Diagnosis of Human Visceral Pentastomiasis

Visceral pentastomiasis in humans is caused by the larval stages (nymphs) of the arthropod-related tongue worms Linguatula serrata, Armillifer armillatus, A. moniliformis, A. grandis, and Porocephalus crotali. The majority of cases has been reported from Africa, Malaysia, and the Middle East, where visceral pentastomiasis may be an incidental finding in autopsies, and less often from China and Latin America. In Europe and North America, the disease is only rarely encountered in immigrants and long-term travelers, and the parasitic lesions may be confused with malignancies, leading to a delay in the correct diagnosis. Since clinical symptoms are variable and serological tests are not readily available, the diagnosis often relies on histopathological examinations. This laboratory symposium focuses on the diagnosis of this unusual parasitic disease and presents its risk factors and epidemiology.     

Screening Leishmania donovani‐specific genes required for visceral infection

Comparison of the Leishmania infantum genome with Leishmania braziliensis and Leishmania major genomes has identified 25 L. infantum species‐specific genes that are absent or pseudogenes in L. major and L. braziliensis. To determine whether these L. infantum species‐specific genes are involved in visceral Leishmania infection, we cloned the orthologues of 14 L. infantum species‐specific genes from the genetically closely related Leishmania donovani and introduced them into L. major. Two of these L. donovani species‐specific genes were found to significantly increase L. major survival in visceral organs in BALB/c mice. One (orthologue of LinJ28_V3.0340; Ld2834) of these two genes was further investigated. The L. donovani Ld2834 null mutants displayed dramatically reduced virulence in BALB/c mice and were unable to survive in axenic amastigote culture conditions arguing that Ld2834 plays a crucial role in enabling L. donovani survive at the increased temperature typically associated with visceral organs. Ld2834 encodes a 50 kDa protein that is localized in the cytoplasma and has no significant sequence similarity with other known genes. This study validates the importance of comparative genomics for understanding Leishmania species pathology and argues that Leishmania species‐specific genes play important roles in tissue tropism and virulence.     

Rotifer muscles as revealed by phalloidin-TRITC staining and confocal scanning laser microscopy

By combining phalloidin‐TRITC staining with confocal scanning laser microscopy (CSLM), the pattern of the musculature in two species of Rotifera, Euchlanis dilatata unisetata and Brachionus quadridentatus is revealed. The same general muscle pattern prevails in both species. The major components of the body wall musculature are: 1. retractor muscles (5 pairs in E. dilatata unisetata and 3 pairs in B. quadridentatus); 2. Two pairs of dorso‐ventral muscles; 3. Two pairs of perpendicular muscles (in E. dilatata unisetata); 4. retractors of the corona (median, lateral and ventral); 5. Foot retractors. In addition, three pairs of cutaneo‐visceral muscles and visceral muscles (including mastax muscles) are described. The sphincter of the corona was found only in B. quadridentatus. The high degree of muscle differentiation points to a high level of development of rotifer muscular system.     

Phylogenetic signal and variation of visceral pigmentation in eight anuran families

Provete, D. B, Franco‐Belussi, L., de Souza Santos, L. R., Zieri, R., Moresco, R. M., Martins, I. A., de Almeida, S. C., & de Oliveira, C. (2012). Phylogenetic signal and variation of visceral pigmentation in eight anuran families. —Zoologica Scripta, 41, 547‐556. Visceral pigmentation is found in several organs and structures of ectothermic animals, comprising the extracutaneous pigmentary system. Its function is not well defined, although it is known that melanin is produced and stored inside pigmented cells. Previous studies demonstrated that the distribution of visceral pigmentation is neither homogeneous among organs among anuran species. We described the diversity of visceral pigmentation in 12 organs/structures from 32 anuran species belonging to eight families in a phylogenetic context. We also determined in which node(s) of the phylogeny there is more variation in the pigmentation and whether this variation has phylogenetic signal. The visceral pigment cells in organs and structures of the abdominal cavity varied among genera. All species had pigmentation in the urogenital and cardiorespiratory systems, whereas the stomach lacks pigmentation in all species. We also found a phylogenetic signal for pigmentation in all organs and structures taken together, besides heart, testes, lumbar parietal peritoneum and lumbar nerve plexus when considered separately. Overall, considering all organs, the highest diversity of categories of pigmentation was found in the nodes corresponding to Cruciabatrachia and Athesphatanura. This study constitutes the first step towards understanding the evolution of visceral pigmentation in anurans.     

