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Selenius JS, Silveira PP, von Bonsdorff M, Lahti J, Koistinen H, Koistinen R, Seppälä M, Eriksson JG, Wasenius NS. Biologically Informed Polygenic Scores for Brain Insulin Receptor Network Are Associated with Cardiometabolic Risk Markers and Diabetes in Women. Diabetes Metab J 2024; 48:960-970. [PMID: 38527457 PMCID: PMC11449818 DOI: 10.4093/dmj.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/25/2023] [Indexed: 03/27/2024] Open
Abstract
BACKGRUOUND To investigate associations between variations in the co-expression-based brain insulin receptor polygenic score and cardiometabolic risk factors and diabetes mellitus. METHODS This cross-sectional study included 1,573 participants from the Helsinki Birth Cohort Study. Biologically informed expression-based polygenic risk scores for the insulin receptor gene network were calculated for the hippocampal (hePRS-IR) and the mesocorticolimbic (mePRS-IR) regions. Cardiometabolic markers included body composition, waist circumference, circulating lipids, insulin-like growth factor 1 (IGF-1), and insulin-like growth factor-binding protein 1 and 3 (IGFBP-1 and -3). Glucose and insulin levels were measured during a standardized 2-hour 75 g oral glucose tolerance test and impaired glucose regulation status was defined by the World Health Organization 2019 criteria. Analyzes were adjusted for population stratification, age, smoking, alcohol consumption, socioeconomic status, chronic diseases, birth weight, and leisure-time physical activity. RESULTS Multinomial logistic regression indicated that one standard deviation increase in hePRS-IR was associated with increased risk of diabetes mellitus in all participants (adjusted relative risk ratio, 1.17; 95% confidence interval, 1.01 to 1.35). In women, higher hePRS-IR was associated with greater waist circumference and higher body fat percentage, levels of glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoprotein B, insulin, and IGFBP-1 (all P≤0.02). The mePRS-IR was associated with decreased IGF-1 level in women (P=0.02). No associations were detected in men and studied outcomes. CONCLUSION hePRS-IR is associated with sex-specific differences in cardiometabolic risk factor profiles including impaired glucose regulation, abnormal metabolic markers, and unfavorable body composition in women.
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Affiliation(s)
- Jannica S. Selenius
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Patricia P. Silveira
- Department of Psychiatry, Faculty of Medicine, McGill University, Verdun, QC, Canada
- Ludmer Center for Neuroinformatic and Mental Health, Douglas Mental Health University Institute, McGill University, Verdun, QC, Canada
| | - Mikaela von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland
| | - Hannu Koistinen
- Department of Clinical Chemistry and Haematology, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Riitta Koistinen
- Department of Clinical Chemistry and Haematology, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markku Seppälä
- Department of Clinical Chemistry and Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Johan G. Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Obstetrics & Gynecology and Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Niko S. Wasenius
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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2
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Rebelos E, Latva-Rasku A, Koskensalo K, Pekkarinen L, Saukko E, Ihalainen J, Honka MJ, Tuisku J, Bucci M, Laurila S, Rajander J, Salminen P, Nummenmaa L, Jansen JFA, Ferrannini E, Nuutila P. Insulin-stimulated brain glucose uptake correlates with brain metabolites in severe obesity: A combined neuroimaging study. J Cereb Blood Flow Metab 2024; 44:407-418. [PMID: 37824728 PMCID: PMC10870965 DOI: 10.1177/0271678x231207114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
The human brain undergoes metabolic adaptations in obesity, but the underlying mechanisms have remained largely unknown. We compared concentrations of often reported brain metabolites measured with magnetic resonance spectroscopy (1H-MRS, 3 T MRI) in the occipital lobe in subjects with obesity and lean controls under different metabolic conditions (fasting, insulin clamp, following weight loss). Brain glucose uptake (BGU) quantified with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)) was also performed in a subset of subjects during clamp. In dataset A, 48 participants were studied during fasting with brain 1H-MRS, while in dataset B 21 participants underwent paired brain 1H-MRS acquisitions under fasting and clamp conditions. In dataset C 16 subjects underwent brain 18F-FDG-PET and 1H-MRS during clamp. In the fasting state, total N-acetylaspartate was lower in subjects with obesity, while brain myo-inositol increased in response to hyperinsulinemia similarly in both lean participants and subjects with obesity. During clamp, BGU correlated positively with brain glutamine/glutamate, total choline, and total creatine levels. Following weight loss, brain creatine levels were increased, whereas increases in other metabolites remained not significant. To conclude, insulin signaling and glucose metabolism are significantly coupled with several of the changes in brain metabolites that occur in obesity.
