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Osteoporose und Multimorbidität. Z Gerontol Geriatr 2019; 52:433-439. [DOI: 10.1007/s00391-019-01569-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/24/2019] [Indexed: 12/18/2022]
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Souza KSCD, Gomes IDS, Oliveira YMDC, Loureiro MB, Silva HPVD, Melo TRD, Santos MGD, Bortolin RH, Maciel Neto JJ, Arrais RF, Almeida MDG, Ururahy MAG, Rezende AAD. Albuminuria and low bone mineral density in paediatric patients with type 1 diabetes. J Paediatr Child Health 2019; 55:411-415. [PMID: 30218466 DOI: 10.1111/jpc.14214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/08/2018] [Accepted: 08/09/2018] [Indexed: 12/15/2022]
Abstract
AIM To evaluate glycaemic control and its influence on albuminuria and bone mineral density (BMD) in children and adolescents with type 1 diabetes (T1D). METHODS We collectively assessed 84 T1D children/adolescents (T1D group), aged between 6 and 17 years, and then divided them into two groups according to their glycaemic profile (T1D with good glycaemic control (T1DG group) and T1D with poor glycaemic control (T1DP group)). Serum glucose, glycated haemoglobin, serum urea, serum creatinine, urinary albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate and BMD levels were assessed. RESULTS Of the patients studied, 77% presented with poor glycaemic control. Patients with T1DP showed an increased ACR (P < 0.001) and a low BMD (P = 0.025) when compared to the T1DG group. In addition, five patients in the T1DP group presented with concomitant albuminuria and a low BMD for their chronological age. Significant negative correlations were identified between the ACR and glycated haemoglobin (r = 0.655, P < 0.001), BMD and glycated haemoglobin (r = -0.262, P = 0.047) and BMD and the ACR (r = -0.631, P = <0.001). In linear regression analysis, the ACR showed a negative effect on BMD (P = 0.044) in the T1D patient group. CONCLUSION Poor glycaemic control was correlated with albuminuria, suggestive of a negative effect on bone tissue, leading to a low BMD in children and adolescents with T1D.
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Affiliation(s)
- Karla S Costa de Souza
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Iago de Souza Gomes
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Yonara M da Costa Oliveira
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil.,Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
| | - Melina Bezerra Loureiro
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Thamara Rodrigues de Melo
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Marcos Gonzaga Dos Santos
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Raul Hernandes Bortolin
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | - José J Maciel Neto
- Radiology Center, Onofre Lopes University Hospital of Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ricardo F Arrais
- Department of Pediatrics, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Maria das G Almeida
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Adriana A de Rezende
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
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Mathiesen IH, Hitz MF, Katzenstein TL, Oturai P, Skov M, Jørgensen NR, Jensen PO, Mikkelsen CR, Krogh-Madsen R, Pressler T, Faurholt-Jepsen D. Markers of bone turnover are reduced in patients with CF related diabetes; the role of glucose. J Cyst Fibros 2019; 18:436-441. [PMID: 30928333 DOI: 10.1016/j.jcf.2019.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/21/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cystic fibrosis(CF) related diabetes(CFRD) and osteoporosis are prevalent in adult patients with CF. We aimed to evaluate if CFRD and markers of glucose metabolism and inflammation are associated with bone turnover in CF. METHODS Cross sectional study at the adult section at the Copenhagen CF Center from January-October 2017. Fasting blood samples, including bone turnover markers(BTMs) and cytokines, Dual-x-ray absorptiometry scan and oral glucose tolerance test were performed. Lung-transplanted participants and patients in antiosteoporotic treatment were excluded from analyses. RESULTS 102 patients were included of whom 19 had a prior CFRD diagnosis. CFRD patients had lower procollagen type 1 N-terminal propeptide(P1NP) and C-Terminal cross-linked Telopeptide(CTX) levels compared to CF patients without diabetes (median[IQR]) 49.5 μg/l [29.6,57.1] vs 56.9 μg/l [38.2,74.3], p = .03 and 0.2 μg/l [0.1,0.3] vs 0.4 μg/l [0.3,0.6], p < .01, respectively. Fasting plasma glucose(FPG) was negatively associated with the bone formation markers P1NP and osteocalcin and bone resorption marker CTX. In multivariate linear regression FPG remained a significant predictor of P1NP -1.07 [-1.09;-0.01] and CTX -1.13 [-1.21;-1.06]. Bone mineral density Z-score was not different between patients with and without CFRD but FPG was negatively associated with hip and femoral neck Z-score. There was no consistent association between inflammatory cytokines and BTMs. CONCLUSIONS Bone turnover markers are reduced in CF patients with CFRD and negatively associated with glucose levels. Extra attention towards frequent hyperglycemia in CF patients should be taken when evaluating decreased BMD. Glycemia may be a future target for improving outcome in CFBD.
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Affiliation(s)
- Inger Hee Mathiesen
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark.
| | - Mette Friberg Hitz
- Dept. of Medicine, Endocrine Division, Zealand University Hospital, Lykkebaekvej 1, DK4600 Koege, Denmark
| | - Terese Lea Katzenstein
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Peter Oturai
- Dept. of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Blegdamsvej 9, Copenhagen University Hospital, DK2100 Copenhagen, Denmark
| | - Marianne Skov
- Copenhagen Cystic Fibrosis Center, Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Juliane Maries Vej 6, DK2100 Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Dept of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Valdemar Hansens Vej 13, 2600 Glostrup, Copenhagen, Denmark
| | - Peter Oestrup Jensen
- Dept. of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Ole Maaløes Vej, 26, DK2200 Copenhagen, Denmark; Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Christine Raaberg Mikkelsen
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- The Centre of Inflammation and Metabolism (CIM), Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Tacjana Pressler
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark; Copenhagen Cystic Fibrosis Center, Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Juliane Maries Vej 6, DK2100 Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
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Wang L, Li T, Liu J, Wu X, Wang H, Li X, Xu E, Chen Q, Yan C, Li H, Xu Y, Wei W. Association between glycosylated hemoglobin A1c and bone biochemical markers in type 2 diabetic postmenopausal women: a cross-sectional study. BMC Endocr Disord 2019; 19:31. [PMID: 30866902 PMCID: PMC6416956 DOI: 10.1186/s12902-019-0357-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND type 2 diabetes mellitus (T2DM) is a complicated disease that can affect bone health, but the change in bone biochemical markers caused by T2DM was controversial, so the aim of this study was to investigate whether there was a discrepancy in the levels of bone biochemical markers between postmenopausal women with T2DM and non-diabetic women and to explore the relationship between the level of glycosylated hemoglobin A1c (HbA1c) and bone biochemical markers in these subjects. METHODS A total of 237 type 2 diabetic postmenopausal women visiting the First Affiliated Hospital of Anhui Medical University from January 2017 to October 2018 and 93 healthy postmenopausal women were retrospectively enrolled. The differences in the levels of bone biochemical markers between patients and controls were analyzed by one-way ANOVA or chi-square test. The relationship between HbA1c and bone biochemical markers was analyzed by multivariate regression, forest plot and fitted curve. RESULTS Bone formation markers including N-MID osteocalcin and procollagen type 1 amino-terminal pro-peptide (PINP) were decreased in postmenopausal women with T2DM compared to controls (17.42 ± 9.50 vs 23.67 ± 7.58, p < 0.001; 48.47 ± 27.27 vs 65.86 ± 21.06, p < 0.001, respectively), but the bone resorption markers β-crossLaps (β-CTX) was no difference between the two groups (0.57 ± 0.28 vs 0.55 ± 0.21, p = 0.868). Multivariate regression showed that HbA1c was inversely associated with N-MID osteocalcin and PINP after adjusting for age, BMI, menopause's years, diabetic duration, TC, TG, HDL-c, LDL-c, creatinine, UA and eGFR. The adjusted coefficients for N-MID osteocalcin and PINP per 1% HbA1c decrease were - 0.71 (- 1.19, - 0.22) and - 1.79 (- 3.30, - 0.28), respectively. A segmentation effect was seen in the fitted curve between HbA1c and β-CTX with an inflection point at 7.4% of HbA1c, the highest quartile of β-CTX (> = 0.74 ng/ml) showed a significantly negative with HbA1c. No significant association was seen between HbA1c and other biochemical markers. CONCLUSIONS Our study found that bone formation was inhibited in postmenopausal women with T2DM, but bone resorption was not affected, and poor glycemic control was related to lower levels of bone formation, may increase the risk of bone fracture in postmenopausal women with T2DM.
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Affiliation(s)
- Lianzi Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Tao Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Anhui Anti-inflammatory and Immune Medicine innovation team, Hefei, 230032 China
| | - Jiaqing Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Xian Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Huihui Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Xuemei Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Enjun Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Qiuli Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Chuan Yan
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Huimin Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Yuanhong Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230032 Anhui China
| | - Wei Wei
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Anhui Anti-inflammatory and Immune Medicine innovation team, Hefei, 230032 China
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Brunetti G, D'Amato G, Chiarito M, Tullo A, Colaianni G, Colucci S, Grano M, Faienza MF. An update on the role of RANKL-RANK/osteoprotegerin and WNT-ß-catenin signaling pathways in pediatric diseases. World J Pediatr 2019; 15:4-11. [PMID: 30343446 DOI: 10.1007/s12519-018-0198-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bone remodeling is a lifelong process due to the balanced activity of osteoclasts (OCs), the bone-reabsorbing cells, and osteoblasts (OBs), and the bone-forming cells. This equilibrium is regulated by numerous cytokines, but it has been largely demonstrated that the RANK/RANKL/osteoprotegerin and Wnt/β-catenin pathways play a key role in the control of osteoclastogenesis and osteoblastogenesis, respectively. The pro-osteoblastogenic activity of the Wnt/β-catenin can be inhibited by sclerostin and Dickkopf-1 (DKK-1). RANKL, sclerostin and DKKs-1 are often up-regulated in bone diseases, and they are the target of new monoclonal antibodies. DATA SOURCES The authors performed a systematic literature search in PubMed and EMBASE to June 2018, reviewed and selected articles, based on pre-determined selection criteria. RESULTS We re-evaluated the role of RANKL, osteoprotegerin, sclerostin and DKK-1 in altered bone remodeling associated with some inherited and acquired pediatric diseases, such as type 1 diabetes mellitus (T1DM), alkaptonuria (AKU), hemophilia A, osteogenesis imperfecta (OI), 21-hydroxylase deficiency (21OH-D) and Prader-Willi syndrome (PWS). To do so, we considered recent clinical studies done on pediatric patients in which the roles of RANKL-RANK/osteoprotegerin and WNT-ß-catenin signaling pathways have been investigated, and for which innovative therapies for the treatment of osteopenia/osteoporosis are being developed. CONCLUSIONS The case studies taken into account for this review demonstrated that quite frequently both bone reabsorbing and bone deposition are impaired in pediatric diseases. Furthermore, for some of them, bone damage began in childhood but only manifested with age. The use of denosumab could represent a valid alternative therapeutic approach to improve bone health in children, although further studies need to be carried out.
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Affiliation(s)
- Giacomina Brunetti
- Section of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | | | - Mariangela Chiarito
- Pediatric Section, Department of Biomedical Sciences and Human Oncology, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Apollonia Tullo
- Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies-IBIOM, CNR, 70126, Bari, Italy
| | - Graziana Colaianni
- Department of Emergency and Organ Transplantation, University "A. Moro" of Bari, Bari, Italy
| | - Silvia Colucci
- Section of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Maria Grano
- Department of Emergency and Organ Transplantation, University "A. Moro" of Bari, Bari, Italy
| | - Maria Felicia Faienza
- Pediatric Section, Department of Biomedical Sciences and Human Oncology, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy.
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Rharass T, Lucas S. High Glucose Level Impairs Human Mature Bone Marrow Adipocyte Function Through Increased ROS Production. Front Endocrinol (Lausanne) 2019; 10:607. [PMID: 31551934 PMCID: PMC6746912 DOI: 10.3389/fendo.2019.00607] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/21/2019] [Indexed: 12/20/2022] Open
Abstract
Bone marrow adipocytes (BMAds) accumulate in aging, menopause, and metabolic diseases such as Type 2 diabetes. These osteoporotic conditions are associated with oxidative stress and hyperglycemia which are both considered as critical factors underlying bone fragility. Glucose excess and reactive oxygen species (ROS) are known to favor adipogenesis over osteoblastogenesis. In this study, we investigated whether high glucose exposure could determine dysfunction of mature BMAds, specifically through ROS production. The effects of low (LG, 5 mM) or high glucose (HG, 25 mM) concentrations were examined using human bone mesenchymal stromal cells (hBMSCs) in the time course of differentiation, and, up to 21 days once adipocytes were mature. HG did not alter the adipocyte differentiation process of hBMSCs. Yet, after 21 days under HG exposure, PPARG, CEBPA, and adiponectin mRNA expressions were decreased. These alterations were also observed following adipogenic inducer withdrawal as well as in adipocytes fully differentiated in LG then cultured in HG for the last 11 days. Without inducers, HG condition also led to decreased leptin mRNA level. Importantly, intracellular and extracellular ROS concentrations measured using Amplex Red were significantly raised by 50% under HG exposure. This rise was observed once adipocytes ended differentiation and was reproduced within the different cell culture settings without any cytotoxicity. Among genes involved in ROS metabolism, the mRNA level of the H2O2 generating enzyme NOX4 was found upregulated in the presence of HG. Following cell separation, mature BMAds were shown to overproduce ROS and to display the gene alterations in contrast to non-lipid-laden cells. Finally, a non-lethal treatment with a pro-oxidant agent under LG condition reduces the mRNA levels of PPARG, adiponectin, and leptin as the HG condition does in the absence of inducers, and amplifies the effect of glucose excess on gene expression. HG concentration drives mature BMAds toward altered expression of the main adipokines and transcriptional factors. These perturbations are associated with a rise in ROS generation likely mediated through enhanced expression of NOX4. Mature BMAds are thus responsive to changes in glucose and ROS concentrations, which is relevant regarding with their phenotype and function in age- or metabolic disease-related osteoporosis.