Methods of Estimation of Visceral Fat: Advantages of Ultrasonography

Objective: To compare methods for the assessment of visceral fat with computed tomography (CT) and establish cutoffs to define visceral obesity based on such alternative methods. Research Methods and Procedures: One hundred women (50.4 ± 7.7 years; BMI 39.2 ± 5.4 kg/m²) underwent anthropometric evaluation, bioelectrical impedance, DXA, abdominal ultrasonography (US), and CT scan. Results: Waist circumference, waist‐to‐hip ratio (WHR), and US‐determined visceral fat values showed the best correlation coefficients with visceral fat determined by CT (r = 0.55, 0.54, and 0.71, respectively; p < 0.01). Fat mass determined by DXA was inversely correlated with visceral‐to‐subcutaneous‐fat ratio (r = ?0.47, p < 0.01). Bioimpedance‐determined fat mass and skinfolds were correlated with only subcutaneous abdominal fat quantified by CT. Linear regression indicated US visceral‐fat distance and WHR as the main predictors of CT‐determined visceral fat (adjusted r² = 0.51, p < 0.01). A waist measurement of 107 cm (82.7% specificity, 60.6% sensitivity) and WHR of 0.97 (78.8% specificity, 63.8% sensitivity) were chosen as discriminator values corresponding with visceral obesity diagnosed by CT. A value of 6.90 cm for visceral fat US‐determined diagnosed visceral obesity with a specificity of 82.8%, a sensitivity of 69.2%, and a diagnostic concordance of 74% with CT. Discussion: US seemed to be the best alternative method for the assessment of intra‐abdominal fat in obese women. Its diagnostic value could be optimized by an anthropometric measurement. Prospective studies are needed to establish CT and US cutoffs for defining visceral‐fat levels related to elevated cardiovascular risk.     

Subdivision of the Subcutaneous Adipose Tissue Compartment and Lipid‐Lipoprotein Levels in Women

Objective: The aim of this study was to compare the relative importance of computed tomography‐measured abdominal fat compartment areas, including adipose tissue located posterior to the subcutaneous Fascia, in predicting plasma lipid‐lipoprotein alterations. Research Methods and Procedures: Areas of visceral as well as subcutaneous deep and superficial abdominal adipose tissue were measured by computed tomography in a sample of 66 healthy women, ages 37 to 60 years, for whom a detailed lipid‐lipoprotein profile was available. Results: Strong significant associations were observed between visceral adipose tissue area and most variables of the lipid‐lipoprotein profile (r = ?0.25, p < 0.05 to 0.62, p < 0.0001). Measures of hepatic lipoprotein synthesis such as very‐low‐density lipoprotein‐triglyceride and cholesterol content as well as total and very‐low‐density lipoprotein‐apolipoprotein B levels were also strongly associated with visceral adipose tissue area (r = 0.57, 0.57, 0.61, and 0.62, respectively, p < 0.0001). Significant associations were found between these variables and the deep subcutaneous adipose tissue area or DXA‐measured total body fat mass. However, the correlation coefficients were of lower magnitude compared to those with visceral adipose tissue area. Multivariate regression analyses demonstrated that visceral adipose tissue area was the strongest predictor of lipid‐lipoprotein profile variables (7% to 48% explained variance, 0.02 ≥ p ≤ 0.0001). Discussion: Although previous studies have generated controversial data as to which abdominal adipose tissue compartment was more closely associated with insulin resistance, our results suggest that visceral adipose tissue area is a stronger correlate of other obesity‐related outcomes such as lipid‐lipoprotein alterations.     

