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Xu M, Hu H, Deng D, Chen M, Xu Z, Wang Y. Prediabetes is associated with genetic variations in the gene encoding the Kir6.2 subunit of the pancreatic ATP-sensitive potassium channel (KCNJ11): A case-control study in a Han Chinese youth population. J Diabetes 2018; 10:121-129. [PMID: 28449408 DOI: 10.1111/1753-0407.12565] [Citation(s) in RCA: 8] [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: 11/25/2016] [Revised: 04/06/2017] [Accepted: 04/24/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The E23K variant of the potassium voltage-gated channel subfamily J member 11 (KCNJ11) gene has been reported to be associated with type 2 diabetes (T2D) in many populations. However, little is known about the role of E23K in the development of prediabetes in Chinese youth. METHODS To investigate the role of E23K in the development of prediabetes, 279 subjects with prediabetes and 240 normal controls (mean [± SD] age 18.1 ± 3.2 and 17.8 ± 4.3 years, respectively) were recruited to the study. Height, weight, and hip and waist circumferences were measured by trained physicians. Genotyping of KCNJ11 polymorphisms and clinical laboratory tests to determine cholesterol, triglyceride (TG), blood glucose, and insulin levels were performed. RESULTS The carrier rate of K23 allele-containing genotypes was higher for prediabetic than control subjects (P = 0.005). Logistic regression analyses revealed that higher body mass index percentiles (P = 0.013), lower insulin levels at 30 min during an oral glucose tolerance test (P = 0.001), a higher ratio of total cholesterol: high-density lipoprotein cholesterol (P = 0.001), and a K allele-containing genotype (P = 0.019) are independent risk factors for prediabetes in Chinese Han youth. Furthermore, K23 allele-containing genotypes were associated with impaired indices of insulin secretion and β-cell function in female youth with prediabetes. These effects were not seen in male youth with prediabetes. CONCLUSIONS The results confirm that the common E23K polymorphism of KCNJ11 carries a higher susceptibility to the development of prediabetes in the Chinese Han population. The results suggest that E23K may have a greater effect on the development of T2D in female Chinese youth.
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Affiliation(s)
- Min Xu
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei, China
| | - Honglin Hu
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei, China
| | - Datong Deng
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei, China
| | - Mingwei Chen
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei, China
| | - Zhenshan Xu
- AnHui AnKe Biotechnology Group, Hefei, China
| | - Youmin Wang
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei, China
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2
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Yang Y, Chan L. Monogenic Diabetes: What It Teaches Us on the Common Forms of Type 1 and Type 2 Diabetes. Endocr Rev 2016; 37:190-222. [PMID: 27035557 PMCID: PMC4890265 DOI: 10.1210/er.2015-1116] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To date, more than 30 genes have been linked to monogenic diabetes. Candidate gene and genome-wide association studies have identified > 50 susceptibility loci for common type 1 diabetes (T1D) and approximately 100 susceptibility loci for type 2 diabetes (T2D). About 1-5% of all cases of diabetes result from single-gene mutations and are called monogenic diabetes. Here, we review the pathophysiological basis of the role of monogenic diabetes genes that have also been found to be associated with common T1D and/or T2D. Variants of approximately one-third of monogenic diabetes genes are associated with T2D, but not T1D. Two of the T2D-associated monogenic diabetes genes-potassium inward-rectifying channel, subfamily J, member 11 (KCNJ11), which controls glucose-stimulated insulin secretion in the β-cell; and peroxisome proliferator-activated receptor γ (PPARG), which impacts multiple tissue targets in relation to inflammation and insulin sensitivity-have been developed as major antidiabetic drug targets. Another monogenic diabetes gene, the preproinsulin gene (INS), is unique in that INS mutations can cause hyperinsulinemia, hyperproinsulinemia, neonatal diabetes mellitus, one type of maturity-onset diabetes of the young (MODY10), and autoantibody-negative T1D. Dominant heterozygous INS mutations are the second most common cause of permanent neonatal diabetes. Moreover, INS gene variants are strongly associated with common T1D (type 1a), but inconsistently with T2D. Variants of the monogenic diabetes gene Gli-similar 3 (GLIS3) are associated with both T1D and T2D. GLIS3 is a key transcription factor in insulin production and β-cell differentiation during embryonic development, which perturbation forms the basis of monogenic diabetes as well as its association with T1D. GLIS3 is also required for compensatory β-cell proliferation in adults; impairment of this function predisposes to T2D. Thus, monogenic forms of diabetes are invaluable "human models" that have contributed to our understanding of the pathophysiological basis of common T1D and T2D.
