Medline Articles in the treatment of Disease
Trace Elements Arguments In The Treatment of Diabetes
Vanadium
compounds--a new class of therapeutic agents for the treatment of diabetes
mellitus].
[Article in Russian]
Beliaeva NF, Gorodetskii VK, Tochilkin
AI, Golubev MA, Semenova NV, Kovel'man IR.
Institute of Biomedical Chemistry, Russian Academy of Medical Sciences.
Vanadium compounds as insulin mimics with promising therapeutic properties are
reviewed. The biological effects of both inorganic forms of vanadium and vanadyl
organic complexes are decried for various animal models. These effects include
hypoglycemic and insulin reserve actions, insulin sensitivity enhance,
cholesterol lowering and other manifestations. The effectiveness of vanadium
compounds in diabetes treatment is confirmed with clinical trials. The possible
mechanisms of insulin-like effects of vanadium are discussed. The various
nutritional supplements for patients with diabetes mellitus including
vanadium-contained used in Russia and abroad are also considered.
Publication Types:
· Review
· Review, tutorial
PMID: 11075417 [PubMed - indexed for MEDLINE]
Studies
of vanadyl sulfate as a glucose-lowering agent in STZ-diabetic rats.
Thompson KH, Leichter J, McNeill JH.
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver,
Canada.
To study the effect of vanadium (V) intake on blood glucose lowering, tissue V
concentrations, glutathione reductase (GR) activity, and plasma trace metal
concentrations, streptozotocin(STZ)-diabetic rats were treated with vanadyl
sulfate (VS) (0.5-1.2 g/l in the drinking water) for up to 12 weeks. Kidney and
plasma V concentrations were positively correlated with V intake. Kidney GR
activities were not affected by VS treatment nor were plasma cobalt, molybdenum,
manganese or lithium concentrations. Individual V intakes were dependent upon
severity of diabetes, with more hyperglycemic rats consuming greater quantities
of VS solution. A diminished effect on glucose lowering of VS above 1 g/l was
noted.
PMID: 8280174 [PubMed - indexed for MEDLINE]
The
role of vanadium in the management of diabetes.
Brichard SM, Henquin JC.
Unite d'Endocrinologie et Metabolism, University of Louvain Faculty of Medicine,
Brussels, Belgium.
Diabetes mellitus results from an absolute or relative deficiency in insulin
secretion and a resistance of target tissues to the action of insulin, in
proportions that vary with the type of the disease. The shortage of insulin can
be corrected by administration of exogenous insulin or stimulation of pancreatic
beta-cells with sulphonylureas. However, insulin resistance remains a major
therapeutic problem. Here, Sonia Brichard and Jean-Claude Henquin review the
recent discoveries that indicate a possible role for vanadium in management of
the disease. In vitro, vanadium salts mimic most effects of insulin on the main
target tissues of the hormone, and in vivo they induce a sustained fall in blood
glucose levels in insulin-deficient diabetic rats, and improve glucose
homeostasis in obese, insulin-resistant diabetic rodents. Recent short-term
clinical trials with vanadium salts also seem promising in type II
(non-insulin-dependent) diabetic patients in whom liver and peripheral insulin
resistance was attenuated, indicating the therapeutic potential of vanadium
salts, pending demonstration of their long-term innocuity.
Publication Types:
Vanadium
compounds as insulin mimics.
Orvig C, Thompson KH, Battell M, McNeill JH.
Department of Chemistry, University of British Columbia, Vancouver, Canada.
That vanadium compounds act in an insulin-mimetic fashion both in vitro and in
vivo has been well established. Both inorganic and organic vanadium compounds
have been shown to lower plasma glucose levels, increase peripheral glucose
uptake, improve insulin sensitivity, decrease plasma lipid levels, and normalize
liver enzyme activities in a variety of animal models of both type I and type II
diabetes. Vanadium treatment of diabetic animals does not restore plasma insulin
levels but may spare pancreatic insulin. Elucidation of the mechanism(s) of
action and potentiation of vanadium's insulin-mimetic effect by appropriate
ligand binding would seem to be the highest priorities for future investigation.
Publication Types:
Increased potency of vanadium using
organic ligands.
McNeill JH, Yuen VG, Dai S, Orvig C.