Localization and induction of the A2 virulence factor in Leishmania: evidence that A2 is a stress response protein

Leishmaniasis is a vector‐borne infectious disease with a wide range of pathologies depending on the species of Leishmania. Leishmania parasites are transmitted by the sand fly vector as promastigotes; within the mammalian host, Leishmania parasites differentiate into amastigotes and replicate in macrophages. The A2 protein from Leishmania donovani is expressed predominantly in amastigotes and therefore likely plays a role in survival in the mammalian host. In the present study, we have determined that the A2 protein colocalized with the Leishmania endoplasmic reticulum binding protein, BiP, was induced by stress and complexed with BiP following heat shock. The A2 gene in Leishmania major is a non‐expressed pseudogene, and we present evidence that ectopic expression of a transfected A2 gene in L. major enhanced its viability following heat shock. A2 may therefore play a role in protecting L. donovani from stress associated with infection in visceral organs, including the fever typically associated with visceral leishmaniasis. Interestingly, when comparing A2 protein localization, we also observed that the Leishmania secreted acid phosphatase SAcP protein was transported out of the parasite‐containing phagolysosome and was located throughout the macrophage cytoplasm in vesicles, providing the first example of a secreted Leishmania‐derived protein exiting the parasite‐containing phagolysosome.     

Visceral adiposity is associated with serum retinol binding protein-4 levels in healthy women

Objective: Retinol binding protein‐4 (RBP4) has been reported to impair insulin sensitivity throughout the body. We investigated the relationship between serum RBP4 levels and adiposity indices as well as metabolic risk variables. Research Methods and Procedure: We recruited a total of 102 healthy women 21 to 67 years old. We assessed body composition by computed tomography and divided the study population into four groups based on body weight and visceral fat area (non‐obese without visceral adiposity, non‐obese with visceral adiposity, obese without visceral adiposity, and obese with visceral adiposity). Serum RBP4 levels were measured by radioimmunoassay. Results: Despite similar levels of total body fat, non‐obese women had lower systolic blood pressure, total cholesterol, triglyceride (TG), low‐density lipoprotein (LDL)‐cholesterol levels, insulin resistance indices, and RBP4 levels than non‐obese women with visceral adiposity and had higher high‐density lipoprotein‐cholesterol levels. Similarly, obese women without visceral adiposity had lower blood pressure, total cholesterol, TG levels, insulin resistance indices, and RBP4 levels than obese women with visceral adiposity. In addition, despite having increased body fat, obese women without visceral adiposity had lower TGs, insulin resistance indices, and serum RBP4 levels than non‐obese women with visceral adiposity. By step‐wise multiple regression analysis, visceral fat areas and LDL‐cholesterol levels independently affected RBP4 levels. Discussion: We determined that serum RBP4 levels are independently associated with visceral fat and LDL‐cholesterol levels. These results suggest that, irrespective of body weight, visceral obesity is an independent predictor of serum RBP4 levels, and RBP4 may represent a link between visceral obesity and cardiovascular disease.     

Higher Free Fatty Acid Uptake in Visceral Than in Abdominal Subcutaneous Fat Tissue in Men

Visceral adipose tissue has been shown to have high lipolytic activity. The aim of this study was to examine whether free fatty acid (FFA) uptake into visceral adipose tissue is enhanced compared to abdominal subcutaneous tissue in vivo. Abdominal adipose tissue FFA uptake was measured using positron emission tomography (PET) and [¹⁸F]‐labeled 6‐thia‐hepta‐decanoic acid ([¹⁸F]FTHA) and fat masses using magnetic resonance imaging (MRI) in 18 healthy young adult males. We found that FFA uptake was 30% higher in visceral compared to subcutaneous adipose tissue (0.0025 ± 0.0018 vs. 0.0020 ± 0.0016 µmol/g/min, P = 0.005). Visceral and subcutaneous adipose tissue FFA uptakes were strongly associated with each other (P < 0.001). When tissue FFA uptake per gram of fat was multiplied by the total tissue mass, total FFA uptake was almost 1.5 times higher in abdominal subcutaneous than in visceral adipose tissue. In conclusion, we observed enhanced FFA uptake in visceral compared to abdominal subcutaneous adipose tissue and, simultaneously, these metabolic rates were strongly associated with each other. The higher total tissue FFA uptake in subcutaneous than in visceral adipose tissue indicates that although visceral fat is active in extracting FFA, its overall contribution to systemic metabolism is limited in healthy lean males. Our results indicate that subcutaneous, rather than visceral fat storage plays a more direct role in systemic FFA availability. The recognized relationship between abdominal visceral fat mass and metabolic complications may be explained by direct effects of visceral fat on the liver.     