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Affiliation(s)
- Eleni Rebelos
- Turku PET Centre, University of Turku, Turku, Finland
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Aino Latva-Rasku
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
| | - Kalle Koskensalo
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Laura Pekkarinen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
| | - Ekaterina Saukko
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Jukka Ihalainen
- Turku PET Centre, Accelerator Laboratory, Åbo Akademi University, Turku, Finland
| | | | - Jouni Tuisku
- Turku PET Centre, University of Turku, Turku, Finland
| | - Marco Bucci
- Turku PET Centre, University of Turku, Turku, Finland
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sanna Laurila
- Turku PET Centre, University of Turku, Turku, Finland
| | - Johan Rajander
- Turku PET Centre, Accelerator Laboratory, Åbo Akademi University, Turku, Finland
| | - Paulina Salminen
- Department of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - Lauri Nummenmaa
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Psychology University of Turku, Turku, Finland
| | - Jacobus FA Jansen
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ele Ferrannini
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
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3
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Bucci M, Rebelos E, Oikonen V, Rinne J, Nummenmaa L, Iozzo P, Nuutila P. Kinetic Modeling of Brain [ 18-F]FDG Positron Emission Tomography Time Activity Curves with Input Function Recovery (IR) Method. Metabolites 2024; 14:114. [PMID: 38393006 PMCID: PMC10890269 DOI: 10.3390/metabo14020114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Accurate positron emission tomography (PET) data quantification relies on high-quality input plasma curves, but venous blood sampling may yield poor-quality data, jeopardizing modeling outcomes. In this study, we aimed to recover sub-optimal input functions by using information from the tail (5th-100th min) of curves obtained through the frequent sampling protocol and an input recovery (IR) model trained with reference curves of optimal shape. Initially, we included 170 plasma input curves from eight published studies with clamp [18F]-fluorodeoxyglucose PET exams. Model validation involved 78 brain PET studies for which compartmental model (CM) analysis was feasible (reference (ref) + training sets). Recovered curves were compared with original curves using area under curve (AUC), max peak standardized uptake value (maxSUV). CM parameters (ref + training sets) and fractional uptake rate (FUR) (all sets) were computed. Original and recovered curves from the ref set had comparable AUC (d = 0.02, not significant (NS)), maxSUV (d = 0.05, NS) and comparable brain CM results (NS). Recovered curves from the training set were different from the original according to maxSUV (d = 3) and biologically plausible according to the max theoretical K1 (53//56). Brain CM results were different in the training set (p < 0.05 for all CM parameters and brain regions) but not in the ref set. FUR showed reductions similarly in the recovered curves of the training and test sets compared to the original curves (p < 0.05 for all regions for both sets). The IR method successfully recovered the plasma inputs of poor quality, rescuing cases otherwise excluded from the kinetic modeling results. The validation approach proved useful and can be applied to different tracers and metabolic conditions.
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Affiliation(s)
- Marco Bucci
- Turku PET Centre, Turku University Hospital, 20521 Turku, Finland
- Turku PET Centre, University of Turku, 20521 Turku, Finland
- Turku PET Centre, Åbo Akademi University, 20521 Turku, Finland
- Theme Inflammation and Aging, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska University, SE-141 84 Stockholm, Sweden
| | - Eleni Rebelos
- Turku PET Centre, University of Turku, 20521 Turku, Finland
| | - Vesa Oikonen
- Turku PET Centre, University of Turku, 20521 Turku, Finland
| | - Juha Rinne
- Turku PET Centre, Turku University Hospital, 20521 Turku, Finland
| | - Lauri Nummenmaa
- Turku PET Centre, University of Turku, 20521 Turku, Finland
- Department of Psychology, University of Turku, 20520 Turku, Finland
| | - Patricia Iozzo
- Institute of Clinical Physiology (IFC), National Research Council (CNR), 56124 Pisa, Italy
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, 20521 Turku, Finland
- Department of Endocrinology, Turku University Hospital, 20521 Turku, Finland
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Ebrahimi M, Sivaprasad S, Thompson P, Perry G. Retinal Neurodegeneration in Euglycemic Hyperinsulinemia, Prediabetes, and Diabetes. Ophthalmic Res 2022; 66:385-397. [PMID: 36463857 DOI: 10.1159/000528503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2023]
Abstract
Diabetic retinopathy (DR) is a challenging public health problem mainly because of its growing prevalence and risk of blindness. In general, our current knowledge and practice have failed to prevent the onset or progression of DR to sight-threatening complications. While there are treatment options for sight-threatening complications of DR, it is crucial to pay more attention to the early stages of DR to decrease its prevalence. Growing evidence suggests many pathologic changes occur before clinical presentations of DR in euglycemic hyperinsulinemia, prediabetes, and diabetes. These pathological changes occur in retinal neurons, glia, and microvasculature. A new focus on these preclinical pathologies - especially on hyperinsulinemia - may provide further insight into disease mechanisms, endpoints for clinical trials, and druggable targets in early disease. Here, we review the current evidence on the pathophysiological changes reported in preclinical DR and appraise preventive and treatment options for DR.