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Chen YY, Kao TW, Wang CC, Chen YJ, Wu CJ, Chen WL. Exploring the link between metabolic syndrome and risk of dysmobility syndrome in elderly population. PLoS One 2018; 13:e0207608. [PMID: 30533044 PMCID: PMC6289450 DOI: 10.1371/journal.pone.0207608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022] Open
Abstract
Dysmobility syndrome (DMS) was considered as a comprehensive approach to evaluate the condition of musculoskeletal system and adverse health problems in older population. The objective of our study was to examine the association between metabolic syndrome (MetS) and DMS in a U.S. adult population. 1760 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 were enrolled in the study. The criteria of DMS consisted of six domains including increased body fat, declined muscle mass, reduced muscle strength, osteoporosis, slow gait speed, and balance problem. A multivariate regression analysis was investigated to clarify the relationship among MetS and its components and DMS. A positive association between increased number of MetS components and the presence of DMS achieved significance (β = 0.142, 95%CI = 0.035, 0.249, p = 0.009). Among the components of MetS, hyperglycemia had a central place in the DMS after adjustment of clinical variables (β = 0.083, 95%CI = 0.030, 0.136, p = 0.002). Notably, insulin resistance assessed by homeostatic model assessment (HOMA-IR) was correlated to increased body fat (r = 0.092, p<0.05), osteoporosis (r = -0.105, p<0.05) and balance (r = 0.105, p<0.05) among these participants with MetS. Our study demonstrated a strong relationship between DMS and the presence of MetS and its components in elderly population, highlighting a possible mechanism through insulin resistance.
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Affiliation(s)
- Yuan-Yuei Chen
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, Republic of China
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Clinical Medical, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Chung-Ching Wang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ying-Jen Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen-Jung Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Family Medicine, Department of Community Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Eguchi Y, Toyoguchi T, Inage K, Fujimoto K, Orita S, Suzuki M, Kanamoto H, Abe K, Norimoto M, Umimura T, Sato T, Koda M, Furuya T, Aoki Y, Nakamura J, Akazawa T, Takahashi K, Ohtori S. Analysis of skeletal muscle mass in women over 40 with degenerative lumbar scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:1618-1625. [DOI: 10.1007/s00586-018-5845-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 11/17/2018] [Accepted: 11/27/2018] [Indexed: 01/06/2023]
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Scharla S. [Diabetes mellitus and osteoporosis: Who should be addressed and how to confirm the diagnosis]. MMW Fortschr Med 2018; 160:65-69. [PMID: 30542856 DOI: 10.1007/s15006-018-1239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Tanaka H, Miura T, Yamashita T, Yoneda M, Takagi S. Characteristics of Bone Strength and Metabolism in Type 2 Diabetic Model Nagoya Shibata Yasuda Mice. Biol Pharm Bull 2018; 41:1567-1573. [PMID: 30012927 DOI: 10.1248/bpb.b18-00275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We evaluated the suitability of Nagoya Shibata Yasuda (NSY) mice as an animal model for examining the influence of a glucose metabolism disorder on bone integrity, using Institute of Cancer Research (ICR) mice as controls. We selected six NSY and ICR mice each that were matched for weight, and measured serum glucose levels, serum insulin levels, and conducted an oral glucose tolerance test. Histological sections of the femurs of both mouse lines were prepared, and the bone strength, mass, and microstructure of the femur were compared, along with bone metabolism. Serum glucose levels were significantly higher in the NSY mice than in the control mice, but body weight and serum insulin levels did not differ between the groups. Bone mass, microstructure, and strength of the femur, and bone metabolism were lower in the NSY mice than in the control mice. In the cortical bone of the femur in the NSY mice, several parts were not stained with eosin, demonstrating a strong negative correlation between serum glucose levels and bone mineral density; however, there was a negative correlation between serum glucose levels and bone metabolic markers. The bone turnover rate in the NSY mice was decreased by hyperglycemia, resulting in a thinner and shorter femur, reduced cortical and trabecular areas, and lower bone mass compared to those of the control mice. Collectively, these results suggest deteriorated bone strength of the femur in NSY mice, serving as a useful model for studying the link between glucose metabolism and bone integrity.
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Affiliation(s)
- Hiroaki Tanaka
- Graduate School of Health Science, Suzuka University of Medical Science
| | - Toshihiro Miura
- Graduate School of Health Science, Suzuka University of Medical Science
| | - Takenori Yamashita
- Department of Radiological Technology, Faculty of Health Science, Suzuka University of Medical Science
| | - Misao Yoneda
- Department of Clinical Nutrition, Faculty of Health Science, Suzuka University of Medical Science
| | - Satoshi Takagi
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University
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Starup-Linde J, Hygum K, Langdahl BL. Skeletal Fragility in Type 2 Diabetes Mellitus. Endocrinol Metab (Seoul) 2018; 33:339-351. [PMID: 30229573 PMCID: PMC6145952 DOI: 10.3803/enm.2018.33.3.339] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes (T2D) is associated with an increased risk of fracture, which has been reported in several epidemiological studies. However, bone mineral density in T2D is increased and underestimates the fracture risk. Common risk factors for fracture do not fully explain the increased fracture risk observed in patients with T2D. We propose that the pathogenesis of increased fracture risk in T2D is due to low bone turnover caused by osteocyte dysfunction resulting in bone microcracks and fractures. Increased levels of sclerostin may mediate the low bone turnover and may be a novel marker of increased fracture risk, although further research is needed. An impaired incretin response in T2D may also affect bone turnover. Accumulation of advanced glycosylation endproducts may also impair bone strength. Concerning antidiabetic medication, the glitazones are detrimental to bone health and associated with increased fracture risk, and the sulphonylureas may increase fracture risk by causing hypoglycemia. So far, the results on the effect of other antidiabetics are ambiguous. No specific guideline for the management of bone disease in T2D is available and current evidence on the effects of antiosteoporotic medication in T2D is sparse. The aim of this review is to collate current evidence of the pathogenesis, detection and treatment of diabetic bone disease.
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Affiliation(s)
- Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Katrine Hygum
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Lomholt Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Roh JG, Yoon JS, Park KJ, Lim JS, Lee HS, Hwang JS. Evaluation of bone mineral status in prepuberal children with newly diagnosed type 1 diabetes. Ann Pediatr Endocrinol Metab 2018; 23:136-140. [PMID: 30286569 PMCID: PMC6177659 DOI: 10.6065/apem.2018.23.3.136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/01/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Many studies have reported that patients with type 1 diabetes have reduced bone mineral density (BMD). We assessed bone status in prepubertal children with type 1 diabetes mellitus (type 1 DM) at initial diagnosis and investigated factors associated with BMD. METHODS Prepubertal children (n=29) with newly diagnosed type 1 diabetes from 2006 to 2014 were included. Dual-energy X-ray absorptiometry measured regional and whole-body composition at initial diagnosis. BMD was compared with healthy controls matched for age, sex, and body mass index (BMI). RESULTS The mean age of all subjects (16 boys and 13 girls) was 7.58±1.36 years (range, 4.8-11.3 years). Initial mean glycosylated hemoglobin (HbA1c) level was 12.2%±1.9%. The mean BMD z-scores of lumbar spine, femur neck, and total body were not significantly different between patients and controls. Three patients (10.3%) had low bone density (total body BMD standard deviation score [SDS] < -2.0). To identify determinants of lumbar spine BMD z-score, multivariate regression analysis was performed with stepwise variable selection of age, pubertal status, BMI SDS, insulin like growth factor-1, and HbA1c. Only BMI SDS was significantly correlated with lumbar spine BMD z-score (β=0.395, P=0.023). CONCLUSION Prepubertal children with newly diagnosed type 1 DM had similar bone mass compared to healthy peers. However, patients with low BMI should be carefully monitored for bone density in type 1 DM.
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Affiliation(s)
- Jung Gi Roh
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jong Seo Yoon
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Kyu Jung Park
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Hae Sang Lee
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea,Address for correspondence: Hae Sang Lee, MD, PhD Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-4454 Fax: +82-31-219-5169 E-mail:
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Pieralice S, Vigevano F, Del Toro R, Napoli N, Maddaloni E. Lifestyle Management of Diabetes: Implications for the Bone-Vascular Axis. Curr Diab Rep 2018; 18:84. [PMID: 30121859 DOI: 10.1007/s11892-018-1060-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To describe the main pathways involved in the interplay between bone and cardiovascular disease and to highlight the possible impact of physical activity and medical nutrition therapy on the bone-vascular axis. RECENT FINDINGS Diabetes increases the risk of both cardiovascular disease and bone fragility fractures, sharing common pathogenic pathways, including OPG/RANK/RANKL, the FGF23/Klotho axis, calciotropic hormones, and circulating osteogenic cells. This may offer new therapeutic targets for future treatment strategies. As lifestyle intervention is the cornerstone of diabetes treatment, there is potential for an impact on the bone-vascular axis. Evidence published suggests the bone-vascular axis encompasses key pathways for cardiovascular disease. This, along with studies showing physical activity plays a crucial role in the prevention of both bone fragility and cardiovascular disease, suggests that lifestyle intervention incorporating exercise and diet may be helpful in managing skeletal health decline in diabetes. Studies investigating the controversial role of high-fiber diet and dietary vitamin D/calcium on bone and cardiovascular health suggest an overall benefit, but further investigations are needed in this regard.
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Affiliation(s)
- Silvia Pieralice
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Francesca Vigevano
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Rossella Del Toro
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy.
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Feldbrin Z, Omelchenko E, Lipkin A, Shargorodsky M. Osteopontin levels in plasma, muscles, and bone in patient with non-healing diabetic foot ulcers: A new player in wound healing process? J Diabetes Complications 2018; 32:795-798. [PMID: 29871782 DOI: 10.1016/j.jdiacomp.2018.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/15/2018] [Accepted: 05/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The present study was designed to investigate the impact of osteopontin (OPN) in different tissue (e.g., plasma, muscles and bone) on amputation rate (in-hospital and during one year follow-up) for non-healing diabetic foot ulcers (DFUs). METHODS This pilot study consisted of 30 diabetic patients, hospitalized due to non-healing DFUs. Patients were divided into two groups: Group 1 included 14 patients who underwent limb-preserved debridement procedure without amputation; Group 2 included 16 subjects who underwent amputation. Additionally, recurrent amputation rate during 1 year follow-up was investigated. RESULTS Plasma OPN was higher and bone OPN was lower in Group 2 compared to Group 1 (p = 0.016 and p = 0.004, respectively). In the logistic regression analysis, bone OPN emerged as a significant independent predictor of amputation (OR = 0.042, 95% CI 0.003-0.699, p = 0.027). Plasma OPN was also associated with amputation such that each unit increase in plasma OPN was associated with an increase in odds of amputation of 17.7% (95% CI 0.997-1.388, p = 0.045). During 1 year follow-up 11 patients underwent recurrent amputation. Plasma OPN were higher and bone osteopontin was lower in patients who underwent amputation compared to patients who did not need amputation at one year follow-up. However, in GLM analysis bone OPN was only marginally associated with one year amputation (OR 0.001, 95% CI 0.000-2.0, p = 0.076). CONCLUSIONS Decreased levels of OPN in bone and increased plasma OPN are independently associated with in-hospital amputation. Consequently, plasma OPN may be relevant in the routine assessment of amputation risk in this patient population.