Transthyretin mouse transgenes direct RFP expression or Cre‐mediated recombination throughout the visceral endoderm

Transthyretin (Ttr) is a thyroid hormone transport protein secreted by cells of the visceral yolk sac and fetal liver in developing embryos, and by hepatocytes and the choroid plexus epithelium of the brain in adult mice. Spatiotemporal localization of Ttr mRNA during embryogenesis suggested that Ttr regulatory elements might drive transgene expression throughout the visceral endoderm of early mouse embryos. We use Ttr cis‐regulatory elements to generate Ttr::RFP and Ttr::Cre strains of mice, driving red fluorescent protein (RFP) and a nuclear‐localized Cre recombinase, respectively. Visualization of RFP fluorescence in Ttr::RFP transgenics confirms reporter localization throughout the visceral endoderm in early embryos and in the visceral yolk sac and fetal liver of later stage embryos. Using both GFP‐based and LacZ‐based Cre reporter strains, we demonstrate that in Ttr::Cre transgenics, Cre‐mediated recombination occurs throughout the visceral endoderm. The Ttr::Cre strain can therefore be used as a tool for genetic modifications within the visceral endoderm lineage. genesis 47:447–455, 2009. © 2009 Wiley‐Liss, Inc.     

Note on the gut preserved in the Lower Cambrian Lingulellotreta (Lingulata, Brachiopoda) from southern China

Lingulellotreta malongensis Rong is the earliest known taxon of the family Lingulellotretidae, which is characterized by the presence of a pedicle foramen as well as an internal pedicle tube. New material from the Early Cambrian Chengjiang Lagerstätte of southern China provides improved anatomical knowledge for lingulellotretid species especially for the digestive system. Additional gut fossils exhibit distinctly the anterior portion composed of esophagus and distended stomach, situated in the alleged visceral cavity, with the recurved intestine accommodated inside a hollow pseudointerarea. The frequency of occurrence of this intestinal layout suggests that this is not just an artefact of preservation. The gross configuration of the guts and the way they are preserved in the fossils suggest that they are in situ and, therefore, we can assume that Lingulellotreta had a hollow cavity presumably subtended by the pseuodelthyrium, which was invaded and occupied by the visceral organs. Hence, these fossils demonstrate the dangers of extrapolating crown‐group soft‐tissue configuration to the stem group.     

Liver Volume and Visceral Obesity in Women with Hepatic Steatosis Undergoing Gastric Banding

Objective: To investigate the relationships between visceral obesity and hepatic steatosis in obese patients undergoing adjustable silicone gastric banding with the LAP‐BAND. Research Methods and Procedures: Six premenopausal, morbidly obese women with an ultrasonographic diagnosis of liver steatosis were evaluated before surgery and 8 and 24 weeks after surgery. Liver volume and body fat distribution were simultaneously analyzed by total‐body multislices magnetic resonance imaging. Results: Before surgery, the only variable found to be correlated with liver volume was visceral adipose tissue volume (r = 0.91; p < 0.01). Weight loss was 9.9 ± 3.8 kg in the period from 0 to 8 weeks (p < 0.01) and 7.1 ± 4.9 kg in the the period from 8 to 24 weeks (p < 0.05). Total fat showed a statistically significant reduction of 6.2 ± 4.0 liters in the 0‐ to 8‐week period and a further significant reduction of 7.7 ± 3.9 liters in the 8‐ to 24‐week period. Visceral adipose tissue showed a statistically significant reduction of 1.0 ± 0.9 liters in the 0‐ to 8‐week period (p < 0.05) but only a further, not significant reduction of 0.6 ± 0.7 liters in the 8‐ to 24‐week period. The relative reduction of visceral fat in the 0‐to 8‐week period was higher than the relative reduction of total fat. Liver volume also showed a statistically significant reduction of 0.24 ± 0.26 liters in the first phase of weight loss (p < 0.05), corresponding to a relative reduction of 12.3 ± 10.6%. During the 8‐ to 24‐week period, liver volume was substantially stable. Discussion: Hepatomegaly was associated with visceral obesity in morbidly obese women with liver steatosis. In the phase of rapid weight loss after gastric surgery, a preferential mobilization of visceral fat, compared with total adipose tissue, occurred. This preferential visceral fat loss was associated with a significant reduction in liver volume.     