Faculty of Pharmaceutical Sciences, Vancouver, B.C., Canada.
The in vivo glucose lowering effect of orally administered inorganic vanadium
compounds in diabetes was first reported in our laboratory in 1985. While both
vanadate and vanadyl forms of vanadium are orally active, they are still not
well absorbed. We have synthesized several organic vanadium compounds and one
compound, bis(maltolato)oxovanadium(lV) or BMOV, has been extensively
investigated. BMOV proved effective in lowering plasma glucose and lipids in STZ-diabetic
rats when administered in drinking water over a 25 week period. The maintenance
dose (0.18 mmol/kg/day) was approximately 50% of that required for vanadyl
sulfate (VS). Secondary complications of diabetes were prevented by BMOV and no
marked toxicity was noted. Oral gavage of STZ-diabetic rats with BMOV also
reduced blood glucose levels. The ED50 for BMOV was 0.5 mmol/kg, while for VS
the estimated ED50 was 0.9 mmol/kg. BMOV was also effective by the
intraperitoneal route in STZ-diabetic rats. The ED50 was 0.08 mmol/kg compared
to 0.22 mmol/kg for VS. Some animals treated p.o. or i.p. remained euglycemic
for up to 14 weeks. An i.v. infusion of BMOV of 0.05 mmol/kg over a 30 min
period reduced plasma glucose levels by 50% while VS was not effective.
Publication Types:
Antidiabetic
action of vanadyl in rats independent of in vivo insulin-receptor kinase
activity.
Venkatesan N, Avidan A, Davidson MB.
Department of Medicine, Cedars-Sinai Medical Center, University of California,
Los Angeles 90048.
The effects of oral vanadyl sulfate administration for 9-12 days on carbohydrate
and lipid metabolism in the basal state and on glucose dynamics during
submaximal hyperinsulinemic clamps were investigated in nondiabetic and
streptozocin-induced diabetic rats. Decreases in growth rate and water and food
consumption were the only significant alterations noted in control animals
receiving vanadyl. Administration of vanadyl to diabetic rats resulted in weight
loss; a significant decrease in plasma glucose, triglyceride, and cholesterol
levels; and decreases in food and water intake, without a concomitant change in
plasma insulin concentrations. Vanadyl treatment did not modify either
peripheral glucose utilization or hepatic glucose production in control rats
during submaximal insulin clamps. In contrast, vanadyl therapy increased
insulin-induced glucose utilization significantly and had a small but
nonsignificant effect on insulin-mediated suppression of glucose production in
diabetic rats. The tyrosine kinase activity of liver- and muscle-derived insulin
receptors from diabetic rats that underwent clamp study, which reflected the in
vivo phosphorylation state of insulin receptor, was not altered by vanadyl
treatment. In conclusion, these results show that augmentation of peripheral
glucose utilization is the major determinant of the antidiabetic action of
vanadyl and support the notion that the action of vanadyl is independent of
insulin-receptor kinase activity.
PMID: 1849104 [PubMed - indexed for MEDLINE]
Studies of vanadyl sulfate as a
glucose-lowering agent in STZ-diabetic rats.
Thompson KH, Leichter J, McNeill JH.
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver,
Canada.
To study the effect of vanadium (V) intake on blood glucose lowering, tissue V
concentrations, glutathione reductase (GR) activity, and plasma trace metal
concentrations, streptozotocin(STZ)-diabetic rats were treated with vanadyl
sulfate (VS) (0.5-1.2 g/l in the drinking water) for up to 12 weeks. Kidney and
plasma V concentrations were positively correlated with V intake. Kidney GR
activities were not affected by VS treatment nor were plasma cobalt, molybdenum,
manganese or lithium concentrations. Individual V intakes were dependent upon
severity of diabetes, with more hyperglycemic rats consuming greater quantities
of VS solution. A diminished effect on glucose lowering of VS above 1 g/l was
noted.
PMID: 8280174 [PubMed - indexed for MEDLINE]
Increased
potency of vanadium using organic ligands.
McNeill JH, Yuen VG, Dai S, Orvig C.
Faculty of Pharmaceutical Sciences, Vancouver, B.C., Canada.