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Affiliation(s)
- Z Feldbrin
- Department of Diabetic Foot, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Omelchenko
- Department of Diabetic Foot, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Lipkin
- Department of Diabetic Foot, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Shargorodsky
- Department of Endocrinology, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Stage TB, Christensen MMH, Jørgensen NR, Beck-Nielsen H, Brøsen K, Gram J, Frost M. Effects of metformin, rosiglitazone and insulin on bone metabolism in patients with type 2 diabetes. Bone 2018; 112:35-41. [PMID: 29654849 DOI: 10.1016/j.bone.2018.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 03/06/2018] [Accepted: 04/06/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fracture risk is increased in individuals with type 2 diabetes (T2D). The pathophysiological mechanisms accentuating fracture risk in T2D are convoluted, incorporating factors such as hyperglycaemia, insulinopenia, and antidiabetic drugs. The objectives of this study were to assess whether different insulin regimens, metformin and rosiglitazone influence bone metabolism. We explored if the concentration of metformin and rosiglitazone in blood or improved glycaemic control altered bone turnover. METHODS Two-year clinical trial designed to investigate effects of antidiabetic treatment in 371 T2D patients. Participants were randomized to short or long-acting human insulin (non-blinded) and then further randomized to metformin + placebo, rosiglitazone + placebo, metformin + rosiglitazone or placebo + placebo (blinded). Fasting bone turnover markers (BTM) representing bone resorption (CTX) and formation (PINP) including HbA1c were measured at baseline and after 3, 12 and 24 months. Trough steady-state plasma concentrations of metformin and rosiglitazone were measured after 3, 6 and 9 months of treatment. Associations between treatments and BTMs during the follow-up of the trial were analysed in mixed-effects models that included adjustments for age, gender, BMI, renal function and repeated measures of HbA1c. RESULTS BTMs increased from baseline to month 12 and remained higher at month 24, with CTX and PINP increasing 28.5% and 23.0% (all: p < 0.001), respectively. Allocation of insulin regimens was not associated with different levels of BTMs. Metformin and metformin + rosiglitazone but not rosiglitazone alone were associated with lower bone formation (PINP). Neither metformin nor rosiglitazone plasma concentrations was associated with BTMs. HbA1c was inversely associated with CTX but not P1NP. CONCLUSIONS The choice of insulin treatment is not influencing BTMs, metformin treatment may decrease BTMs, and improvement of glycaemic control may influence bone resorption activity.
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Affiliation(s)
- Tore Bjerregaard Stage
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, USA
| | | | - Niklas Rye Jørgensen
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | | | - Kim Brøsen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jeppe Gram
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - Morten Frost
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
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Devlin M, Robbins A, Cosman M, Moursi C, Cloutier A, Louis L, Van Vliet M, Conlon C, Bouxsein M. Differential effects of high fat diet and diet-induced obesity on skeletal acquisition in female C57BL/6J vs. FVB/NJ Mice. Bone Rep 2018; 8:204-214. [PMID: 29955639 PMCID: PMC6020275 DOI: 10.1016/j.bonr.2018.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 03/06/2018] [Accepted: 04/16/2018] [Indexed: 12/28/2022] Open
Abstract
The effects of obesity on bone metabolism are complex, and may be mediated by consumption of a high fat diet and/or by obesity-induced metabolic dysregulation. To test the hypothesis that both high fat (HF) diet and diet-induced metabolic disease independently decrease skeletal acquisition, we compared effects of HF diet on bone mass and microarchitecture in two mouse strains: diet-induced obesity (DIO)-susceptible C57BL/6J (B6) and DIO-resistant FVB/NJ (FVB). At 3 wks of age we weaned 120 female FVB and B6 mice onto normal (N, 10% Kcal/fat) or HF diet (45% Kcal/fat) and euthanized them at 6, 12 and 20 weeks of age (N = 10/grp). Outcomes included body mass; percent fat and whole-body bone mineral density (WBBMD, g/cm2) via DXA; cortical and trabecular bone architecture at the midshaft and distal femur via μCT; and marrow adiposity via histomorphometry. In FVB HF, body mass, percent body fat, WBBMD and marrow adiposity did not differ vs. N, but trabecular bone mass was lower at 6 wks of age only (p < 0.05), cortical bone geometric properties were lower at 12 wks only, and bone strength was lower at 20 wks of age only in HF vs. N (p < 0.05). In contrast, B6 HF had higher body mass, percent body fat, and leptin vs. N. B6 HF also had higher WBBMD (p < 0.05) at 9 and 12 wks of age but lower distal femur trabecular bone mass at 12 wks of age, and lower body mass-adjusted cortical bone properties at 20 wks of age compared to N (p < 0.05). Marrow adiposity was also markedly higher in B6 HF vs. N. Overall, HF diet negatively affected bone mass in both strains, but was more deleterious to trabecular bone microarchitecture and marrow adiposity in B6 than in FVB mice. These data suggest that in addition to fat consumption itself, the metabolic response to high fat diet independently alters skeletal acquisition in obesity.
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Affiliation(s)
- M.J. Devlin
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48104, United States
| | - A. Robbins
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48104, United States
| | - M.N. Cosman
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48104, United States
| | - C.A. Moursi
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48104, United States
| | - A.M. Cloutier
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, United States
| | - L. Louis
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, United States
| | - M. Van Vliet
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, United States
| | - C. Conlon
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, United States
| | - M.L. Bouxsein
- Harvard Medical School, Boston, MA 02215, United States
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, United States
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Chaves Neto AH, Brito VGB, Landim de Barros T, do Amaral CCF, Sumida DH, Oliveira SHP. Chronic high glucose and insulin stimulate bone‐marrow stromal cells adipogenic differentiation in young spontaneously hypertensive rats. J Cell Physiol 2018; 233:6853-6865. [DOI: 10.1002/jcp.26445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/05/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Antonio H. Chaves Neto
- Department of Basic Sciences, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
| | - Victor G. B. Brito
- Department of Basic Sciences, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
- Department of Basic Sciences, Programa de Pós‐graduação Multicêntrico em Ciências Fisiológicas‐SBFIs, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
| | - Thamine Landim de Barros
- Department of Basic Sciences, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
- Department of Basic Sciences, Programa de Pós‐graduação Multicêntrico em Ciências Fisiológicas‐SBFIs, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
| | - Caril C. F. do Amaral
- Department of Basic Sciences, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
- Department of Basic Sciences, Programa de Pós‐graduação Multicêntrico em Ciências Fisiológicas‐SBFIs, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
| | - Dóris H. Sumida
- Department of Basic Sciences, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
- Department of Basic Sciences, Programa de Pós‐graduação Multicêntrico em Ciências Fisiológicas‐SBFIs, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
| | - Sandra H. P. Oliveira
- Department of Basic Sciences, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
- Department of Basic Sciences, Programa de Pós‐graduação Multicêntrico em Ciências Fisiológicas‐SBFIs, School of DentistrySão Paulo State University—UNESPAraçatubaSão PauloBrazil
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de Azevedo Queiroz IO, Mello WG, Martins CM, Dal Fabbro R, Narciso LG, Massunari L, Cintra LTA, Ervolino E, Gomes-Filho JE. Systemic bone marker expression induced by grey and white mineral trioxide aggregate in normal and diabetic conditions. Int Endod J 2018; 51:889-900. [PMID: 29377189 DOI: 10.1111/iej.12900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/22/2018] [Indexed: 01/28/2023]
Abstract
AIM To investigate the relationship between diabetes mellitus and local/systemic effects of both grey and white mineral trioxide aggregate (MTA) Angelus on bone marker expression. METHODOLOGY Wistar rats were divided into two groups: healthy and diabetic (Alloxan induced), which were further divided into three subgroups (control, GMTA Angelus and WMTA Angelus). Polyethylene tubes filled with MTA materials or empty tubes were implanted in dorsal connective tissue. On days 7 and 30, blood samples were collected for calcium, phosphorus and ALP measurement. The animals were euthanized; implanted tubes were removed and processed for immunohistochemical analysis of osteocalcin (OCN) and osteopontin (OPN). Kruskal-Wallis followed by Dunn's multiple comparison test was performed for nonparametric data, and anova followed by Tukey's test for parametric data. RESULTS No difference in systemic serum calcium levels between both groups was observed. On day 7, serum phosphorus levels within the WMTA healthy group were higher than that of the diabetic group. On day 30, healthy rats exhibited lower phosphorus levels than diabetic ones. At both time points, the diabetic group was associated with more ALP activity than the healthy group. Immunohistochemical analyses of the healthy group revealed OCN- and OPN-positive cells in the presence of both MTA materials. However, under diabetic conditions, both OCN and OPN were absent. CONCLUSION Both MTA materials were associated with an increase in serum calcium, phosphorus and ALP, suggesting a potential systemic effect, along with triggered differentiation of OCN- and OPN-positive cells. Moreover, in diabetic conditions, an inhibitory effect on MTA-induced differentiation of OCN- and OPN-positive cells was detected.
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Affiliation(s)
- I O de Azevedo Queiroz
- Department of Endodontics, Araçatuba School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil
| | - W G Mello
- Department of Basic Science, Araçatuba School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil.,Centro Universitário Toledo - UNITOLEDO, Araçatuba, São Paulo, Brazil
| | - C M Martins
- Department of Endodontics, Araçatuba School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil
| | - R Dal Fabbro
- Department of Endodontics, Araçatuba School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil
| | - L G Narciso
- Department of Clinic and Surgery and Animal Reproduction, Araçatuba School of Veterinary Medicine, São Paulo State University (UNESP), São Paulo, Brazil
| | - L Massunari
- Department of Endodontics, Araçatuba School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil
| | - L T A Cintra
- Department of Endodontics, Araçatuba School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil
| | - E Ervolino
- Department of Basic Science, Araçatuba School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil
| | - J E Gomes-Filho
- Department of Endodontics, Araçatuba School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil
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Conditions Inducing Excessive O-GlcNAcylation Inhibit BMP2-Induced Osteogenic Differentiation of C2C12 Cells. Int J Mol Sci 2018; 19:ijms19010202. [PMID: 29315243 PMCID: PMC5796151 DOI: 10.3390/ijms19010202] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 02/07/2023] Open
Abstract
Hyperglycemic conditions in diabetic patients can affect various cellular functions, including the modulation of osteogenic differentiation. However, the molecular mechanisms by which hyperglycemia affects osteogenic differentiation are yet to be clarified. This study aimed to investigate whether the aberrant increase in protein O-linked-β-N-acetylglucosamine glycosylation (O-GlcNAcylation) contributes to the suppression of osteogenic differentiation due to hyperglycemia. To induce osteogenic differentiation, C2C12 cells were cultured in the presence of recombinant human bone morphogenetic protein 2 (BMP2). Excessive protein O-GlcNAcylation was induced by treating C2C12 cells with high glucose, glucosamine, or N-acetylglucosamine concentrations or by O-GlcNAc transferase (OGT) overexpression. The effect of O-GlcNAcylation on osteoblast differentiation was then confirmed by examining the expression levels of osteogenic marker gene mRNAs, activity of alkaline phosphatase, and transcriptional activity of Runx2, a critical transcription factor for osteoblast differentiation and bone formation. Cell treatment with high glucose, glucosamine or N-acetylglucosamine increased O-GlcNAcylation of Runx2 and the total levels of O-GlcNAcylated proteins, which led to a decrease in the transcriptional activity of Runx2, expression levels of osteogenic marker genes (Runx2, osterix, alkaline phosphatase, and type I collagen), and activity of alkaline phosphatase. These inhibitory effects were rescued by lowering protein O-GlcNAcylation levels by adding STO45849, an OGT inhibitor, or by overexpressing β-N-acetylglucosaminidase. Our findings suggest that excessive protein O-GlcNAcylation contributes to high glucose-suppressed osteogenic differentiation.
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Fang H, Xu XY, Xu RZ, Zhen YF, Xu G, Li YK. Decreased serum undercarboxylated osteocalcin is associated with cognitive impairment in male patients with type 2 diabetes. J Diabetes Complications 2018; 32:56-60. [PMID: 29126874 DOI: 10.1016/j.jdiacomp.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/22/2017] [Accepted: 09/02/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Basic and clinical researches have suggested that type 2 diabetes (T2DM) is associated with cognitive impairment, and diabetes mellitus increases the risk of cognitive impairment and dementia. Recently, some reports found that undercarboxylated osteocalcin (ucOC) could affect brain functions, and decreased in patients with T2DM. We aimed to investigate the association of serum ucOC with cognitive impairment in T2DM patients. METHODS A total of 196 male T2DM patients without medications known to affect bone metabolism or history of bone fracture, aged ≥18years were recruited and divided into impaired cognition group and normal cognition group. We use the scores of Minimum Mental State Examination (MMSE) to evaluate the subjects' cognitive function. Detailed cognitive performance was also evaluated by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Serum ucOC was measured by Enzyme-Linked Immunosorbent Assay (ELISA) kit. RESULTS Compared to male T2DM patients with normal cognition, the mean osteocalcin concentrations were significantly lower in male T2DM patients with impaired cognition (P<0.05). RBANS total and all indexes scores were also lower in patients with impaired cognition (all P<0.05). After adjusted effects of confounding factors, serum ucOC was positively correlated with a variety indexes of RBANS except visuospatial/constructional. CONCLUSIONS The serum ucOC is positively correlated with RBANS scores in male T2DM patients. It suggests that serum ucOC may be involved in the development and progression of cognitive dysfunction in T2DM patients.