The association between birth weight and visceral fat in middle-age adults

Objective: Low birth weight, a proxy for fetal underdevelopment, is associated with increased risk of developing type 2 diabetes during adulthood. Low birth weight is also associated with central obesity, but little is known about the association between birth weight and visceral adiposity. The purpose of this study is to test the hypothesis that lower birth weight is associated with increased amounts of visceral fat in middle‐age adults. Research Methods and Procedures: This is an observational study of 91 adults (58 men and 33 women) 40 ± 6 years of age (mean ± standard deviation). Ethnicity was either Japanese American (79%) or non‐Hispanic white (21%). Birth weight was obtained from State Departments of Health. Measurements included smoking status, BMI, and visceral (intra‐abdominal) fat measured by computed tomography. Results: Visceral fat was not associated with birth weight after adjustment for age, sex, ethnicity, BMI, or smoking status (p = 0.76). There was no evidence that the association between birth weight and visceral fat varied by age, sex, or ethnicity. Discussion: We found no evidence that low birth weight is associated with increased visceral fat in middle‐age adults     

Polymorphic dinucleotide microsatellite loci in the sandfly Lutzomyia longipalpis (Diptera: Phlebotominae)

The sandfly Lutzomyia longipalpis, an important vector of visceral leishmaniasis in the New World, is believed to be a species complex. In an effort to better understand population dynamics and speciation in this vector we developed a panel of dinucleotide — (CA)_n— microsatellite loci using an enrichment technique. Eleven polymorphic loci that produced consistent allelic banding patterns were characterized using a laboratory population of L. longipalpis. These dinucleotide microsatellite loci were more polymorphic than trinucleotide microsatellites characterized in wild‐caught samples of two other sandfly species; the variability of these loci was unexpected because the laboratory flies were believed to be inbred.     

Preventing Overestimation of Pixels in Computed Tomography Assessment of Visceral Fat

Objective: Computed tomography (CT) is a common research procedure for measuring abdominal fat distribution, but little is written about the software used to analyze images. Our objective was to compare in‐house and commercially available software for quantitative measurement of abdominal fat distribution. In the process, we encountered some unexpected problems. Research Methods and Procedures: A total of 123 volunteers had single‐slice abdominal CT images taken that were used to evaluate various aspects of the commercial image analysis program. Results: The agreement between the commercial and in‐house programs was excellent (r = 0.996, p < 0.00, 001) for both total and intraabdominal fat, and we were able to reduce between‐observer variability in measured fat areas through the use of statistical handling of region of interest information. We also noted that intracolonic contents sometimes had the same Hounsfield units as adipose tissue. We analyzed single‐slice CT images from 50 volunteers to determine the potential impact of this effect on visceral fat area; the overestimate of visceral fat area was 19 ± 22% (maximum, 112% overestimate). The commercial program could prevent this error, whereas our in‐house program could not. Discussion: We concluded that a readily available commercial image analysis program compares well with a previously validated in‐house program and that it offers some advantages with respect to preventing overestimation of pixels as visceral fat.     

Two-dimensional predictive equation to classify visceral obesity in clinical practice

Objective: Visceral obesity assessment is not easy, and although computed tomography (CT) is an accurate tool, this technique is expensive and sometimes not suitable in clinical practice. We developed a new two‐dimensional elliptical anthropometric equation to classify visceral obesity and evaluated the validity and the reliability of the new equation compared with CT. Research Methods and Procedures: We collected anthropometric and CT data from overweight/obese subjects (n = 61, BMI = 32.4 ± 3.7 kg/m²). A validation group of 32 subjects was also selected. An equation for the assessment of visceral obesity was developed using multiple regression analysis. Once validated, the equation was compared with previous models. Tests for accuracy included mean differences, analysis of diagnostic, R², Snedecor's F‐test, and Bland‐Altman plot. Results: Multiple regression analysis revealed that the sagittal and coronal diameters and the triceps skinfold were significant contributors to the model. The final equation was: visceral area (VA)/subcutaneous area (SA)_predicted = 0.868 + 0.064 × sagittal diameter ?0.036 × coronal diameter ?0.022 × triceps skinfold. Patients with visceral‐subcutaneous area ratio (VA/SA) >0.42 were classified as having visceral obesity. The predictive equation was valid, showing a significant association with VA/SA assessed by CT (VA/SA_CT; r = 0.68; p < 0.0001). Paired Student's t test showed no significant differences with VA/SA_CT (p = 0.541). The reliability was high [F(24/60) = 2.12; p = 0.01]. Discussion: The new two‐dimensional and elliptical predictive equation is valid to assess visceral obesity and is more precise than previous models.     