The in vivo glucose lowering effect of orally administered inorganic vanadium
compounds in diabetes was first reported in our laboratory in 1985. While both
vanadate and vanadyl forms of vanadium are orally active, they are still not
well absorbed. We have synthesized several organic vanadium compounds and one
compound, bis(maltolato)oxovanadium(lV) or BMOV, has been extensively
investigated. BMOV proved effective in lowering plasma glucose and lipids in STZ-diabetic
rats when administered in drinking water over a 25 week period. The maintenance
dose (0.18 mmol/kg/day) was approximately 50% of that required for vanadyl
sulfate (VS). Secondary complications of diabetes were prevented by BMOV and no
marked toxicity was noted. Oral gavage of STZ-diabetic rats with BMOV also
reduced blood glucose levels. The ED50 for BMOV was 0.5 mmol/kg, while for VS
the estimated ED50 was 0.9 mmol/kg. BMOV was also effective by the
intraperitoneal route in STZ-diabetic rats. The ED50 was 0.08 mmol/kg compared
to 0.22 mmol/kg for VS. Some animals treated p.o. or i.p. remained euglycemic
for up to 14 weeks. An i.v. infusion of BMOV of 0.05 mmol/kg over a 30 min
period reduced plasma glucose levels by 50% while VS was not effective.
Publication Types:
Oral
vanadyl sulfate in treatment of diabetes mellitus in rats.
Ramanadham S, Mongold JJ, Brownsey RW, Cros GH, McNeill JH.
Division of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences,
University of British Columbia, Vancouver, Canada.
Recent reports have suggested that vanadium in the form of vanadyl (+IV)
possesses insulin-like activity. Therefore, in the present study we examined the
effects of administering oral vanadyl to diabetic animals. Wistar rats made
diabetic with streptozotocin and age-matched controls were maintained for 10 wk
in the absence and presence of vanadyl sulfate trihydrate in the drinking water.
In the presence of vanadyl, decreases in rate of growth and circulating levels
of insulin were the only significant alterations recorded in control animals. In
contrast, diabetic animals treated with vanadyl, despite having lower body
weights and insulin levels, had normal plasma concentrations of glucose, lipid,
creatinine, and thyroid hormone. In addition, abnormalities in isolated working
heart function and glycerol output from adipose tissue of diabetic animals were
also corrected after vanadyl treatment. These results suggest that vanadium when
used in the vanadyl form is effective in diminishing the diabetic state in the
rat by substituting for and replacing insulin or possibly by enhancing the
effects of endogenous insulin.
PMID: 2675634 [PubMed - indexed for MEDLINE]
Magnesium
and ascorbic acid supplementation in diabetes mellitus.
Eriksson J, Kohvakka A.
Malmi Municipal Hospital, Helsinki, Finland.
The effect of magnesium (Mg) and ascorbic acid (AA) supplementation on metabolic
control was assessed in 56 outpatient diabetics. A 90-day run-in period was
followed by two 90-day treatment periods, during which Mg (600 mg/day) and AA (2
g/day) were administered in a randomized double-blind cross-over fashion. A
decrease in systolic and diastolic blood pressure (132 +/- 3 vs. 138 +/- 4 and
77 +/- 2 vs. 82 +/- 2 mm Hg; p < 0.05) was observed in insulin-dependent
diabetes mellitus subjects during Mg supplementation. No beneficial effect of Mg
supplementation was observed on glycemic control, lipids or blood pressure in
non-insulin-dependent diabetes mellitus (NIDDM) subjects. AA supplementation
improved glycemic control among NIDDM subjects and both fasting blood glucose
(9.1 +/- 0.5 vs. 10.1 +/- 0.6 mmol/l; p < 0.05) and HbA1c (8.5 +/- 0.3 vs.
9.3 +/- 0.3%; p < 0.05) improved. Beneficial effects of AA supplementation on
cholesterol (5.9 +/- 0.2 vs. 6.2 +/- 0.2 mmol/l; p < 0.05) and triglycerides
(2.2 +/- 0.2 vs. 2.5 +/- 0.2; p < 0.05) were also observed in NIDDM subjects.
The results suggest that high-dose AA supplementation may have a beneficial
effect in NIDDM subjects on both glycemic control and blood lipids.
