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Evaluation of Immunomodulatory Responses and Changed Wound Healing in Type 2 Diabetes-A Study Exploiting Dermal Fibroblasts from Diabetic and Non-Diabetic Human Donors. Cells 2021; 10:cells10112931. [PMID: 34831154 PMCID: PMC8616411 DOI: 10.3390/cells10112931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The dermis is the connective layer between the epidermis and subcutis and harbours nerve endings, glands, blood vessels, and hair follicles. The most abundant cell type is the fibroblast. Dermal fibroblasts have a versatile portfolio of functions within the dermis that correspond with different types of cells by either direct contact or by autocrine and paracrine signalling. Diabetic skin is characterized by itching, numbness, ulcers, eczema, and other pathophysiological changes. These pathogenic phenotypes have been associated with the effects of the reactive glucose metabolite methylglyoxal (MGO) on dermal cells. In this study, dermal fibroblasts were isolated from diabetic and non-diabetic human donors. Cultured dermal fibroblasts from diabetic donors exhibited reduced insulin-induced glucose uptake and reduced expression of the insulin receptor. This diabetic phenotype persists under cell culture conditions. Secretion of IL-6 was increased in fibroblasts from diabetic donors. Increased secretion of IL-6 and MIF was also observed upon the treatment of dermal fibroblasts with MGO, suggesting that MGO is sufficient for triggering these immunomodulatory responses. Remarkably, MIF treatment resulted in decreased activity of MGO-detoxifying glyoxalase-1. Given that reduced glyoxalase activity results in increased MGO levels, these findings suggested a positive-feedback loop for MGO generation, in which MIF, evoked by MGO, in turn blocks MGO-degrading glyoxalase activity. Finally, secretion of procollagen Type I C-Peptide (PICP), a marker of collagen production, was reduced in fibroblast from diabetic donors. Remarkably, treatment of fibroblasts with either MGO or MIF was sufficient for inducing reduced PICP levels. The observations of this study unravel a signalling network in human dermal fibroblasts with the metabolite MGO being sufficient for inflammation and delayed wound healing, hallmarks of T2D.
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Shen CB, Qian X, Yu RX, Ji XL, Shi YJ, Gao J, Li CX, Li KK, Fei WM, Shen X, Wang ZY, Han Y, Ning XL, Ko R, Hsu YH, Yin XY, Li GW, Cui Y. Skin diseases in the Da Qing Diabetes Study: a cross-sectional study. Chin Med J (Engl) 2021; 134:1191-1198. [PMID: 34018997 PMCID: PMC8143734 DOI: 10.1097/cm9.0000000000001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The prevalence of skin diseases and diabetes mellitus (DM) are prominent around the world. The current scope of knowledge regarding the prevalence of skin diseases and comorbidities with type 2 DM (T2DM) is limited, leading to limited recognition of the correlations between skin diseases and T2DM. METHODS We collected 383 subjects from the Da Qing Diabetes Study during the period from July 9th to September 1st, 2016. The subjects were categorized into three groups: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. The prevalence and clinical characteristics of skin diseases were recorded and investigated. RESULTS In this cross-sectional study, 383 individuals with ages ranging from 53 to 89-year-old were recruited. The overall prevalence of skin diseases was 93.5%, and 75.7% of individuals had two or more kinds of skin diseases. Additionally, there were 47 kinds of comorbid skin diseases in patients with T2DM, of which eight kinds of skin diseases had a prevalence >10%. The prevalence of skin diseases in NGT, IGT, and T2DM groups were 93.3%, 91.5%, and 96.6%, respectively; stratified analysis by categories showed a statistically significant difference in "disturbances of pigmentation" and "neurological and psychogenic dermatoses". The duration of T2DM also significantly associated with the prevalence of "disturbances of pigmentation" and "neurological and psychogenic dermatoses". Subsequently, the prevalence of "disturbances of pigmentation" was higher in males than females in NGT (P < 0.01) and T2DM (P < 0.01) groups. In addition, the difference in the prevalence of "disturbances of pigmentation" was also significant in NGT and T2DM groups (P < 0.01). CONCLUSIONS There was a high prevalence of skin diseases in the Da Qing Diabetes Study. To address the skin diseases in the Da Qing Diabetes Study, increased awareness and intervention measures should be implemented.
