الفهرس 
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Abstract
Adiponectin (Acrp30) is an a dipocyte specific secretory protein and has been shown to play an important role in energy homeostasis. Acrp30 like other C19 homologues, trimerizes and this homotrimer is the building block for higher order complex found in serum. Acrp30 Oligomerization is mediated by collagenous tail, it circulates in serum in multimers full length or high molecular weight (HMW), and low molecular weight (LMW). Additionally full length Acrp30 may be cleaved to smaller globular fragment (gAD) which has been proposed to have greater potency than the full length protein.
Although the existence of Acrp30 complexes has been known, regulation at the levels of these complexes with regulatory step taking place at molecular levels has not been studied to date.
We characterized in the present work the rate limiting step at the level of an upstream activator of the ligand (serum reductase and protease) that trigger the dissociation of the higher order complex toward the final active ligand in obese type. II DM and its alteration under insulin sensitizing effects of thiazolidinediones (TZDs).
The present study aimed to determine serum aldose reductase and protease for full length adiponectin cleavages in obese type 2 diabetes mellitus treated with thiazolidinedione (TZDs).
The study was carried out on sixty subjects of both sexes, aged between 40-58 years. All subjects were not used TZDs in the last three months , the subjects were divided into two groups , thirty in each :
group I : Comprised thirty healthy non obese subjects with body mass index between (18.5 – 24.9) kg/m2 with normal blood glucose (13 females and 17 males) saved as control group matched for age and sex to other group .
group II : Included thirty obese diabetic subjects with body mass index was > 30 kg/m2 , (16 females and 14 males).
All subjects were free of any disease include renal or hepatic disease , coronary disease based on history and had not long term complication from diabetes.
Obesity was assessed by measuring body mass index (BMI) for all studied groups.
Laboratory investigation : fasting venous blood samples (6-8 hours) were withdrawn from all patients (before and after 3 months of TZDs treatment) and from control subjects for measurements of serum aldose reductase (AR) , protease and insulin .
Plasma glucose (FG), hemoglobin A1c (HbA1c) , total adiponectin and high-molecular weight (HMW).
Chapter VI: Summary & Conclusion & Recommendation
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This study has shown that decrease in SA index which is HMW / HMW + LMW in insulin resistant obese type II DM subjects compared to controls even when adjusted to the same total adiponectin , suggesting that HMW form may be indicator of insulin sensitivity . Decreased SA in resistant subjects held uniquely with decreased HMW , insulin sensitivity , serum reductase , serum protease and increased LMW suggesting that SA not absolute amount of Acro30 may be the accurate indicator of insulin sensitivity.