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Affiliation(s)
- Moein Ebrahimi
- Network of Immunity in Infection, Malignancy, and Autoimmunity, Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Paul Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - George Perry
- Department of Biology, University of Texas and San Antonio, San Antonio, Texas, USA
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5
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Pekkarinen L, Kantonen T, Rebelos E, Latva-Rasku A, Dadson P, Karjalainen T, Bucci M, Kalliokoski K, Laitinen K, Houttu N, Kirjavainen AK, Rajander J, Rönnemaa T, Nummenmaa L, Nuutila P. Obesity risk is associated with brain glucose uptake and insulin resistance. Eur J Endocrinol 2022; 187:917-928. [PMID: 36288097 PMCID: PMC9782452 DOI: 10.1530/eje-22-0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/26/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate whether alterations in brain glucose uptake (BGU), insulin action in the brain-liver axis and whole-body insulin sensitivity occur in young adults in pre-obese state. METHODS Healthy males with either high risk (HR; n = 19) or low risk (LR; n = 22) for developing obesity were studied with [18F]fluoro-d-glucose ([18F]FDG)-positron emission tomography during hyperinsulinemic-euglycemic clamp. Obesity risk was assessed according to BMI, physical activity and parental overweight/obesity and type 2 diabetes. Brain, skeletal muscle, brown adipose tissue (BAT), visceral adipose tissue (VAT) and abdominal and femoral s.c. adipose tissue (SAT) glucose uptake (GU) rates were measured. Endogenous glucose production (EGP) was calculated by subtracting the exogenous glucose infusion rate from the rate of disappearance of [18F]FDG. BGU was analyzed using statistical parametric mapping, and peripheral tissue activity was determined using Carimas Software imaging processing platform. RESULTS BGU was higher in the HR vs LR group and correlated inversely with whole-body insulin sensitivity (M value) in the HR group but not in the LR group. Insulin-suppressed EGP did not differ between the groups but correlated positively with BGU in the whole population, and the correlation was driven by the HR group. Skeletal muscle, BAT, VAT, abdominal and femoral SAT GU were lower in the HR group as compared to the LR group. Muscle GU correlated negatively with BGU in the HR group but not in the LR group. CONCLUSION Increased BGU, alterations in insulin action in the brain-liver axis and decreased whole-body insulin sensitivity occur early in pre-obese state.
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Affiliation(s)
- Laura Pekkarinen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
| | - Tatu Kantonen
- Turku PET Centre, University of Turku, Turku, Finland
- Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Eleni Rebelos
- Turku PET Centre, University of Turku, Turku, Finland
| | | | - Prince Dadson
- Turku PET Centre, University of Turku, Turku, Finland
| | | | - Marco Bucci
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Åbo Akademi University, Turku, Finland
| | | | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Noora Houttu
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | | | - Johan Rajander
- Turku PET Centre, Åbo Akademi University, Turku, Finland
| | - Tapani Rönnemaa
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Lauri Nummenmaa
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Correspondence should be addressed to P Nuutila;
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Rebelos E, Rinne JO, Nuutila P, Ekblad LL. Brain Glucose Metabolism in Health, Obesity, and Cognitive Decline-Does Insulin Have Anything to Do with It? A Narrative Review. J Clin Med 2021; 10:jcm10071532. [PMID: 33917464 PMCID: PMC8038699 DOI: 10.3390/jcm10071532] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022] Open
Abstract
Imaging brain glucose metabolism with fluorine-labelled fluorodeoxyglucose ([18F]-FDG) positron emission tomography (PET) has long been utilized to aid the diagnosis of memory disorders, in particular in differentiating Alzheimer’s disease (AD) from other neurological conditions causing cognitive decline. The interest for studying brain glucose metabolism in the context of metabolic disorders has arisen more recently. Obesity and type 2 diabetes—two diseases characterized by systemic insulin resistance—are associated with an increased risk for AD. Along with the well-defined patterns of fasting [18F]-FDG-PET changes that occur in AD, recent evidence has shown alterations in fasting and insulin-stimulated brain glucose metabolism also in obesity and systemic insulin resistance. Thus, it is important to clarify whether changes in brain glucose metabolism are just an epiphenomenon of the pathophysiology of the metabolic and neurologic disorders, or a crucial determinant of their pathophysiologic cascade. In this review, we discuss the current knowledge regarding alterations in brain glucose metabolism, studied with [18F]-FDG-PET from metabolic disorders to AD, with a special focus on how manipulation of insulin levels affects brain glucose metabolism in health and in systemic insulin resistance. A better understanding of alterations in brain glucose metabolism in health, obesity, and neurodegeneration, and the relationships between insulin resistance and central nervous system glucose metabolism may be an important step for the battle against metabolic and cognitive disorders.