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Affiliation(s)
- Chang-Bing Shen
- Department of Dermatology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
- Shenzhen Key Laboratory for Translational Medicine of Dermatology, Shenzhen Peking University – The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong 518036, China
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, MA 02131, USA
| | - Xin Qian
- Center of Endocrinology and Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Rui-Xing Yu
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Institute of Skin Health, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xue-Lei Ji
- Department of Endocrinology and Metabolism, Second People's Hospital of Wuhu, Wuhu, Anhui 241000, China
| | - Yin-Juan Shi
- Department of Dermatology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Jing Gao
- Department of Dermatology, Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui 230601, China
| | - Cheng-Xu Li
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Institute of Skin Health, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ke-Ke Li
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Institute of Skin Health, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wen-Min Fei
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Institute of Skin Health, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xue Shen
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
| | - Zi-Yi Wang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Institute of Skin Health, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yang Han
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Institute of Skin Health, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Li Ning
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Institute of Skin Health, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Randy Ko
- The University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Yi-Hsiang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, MA 02131, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Xian-Yong Yin
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Guang-Wei Li
- Center of Endocrinology and Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Institute of Skin Health, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
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von Krogh F, Zink A. [Diabetes mellitus - the skin as a monitor]. MMW Fortschr Med 2020; 162:49-53. [PMID: 32124344 DOI: 10.1007/s15006-020-0219-z] [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: 06/10/2023]
Affiliation(s)
| | - Alexander Zink
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein Fakultät für Medizin, Technische Universität München, Biedersteiner Straße 29, D-80802, München, Deutschland.
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Mahmud FH, Elbarbary NS, Fröhlich-Reiterer E, Holl RW, Kordonouri O, Knip M, Simmons K, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 Suppl 27:275-286. [PMID: 30066458 PMCID: PMC6748835 DOI: 10.1111/pedi.12740] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Farid H. Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | - Mikael Knip
- Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado
| | - Maria E. Craig
- The Children’s Hospital at Westmead, Westmead, NSW, Australia,Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia,School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
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Kamel MI, Elhenawy YI, Saudi WM. Relation between cutaneous and extracutaneous complications in pediatric patients with type 1 diabetes. DERMATO-ENDOCRINOLOGY 2018; 10:e1467717. [PMID: 30279952 PMCID: PMC6166603 DOI: 10.1080/19381980.2018.1467717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 01/19/2023]
Abstract
Background: The relationship between cutaneous and extracutaneous complications in pediatric patients with type 1 diabetes is unclear. Objective: The objective of the current study is to investigate the relationship between skin disorders and diabetic microangiopathic changes in pediatric and adolescent patients with type 1 diabetes. Patients and methods: Eighty patients with type 1 diabetes and 50 healthy controls were enrolled in the study. All recruited patients were followed up monthly for a total period of 12 month. Monthly visit included thorough clinical examination with system review, as well as whole-body cutaneous examination. HbA1c was assessed every 3 month. Twenty-four hours urine was collected for measurement of urinary albumin. Results: Fifty percent of the screened diabetic cohort had diabetic nephropathy (DN). The overall prevalence of cutaneous lesion among the studied diabetic cohort was high (72.5%), with cutaneous infections (40%) and xerosis (30%) being the most prevalent. The frequency of cutaneous infections, xerosis and rubeosis faciei was higher in patients with nephropathy than in those without nephropathy. Conclusion: cutaneous affection in patients with diabetes may be a clue to the presence of associated microangioapthic complications. The significant association between diabetic nephropathy and cutaneous lesions support the concept that cutaneous lesion in diabetes is a reflection of diabetic angiopathy, highlighting the importance of identifying patients at risk of other microvascular complications.
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Affiliation(s)
- M. I. Kamel
- Department of Dermatology, Venerology and Andrology, Al-Azhar Faculty of Medicine, Cairo, Egypt
| | - Y. I. Elhenawy
- Division of Pediatric Diabetes, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - W. M. Saudi
- Department of Dermatology, Faculty of Medicine, Misr University for Science & Technology (MUST), Cairo, Egypt
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Makrantonaki E, Jiang D, Hossini AM, Nikolakis G, Wlaschek M, Scharffetter-Kochanek K, Zouboulis CC. Diabetes mellitus and the skin. Rev Endocr Metab Disord 2016; 17:269-282. [PMID: 27432328 DOI: 10.1007/s11154-016-9373-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diabetes is a debilitating, life-threatening disease accounting in 2015 for the death of 5 million people worldwide. According to new estimations, 415 million adults currently suffer from the disease, and this number is expected to rise to 642 million by 2040. High glucose blood levels also affect the skin among systemic organs, and skin disorders can often predict the onset of this metabolic disorder. In this review, we address the pathomechanistic effects of diabetes on the skin and give an overview on the most common skin diseases associated with diabetes.