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Affiliation(s)
- Hui Fang
- Department of Endocrinology, Tangshan Gongren Hospital, Tangshan, China
| | - Xiao-Yu Xu
- Department of Endocrinology, Tangshan Gongren Hospital, Tangshan, China
| | - Rui-Zhe Xu
- Department of Finance and Economy, Tangshan Vocational and Technical College, Tangshan, China
| | - Yan-Feng Zhen
- Department of Endocrinology, Tangshan Gongren Hospital, Tangshan, China
| | - Gang Xu
- Department of Surgery, Tangshan Gongren Hospital, Tangshan, China.
| | - Yu-Kai Li
- Department of Endocrinology, Tangshan Gongren Hospital, Tangshan, China
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Kacso A, Goia-Socol M, Hazi G, Tomoaia G, Kacso IM, Georgescu CE. EFFECT OF EXPERIMENTAL DYSGLYCEMIA ON UNDER-CARBOXYLATED OSTEOCALCIN PRODUCTION IN HUMAN PRIMARY OSTEOBLAST-LIKE CELL CULTURES. ACTA ENDOCRINOLOGICA-BUCHAREST 2018; 14:11-15. [PMID: 31149230 DOI: 10.4183/aeb.2018.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Context The undercarboxylated form of osteocalcin (ucOC) and osteoprotegerin (OPG) are bone-derived molecules involved in the endocrine crosstalk governing the bone, the adipose tissue and the pancreas. In addition, glucocorticoids are major determinants of both insulin resistance and osteoporosis. Objective We aimed to investigate the response of ucOC and OPG to dysglycemia and/or dexamethasone (DXM) in primary human osteoblastic cell (HOC) cultures. Design and methods Third-passage sub-confluent primary HOC cultures were treated with glucose: 2.8 mmol/L, 5.6 mmol/L, 11.1 mmol/L and 28 mmol/L, respectively. Alternatively, HOC cultures were subjected to DXM 1 μmol/L. In more complex experiments, HOC cultures were pre-treated with glucose (5.6 mmol/L) with/without insulin (1 pmol/L) followed by DXM (1 μmol/L). 24-hours post-treatment, culture medium ucOC and OPG were measured by ELISA. Results ucOC production differed significantly (p<0.05) between cell groups, decreasing in a dose-dependent manner as glucose concentration in the medium increased. Insulin prevented this effect. OPG levels appeared not to be significantly influenced by the hyperglycemic culture medium and were not related to ucOC concentration (p>0.05). Addition of DXM resulted in significantly lower ucOC concentrations compared to vehicle-treated cells (p<0.05). However, the effect of insulin co-treatment on ucOC was not counteracted by DXM (p<0.05). Conclusions An obvious alteration of OC production/metabolism was observed as glucose levels changed in the bone microenvironment, to potentially be involved in diabetes-related osteopenia. DXM suppressed ucOC levels however not in insulin-rich environment.
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Affiliation(s)
- A Kacso
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Department of Endocrinology, Cluj-Napoca, Romania
| | - M Goia-Socol
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Department of Endocrinology, Cluj-Napoca, Romania
| | - G Hazi
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Hormonology Laboratory, Cluj-Napoca, Romania
| | - G Tomoaia
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Department of Ortopedics and Traumatology, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Orthopedics and Traumatology Clinic, Cluj-Napoca, Romania
| | - I M Kacso
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Department of Nephrology, Cluj County Emergency Hospital - Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Nephrology Clinic, Cluj-Napoca, Romania
| | - C E Georgescu
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Department of Endocrinology, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Endocrinology Clinic, Cluj-Napoca, Romania
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Xiong Y, Zhang Y, Xin N, Yuan Y, Zhang Q, Gong P, Wu Y. 1α,25-Dihydroxyvitamin D 3 promotes bone formation by promoting nuclear exclusion of the FoxO1 transcription factor in diabetic mice. J Biol Chem 2017; 292:20270-20280. [PMID: 29042442 PMCID: PMC5724012 DOI: 10.1074/jbc.m117.796367] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/27/2017] [Indexed: 02/05/2023] Open
Abstract
1α,25-Dihydroxyvitamin D3 (1,25(OH)2D3) is the active form of vitamin D, which is responsible for reducing the risk for diabetes mellitus (DM), decreasing insulin resistance, and improving insulin secretion. Previous studies have shown that 1,25(OH)2D3 inhibited the activity of FoxO1, which has been implicated in the regulation of glucose metabolism. However, its function and mechanism of action in DM-induced energy disorders and also in bone development remains unclear. Here, using in vitro and in vivo approaches including osteoblast-specific, conditional FoxO1-knock-out mice, we demonstrate that 1,25(OH)2D3 ameliorates abnormal osteoblast proliferation in DM-induced oxidative stress conditions and rescues the impaired glucose and bone metabolism through FoxO1 nuclear exclusion resulting from the activation of PI3K/Akt signaling. Using alizarin red staining, alkaline phosphatase assay, Western blot, and real-time qPCR techniques, we found that 1,25(OH)2D3 promotes osteoblast differentiation and expression of osteogenic phenotypic markers (i.e. alkaline phosphatase (1), collagen 1 (COL-1), osteocalcin (OCN), and osteopontin (OPN)) in a high-glucose environment. Moreover, 1,25(OH)2D3 increased both total OCN secretion and levels of uncarboxylated OCN (GluOC) by phosphorylating FoxO1 and promoting its nuclear exclusion, indicated by Western blot and cell immunofluorescence analyses. Taken together, our findings confirm that FoxO1 is a key mediator involved in glucose homeostasis and indicate that 1,25(OH)2D3 improves glucose metabolism and bone development via regulation of PI3K/Akt/FoxO1/OCN pathway.
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Affiliation(s)
- Yi Xiong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China; Department of Implantology, Chengdu 610041, China
| | - Yixin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China; Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Na Xin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China; Department of Implantology, Chengdu 610041, China
| | - Ying Yuan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China; Department of Implantology, Chengdu 610041, China
| | - Qin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China; Department of Implantology, Chengdu 610041, China
| | - Ping Gong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China; Department of Implantology, Chengdu 610041, China.
| | - Yingying Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China; Department of Implantology, Chengdu 610041, China.
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73
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Xiong Y, Zhang Y, Guo Y, Yuan Y, Guo Q, Gong P, Wu Y. 1α,25-Dihydroxyvitamin D3 increases implant osseointegration in diabetic mice partly through FoxO1 inactivation in osteoblasts. Biochem Biophys Res Commun 2017; 494:626-633. [DOI: 10.1016/j.bbrc.2017.10.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/05/2017] [Indexed: 01/08/2023]
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74
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Iki M, Fujita Y, Kouda K, Yura A, Tachiki T, Tamaki J, Winzenrieth R, Sato Y, Moon JS, Okamoto N, Kurumatani N. Hyperglycemia is associated with increased bone mineral density and decreased trabecular bone score in elderly Japanese men: The Fujiwara-kyo osteoporosis risk in men (FORMEN) study. Bone 2017; 105:18-25. [PMID: 28821456 DOI: 10.1016/j.bone.2017.08.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/18/2017] [Accepted: 08/15/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Patients with type 2 diabetes mellitus (T2DM) have an increased fracture risk despite having higher areal bone mineral density (aBMD). This study aimed to clarify the association between glycemic and insulin resistance status and bone microarchitecture, and whether pentosidine and bone turnover markers play any roles in the association. METHODS A total of 2012 community-dwelling men aged ≥65years completed baseline measurements of spine aBMD, fasting plasma glucose (FPG) and serum insulin, hemoglobin A1c (HbA1c), osteocalcin, type I procollagen N-terminal propeptide, type I collagen C-terminal crosslinking telopeptide, tartrate-resistant acid phosphatase isoenzyme 5b, pentosidine, height and weight and an interview regarding past disease history. Homeostasis model assessment-insulin resistance (HOMA-IR) was also calculated. T2DM was defined as physician-diagnosed middle age or elderly-onset diabetes mellitus, or according to biochemical test results. To evaluate bone microarchitecture, trabecular bone score (TBS) was calculated at the same vertebrae as those used for aBMD measurement. RESULTS After excluding participants who had a disease history and/or were taking medications affecting bone metabolism, 1683 men (age, 72.9±5.2years) were analyzed. Men with T2DM had significantly higher aBMD compared to those without T2DM. There was no significant difference in TBS. However, FPG, HbA1c and HOMA-IR levels were significantly inversely correlated with TBS after adjusting for age, BMI and aBMD. Multivariate linear regression analyses revealed that glycemic indices (FPG and HbA1c) were significantly associated with increased aBMD and decreased TBS, and that HOMA-IR was associated only with TBS. These associations did not change after further adjusting for bone turnover makers and pentosidine levels. CONCLUSIONS Hyperglycemia and elevated insulin-resistance were associated with low TBS independently of bone turnover and pentosidine levels.
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Affiliation(s)
- Masayuki Iki
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan.
| | - Yuki Fujita
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Katsuyasu Kouda
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Akiko Yura
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Takahiro Tachiki
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Junko Tamaki
- Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Renaud Winzenrieth
- Medimaps, Parc d'activités Kennedy Bâtiment F, 5 Avenue Henri Becquerel, 33700 Mérignac, France
| | - Yuho Sato
- Department of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui 915-8586, Japan
| | - Jong-Seong Moon
- Department of Nursing, Kio University, 4-2-2 Umami-naka, Koryo-cho, Nara 365-0832, Japan
| | - Nozomi Okamoto
- Department of Epidemiology and Preventive Medicine, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara 634-8521, Japan
| | - Norio Kurumatani
- Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara 634-8521, Japan
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75
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Xiong Y, Zhang Y, Xin N, Yuan Y, Zhang Q, Gong P, Wu Y. 1α,25-Dihydroxyvitamin D 3 promotes osteogenesis by promoting Wnt signaling pathway. J Steroid Biochem Mol Biol 2017; 174:153-160. [PMID: 28859991 DOI: 10.1016/j.jsbmb.2017.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/23/2017] [Accepted: 08/26/2017] [Indexed: 02/05/2023]
Abstract
Diabetes mellitus (DM) remarkably affects bone metabolism and causes multiple skeletal disorders, which are associated with the increased oxidative stress that activates Forkhead family of transcription factors (FoxOs). 1α,25-Dihydroxy vitamin D3 (1,25(OH)2D3), the hormonally active form of vitamin D, plays a potential role in the prevention of glucose tolerance. However, its mechanism of action in high glucose-induced energy disorders remains unclear. In vitro study shows that 1,25(OH)2D3 promotes osteogenesis in high glucose-induced oxidative stress mainly results from increased osteoblasts proliferation and decreased apoptosis. Cells treated with 1,25(OH)2D3 exhibit an increased osteogenic differentiation capacity and an elevated level of osteogenic phenotype (i.e. alkaline phosphatase, collagen 1, osteocalcin, and osteopontin). We also found that the effect of 1,25(OH)2D3 on osteogenesis is achieved by FoxO1 inactivation and nuclear exclusion through PI3K/Akt pathway in a time- and dose-dependent manner. Moreover, the diversion of β-catenin from FoxO1- to Wnt/TCF4-mediated transcription was indirectly promoted by the inactivation of FoxO1. These data together reveals that the activated Wnt/β-catenin signaling is involved in the regulatory action of 1,25(OH)2D3 on osteogenesis in oxidative stress. This study also provides a novel understanding of the effect of 1,25(OH)2D3 on skeleton in oxidative stress condition.
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Affiliation(s)
- Yi Xiong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yixin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Na Xin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ying Yuan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ping Gong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yingying Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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76
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Hussein RM. Biochemical relationships between bone turnover markers and blood glucose in patients with type 2 diabetes mellitus. Diabetes Metab Syndr 2017; 11 Suppl 1:S369-S372. [PMID: 28283396 DOI: 10.1016/j.dsx.2017.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with type 2 diabetes mellitus develop many complications including osteopenia, which is associated with high fracture risk. Osteocalcin is a non collagenous protein derived from the osteoblasts. Recently, it was found that osteocalcin enhances the pancreatic beta cell proliferation, insulin secretion and protection against type 2 diabetes. OBJECTIVE Investigation of the association of serum osteocalcin and other bone turnover markers with blood glucose level and diabetes mellitus duration in type 2 diabetic patients. SUBJECTS AND METHODS Twenty diagnosed type 2 diabetic patients together with 20 healthy controls were enrolled in this study. Serum osteocalcin, alkaline phosphatase activity and calcium concentrations were measured by commercial ELISA kits. RESULTS The results showed that type 2 diabetic patients exhibited a significantly lower serum osteocalcin and calcium (p=0.0001 and 0.002 respectively) and a higher alkaline phosphatase (p=0.008) compared to the controls. Multiple linear regression analysis revealed that serum osteocalcin was inversely associated with fasting blood glucose and Diabetes Mellitus duration (β=- 0.018; p=0.007 and β=- 0.085; p=0.014 respectively) in Type 2 diabetic patients. In addition, alkaline phosphatase was positively associated (β=0.828; p=0.015) while serum calcium was negatively associated (β=- 0.046; p=0.048) with Diabetes Mellitus duration. CONCLUSION These results refer to the strong association between diabetes and bone turnover markers and call for monitoring of diabetes-associated osteopenia in type 2 diabetic patients.