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Affiliation(s)
- Eleni Rebelos
- Turku PET Centre, University of Turku and Turku University Hospital, 20520 Turku, Finland; (E.R.); (J.O.R.); (P.N.)
| | - Juha O. Rinne
- Turku PET Centre, University of Turku and Turku University Hospital, 20520 Turku, Finland; (E.R.); (J.O.R.); (P.N.)
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku and Turku University Hospital, 20520 Turku, Finland; (E.R.); (J.O.R.); (P.N.)
- Department of Endocrinology, Turku University Hospital, 20520 Turku, Finland
| | - Laura L. Ekblad
- Turku PET Centre, University of Turku and Turku University Hospital, 20520 Turku, Finland; (E.R.); (J.O.R.); (P.N.)
- Correspondence: ; Tel.: +358-2-3138721
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Rebelos E, Honka MJ, Ekblad L, Bucci M, Hannukainen JC, Fernandes Silva L, Virtanen KA, Nummenmaa L, Nuutila P. The Obesity Risk SNP (rs17782313) near the MC4R Gene Is Not Associated with Brain Glucose Uptake during Insulin Clamp-A Study in Finns. J Clin Med 2021; 10:jcm10061312. [PMID: 33806715 PMCID: PMC8004974 DOI: 10.3390/jcm10061312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
The melanocortin system is involved in the control of adiposity through modulation of food intake and energy expenditure. The single nucleotide polymorphism (SNP) rs17782313 near the MC4R gene has been linked to obesity, and a previous study using magnetoencephalography has shown that carriers of the mutant allele have decreased cerebrocortical response to insulin. Thus, in this study, we addressed whether rs17782313 associates with brain glucose uptake (BGU). Here, [18F]-fluorodeoxyglucose positron emission tomography (PET) data from 113 Finnish subjects scanned under insulin clamp conditions who also had the rs17782313 determined were compiled from a single-center cohort. BGU was quantified by the fractional uptake rate. Statistical analysis was performed with statistical parametric mapping. There was no difference in age, BMI, and insulin sensitivity as indexed by the M value between the rs17782313-C allele carriers and non-carriers. Brain glucose uptake during insulin clamp was not different by gene allele, and it correlated with the M value, in both the rs17782313-C allele carriers and non-carriers. The obesity risk SNP rs17782313 near the MC4R gene is not associated with brain glucose uptake during insulin clamp in humans, and this frequent mutation cannot explain the enhanced brain glucose metabolic rates in insulin resistance.
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Affiliation(s)
- Eleni Rebelos
- Turku PET Centre, University of Turku, 20520 Turku, Finland; (L.E.); (M.B.); (J.C.H.); (K.A.V.); (L.N.)
- Correspondence: (E.R.); (P.N.); Tel.: +39-3488454140 (E.R.); +358-2313-1868 (P.N.)
| | | | - Laura Ekblad
- Turku PET Centre, University of Turku, 20520 Turku, Finland; (L.E.); (M.B.); (J.C.H.); (K.A.V.); (L.N.)
| | - Marco Bucci
- Turku PET Centre, University of Turku, 20520 Turku, Finland; (L.E.); (M.B.); (J.C.H.); (K.A.V.); (L.N.)