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Affiliation(s)
- E Makrantonaki
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany.
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany.
| | - D Jiang
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - A M Hossini
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - G Nikolakis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - M Wlaschek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - K Scharffetter-Kochanek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - C C Zouboulis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
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de Béchade T, Eyerich K. [Diabetes and skin]. MMW Fortschr Med 2016; 158:55-60. [PMID: 27596197 DOI: 10.1007/s15006-016-8663-5] [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: 06/06/2023]
Affiliation(s)
- Tanja de Béchade
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Biedersteiner Straße 29, D-80802, München, Deutschland.
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Cutaneous manifestations among Egyptian children and adolescents with type 1 diabetes. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2015.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Abstract
The incidence of insulinopenic diabetes mellitus is constantly increasing, and in addition, approximately a third of all hyperinsulinemic diabetic patients develop insulinopenia. Optimal glycemic control is essential to minimize the risk for diabetes-induced complications, but the majority of diabetic patients fail to achieve proper long-term glucose levels even in clinical trials, and even more so in clinical practice. Compliance with a treatment regimen is likely to be higher if the procedure is simple, painless, and discreet. Thus, insulin has been suggested for nasal, gastrointestinal, and inhalation therapy, but so far with considerable downsides in effect, side effects, or patient acceptance. The stratum corneum is the main barrier preventing convenient drug administration without the drawbacks of subcutaneous injections. Recently, devices with miniaturized needles have been developed that combine the simplicity and discretion of patch-based treatments, but with the potential of peptide and protein administration. As this review describes, initial comparisons with subcutaneous administration now suggest microneedle patches for active insulin delivery are efficient in maintaining glycemic control. Hollow microneedle technology could also prove to be efficient in systemic as well as local delivery of other macromolecular drugs, such as vaccines.
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Affiliation(s)
- Michael Hultström
- Department of Medical Cell Biology, Division of Integrative Physiology, Uppsala University, Uppsala, Sweden Anaesthesia and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Niclas Roxhed
- Micro and Nanosystems, School of Electrical Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Lina Nordquist
- Department of Medical Cell Biology, Division of Integrative Physiology, Uppsala University, Uppsala, Sweden
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Jecht M. Hautveränderungen bei Diabetes mellitus. DIABETOLOGE 2009. [DOI: 10.1007/s11428-008-0351-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nordquist L, Roxhed N, Griss P, Stemme G. Novel Microneedle Patches for Active Insulin Delivery are Efficient in Maintaining Glycaemic Control: An Initial Comparison with Subcutaneous Administration. Pharm Res 2007; 24:1381-8. [PMID: 17387600 DOI: 10.1007/s11095-007-9256-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 01/30/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE Good glycaemic control is essential to minimize the risk for diabetes-induced complications. Also, compliance is likely to be higher if the procedure is simple and painless. This study was designed to validate painless intradermal delivery via a patch-like microneedle array. MATERIALS AND METHODS Diabetes was induced by an intravenous injection of streptozotocin (50 mg/kg bw) in adult male Sprague Dawley rats. Plasma insulin and blood glucose were measured before, during and after subcutaneous or intradermal (microneedles) infusion of insulin (0.2 IU/h) under Inactin-anaesthesia. RESULTS Before insulin administration, all animals displayed a pronounced hyperglycaemia (19 +/- 1 mM; 359 mg/dl). Administration of insulin resulted in a reduced plasma glucose independently of administration route (subcutaneous 7.5 +/- 4.2, n = 9, and intradermal 11 +/- 1.8, n = 9 after 240 min), but with less errors of the mean in the intradermal group. In the intradermal group, plasma insulin was increased in all latter measurements (72 +/- 22, 81 +/- 34, and 87 +/- 20 microIU/ml), as compared to the first measurement (26 +/- 13). In the subcutaneous group, plasma insulin was elevated during the last measurement (to 154 +/- 3.5 microIU/ml from 21 +/- 18). CONCLUSION This study presents a novel possibility of insulin delivery that is controllable and requires minimal training. This treatment strategy could improve compliance, and thus be beneficial for patients' glycaemic control.
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Affiliation(s)
- Lina Nordquist
- Department of Medical Cell Biology, Division of Integrative Physiology, Biomedical Centre, Uppsala University, Uppsala, Sweden.
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Affiliation(s)
- Johannes Wohlrab
- Department of Dermatology and Venereology, University Clinic and Polyclinic for Orthopedic and Physical Medicine, Martin-Luther-University Halle-Wittenberg, Germany.
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