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Affiliation(s)
- Rasha M Hussein
- Department of Biochemistry, Faculty of Pharmacy, Beni-Suef University, Salah Salem Street, 62511, Beni-Suef, Egypt.
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77
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Rubin MR. Skeletal fragility in diabetes. Ann N Y Acad Sci 2017; 1402:18-30. [PMID: 28926113 DOI: 10.1111/nyas.13463] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 02/06/2023]
Abstract
Fracture risk is heightened in patients with both type 1 diabetes (T1D) and type 2 diabetes (T2D). Although bone mineral density by dual-energy X-ray absorptiometry is decreased in T1D, it is paradoxically increased with T2D. To predict fracture risk, the Fracture Risk Assessment Tool (FRAX) can be used in diabetes patients, albeit with refinement. Skeletal abnormalities in diabetes include alterations in microarchitecture in T1D and T2D as well as compromised impact microindentation in T2D. Changes in bone microvasculature, advanced glycation end product accumulation, and bone formation may underlie these findings. When fractures occur in T1D and T2D, consequences are worse than in nondiabetic patients with regard to both morbidity and mortality. With regard to treatment, antiresorptive osteoporosis therapies appear to be effective in the setting of diabetes.
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Affiliation(s)
- Mishaela R Rubin
- Metabolic Bone Disease Unit, Columbia University, New York, New York
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78
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Lin HF, Liao KF, Chang CM, Lin CL, Lin CH, Lai SW. Use of thiazolidinediones and risk of hip fracture in old people in a case-control study in Taiwan. Medicine (Baltimore) 2017; 96:e7712. [PMID: 28885328 PMCID: PMC6392959 DOI: 10.1097/md.0000000000007712] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Little research is available on the association between use of thiazolidinediones and hip fracture in old people in Taiwan. We conducted a population-based case-control study to examine this issue.Using the database of the Taiwan National Health Insurance Program, we identified 603 type 2 diabetic subjects 65 years or older in age with newly diagnosed hip fracture in 2000 to 2013 as cases. We randomly selected 603 type 2 diabetic subjects 65 years or older without hip fracture as the controls. Both cases and controls were matched with sex, age, comorbidities, and index year of diagnosing hip fracture. Current use of thiazolidinediones was defined as subjects whose last remaining one tablet of thiazolidinediones was noted ≤30 days before the date of diagnosing hip fracture. Never use of thiazolidinediones was defined as subjects who never had a prescription of thiazolidinediones. The odds ratio (OR) and 95% confidence interval (CI) for hip fracture associated with thiazolidinediones use was estimated by the multivariable unconditional logistic regression analysis.After adjustment for covariables, the multivariable logistic regression analysis revealed that the adjusted OR of hip fracture was 1.64 for subjects with current use of thiazolidinediones (95% CI 1.01, 2.67), when compared with subjects with never use of thiazolidinediones.Our findings suggest that current use of thiazolidinediones is associated with a 64% higher risk of hip fracture in type 2 diabetic old people in Taiwan. Clinicians should consider the possibility of thiazolidinediones-associated hip fracture among type 2 diabetic old people currently using thiazolidinediones.
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Affiliation(s)
- Hsien-Feng Lin
- School of Chinese Medicine
- Department of Family Medicine, China Medical University Hospital, Taichung
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung
- College of Medicine, Tzu Chi University, Hualien
- Graduate Institute of Integrated Medicine, China Medical University Hospital, Taichung
| | - Ching-Mei Chang
- Department of Nursing, Tungs’ Taichung Metro Harbor Hospital, Taichung
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung
- College of Medicine, China Medical University, Taichung
| | - Shih-Wei Lai
- Department of Family Medicine, China Medical University Hospital, Taichung
- College of Medicine, China Medical University, Taichung
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79
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Carvalho AL, DeMambro VE, Guntur AR, Le P, Nagano K, Baron R, de Paula FJA, Motyl KJ. High fat diet attenuates hyperglycemia, body composition changes, and bone loss in male streptozotocin-induced type 1 diabetic mice. J Cell Physiol 2017. [PMID: 28631813 DOI: 10.1002/jcp.26062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There is a growing and alarming prevalence of obesity and the metabolic syndrome in type I diabetic patients (T1DM), particularly in adolescence. In general, low bone mass, higher fracture risk, and increased marrow adipose tissue (MAT) are features of diabetic osteopathy in insulin-deficient subjects. On the other hand, type 2 diabetes (T2DM) is associated with normal or high bone mass, a greater risk of peripheral fractures, and no change in MAT. Therefore, we sought to determine the effect of weight gain on bone turnover in insulin-deficient mice. We evaluated the impact of a 6-week high-fat (HFD) rich in medium chain fatty acids or low-fat diet (LFD) on bone mass and MAT in a streptozotocin (STZ)-induced model using male C57BL/6J mice at 8 weeks of age. Dietary intervention was initiated after diabetes confirmation. At the endpoint, lower non-fasting glucose levels were observed in diabetic mice fed with high fat diet compared to diabetic mice fed the low fat diet (STZ-LFD). Compared to euglycemic controls, the STZ-LFD had marked polydipsia and polyphagia, as well as reduced lean mass, fat mass, and bone parameters. Interestingly, STZ-HFD mice had higher bone mass, namely less cortical bone loss and more trabecular bone than STZ-LFD. Thus, we found that a HFD, rich in medium chain fatty acids, protects against bone loss in a T1DM mouse model. Whether this may also translate to T1DM patients who are overweight or obese in respect to maintenance of bone mass remains to be determined through longitudinal studies.
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Affiliation(s)
- Adriana Lelis Carvalho
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine.,Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Victoria E DeMambro
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine
| | - Anyonya R Guntur
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine
| | - Phuong Le
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine
| | - Kenichi Nagano
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts
| | - Roland Baron
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts
| | | | - Katherine J Motyl
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine.,Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, Maine
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80
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Gu PY, Yu F, Jin S, Yang Q, Su J, Chen Y, Zhao L, Hu SL. Analysis of serum undercarboxylated osteocalcin level in rats with type 2 diabetes mellitus and the correlation with cognitive impairment. Exp Ther Med 2017; 14:2603-2607. [PMID: 28962201 PMCID: PMC5609217 DOI: 10.3892/etm.2017.4838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/13/2017] [Indexed: 01/21/2023] Open
Abstract
The aim of the study was to investigate the correlation between the serum undercarboxylated osteocalcin (ucOC) level and the blood biochemistry and cognitive impairment in rats with type 2 diabetes mellitus (T2DM). Sprague-Dawley (SD) rats were randomly divided into the normal control group (NC) and type 2 DM group. DM group received the high-fat and high-sugar diet combined with the intraperitoneal injection of low-dose STZ to establish the type 2 DM rat model. After 12 weeks of feeding, a Morris water maze was used to observe the rats' cognitive ability, and the levels of blood lipid, ucOC, insulin and adiponectin in the two groups were measured. The results showed that blood glucose of rats in DM group was increased significantly at 2–12 weeks (p<0.01) and the body weight was significantly increased at 4–12 weeks (p<0.01). The levels of serum triglyceride (TG), total cholesterol, low-density lipoprotein and insulin in rats in DM group were significantly increased compared with those in NC group (p<0.01) and the levels of high-density lipoprotein, adiponectin and ucOC were significantly decreased compared with those in the NC group (p<0.01). The place navigation and spatial exploration capacities of rats in DM group were significantly decreased compared with those in NC group (p<0.01). In the DM group, the place navigation and spatial exploration capacities of rats in the low ucOC group were significantly decreased compared with those in the high ucOC group (p<0.01). Additionally, single-factor correlation analysis revealed that ucOC was negatively correlated with blood glucose, TG and escape latency (p<0.01), but was positively correlated with adiponectin, residence time in target quadrant and traversing times (p<0.05 or p<0.01). In conclusion, the decreased serum ucOC level in rats with type 2 diabetes mellitus has a certain correlation with cognitive impairment.
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Affiliation(s)
- Peng-Ying Gu
- Department of Geriatric Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Feng Yu
- Department of Neurology, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Song Jin
- Department of Geriatric Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Qian Yang
- Department of Geriatric Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Jing Su
- Department of Geriatric Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Yan Chen
- Department of Endocrine Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Liang Zhao
- Department of Clinical Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Shi-Lian Hu
- Department of Geriatric Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
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81
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Raisingani M, Preneet B, Kohn B, Yakar S. Skeletal growth and bone mineral acquisition in type 1 diabetic children; abnormalities of the GH/IGF-1 axis. Growth Horm IGF Res 2017; 34:13-21. [PMID: 28482269 PMCID: PMC5516798 DOI: 10.1016/j.ghir.2017.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/23/2017] [Accepted: 04/27/2017] [Indexed: 12/29/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases diagnosed in childhood. Childhood and adolescent years are also the most important period for growth in height and acquisition of skeletal bone mineral density (BMD). The growth hormone (GH)/insulin like growth factor -1 (IGF-1) axis which regulates growth, is affected by T1DM, with studies showing increased GH and decreased IGF-1 levels in children with T1DM. There is conflicting data as to whether adolescents with TIDM are able to achieve their genetically-determined adult height. Furthermore, data support that adolescents with T1DM have decreased peak BMD, although the pathophysiology of which has not been completely defined. Various mechanisms have been proposed for the decrease in BMD including low osteocalcin levels, reflecting decreased bone formation; increased sclerostin, an inhibitor of bone anabolic pathways; and increased leptin, an adipocytokine which affects bone metabolism via central and peripheral mechanisms. Other factors implicated in the increased bone resorption in T1DM include upregulation of the osteoprotegerin/ receptor-activator of the nuclear factor-κB ligand pathway, elevated parathyroid hormone levels, and activation of other cytokines involved in chronic systemic inflammation. In this review, we summarize the clinical studies that address the alterations in the GH/IGF-I axis, linear growth velocity, and BMD in children and adolescents with T1DM; and we review the possible molecular mechanisms that may contribute to an attenuation of linear growth and to the reduction in the acquisition of peak bone mass in the child and adolescent with T1DM.
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Affiliation(s)
- Manish Raisingani
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York University School of Medicine, New York, NY 10016, United States
| | - Brar Preneet
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York University School of Medicine, New York, NY 10016, United States
| | - Brenda Kohn
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York University School of Medicine, New York, NY 10016, United States
| | - Shoshana Yakar
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, NY 10010-4086, United States.
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82
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Chen Y, Hu Y, Yang L, Zhou J, Tang Y, Zheng L, Qin P. Runx2 alleviates high glucose-suppressed osteogenic differentiation via PI3K/AKT/GSK3β/β-catenin pathway. Cell Biol Int 2017; 41:822-832. [PMID: 28462510 DOI: 10.1002/cbin.10779] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/23/2017] [Indexed: 01/18/2023]
Abstract
Hyperglycemia is one of the most important pathogenesis of diabetic osteopathy. Several lines of studies indicate Runx2 plays a critical role in the process of osteogenic differentiation. However, little studies have analyzed the effect of Runx2 on osteoblast differentiation of rat bone mesenchymal stem cells (rBMSCs) in high-glucose condition. In this study, the effect of Runx2 on osteoblast differentiation in high-glucose condition was evaluated by the expression of osteogenesis-related maker including Runx2, ALP, OC, and OPN, as well as ALP staining, ALP activity, and Alizarin red S staining. Western blot analysis was performed to detect the protein expression levels of p-AKT, AKT, p-GSK3β, GSK3β, and β-catenin. Immunofluorescence staining analysis was performed to detect subcellular localization of β-catenin. Our results revealed that high glucose significantly inhibited osteogenic differentiation, hyperosmolarity did not cause a suppression. In addition, Runx2 could upregulate the expression of osteogenic-related genes and increase matrix mineralization, while applying 10 µM PI3K/AKT inhibitor LY294002 abolished the beneficial effect. Collectively, these results indicate that Runx2 alleviates high glucose-induced inhibition of osteoblast differentiation by modulating PI3K/AKT/GSK3β/β-catenin pathway.