Publication Types:
· Clinical trial
· Randomized controlled trial
PMID: 8546437 [PubMed - indexed for MEDLINE]
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N Engl J Med 1997 Sep 4;337(10):670-6 |
Comment in:
· ACP J Club. 1998 Mar-Apr;128(2):47
· N Engl J Med. 1997 Sep 4;337(10):701-2
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Glucose-lowering
effects of a new organic vanadium complex, bis(maltolato)oxovanadium(IV).
Yuen VG, Orvig C, McNeill JH.
Division of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences,
University of British Columbia, Vancouver, Canada.
Inorganic vanadium has been shown, both in vivo and in vitro, to have
insulin-mimetic properties. A new organic vanadium complex,
bis(maltolato)oxovanadium(IV) (BMOV), was developed to increase the absorption
of vanadium from the gastrointestinal tract, thereby reducing the dose of
vanadium necessary to produce glucose-lowering effects. BMOV was administered in
the drinking water for 25 weeks to control and streptozotocin-induced diabetic,
male Wistar rats. BMOV treatment produced a stable euglycemic state in 70% of
diabetic treated animals. The other 30% of the diabetic treated animals
demonstrated fluctuations in glucose control over the entire study period. The
initial effective dose of BMOV was 0.45 mmol/kg, which decreased to an effective
maintenance dose of 0.18 mmol/kg, significantly lower than the dose of inorganic
vanadium salts used in previous studies. BMOV treatment did significantly reduce
fluid consumption levels in control treated animals after 10 weeks of therapy;
however, the food consumption for control treated animals was only
intermittently lower than that for controls. Plasma cholesterol and triglyceride
levels were normalized with BMOV treatment for all diabetic treated animals,
without a concomitant increase in plasma insulin levels. An oral glucose
tolerance test demonstrated that glucose homeostasis in control-treated animals
occurred at significantly lower plasma insulin levels than in control animals.
BMOV effectively produced the glucose-lowering effects at significantly lower
dose than previously used for inorganic vanadium salts, without any overt signs
of toxicity.
PMID: 8402390 [PubMed - indexed for MEDLINE]
Chromium
in the prevention and control of diabetes.
Anderson RA.
Nutrient Requirements and Functions Laboratory, Beltsville Human Nutrition
Research, U.S. Department of Agriculture, ARS, Beltsville, Maryland 20705-2350,
USA. anderson@307.bhnrc.usda.gov
Chromium is an essential nutrient involved in the metabolism of glucose, insulin
and blood lipids. Suboptimal dietary intake of chromium is associated with
increased risk factors associated with diabetes and cardiovascular diseases.
Within the past five years, chromium has been shown to improve glucose and
related variables in subjects with glucose intolerance and type 1, type 2,
gestational and steroid-induced diabetes. Severe neuropathy and glucose
intolerance of a patient on total parenteral nutrition, who was receiving
currently recommended levels of chromium, were reversed by additional
supplemental chromium. Chromium increases insulin binding to cells, insulin
receptor number and activates insulin receptor kinase leading to increased
insulin sensitivity. Additional studies are urgently needed to elucidate the
mechanism of action of chromium and its role in the prevention and control of
diabetes.
Publication Types:
·
Review
·
Review,
tutorial
PMID: 10705100 [PubMed - indexed for MEDLINE]
Magnesium
and ascorbic acid supplementation in diabetes mellitus.
Eriksson J, Kohvakka A.
Malmi Municipal Hospital, Helsinki, Finland.
The effect of magnesium (Mg) and ascorbic acid (AA) supplementation on metabolic
control was assessed in 56 outpatient diabetics. A 90-day run-in period was
followed by two 90-day treatment periods, during which Mg (600 mg/day) and AA (2
g/day) were administered in a randomized double-blind cross-over fashion. A
decrease in systolic and diastolic blood pressure (132 +/- 3 vs. 138 +/- 4 and
77 +/- 2 vs. 82 +/- 2 mm Hg; p < 0.05) was observed in insulin-dependent
diabetes mellitus subjects during Mg supplementation. No beneficial effect of Mg
supplementation was observed on glycemic control, lipids or blood pressure in
non-insulin-dependent diabetes mellitus (NIDDM) subjects. AA supplementation
improved glycemic control among NIDDM subjects and both fasting blood glucose
(9.1 +/- 0.5 vs. 10.1 +/- 0.6 mmol/l; p < 0.05) and HbA1c (8.5 +/- 0.3 vs.