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Jarna C. Hannukainen
- Turku PET Centre, University of Turku, 20520 Turku, Finland; (L.E.); (M.B.); (J.C.H.); (K.A.V.); (L.N.)
| | - Lilian Fernandes Silva
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, 70210 Kuopio, Finland;
| | - Kirsi A. Virtanen
- Turku PET Centre, University of Turku, 20520 Turku, Finland; (L.E.); (M.B.); (J.C.H.); (K.A.V.); (L.N.)
| | - Lauri Nummenmaa
- Turku PET Centre, University of Turku, 20520 Turku, Finland; (L.E.); (M.B.); (J.C.H.); (K.A.V.); (L.N.)
- Department of Psychology, University of Turku, 20520 Turku, Finland
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, 20520 Turku, Finland; (L.E.); (M.B.); (J.C.H.); (K.A.V.); (L.N.)
- Department of Endocrinology, Turku University Hospital, 20521 Turku, Finland
- Correspondence: (E.R.); (P.N.); Tel.: +39-3488454140 (E.R.); +358-2313-1868 (P.N.)
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Rebelos E, Bucci M, Karjalainen T, Oikonen V, Bertoldo A, Hannukainen JC, Virtanen KA, Latva-Rasku A, Hirvonen J, Heinonen I, Parkkola R, Laakso M, Ferrannini E, Iozzo P, Nummenmaa L, Nuutila P. Insulin Resistance Is Associated With Enhanced Brain Glucose Uptake During Euglycemic Hyperinsulinemia: A Large-Scale PET Cohort. Diabetes Care 2021; 44:788-794. [PMID: 33446523 PMCID: PMC7896252 DOI: 10.2337/dc20-1549] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/04/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Whereas insulin resistance is expressed as reduced glucose uptake in peripheral tissues, the relationship between insulin resistance and brain glucose metabolism remains controversial. Our aim was to examine the association of insulin resistance and brain glucose uptake (BGU) during a euglycemic hyperinsulinemic clamp in a large sample of study participants across a wide range of age and insulin sensitivity. RESEARCH DESIGN AND METHODS [18F]-fluorodeoxyglucose positron emission tomography (PET) data from 194 participants scanned under clamp conditions were compiled from a single-center cohort. BGU was quantified by the fractional uptake rate. We examined the association of age, sex, M value from the clamp, steady-state insulin and free fatty acid levels, C-reactive protein levels, HbA1c, and presence of type 2 diabetes with BGU using Bayesian hierarchical modeling. RESULTS Insulin sensitivity, indexed by the M value, was associated negatively with BGU in all brain regions, confirming that in insulin-resistant participants BGU was enhanced during euglycemic hyperinsulinemia. In addition, the presence of type 2 diabetes was associated with additional increase in BGU. On the contrary, age was negatively related to BGU. Steady-state insulin levels, C-reactive protein and free fatty acid levels, sex, and HbA1c were not associated with BGU. CONCLUSIONS In this large cohort of participants of either sex across a wide range of age and insulin sensitivity, insulin sensitivity was the best predictor of BGU.
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Affiliation(s)
- Eleni Rebelos
- Turku PET Centre, University of Turku, Turku, Finland
| | - Marco Bucci
- Turku PET Centre, University of Turku, Turku, Finland
| | | | - Vesa Oikonen
- Turku PET Centre, University of Turku, Turku, Finland
| | | | | | - Kirsi A Virtanen
- Turku PET Centre, University of Turku, Turku, Finland.,Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka Heinonen
- Turku PET Centre, University of Turku, Turku, Finland.,Rydberg Laboratory of Applied Sciences, University of Halmstad, Halmstad, Sweden
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ele Ferrannini
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Patricia Iozzo
- Turku PET Centre, University of Turku, Turku, Finland.,Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Lauri Nummenmaa
- Turku PET Centre, University of Turku, Turku, Finland.,Department of Psychology, University of Turku, Turku, Finland
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland .,Department of Endocrinology, Turku University Hospital, Turku, Finland
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Malbert CH. Vagally Mediated Gut-Brain Relationships in Appetite Control-Insights from Porcine Studies. Nutrients 2021; 13:nu13020467. [PMID: 33573329 PMCID: PMC7911705 DOI: 10.3390/nu13020467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/07/2023] Open
Abstract
Signals arising from the upper part of the gut are essential for the regulation of food intake, particularly satiation. This information is supplied to the brain partly by vagal nervous afferents. The porcine model, because of its sizeable gyrencephalic brain, omnivorous regimen, and comparative anatomy of the proximal part of the gut to that of humans, has provided several important insights relating to the relevance of vagally mediated gut-brain relationships to the regulation of food intake. Furthermore, its large size combined with the capacity to become obese while overeating a western diet makes it a pivotal addition to existing murine models, especially for translational studies relating to obesity. How gastric, proximal intestinal, and portal information relating to meal arrival and transit are encoded by vagal afferents and their further processing by primary and secondary brain projections are reviewed. Their peripheral and central plasticities in the context of obesity are emphasized. We also present recent insights derived from chronic stimulation of the abdominal vagi with specific reference to the modulation of mesolimbic structures and their role in the restoration of insulin sensitivity in the obese miniature pig model.