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Affiliation(s)
- Yang Chen
- College of Stomatology, Chongqing Medical University, Chongqing, 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Yun Hu
- College of Stomatology, Chongqing Medical University, Chongqing, 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Lan Yang
- College of Stomatology, Chongqing Medical University, Chongqing, 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Jie Zhou
- College of Stomatology, Chongqing Medical University, Chongqing, 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Yuying Tang
- College of Stomatology, Chongqing Medical University, Chongqing, 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Leilei Zheng
- College of Stomatology, Chongqing Medical University, Chongqing, 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Pu Qin
- College of Stomatology, Chongqing Medical University, Chongqing, 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
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83
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Maycas M, Portolés MT, Matesanz MC, Buendía I, Linares J, Feito MJ, Arcos D, Vallet-Regí M, Plotkin LI, Esbrit P, Gortázar AR. High glucose alters the secretome of mechanically stimulated osteocyte-like cells affecting osteoclast precursor recruitment and differentiation. J Cell Physiol 2017; 232:3611-3621. [PMID: 28138960 DOI: 10.1002/jcp.25829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 02/05/2023]
Abstract
Diabetes mellitus (DM) induces bone deterioration, while mechanical stimulation promotes osteocyte-driven bone formation. We aimed to evaluate the interaction of acute exposure (24 h) to high glucose (HG) with both the pro-survival effect conferred to osteocytic MLO-Y4 cells and osteoblastic MC3T3-E1 cells by mechanical stimulation and the interaction of these cells with osteoclast precursor RAW264.7 cells. We found that 24 h of HG (25 mM) pre-exposure prevented both cell survival and ERK and β-catenin nuclear translocation upon mechanical stimulation by fluid flow (FF) (10 min) in both MLO-Y4 and MC3T3-E1 cells. However, migration of RAW 264.7 cells was inhibited by MLO-Y4 cell-conditioned medium (CM), but not by MC3T3-E1 cell-CM, with HG or FF. This inhibitory effect was associated with consistent changes in VEGF, RANTES, MIP-1α, MIP-1β MCP-1, and GM-CSF in MLO-Y4 cell-CM. RAW264.7 proliferation was inhibited by MLO-Y4 CM under static or HG conditions, but it increased by FF-CM with or without HG. In addition, both FF and HG abrogated the capacity of RAW 264.7 cells to differentiate into osteoclasts, but in a different manner. Thus, HG-CM in static condition allowed formation of osteoclast-like cells, which were unable to resorb hydroxyapatite. In contrast, FF-CM prevented osteoclastogenesis even in HG condition. Moreover, HG did not affect basal RANKL or IL-6 secretion or their inhibition induced by FF in MLO-Y4 cells. In conclusion, this in vitro study demonstrates that HG exerts disparate effects on osteocyte mechanotransduction, and provides a novel mechanism by which DM disturbs skeletal metabolism through altered osteocyte-osteoclast communication.
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Affiliation(s)
- Marta Maycas
- Laboratorio de Metabolismo Mineral y Óseo, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - María Teresa Portolés
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Biología Molecular I, UCM, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - María Concepción Matesanz
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Biología Molecular I, UCM, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Irene Buendía
- IMMA- Facultad de Medicina, Universidad San Pablo CEU, Boadilla del Monte, Madrid, Spain
| | - Javier Linares
- Facultad de Farmacia, Departamento de Química Inorgánica y Bioinorgánica, UCM, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (i + 12) CIBER-BBN, Madrid, Spain
| | - María José Feito
- Facultad de Farmacia, Departamento de Química Inorgánica y Bioinorgánica, UCM, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (i + 12) CIBER-BBN, Madrid, Spain
| | - Daniel Arcos
- Facultad de Farmacia, Departamento de Química Inorgánica y Bioinorgánica, UCM, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (i + 12) CIBER-BBN, Madrid, Spain
| | - María Vallet-Regí
- Facultad de Farmacia, Departamento de Química Inorgánica y Bioinorgánica, UCM, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (i + 12) CIBER-BBN, Madrid, Spain
| | - Lilian I Plotkin
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana.,Roudebush Veterans Administration Medical Center, Indianapolis, Indiana.,Indiana Center for Musculoskeletal Health, Indianapolis, Indiana
| | - Pedro Esbrit
- Laboratorio de Metabolismo Mineral y Óseo, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Arancha R Gortázar
- IMMA- Facultad de Medicina, Universidad San Pablo CEU, Boadilla del Monte, Madrid, Spain
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84
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Napoli N, Chandran M, Pierroz DD, Abrahamsen B, Schwartz AV, Ferrari SL. Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol 2017; 13:208-219. [PMID: 27658727 DOI: 10.1038/nrendo.2016.153] [Citation(s) in RCA: 595] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The risk of fragility fractures is increased in patients with either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Although BMD is decreased in T1DM, BMD in T2DM is often normal or even slightly elevated compared with an age-matched control population. However, in both T1DM and T2DM, bone turnover is decreased and the bone material properties and microstructure of bone are altered; the latter particularly so when microvascular complications are present. The pathophysiological mechanisms underlying bone fragility in diabetes mellitus are complex, and include hyperglycaemia, oxidative stress and the accumulation of advanced glycation endproducts that compromise collagen properties, increase marrow adiposity, release inflammatory factors and adipokines from visceral fat, and potentially alter the function of osteocytes. Additional factors including treatment-induced hypoglycaemia, certain antidiabetic medications with a direct effect on bone and mineral metabolism (such as thiazolidinediones), as well as an increased propensity for falls, all contribute to the increased fracture risk in patients with diabetes mellitus.
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Affiliation(s)
- Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro di Portillo 21, 00128 Roma, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, Missouri, USA
- Diabetes and Bone Network
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Outram Road, 169608 Singapore
| | - Dominique D Pierroz
- International Osteoporosis Foundation (IOF), Rue Juste-Olivier 9, 1260 Nyon, Switzerland
| | - Bo Abrahamsen
- University of Southern Denmark, Department of Medicine, Faculty of Health, Holbaek Hospital, Holbaek, Denmark
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California, 550 16th Street, San Francisco, California 94158, USA
| | - Serge L Ferrari
- Service of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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85
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Hazell TJ, Olver TD, Kowalchuk H, McDonald MW, Dey A, Grisé KN, Noble EG, Melling CWJ, Lavery P, Weiler HA. Aerobic Endurance Training Does Not Protect Bone Against Poorly Controlled Type 1 Diabetes in Young Adult Rats. Calcif Tissue Int 2017; 100:374-381. [PMID: 28110443 DOI: 10.1007/s00223-016-0227-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/20/2016] [Indexed: 02/06/2023]
Abstract
Streptozotocin (STZ)-induced type 1 diabetes mellitus (T1DM) decreases trabecular bone volume and bone strength in rodents. The current study investigated the potential protective effects of aerobic endurance training (AET) on bone in STZ-induced T1DM young adult rats. Sixty-four 8-week-old male Sprague-Dawley rats were randomly divided into 4 groups of 16: control non-T1DM sedentary (CS) and exercised (CX), T1DM sedentary (DS) and exercised (DX). Blood glucose was maintained at 9-15 mmol/L using subcutaneously implanted insulin pellets (Linplant, Linshin Canada, Inc.). AET was performed at ~75-85% VO2max for 1 h/day, 5 day/week for 10 weeks. Areal and volumetric bone mineral density (aBMD and vBMD; excised femur) were measured using dual-energy X-ray absorptiometry (DXA; QDR 4500A) and micro computed tomography (μCT; Aloka). Bone strength was tested using a 3-point bending test (Instron 5544 Load Frame). Two-way ANOVA was used to test for T1DM and exercise differences followed by Tukey's HSD tests for interaction effects; significance was set at P < 0.05. T1DM had lower body weight (18.0%), aBMD (8.6%), cortical vBMD (1.6%), trabecular vBMD (2.1%), maximum load at break (22.2%), and increased elastic modulus (11.3%) vs. control (P < 0.001). Exercise in T1DM further decreased body weight (4.7%) vs. sedentary (P = 0.043) and maximum extension during the bending test that demonstrated DX was increased (7.3%) vs. CX (P = 0.033). There were no other beneficial effects of exercise on bone. These results suggest that 10 weeks of AET in rats do not have protective effects on bone in the short term and that T1DM rats have compromised bone health.
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Affiliation(s)
- Tom J Hazell
- Department of Kinesiology and Physical Education, Faculty Science, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada.
| | - T Dylan Olver
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, N6G 1AH, Canada
| | - Hana Kowalchuk
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, N6G 1AH, Canada
| | - Matthew W McDonald
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, N6G 1AH, Canada
| | - Adwitia Dey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, N6G 1AH, Canada
| | - Kenneth N Grisé
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, N6G 1AH, Canada
| | - Earl G Noble
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, N6G 1AH, Canada
| | - C W James Melling
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, N6G 1AH, Canada
| | - Paula Lavery
- School of Dietetics and Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Ste-Anne-de-Bellevue, QC, H9X 2E3, Canada
| | - Hope A Weiler
- School of Dietetics and Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Ste-Anne-de-Bellevue, QC, H9X 2E3, Canada
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86
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Faienza MF, Ventura A, Delvecchio M, Fusillo A, Piacente L, Aceto G, Colaianni G, Colucci S, Cavallo L, Grano M, Brunetti G. High Sclerostin and Dickkopf-1 (DKK-1) Serum Levels in Children and Adolescents With Type 1 Diabetes Mellitus. J Clin Endocrinol Metab 2017; 102:1174-1181. [PMID: 28388723 DOI: 10.1210/jc.2016-2371] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/07/2016] [Indexed: 12/28/2022]
Abstract
CONTEXT Childhood type 1 diabetes mellitus (T1DM) is associated with decreased bone mass. Sclerostin and dickkopf-1 (DKK-1) are Wnt inhibitors that regulate bone formation. OBJECTIVE To evaluate sclerostin and DKK-1 levels in T1DM children and to analyze the influence of glycemic control on bone health. DESIGN AND SETTING Cross-sectional study conducted at a clinical research center. PARTICIPANTS One hundred and six T1DM subjects (12.2 ± 4 years), 66 on multiple daily injections (MDIs) and 40 on continuous subcutaneous infusion of insulin (CSII), and 80 controls. RESULTS The average bone transmission time (BTT) and amplitude-dependent speed of sound (AD-SoS) z scores were lower in patients with diabetes than in controls. Significantly increased DKK-1 (3593 ± 1172 vs 2652 ± 689 pg/mL; P < 0.006) and sclerostin (29.45 ± 12.32 vs 22.53 ± 8.29; P < 0.001) levels were found in patients with diabetes with respect to controls, particularly in patients on MDI compared with ones on CSII. Glycemic control was improved in CSII patients compared with MDI ones (P < 0.001) and was also associated with significantly higher BMI-SDS (P < 0.002) and BTT z scores (P < 0.02). With adjustment for age, multiple linear regression analysis of DKK-1 and sclerostin as dependent variables showed that levels of glycated hemoglobin, glucose, 25(OH) vitamin D, osteocalcin, and parathyroid hormone; years of diabetes; and BMI-SDS and AD-SoS z score were the most important predictors (P < 0.0001). CONCLUSIONS Our study highlighted (1) the high serum levels of DKK-1 and sclerostin in T1DM children and their relationship with altered glycemic control and (2) the effect of CSII on improvement of glycemic control and bone health in T1DM children.
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Affiliation(s)
| | - Annamaria Ventura
- Departments of Biomedical Science and Human Oncology, Pediatric Unit, and
| | | | - Anna Fusillo
- Departments of Biomedical Science and Human Oncology, Pediatric Unit, and
| | - Laura Piacente
- Departments of Biomedical Science and Human Oncology, Pediatric Unit, and
| | - Gabriella Aceto
- Departments of Biomedical Science and Human Oncology, Pediatric Unit, and
| | - Graziana Colaianni
- Basic and Medical Sciences, Neurosciences and Sense Organs, Section of Human Anatomy and Histology, University of Bari A. Moro, 70124 Bari, Italy
| | - Silvia Colucci
- Basic and Medical Sciences, Neurosciences and Sense Organs, Section of Human Anatomy and Histology, University of Bari A. Moro, 70124 Bari, Italy
| | - Luciano Cavallo
- Departments of Biomedical Science and Human Oncology, Pediatric Unit, and
| | - Maria Grano
- Department of Emergency and Organ Transplantation, University of Bari A. Moro, 70121 Bari, Italy
| | - Giacomina Brunetti
- Basic and Medical Sciences, Neurosciences and Sense Organs, Section of Human Anatomy and Histology, University of Bari A. Moro, 70124 Bari, Italy
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87
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Abstract
PURPOSE OF REVIEW The objective of this literature review is to determine whether there are indications that microvascular complications occur in diabetic bone. Evidence definitively linking diabetic skeletal fragility with microvascular complications in bone remains elusive. RECENT FINDINGS Circumstantial evidence, some recent and some lost to time, suggests that atherosclerotic vascular diseases such as peripheral arterial disease cause poor blood perfusion of bone and subsequent hypoxia and contribute to low bone density and high cortical porosity, patterns similar to some recently observed in diabetic subjects. Evidence also exists to suggest that potentially anti-angiogenic conditions, such as impaired vascular endothelial growth factor (VEGF) signaling, predominate in diabetic bone. Microvascular complications may contribute, in part, to diabetic skeletal fragility but data supporting this interpretation are primarily circumstantial at this time. This review highlights gaps in our knowledge and hopefully spurs further discussions and research on this topic.