9.3 +/- 0.3%; p < 0.05) improved. Beneficial effects of AA supplementation on
cholesterol (5.9 +/- 0.2 vs. 6.2 +/- 0.2 mmol/l; p < 0.05) and triglycerides
(2.2 +/- 0.2 vs. 2.5 +/- 0.2; p < 0.05) were also observed in NIDDM subjects.
The results suggest that high-dose AA supplementation may have a beneficial
effect in NIDDM subjects on both glycemic control and blood lipids.
Publication Types:
·
Clinical
trial
·
Randomized
controlled trial
PMID: 8546437 [PubMed - indexed for MEDLINE]
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Effects
of glucose/insulin perturbations on aging and chronic disorders of aging: the
evidence.
Among changes associated with aging is a decline in glucose tolerance. The reported causes are increased insulin resistance from receptor and/or post receptor disturbances and diminished pancreatic islet B-cell sensitivity to glucose. Many recent reports indicate that insulin resistance with hyperinsulinemia and/or hyperglycemia contribute to or even causes many chronic disorders associated with aging, i.e., chronic metabolic perturbations including noninsulin-dependent diabetes mellitus, obesity, hypertension, lipid abnormalities, and atherosclerosis. How could such disturbances in glucose/insulin metabolism lead to many chronic disorders associated with aging? In aging, similar to diabetes, the elevation in circulating glucose and other reducing sugars secondary to age-induced insulin resistance can react nonenzymatically with proteins and nucleic acids to form products that affect function and diminish tissue elasticity. Also, perturbations in glucose/insulin metabolism are associated with enhanced lipid peroxidation secondary to greater free radical formation. Free radicals of oxygen are important known causes of tissue damage and have been associated with many aspects of aging including inflammatory diseases, cataracts, diabetes, and cardiovascular diseases. Augmented free radical formation and lipid peroxidation are not uncommon in diabetes mellitus, commonly associated with "premature aging". Ingestion of sugars, fats, and sodium have been linked to decreased insulin sensitivity, while caloric restriction, exercise, ingestion of chromium, vanadium, soluble fibers, magnesium, and certain antioxidants are associated with greater insulin sensitivity. Thus, manipulation of diet by influencing the glucose/insulin system may favorably affect life span and reduce the incidence of chronic disorders associated with aging.
Preuss-HG
J-Am-Coll-Nutr. 1997 Oct; 16(5): 397-403
Partial
preservation of pancreatic beta-cells by vanadium: evidence for long-term
amelioration of diabetes.
Streptozotocin (STZ)-diabetic rats treated with vanadium can remain euglycemic for up to 20 weeks following withdrawal from vanadium treatment. In this study, we examined the effects of short-term vanadium treatment in preventing or reversing the STZ-induced diabetic state. Male Wistar rats were untreated (D) or treated (DT) with vanadyl sulfate for 1 week before administering STZ. Treatment was subsequently maintained for 3 days (DT3) or 14 days (DT14) post-STZ, after which vanadium was withdrawn. At 4 to 5 weeks post-STZ and following long-term withdrawal from vanadium, DT14 rats demonstrated levels of food and fluid intake and glucose tolerance that were not significantly different from those of age-matched untreated nondiabetic rats, and had significantly reduced glycemic levels in the fed state compared with D and DT3 groups. The proportion of animals that were euglycemic (fed plasma glucose < 9.0 mmol/L) was significant in DT14 (five of 10) relative to D (one of 10) and DT3 (one of 10) (P = .01). All euglycemic animals had an improved pancreatic insulin content that, albeit low (12% of control), was strongly linked to euglycemia in the fed state (r = -.91, P < .0001). Moreover, the highly significant correlation persisted with the analysis of untreated STZ-rats alone (r = -.95, P < .0001). Similarly, improvements in glucose tolerance and insulin secretory function in euglycemic rats were strongly correlated with small changes in residual insulin content. Hence, as vanadium pretreatment did not prevent STZ-induced beta-cytotoxicity, the vanadium-induced amelioration of the diabetic state appears to be secondary to the preservation of a functional portion of pancreatic beta cells that initially survived STZ toxicity. The partial preservation of pancreatic beta cells, albeit small in proportion to the total insulin store, was both critical and sufficient for a long-term reversal of the diabetic state. These results suggest that apparently modest effects in preserving residual pancreatic insulin content can have profound consequences on glucose homeostasis and may bear important implications for interventions that have "limited" protective effects on beta cells.