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Affiliation(s)
- Charles-Henri Malbert
- Aniscan Unit, INRAE, Saint-Gilles, 35590 Paris, France;
- National Academy of Medicine, 75000 Paris, France
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
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Malbert CH, Val-Laillet D, Meurice P, Lallès JP, Delarue J. Contrasted central effects of n-3 versus n-6 diets on brain functions in diet-induced obesity in minipigs. Nutr Neurosci 2021; 25:1453-1465. [PMID: 33427097 DOI: 10.1080/1028415x.2020.1866881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION N3 polyunsaturated fatty acids (n-3 PUFAs) exert anti-inflammatory effects for the hypothalamus, but their extra-hypothalamic outcome lack documentation. We evaluated the central consequences of the substitution of saturated fatty acids with n-3 or n-6 PUFA in obesogenic diets. METHODS Twenty-one miniature pigs were fed ad libitum obesogenic diets enriched in fat provided either as lard, fish oil (source for n-3 PUFAs), or sunflower oil (source for n-6 PUFAs) for ten weeks. The blood-brain barrier (BBB) permeability was quantified by CT perfusion. Central autonomic network was evaluated using heart rate variability, and PET 18FDG was performed to assess brain metabolism. RESULTS BBB permeability was higher in lard group, but heart rate variability changed only in fish oil group. Brain connectivity analysis and voxel-based comparisons show regional differences between groups except for the cingulate cortex in fish oil vs. sunflower oil groups. DISCUSSION : The minute changes in brain metabolism in obese pigs feed with fish oil compared with saturated fatty acids were sufficient to induce detrimental changes in heart rate variability. On the contrary, the BBB's decreased permeability in n-3 and n-6 PUFAs groups was protective against an obesity-driven damaged BBB.
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Affiliation(s)
| | - David Val-Laillet
- INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Saint-Gilles, France
| | - Paul Meurice
- INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Saint-Gilles, France
| | - Jean-Paul Lallès
- Division of Human Nutrition, INRAE, SDAR, Domaine de la Motte, Le Rheu, France
| | - Jacques Delarue
- Department of Nutritional Sciences & Laboratory of Human Nutrition, Hospital University/Faculty of Medicine/University of Brest, France
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Malbert CH, Chauvin A, Horowitz M, Jones KL. Pancreatic GLP-1r binding potential is reduced in insulin-resistant pigs. BMJ Open Diabetes Res Care 2020; 8:8/2/e001540. [PMID: 33132211 PMCID: PMC7607594 DOI: 10.1136/bmjdrc-2020-001540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The insulinotropic capacity of exogenous glucagon like peptide-1 (GLP-1) is reduced in type 2 diabetes and the insulin-resistant obese. We have tested the hypothesis that this response is the consequence of a reduced pancreatic GLP-1 receptor (GLP-1r) density in insulin-resistant obese animals. RESEARCH DESIGN AND METHODS GLP-1r density was measured in lean and insulin-resistant adult miniature pigs after the administration of a 68Ga-labeled GLP-1r agonist. The effect of hyperinsulinemia on GLP-1r was assessed using sequential positron emission tomography (PET), both in the fasted state and during a clamp. The impact of tissue perfusion, which could account for changes in GLP-1r agonist uptake, was also investigated using 68Ga-DOTA imaging. RESULTS GLP-1r binding potential in the obese pancreas was reduced by 75% compared with lean animals. Similar reductions were evident for fat tissue, but not for the duodenum. In the lean group, induced hyperinsulinemia reduced pancreatic GLP-1r density to a level comparable with that of the obese group. The reduction in blood to tissue transfer of the GLP-1r ligand paralleled that of tissue perfusion estimated using 68Ga-DOTA. CONCLUSIONS These observations establish that a reduction in abdominal tissue perfusion and a lower GLP-1r density account for the diminished insulinotropic effect of GLP-1 agonists in type 2 diabetes.
