 19 families.

Results

We identified 15 different mutations in the WFS1 gene in 26 patients, among which nine are novel. All mutations occurred in exon 8, except for one missense mutation which was located in exon 5. Although we did not find any clear phenotype–genotype relationship in patients with mutations in exon 8, the homozygous missense mutation in exon 5 was associated with a mild phenotype: onset of diabetes mellitus and optic atrophy during adulthood with good metabolic control being achieved with low doses of sulfonylurea.

Conclusions

Our data show that WFS1 is the major gene involved in WS in Brazilian patients and most mutations are concentrated in exon 8. Also, our study increases the spectrum of WFS1 mutations. Although no clear phenotype–genotype relationship was found for mutations in exon 8, a mild phenotype was associated with a homozygous missense mutation in exon 5.