Cam-MC; Li-WM; McNeill-JH
Metabolism. 1997 Jul; 46(7): 769-78
Insulin-like
effects on liver Golgi membrane preparations of bis(oxalato)oxovanadate(IV)
complex ion, a new vanadate compound.
Recent studies have shown the insulin-like effect of vanadyl sulphate or sodium ortho (or meta-) vanadate administered orally to rats. Toxicity of these drugs and reluctance by the animals to drink the solutions and take food, concerning the amelioration of some diabetes syndrome discussed in 1994 by Domingo et al. (1), McNeill et al. (2) and Wiliams and Malabu (3), prompted us to investigate a new vanadate complex: disodium bis (oxalato) oxovanadate (IV), Na2[VO(OX)2]H2O.
The main object of the experiment was to study whether this complex administered as 3 mmol/l solution in 0.5% NaCl during 7 days could act on the subcellular level and influence the activity of liver Golgi membrane galactosyltransferase activity. Free blood sugar level was lowered (but was still higher than in the control group) in diabetic rats after seven days of vanadate action and was accompanied by lowered, however not statistically significant, serum triglyceride levels. The yields of isolated Golgi-rich membrane fractions were about half of the level in diabetic groups (untreated and treated with vanadium) compared with the control groups. Purity of these membrane fractions, expressed as nmol Gal transferred per mg of proteins and per h, was the same in four groups investigated and showed the possibility to compare them. Activity of galactosyltransferase calculated in nmol Gal transferred per 1 g of liver and per 1 h or per whole liver in the same time (as a possibility of glycosylation of the secretory and membrane glycoproteins) was lower in both diabetic groups. However, after vanadium treatment (D+V group), the activity was higher than in untreated diabetic rats (D group) in three of five investigated animals. Vanadyl-oxalate complex did not normalize in a statistically significant manner the enzyme activity which was significantly lower in diabetes than in control. This is similar to insulin influence on the galactosyltransferase activity reported previously by Kaczmarski et al. in 1981 (4) and Kordowiak et al. in 1981 (5).
Kordowiak-AM; Trzos-R; Grybos-R
Horm-Metab-Res. 1997 Mar; 29(3): 101-5
Role
of essential trace elements in the disturbance of carbohydrate metabolism
Zinc and chromium have been well known to be important trace elements in diabetes as a cofactor for insulin, although their real mechanisms in carbohydrate metabolism are not clear. Especially, chromium is considered essential for maintenance of normal glucose tolerance, and a chromium complex occurring in brewer's yeast, termed glucose tolerance factor (GTF), was found to be of outstanding activity. Recently, some essential trace elements such as vanadium and selenium were observed to have several physiological insulin-like effects by a post-insulin receptor kinase mechanism. It is very likely that chromium, manganese, vanadium, and selenium have a favorable effect on carbohydrate metabolism.
Kimura-K
Dai S, Thompson KH, McNeill JH.
Division of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences,
University of British Columbia, Vancouver, Canada.
Streptozotocin-diabetic and non-diabetic rats were given various concentrations
of vanadyl sulphate in drinking water for one year. It was found that vanadyl
sulphate caused significant decreases in body weight gain and plasma insulin
level in non-diabetic rats, but did not significantly alter fluid and food
intakes or plasma levels of glucose, triglycerides, or cholesterol. In diabetic
animals, vanadyl treatment significantly alleviated or prevented the occurrence
of hyperglycaemia, hypoinsulinaemia, hyperphagia, polydipsia, hyperlipidaemia,
or cataract formation, but the slower body weight gain was not improved. There
were gradual decreases in the intake of the compound required to correct
hyperglycaemia in the values of ED50 with age of the rats. The beneficial
effects of vanadyl treatment persisted 16 weeks following the withdrawal of the
compound. It is concluded that vanadyl sulphate is an effective agent for
chronic therapy of streptozotocin-induced diabetes in rats, and its prolonged
use does not lead to the development of tolerance.
PMID: 8190697 [PubMed - indexed for MEDLINE]