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Affiliation(s)
| | - Alain Chauvin
- UEPR Unit, Department of Animal Physiology, INRAE, Saint-Gilles, France
| | - Michael Horowitz
- Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen L Jones
- Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
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Rebelos E, Mari A, Bucci M, Honka M, Hannukainen JC, Virtanen KA, Hirvonen J, Nummenmaa L, Heni M, Iozzo P, Ferrannini E, Nuutila P. Brain substrate metabolism and ß-cell function in humans: A positron emission tomography study. Endocrinol Diabetes Metab 2020; 3:e00136. [PMID: 32704559 PMCID: PMC7375082 DOI: 10.1002/edm2.136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/06/2020] [Accepted: 03/28/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Recent clinical studies have shown enhanced brain glucose uptake during clamp and brain fatty acid uptake in insulin-resistant individuals. Preclinical studies suggest that the brain may be involved in the control of insulin secretion. The aim of this study was to investigate whether brain metabolism assessed as brain glucose and fatty acid uptake is associated with the parameters of β-cell function in humans. MATERIALS AND METHODS We analysed cross-sectional data of 120 subjects across a wide range of BMI and insulin sensitivity. Brain glucose uptake (BGU) was measured during euglycaemic-hyperinsulinaemic clamp (n = 67) and/or during fasting (n = 45) using [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET). In another group of subjects (n = 34), brain fatty acid uptake was measured using [18F]-fluoro-6-thia-heptadecanoic acid (FTHA) PET during fasting. The parameters of β-cell function were derived from OGTT modelling. Statistical analysis was performed with whole-brain voxel-based statistical parametric mapping. RESULTS In non-diabetics, BGU during euglycaemic hyperinsulinaemic clamp correlated positively with basal insulin secretion rate (r = 0.51, P = .0008) and total insulin output (r = 0.51, P = .0008), whereas no correlation was found in type 2 diabetics. BGU during clamp correlated positively with potentiation in non-diabetics (r = 0.33, P = .02) and negatively in type 2 diabetics (r = -0.61, P = .02). The associations in non-diabetics were not explained with whole-body insulin sensitivity or BMI. No correlations were found between baseline (fasting) BGU and basal insulin secretion rate, whereas baseline brain fatty acid uptake correlated directly with basal insulin secretion rate (r = 0.39, P = .02) and inversely with potentiation (r = -0.36, P = .04). CONCLUSIONS Our study provides coherent, though correlative, evidence that, in humans, the brain may be involved in the control of insulin secretion independently of insulin sensitivity.
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Affiliation(s)
| | - Andrea Mari
- Institute of NeuroscienceNational Research CouncilPaduaItaly
| | - Marco Bucci
- Turku PET CentreUniversity of TurkuTurkuFinland
| | | | | | - Kirsi A. Virtanen
- Turku PET CentreUniversity of TurkuTurkuFinland
- Clinical NutritionInstitute of Public Health and Clinical NutritionUniversity of Eastern Finland (UEF)KuopioFinland
| | - Jussi Hirvonen
- Department of RadiologyTurku University Hospital and University of TurkuTurkuFinland
| | - Lauri Nummenmaa
- Turku PET CentreUniversity of TurkuTurkuFinland
- Department of PsychologyUniversity of TurkuTurkuFinland
| | - Martin Heni
- Department of Internal MedicineDivision of EndocrinologyDiabetology, Angiology, Nephrology and Clinical ChemistryEberhard Karls University TuebingenTuebingenGermany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz CenterMunich at the University of TuebingenTuebingenGermany
- German Center for Diabetes Research (DZD e.V.)NeuherbergGermany
| | - Patricia Iozzo
- Turku PET CentreUniversity of TurkuTurkuFinland
- Institute of Clinical PhysiologyNational Research Council (CNR)PisaItaly
| | - Ele Ferrannini
- Institute of Clinical PhysiologyNational Research Council (CNR)PisaItaly
| | - Pirjo Nuutila
- Turku PET CentreUniversity of TurkuTurkuFinland
- Department of EndocrinologyTurku University HospitalTurkuFinland
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Iozzo P, Guzzardi MA. Imaging of brain glucose uptake by PET in obesity and cognitive dysfunction: life-course perspective. Endocr Connect 2019; 8:R169-R183. [PMID: 31590145 PMCID: PMC6865363 DOI: 10.1530/ec-19-0348] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022]
Abstract