Visceral obesity is a negative predictor of remission of diabetes 1 year after bariatric surgery

Our aim was to identify preoperative anthropometric and clinical parameters that predict the remission of diabetes after Roux‐en‐Y gastric bypass (RYGB). Fifty severely obese Korean patients with type 2 diabetes underwent RYGB. Visceral and abdominal subcutaneous fat area (SFA) was assessed using computed tomography before and 6 and 12 months after RYGB. Remission was defined as a glycated hemoglobin (A_1C) level <6.5% and a fasting glucose concentration <126 mg/dl for 1 year or more without the use of medication. The visceral‐to‐SFA ratio decreased from 0.60 ± 0.30 to 0.53 ± 0.29 (P = 0.001) after 6 months and decreased further to 0.42 ± 0.24 (P < 0.001) after 12 months. Thirty‐four of the 50 patients (68%) had remission of diabetes (remission group). Compared with patients in the nonremission group, patients in the remission group had a shorter duration of diabetes and lower preoperative A_1C level, and were less likely to use insulin preoperatively. Preoperative BMI did not differ in two groups. However, the preoperative visceral‐to‐SFA ratio was greater in the nonremission group compared with the remission group (0.79 ± 0.29 vs. 0.53 ± 0.26, P = 0.003). Finally, the preoperative visceral‐to‐SFA ratio was an independent predictor of the remission of diabetes after RYGB in multiple stepwise logistic regression analysis. In conclusion, our data suggest that visceral adiposity negatively influence the likelihood of the patient experiencing the remission of diabetes after RYGB.     

High Expression of Complement Components in Omental Adipose Tissue in Obese Men

Objective: Accumulation of visceral fat is recognized as a predictor of obesity‐related metabolic disturbances. Factors that are predominantly expressed in this depot could mediate the link between visceral obesity and associated diseases. Research Methods and Procedures: Paired subcutaneous and omental adipose tissue biopsies were obtained from 10 obese men. Gene expression was analyzed by DNA microarrays in triplicate and by real‐time polymerase chain reaction. Serum C3 and C4 were analyzed by radial immunodiffusion assays in 91 subjects representing a cross section of the general population. Body composition was measured by computerized tomography. Results: Complement components C2, C3, C4, C7, and Factor B had higher expression in omental compared with subcutaneous adipose tissue (～2‐, 4‐, 17‐, 10‐, and 7‐fold, respectively). In addition, adipsin, which belongs to the alternative pathway, and the classical pathway components C1QB, C1R, and C1S were expressed in both depots. Analysis of tissue distribution showed high expression of C2, C3, and C4 in omental adipose tissue, and only liver had higher expression of these genes. Serum C3 levels correlated with both visceral and subcutaneous adipose tissue in both men (r = 0.65 and p < 0.001 and r = 0.52 and p < 0.001, respectively) and women (r = 0.34 and p = 0.023 and r = 0.49 and p < 0.001, respectively), whereas C4 levels correlated with only visceral fat in men (r = 0.36, p = 0.015) and with both depots in women (visceral: r = 0.58, p < 0.001; and subcutaneous: r = 0.51, p < 0.001). Discussion: Recent studies show that the metabolic syndrome is associated with chronically elevated levels of several immune markers, some of which may have metabolic effects. The high expression of complement genes in intra‐abdominal adipose tissue might suggest that the complement system is involved in the development of visceral adiposity and/or contributes to the metabolic complications associated with increased visceral fat mass.