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Affiliation(s)
- Roberto Jose Fajardo
- Department of Orthopaedics, University of Texas Health Science Center at San Antonio, Med 518C, 7703 Floyd Curl Dr., San Antonio, TX, 78229, USA.
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88
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Sundararaghavan V, Mazur MM, Evans B, Liu J, Ebraheim NA. Diabetes and bone health: latest evidence and clinical implications. Ther Adv Musculoskelet Dis 2017; 9:67-74. [PMID: 28344668 DOI: 10.1177/1759720x16687480] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
As the prevalence of diabetes is increasing worldwide, research on some of the lesser-known effects, including impaired bone health, are gaining a lot of attention. The two most common forms of diabetes are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). These two differ in their physiology, with T1DM stemming from an inability to produce insulin, and T2DM involving an insufficient response to the insulin that is produced. This review aims to highlight the most current information regarding diabetes as it relates to bone health. It looks at biochemical changes that characterize diabetic bone; notably increased adiposity, altered bone metabolism, and variations in bone mineral density (BMD). Then several hypotheses are analyzed, concerning how these changes may be detrimental to the highly orchestrated processes that are involved in bone formation and turnover, and ultimately result in the distinguishing features of diabetic bone. The review proceeds by explaining the effects of antidiabetes medications on bone health, then highlighting several ways that diabetes can play a part in other clinical treatment outcomes. With diabetes negatively affecting bone health and creating other clinical problems, and its treatment options potentiating these effects, physicians should consider the use of anti-osteoporotic drugs to supplement standard anti-diabetes medications in patients suffering with diabetic bone loss.
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Affiliation(s)
| | - Matthew M Mazur
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Brad Evans
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Jiayong Liu
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, USA
| | - Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
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89
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Kalaitzoglou E, Popescu I, Bunn RC, Fowlkes JL, Thrailkill KM. Effects of Type 1 Diabetes on Osteoblasts, Osteocytes, and Osteoclasts. Curr Osteoporos Rep 2016; 14:310-319. [PMID: 27704393 PMCID: PMC5106298 DOI: 10.1007/s11914-016-0329-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW To describe the effects of type 1 diabetes on bone cells. RECENT FINDINGS Type 1 diabetes (T1D) is associated with low bone mineral density, increased risk of fractures, and poor fracture healing. Its effects on the skeleton were primarily attributed to impaired bone formation, but recent data suggests that bone remodeling and resorption are also compromised. The hyperglycemic and inflammatory environment associated with T1D impacts osteoblasts, osteocytes, and osteoclasts. The mechanisms involved are complex; insulinopenia, pro-inflammatory cytokine production, and alterations in gene expression are a few of the contributing factors leading to poor osteoblast activity and survival and, therefore, poor bone formation. In addition, the observed sclerostin level increase accompanied by decreased osteocyte number and enhanced osteoclast activity in T1D results in uncoupling of bone remodeling. T1D negatively impacts osteoblasts and osteocytes, whereas its effects on osteoclasts are not well characterized, although the limited studies available indicate increased osteoclast activity, favoring bone resorption.
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Affiliation(s)
- Evangelia Kalaitzoglou
- UK Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, 830 S. Limestone St., Lexington, KY, 40536, USA.
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, 40536, USA.
| | - Iuliana Popescu
- UK Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, 830 S. Limestone St., Lexington, KY, 40536, USA
| | - R Clay Bunn
- UK Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, 830 S. Limestone St., Lexington, KY, 40536, USA
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - John L Fowlkes
- UK Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, 830 S. Limestone St., Lexington, KY, 40536, USA
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - Kathryn M Thrailkill
- UK Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, 830 S. Limestone St., Lexington, KY, 40536, USA
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
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90
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Bortolin RH, Freire Neto FP, Arcaro CA, Bezerra JF, Silva FS, Ururahy MAG, Souza KSDC, Lima VMGDM, Luchessi AD, Lima FP, Lia Fook MV, Silva BJ, Almeida MDG, Abreu BJ, Rezende LA, Rezende AA. Anabolic Effect of Insulin Therapy on the Bone:
Osteoprotegerin
and
Osteocalcin
Up‐Regulation in Streptozotocin‐Induced Diabetic Rats. Basic Clin Pharmacol Toxicol 2016; 120:227-234. [DOI: 10.1111/bcpt.12672] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/01/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Raul Hernandes Bortolin
- Department of Clinical and Toxicological Analyses Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | | | - Carlos Alberto Arcaro
- Department of Clinical Analyses São Paulo State University Araraquara São Paulo Brazil
| | - João Felipe Bezerra
- Department of Clinical and Toxicological Analyses Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Flávio Santos Silva
- Department of Morphology Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Marcela Abbott Galvão Ururahy
- Department of Clinical and Toxicological Analyses Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Karla Simone da Costa Souza
- Department of Clinical and Toxicological Analyses Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | | | - André Ducati Luchessi
- Department of Clinical and Toxicological Analyses Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Francisco Pignataro Lima
- Department of Clinical Pathology Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Marcus Vinicius Lia Fook
- Laboratory of Evaluation and Development of Biomaterials Federal University of Campina Grande Campina Grande Paraíba Brazil
| | - Bartolomeu Jorge Silva
- Laboratory of Evaluation and Development of Biomaterials Federal University of Campina Grande Campina Grande Paraíba Brazil
| | - Maria das Graças Almeida
- Department of Clinical and Toxicological Analyses Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Bento João Abreu
- Department of Morphology Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | | | - Adriana Augusto Rezende
- Department of Clinical and Toxicological Analyses Federal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
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91
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Ghodsi M, Larijani B, Keshtkar AA, Nasli-Esfahani E, Alatab S, Mohajeri-Tehrani MR. Mechanisms involved in altered bone metabolism in diabetes: a narrative review. J Diabetes Metab Disord 2016; 15:52. [PMID: 27891497 PMCID: PMC5111345 DOI: 10.1186/s40200-016-0275-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/01/2016] [Indexed: 02/08/2023]
Abstract
Many studies have shown that change in metabolism caused by diabetes can influence the bone metabolism in a way that quality and strength of bone is decreased. A 6 times and 2 times increased risk of fracture is reported in patients with type 1 and type 2 diabetes, respectively. There are several mechanisms by which diabetes can affect the bone. The fact that some of these mechanisms are acting in opposite ways opens the door for debate on pathways by which diabetes affects the bones. On the other hand, bone is not a simple organ that only get influence from other organs, but it is an endocrine organ that by secreting the agents such as osteocalcin, adiponectin and visfatin which can affect the insulin sensitivity and metabolism. In this paper we tried to briefly assess the latest finding in this matter.
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Affiliation(s)
- Maryam Ghodsi
- Diabetes Research Center (DRC), Endocrinology and Metabolism Research Institute (EMRI), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center (EMRC), Endocrinology and Metabolism Resarch Institute (EMRI), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abbass Ali Keshtkar
- Department of Health Sciences Education Development, School of Public Health (SPH), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center (DRC), Endocrinology and Metabolism Research Institute (EMRI), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sudabeh Alatab
- Urology Research Center (URC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Reza Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center (EMRC), Endocrinology and Metabolism Resarch Institute (EMRI), Tehran University of Medical Sciences (TUMS), Tehran, Iran
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92
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Maghbooli Z, Emamgholipour S, Hossein-Nezhad A, Shirzad M, Gorgani Firuzjaee S. Suitable bone markers assessing bone status in patients with both coronary artery disease and diabetes. J Diabetes Metab Disord 2016; 15:35. [PMID: 27602333 PMCID: PMC5012061 DOI: 10.1186/s40200-016-0259-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/28/2016] [Indexed: 01/10/2023]
Abstract
Background We aimed to investigate the bone turnover markers in coronary artery disease (CAD) patients with and without type 2 diabetes (T2DM) in comparison with control subjects without CAD and T2DM. Methods This cross-sectional study was performed on 45 subjects undergoing elective heart surgery; either for coronary artery bypass grafting or for valve surgery. According to angiographic results, participants were grouped in two groups with CAD (n = 33) and without CAD (n = 12). The serum levels of osteocalcin (OC), procollagen I aminoterminal propeptide (P1NP) and carboxy-terminal collagen crosslinks (CTX), as bone turnover markers, as well as serum levels of 25 (OH) vitamin D3, PTH, and common metabolic factors were analyzed in all participants. Results Serum levels of bone markers did not differ in patients with CAD compared to non-CAD subjects. Regarding metabolic factors, serum levels of FBG had invert correlation with OC in CAD patients (p = 0.004). The data of subgroup analysis showed serum levels of OC and CTX were statistically significant lower in CAD-DM than CAD-non DM (p < 0.05). There were not any significant differences in the P1NP levels between groups. Conclusions Our data suggest that CTX and OC would be used as suitable bone markers in CAD patients with T2DM. However, further clinical studies need to establish the role of these markers in CAD patients with diabetes.
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Affiliation(s)
- Zhila Maghbooli
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Solaleh Emamgholipour
- Clinical Biochemistry Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Hossein-Nezhad
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran ; EMRI, 5th floor, Shariati Hospital, North Karegar Avenue, P.O Box: 1411413137, Tehran, Iran
| | - Mahmood Shirzad
- Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sattar Gorgani Firuzjaee
- Department of Medical Laboratory Sciences, School of Allied Health Medicine, AJA University of Medical Sciences, Tehran, Iran
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93
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Seref-Ferlengez Z, Suadicani SO, Thi MM. A new perspective on mechanisms governing skeletal complications in type 1 diabetes. Ann N Y Acad Sci 2016; 1383:67-79. [PMID: 27571221 DOI: 10.1111/nyas.13202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 12/29/2022]
Abstract
This review focuses on bone mechanobiology in type 1 diabetes (T1D), an area of research on diabetes-associated skeletal complications that is still in its infancy. We first provide a brief overview of the deleterious effects of diabetes on the skeleton and of the knowledge gained from studies with rodent models of T1D. Second, we discuss two specific hallmarks of T1D, low insulin and high glucose, and address the extent to which they affect skeletal health. Third, we highlight the mechanosensitive nature of bone tissue and the importance of mechanical loading for bone health. We also summarize recent advances in bone mechanobiology that implicate osteocytes as the mechanosensors and major regulatory cells in the bone. Finally, we discuss recent evidence indicating that the diabetic bone is "deaf" to mechanical loading and that osteocytes are central players in mechanisms that lead to bone loss in T1D.
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Affiliation(s)
- Zeynep Seref-Ferlengez
- Department of Orthopaedic Surgery.,Laboratories of Musculoskeletal Orthopedic Research at Einstein-Montefiore (MORE)
| | - Sylvia O Suadicani
- Laboratories of Musculoskeletal Orthopedic Research at Einstein-Montefiore (MORE).,Department of Neuroscience.,Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Mia M Thi
- Department of Orthopaedic Surgery.,Laboratories of Musculoskeletal Orthopedic Research at Einstein-Montefiore (MORE).,Department of Neuroscience
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94
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Alpan AL, Toker H, Ozer H. Ozone Therapy Enhances Osseous Healing in Rats With Diabetes With Calvarial Defects: A Morphometric and Immunohistochemical Study. J Periodontol 2016; 87:982-9. [DOI: 10.1902/jop.2016.160009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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95
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Peng J, Hui K, Hao C, Peng Z, Gao QX, Jin Q, Lei G, Min J, Qi Z, Bo C, Dong QN, Bing ZH, Jia XY, Fu DL. Low bone turnover and reduced angiogenesis in streptozotocin-induced osteoporotic mice. Connect Tissue Res 2016; 57:277-89. [PMID: 27028715 DOI: 10.3109/03008207.2016.1171858] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is known that type 1 diabetes (T1D) reduces bone mass and increases the risk for fragility fractures, an effect that has been largely ascribed to decreased bone formation. However, the potential role of decreased angiogenesis as a factor in osteogenesis reduction has not been extensively studied. Furthermore, there is controversy surrounding the effect of T1D on bone resorption. This study characterized bone microstructure, bone strength, and bone turnover of streptozotocin (STZ)-induced diabetic mice (T1D mice) and explored the role of angiogenesis in the pathogenesis of T1D-induced osteoporosis. Results demonstrate that T1D deteriorated trabecular microarchitecture and led to reduced bone strength. Furthermore, T1D mice showed reduced osteoblast number/bone surface (N.Ob/BS), mineral apposition rate, mineral surface/BS, and bone formation rate/BS, suggesting attenuated bone formation. Decreased angiogenesis was shown by a reduced number of blood vessels in the femur and decreased expression of platelet endothelial cell adhesion molecule (CD31), nerve growth factor, hypoxia-inducible factor-1α, and vascular endothelial growth factor was observed. On the other hand, reduced bone resorption, an effect that could lead to impaired osteogenesis, was demonstrated by lower osteoclast number/BS and decreased tartrate-resistant acid phosphatase and cathepsin K mRNA levels. Reduced number of osteoblasts and decreased expression of receptor activator for nuclear factor-κB ligand could be responsible for compromised bone resorption in T1D mice. In conclusion, T1D mice display reduced bone formation and bone resorption, suggesting decreased bone turnover. Furthermore, this study points to impairments in angiogenesis as a pivotal cause of decreased bone formation.