The prevalence of obesity has reached epidemic proportions and keeps growing. Obesity seems implicated in the pathogenesis of cognitive dysfunction, Alzheimer's disease and dementia, and vice versa. Growing scientific efforts are being devoted to the identification of central mechanisms underlying the frequent association between obesity and cognitive dysfunction. Glucose brain handling undergoes dynamic changes during the life-course, suggesting that its alterations might precede and contribute to degenerative changes or signaling abnormalities. Imaging of the glucose analog 18F-labeled fluorodeoxyglucose (18FDG) by positron emission tomography (PET) is the gold-standard for the assessment of cerebral glucose metabolism in vivo. This review summarizes the current literature addressing brain glucose uptake measured by PET imaging, and the effect of insulin on brain metabolism, trying to embrace a life-course vision in the identification of patterns that may explain (and contribute to) the frequent association between obesity and cognitive dysfunction. The current evidence supports that brain hypermetabolism and brain insulin resistance occur in selected high-risk conditions as a transient phenomenon, eventually evolving toward normal or low values during life or disease progression. Associative studies suggest that brain hypermetabolism predicts low BDNF levels, hepatic and whole body insulin resistance, food desire and an unfavorable balance between anticipated reward from food and cognitive inhibitory control. Emerging mechanistic links involve the microbiota and the metabolome, which correlate with brain metabolism and cognition, deserving attention as potential future prevention targets.
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Affiliation(s)
- Patricia Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
- Correspondence should be addressed to P Iozzo:
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Malbert CH, Horowitz M, Young RL. Low-calorie sweeteners augment tissue-specific insulin sensitivity in a large animal model of obesity. Eur J Nucl Med Mol Imaging 2019; 46:2380-2391. [PMID: 31338548 DOI: 10.1007/s00259-019-04430-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
PURPOSES Whether low-calorie sweeteners (LCS), such as sucralose and acesulfame K, can alter glucose metabolism is uncertain, particularly given the inconsistent observations relating to insulin resistance in recent human trials. We hypothesized that these discrepancies are accounted for by the surrogate tools used to evaluate insulin resistance and that PET 18FDG, given its capacity to quantify insulin sensitivity in individual organs, would be more sensitive in identifying changes in glucose metabolism. Accordingly, we performed a comprehensive evaluation of the effects of LCS on whole-body and organ-specific glucose uptake and insulin sensitivity in a large animal model of morbid obesity. METHODS Twenty mini-pigs with morbid obesity were fed an obesogenic diet enriched with LCS (sucralose 1 mg/kg/day and acesulfame K 0.5 mg/kg/day, LCS diet group), or without LCS (control group), for 3 months. Glucose uptake and insulin sensitivity were determined for the duodenum, liver, skeletal muscle, adipose tissue and brain using dynamic PET 18FDG scanning together with direct measurement of arterial input function. Body composition was also measured using CT imaging and energy metabolism quantified with indirect calorimetry. RESULTS The LCS diet increased subcutaneous abdominal fat by ≈ 20% without causing weight gain, and reduced insulin clearance by ≈ 40%, while whole-body glucose uptake and insulin sensitivity were unchanged. In contrast, glucose uptake in the duodenum, liver and brain increased by 57, 66 and 29% relative to the control diet group (P < 0.05 for all), while insulin sensitivity increased by 53, 55 and 28% (P < 0.05 for all), respectively. In the brain, glucose uptake increased significantly only in the frontal cortex, associated with improved metabolic connectivity towards the hippocampus and the amygdala. CONCLUSIONS In miniature pigs, the combination of sucralose and acesulfame K is biologically active. While not affecting whole-body insulin resistance, it increases insulin sensitivity and glucose uptake in specific tissues, mimicking the effects of obesity in the adipose tissue and in the brain.
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Affiliation(s)
- Charles-Henri Malbert
- Aniscan Unit, Department of Human Nutrition, INRA, 16, le clos, 35590, Saint-Gilles, France.
| | - Michael Horowitz
- Center of Research Excellence in Translating Nutrition to Good Health, The University of Adelaide, Adelaide, 5005, Australia
| | - Richard L Young
- Center of Research Excellence in Translating Nutrition to Good Health, The University of Adelaide, Adelaide, 5005, Australia
- Nutrition & Metabolism, South Australia Health & Medical Research Institute, Adelaide, 5000, Australia
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