Mucosal immune response to an antigen leads to a state of attenuated systemic response to the same antigen, known as mucosal or oral tolerance. Thus, autoantigen administration via mucosal routes could be useful in the prevention of autoimmune diseases. Although in various models of autoimmune disease it is often effective, in some cases it is ineffective and in other cases even harmful. In these cases it is likely that, concomitantly with tolerance, a productive immune response is induced that exacerbates autoimmunity. Recent evidence suggests that induction of cytotoxic T lymphocytes capable of destroying pancreatic beta cells may be an unavoidable consequence of mucosal administration of pancreatic beta-cell associated autoantigen. To improve the safety and efficacy of mucosal tolerance induction in the prevention of type 1 diabetes, further means to control the induction of cytotoxic T lymphocytes and other potentially tissue-destructive immune effectors may be required.

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Objective: Relatively higher blood pressure (BP) levels in early pregnancy, absence of mid-pregnancy BP fall as well as individual components of the insulin resistance syndrome have been reported to be associated with greater risk of preeclampsia. Home BP is considered as theoretically ideal for monitoring changes in BP during pregnancy. The objective of this study was to evaluate association between trend in home BP level and insulin resistance during normotensive pregnancy.Methods: This study is a part of the BOSHI study, conducted in Suzuki Memorial Hospital, which is the only hospital specializing in obstetrics gynecology and in vitro fertilization the Sendai City area of Miyagi Prefecture, Japan. We enrolled 242 normotensive pregnant women (mean age, 31.0 years). They were asked to measure home BP every morning based on the Japanese society of hypertension guidelines for self-monitoring of BP at home. Plasma insulin concentration and HOMA-IR (Homeostasis model assessment insulin resistance) were used as insulin resistance indexes. The subjects were equally divided into quintile according to plasma insulin concentration and HOMA-IR, respectively (Q1-Q5). Home BP values among quintiles were compared by mixed liner model adjusting for prepregnancy BMI, age, and minimum outside temperature. Mid pregnancy fall in BP was obtained by subtracting BP values at 20th gestational week from that at 12th gestational week.Result: Mean AE SD of plasma insulin concentration and HOMA-IR at 14 AE 2 gestational weeks were 4.9AE3.0 mU, 1.0 AE 0.7, respectively. The women with higher plasma insulin concentration had significantly higher home systolic/ diastolic BP values during pregnancy (P ¼ 0.0001/0.0005). As increase in the plasma insulin concentration, the mid pregnancy fall in BP became smaller (Q1, 1.7/3.2mmHg; Q2, 2.9/3.2mmHg; Q3, 2.5/2.9mmHg; Q4, À1.1/ 0.5mmHg; Q5, À1.8/0.4mmHg; trend P ¼ 0.002/0.001). HOMA-IR showed a similar association.Conclusion: Women with higher plasma insulin concentration or higher HOMA-IR at first-trimester had significantly high home BP values during pregnancy and a decreased mid pregnancy fall in BP. In women with insulin resistance, BP management during pregnancy using home BP measurement might be important.Objective: Previous studies with some limitations have provided equivocal results for the prognostic significance of home-measured blood pressure (BP). We investigated whether home-measured BP is more strongly associated with cardiovascular events and total mortality than is office BP.Design and Methods: A prospective nationwide study was initiated in 2000-2001 on 2081 randomly selected subjects aged 45-74 years. Home and office BP were determined at baseline along with other cardiovascular risk factors. The primary endpoint was incidence of a cardiovascular event (cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, percutaneous coronary intervention, and coronary artery bypass graft surgery). The secondary endpoint was total morta...

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