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Affiliation(s)
- Jia Peng
- a Department of Orthopaedics , The Second Affiliated Hospital of Soochow University , Suzhou , Jiangsu Province , China.,b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Kang Hui
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Chen Hao
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Zhao Peng
- c Intensive Care Unit , The Second Affiliated Hospital of Soochow University , Suzhou , Jiangsu Province , China
| | - Qian Xing Gao
- d Department of Rehabilitation, 359th Hospital of Chinese People's Liberation Army , Zhen Jiang , Jiangsu Province , China
| | - Qi Jin
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Guo Lei
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jiang Min
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Zhou Qi
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Chen Bo
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Qian Nian Dong
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Zhou Han Bing
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xu You Jia
- a Department of Orthopaedics , The Second Affiliated Hospital of Soochow University , Suzhou , Jiangsu Province , China
| | - Deng Lian Fu
- b Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
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96
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Epstein S, Defeudis G, Manfrini S, Napoli N, Pozzilli P. Diabetes and disordered bone metabolism (diabetic osteodystrophy): time for recognition. Osteoporos Int 2016; 27:1931-51. [PMID: 26980458 DOI: 10.1007/s00198-015-3454-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/07/2015] [Indexed: 02/06/2023]
Abstract
Diabetes and osteoporosis are rapidly growing diseases. The link between the high fracture incidence in diabetes as compared with the non-diabetic state has recently been recognized. While this review cannot cover every aspect of diabetic osteodystrophy, it attempts to incorporate current information from the First International Symposium on Diabetes and Bone presentations in Rome in 2014. Diabetes and osteoporosis are fast-growing diseases in the western world and are becoming a major problem in the emerging economic nations. Aging of populations worldwide will be responsible for an increased risk in the incidence of osteoporosis and diabetes. Furthermore, the economic burden due to complications of these diseases is enormous and will continue to increase unless public awareness of these diseases, the curbing of obesity, and cost-effective measures are instituted. The link between diabetes and fractures being more common in diabetics than non-diabetics has been widely recognized. At the same time, many questions remain regarding the underlying mechanisms for greater bone fragility in diabetic patients and the best approach to risk assessment and treatment to prevent fractures. Although it cannot cover every aspect of diabetic osteodystrophy, this review will attempt to incorporate current information particularly from the First International Symposium on Diabetes and Bone presentations in Rome in November 2014.
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Affiliation(s)
- S Epstein
- Division of Endocrinology, Mount Sinai School of Medicine, New York, NY, USA
| | - G Defeudis
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy.
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - S Manfrini
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - P Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
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97
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Seref-Ferlengez Z, Maung S, Schaffler MB, Spray DC, Suadicani SO, Thi MM. P2X7R-Panx1 Complex Impairs Bone Mechanosignaling under High Glucose Levels Associated with Type-1 Diabetes. PLoS One 2016; 11:e0155107. [PMID: 27159053 PMCID: PMC4861344 DOI: 10.1371/journal.pone.0155107] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/25/2016] [Indexed: 12/21/2022] Open
Abstract
Type 1 diabetes (T1D) causes a range of skeletal problems, including reduced bone density and increased risk for bone fractures. However, mechanisms underlying skeletal complications in diabetes are still not well understood. We hypothesize that high glucose levels in T1D alters expression and function of purinergic receptors (P2Rs) and pannexin 1 (Panx1) channels, and thereby impairs ATP signaling that is essential for proper bone response to mechanical loading and maintenance of skeletal integrity. We first established a key role for P2X7 receptor-Panx1 in osteocyte mechanosignaling by showing that these proteins are co-expressed to provide a major pathway for flow-induced ATP release. To simulate in vitro the glucose levels to which bone cells are exposed in healthy vs. diabetic bones, we cultured osteoblast and osteocyte cell lines for 10 days in medium containing 5.5 or 25 mM glucose. High glucose effects on expression and function of P2Rs and Panx1 channels were determined by Western Blot analysis, quantification of Ca2+ responses to P2R agonists and oscillatory fluid shear stress (± 10 dyne/cm2), and measurement of flow-induced ATP release. Diabetic C57BL/6J-Ins2Akita mice were used to evaluate in vivo effects of high glucose on P2R and Panx1. Western blotting indicated altered P2X7R, P2Y2R and P2Y4R expression in high glucose exposed bone cells, and in diabetic bone tissue. Moreover, high glucose blunted normal P2R- and flow-induced Ca2+ signaling and ATP release from osteocytes. These findings indicate that T1D impairs load-induced ATP signaling in osteocytes and affects osteoblast function, which are essential for maintaining bone health.
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Affiliation(s)
- Zeynep Seref-Ferlengez
- Departments of Orthopaedic Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
- Laboratories of Musculoskeletal Orthopedic Research at Einstein-Montefiore (MORE), Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
| | - Stephanie Maung
- Departments of Orthopaedic Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
- Laboratories of Musculoskeletal Orthopedic Research at Einstein-Montefiore (MORE), Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
| | - Mitchell B. Schaffler
- Department of Biomedical Engineering, City College of New York, New York, NY, United States of America
| | - David C. Spray
- Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
- Laboratories of Musculoskeletal Orthopedic Research at Einstein-Montefiore (MORE), Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
| | - Sylvia O. Suadicani
- Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
- Laboratories of Musculoskeletal Orthopedic Research at Einstein-Montefiore (MORE), Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
| | - Mia M. Thi
- Departments of Orthopaedic Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
- Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
- Laboratories of Musculoskeletal Orthopedic Research at Einstein-Montefiore (MORE), Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States of America
- * E-mail:
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98
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Wallner C, Abraham S, Wagner JM, Harati K, Ismer B, Kessler L, Zöllner H, Lehnhardt M, Behr B. Local Application of Isogenic Adipose-Derived Stem Cells Restores Bone Healing Capacity in a Type 2 Diabetes Model. Stem Cells Transl Med 2016; 5:836-44. [PMID: 27102648 DOI: 10.5966/sctm.2015-0158] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/13/2016] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Bone regeneration is typically a reliable process without scar formation. The endocrine disease type 2 diabetes prolongs and impairs this healing process. In a previous work, we showed that angiogenesis and osteogenesis-essential steps of bone regeneration-are deteriorated, accompanied by reduced proliferation in type 2 diabetic bone regeneration. The aim of the study was to improve these mechanisms by local application of adipose-derived stem cells (ASCs) and facilitate bone regeneration in impaired diabetic bone regeneration. The availability of ASCs in great numbers and the relative ease of harvest offers unique advantages over other mesenchymal stem cell entities. A previously described unicortical tibial defect model was utilized in diabetic mice (Lepr(db-/-)). Isogenic mouse adipose-derived stem cells (mASCs)(db-/db-) were harvested, transfected with a green fluorescent protein vector, and isografted into tibial defects (150,000 living cells per defect). Alternatively, control groups were treated with Dulbecco's modified Eagle's medium or mASCs(WT). In addition, wild-type mice were identically treated. By means of immunohistochemistry, proteins specific for angiogenesis, cell proliferation, cell differentiation, and bone formation were analyzed at early (3 days) and late (7 days) stages of bone regeneration. Additionally, histomorphometry was performed to examine bone formation rate and remodeling. Histomorphometry revealed significantly increased bone formation in mASC(db-/db-)-treated diabetic mice as compared with the respective control groups. Furthermore, locally applied mASCs(db-/db-) significantly enhanced neovascularization and osteogenic differentiation. Moreover, bone remodeling was upregulated in stem cell treatment groups. Local application of mACSs can restore impaired diabetic bone regeneration and may represent a therapeutic option for the future. SIGNIFICANCE This study showed that stem cells obtained from fat pads of type 2 diabetic mice are capable of reconstituting impaired bone regeneration in type 2 diabetes. These multipotent stem cells promote both angiogenesis and osteogenesis in type 2 diabetic bony defects. These data might prove to have great clinical implications for bony defects in the ever-increasing type 2 diabetic patient population.
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Affiliation(s)
- Christoph Wallner
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Stephanie Abraham
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Johannes Maximilian Wagner
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Kamran Harati
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Britta Ismer
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lukas Kessler
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Hannah Zöllner
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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99
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Hough FS, Pierroz DD, Cooper C, Ferrari SL. MECHANISMS IN ENDOCRINOLOGY: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus. Eur J Endocrinol 2016; 174:R127-38. [PMID: 26537861 DOI: 10.1530/eje-15-0820] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/04/2015] [Indexed: 12/20/2022]
Abstract
Subjects with type 1 diabetes mellitus (T1DM) have decreased bone mineral density and an up to sixfold increase in fracture risk. Yet bone fragility is not commonly regarded as another unique complication of diabetes. Both animals with experimentally induced insulin deficiency syndromes and patients with T1DM have impaired osteoblastic bone formation, with or without increased bone resorption. Insulin/IGF1 deficiency appears to be a major pathogenetic mechanism involved, along with glucose toxicity, marrow adiposity, inflammation, adipokine and other metabolic alterations that may all play a role on altering bone turnover. In turn, increasing physical activity in children with diabetes as well as good glycaemic control appears to provide some improvement of bone parameters, although robust clinical studies are still lacking. In this context, the role of osteoporosis drugs remains unknown.
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Affiliation(s)
- F S Hough
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - D D Pierroz
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - C Cooper
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - S L Ferrari
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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100
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Sato H, Kondo N, Wada Y, Nakatsue T, Iguchi S, Fujisawa J, Kazama JJ, Kuroda T, Nakano M, Endo N, Narita I. The cumulative incidence of and risk factors for latent beaking in patients with autoimmune diseases taking long-term glucocorticoids and bisphosphonates. Osteoporos Int 2016; 27:1217-1225. [PMID: 26519417 DOI: 10.1007/s00198-015-3382-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/20/2015] [Indexed: 02/25/2023]
Abstract
SUMMARY The incidence of beaking, which has been reported to precede atypical femoral fracture, was high and increased over 2 years in patients with autoimmune diseases who were taking bisphosphonates and glucocorticoids. Regular femoral X-rays are strongly recommended to screen for beaking, and bisphosphonate drug holidays should be considered. INTRODUCTION Atypical femoral fractures (AFFs) have been recently recognized as complications associated with bisphosphonate (BP) use. AFFs are considered to be stress fractures; localized periosteal thickening of the lateral cortex is often present at the fracture site; this thickening is termed "beaking." Beaking has been reported to precede AFF. The aims of the present study were to evaluate the incidence of latent beaking in patients with autoimmune diseases taking BPs and glucocorticoids and to identify risk factors for beaking. METHODS A total of 125 patients with autoimmune diseases who were taking BPs and glucocorticoids was included; 116 patients underwent X-rays and analysis of serum and urine bone metabolic markers annually for 2 years. Mean patient age was 54.5 years; there were 105 (90.5%) females and the mean duration of disease was 13.2 years. Focal lateral cortical thickening in femoral X-rays was defined as beaking. RESULTS Beaking was detected in 15 femora of 10 patients (8.0%) at the time of recruitment. Over the 2-year observation period, the incidence of beaking increased to 21 femora of 12 patients (10.3%), and a complete AFF at the location of beaking occurred in one patient. Beaking was associated with a longer duration of BP treatment (6.1 ± 1.0 years vs. 5.0 ± 2.9 years, p = 0.01). Age 40-60 years, BP therapy ≥4 years, and diabetes mellitus were significantly associated with beaking. CONCLUSIONS The incidence of beaking was high, and increased over 2 years, in patients with autoimmune diseases who were taking BPs and glucocorticoids. Regular femoral X-rays are strongly recommended to screen for beaking. Long-term BP/glucocorticoid use was a risk factor for beaking in patients with autoimmune diseases; BP drug holidays should be considered.
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Affiliation(s)
- H Sato
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan.
| | - N Kondo
- Division of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - Y Wada
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - T Nakatsue
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - S Iguchi
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - J Fujisawa
- Division of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - J J Kazama
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - T Kuroda
- Health Administration Center, Niigata University, 2-8050 Ikarashi, Nishiku, Niigata City, 950-2181, Japan
| | - M Nakano
- Department of Medical Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-Dori, Chuoku, Niigata City, 951-8518, Japan
| | - N Endo
- Division of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - I Narita
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
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