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Affiliation(s)
- Yisheng Yang
- Division of Endocrinology (Y.Y.), Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio 44109; and Diabetes and Endocrinology Research Center (L.C.), Division of Diabetes, Endocrinology and Metabolism, Departments of Medicine, Molecular and Cellular Biology, Biochemistry and Molecular Biology, and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030
| | - Lawrence Chan
- Division of Endocrinology (Y.Y.), Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio 44109; and Diabetes and Endocrinology Research Center (L.C.), Division of Diabetes, Endocrinology and Metabolism, Departments of Medicine, Molecular and Cellular Biology, Biochemistry and Molecular Biology, and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030
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3
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Modeling K,ATP--dependent excitability in pancreatic islets. Biophys J 2015; 107:2016-26. [PMID: 25418087 DOI: 10.1016/j.bpj.2014.09.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 09/22/2014] [Accepted: 09/30/2014] [Indexed: 11/23/2022] Open
Abstract
In pancreatic ?-cells, K,ATP channels respond to changes in glucose to regulate cell excitability and insulin release. Confirming a high sensitivity of electrical activity to K,ATP activity, mutations that cause gain of K,ATP function cause neonatal diabetes. Our aim was to quantitatively assess the contribution of K,ATP current to the regulation of glucose-dependent bursting by reproducing experimentally observed changes in excitability when K,ATP conductance is altered by genetic manipulation. A recent detailed computational model of single cell pancreatic ?-cell excitability reproduces the ?-cell response to varying glucose concentrations. However, initial simulations showed that the model underrepresents the significance of K,ATP activity and was unable to reproduce K,ATP conductance-dependent changes in excitability. By altering the ATP and glucose dependence of the L-type Ca(2+) channel and the Na-K ATPase to better fit experiment, appropriate dependence of excitability on K,ATP conductance was reproduced. Because experiments were conducted in islets, which contain cell-to-cell variability, we extended the model from a single cell to a three-dimensional model (10×10×10 cell) islet with 1000 cells. For each cell, the conductance of the major currents was allowed to vary as was the gap junction conductance between cells. This showed that single cell glucose-dependent behavior was then highly variable, but was uniform in coupled islets. The study highlights the importance of parameterization of detailed models of ?-cell excitability and suggests future experiments that will lead to improved characterization of ?-cell excitability and the control of insulin secretion.
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Sokolova EA, Bondar IA, Shabelnikova OY, Pyankova OV, Filipenko ML. Replication of KCNJ11 (p.E23K) and ABCC8 (p.S1369A) Association in Russian Diabetes Mellitus 2 Type Cohort and Meta-Analysis. PLoS One 2015; 10:e0124662. [PMID: 25955821 PMCID: PMC4425644 DOI: 10.1371/journal.pone.0124662] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/17/2015] [Indexed: 12/26/2022] Open
Abstract
The genes ABCC8 and KCNJ11 have received intense focus in type 2 diabetes mellitus (T2DM) research over the past two decades. It has been hypothesized that the p.E23K (KCNJ11) mutation in the 11p15.1 region may play an important role in the development of T2DM. In 2009, Hamming et al. found that the p.1369A (ABCC8) variant may be a causal factor in the disease; therefore, in this study we performed a meta-analysis to evaluate the association between these single nucleotide polymorphisms (SNPs), including our original data on the Siberian population (1384 T2DM and 414 controls). We found rs5219 and rs757110 were not associated with T2DM in this population, and that there was linkage disequilibrium in Siberians (D’=0.766, r2= 0.5633). In addition, the haplotype rs757110[T]-rs5219[C] (p.23K/p.S1369) was associated with T2DM (OR = 1.52, 95% CI: 1.04-2.24). We included 44 original studies published by June 2014 in a meta-analysis of the p.E23K association with T2DM. The total OR was 1.14 (95% CI: 1.11-1.17) for p.E23K for a total sample size of 137,298. For p.S1369A, a meta-analysis was conducted on a total of 10 studies with a total sample size of 14,136 and pooled OR of 1.14 [95% CI (1.08-1.19); p = 2 x 10-6]. Our calculations identified causal genetic variation within the ABCC8/KCNJ11 region for T2DM with an OR of approximately 1.15 in Caucasians and Asians. Moreover, the OR value was not dependent on the frequency of p.E23K or p.S1369A in the populations.
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Affiliation(s)
- Ekaterina Alekseevna Sokolova
- Laboratory of Pharmacogenomics, Institute of Chemical Biology and Fundamental Medicine, Siberian Division, Russian Academy of Sciences, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - Irina Arkadievna Bondar
- Novosibirsk State Regional Hospital, Regional Diabetes center, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - Olesya Yurievna Shabelnikova
- Novosibirsk State Regional Hospital, Regional Diabetes center, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - Olga Vladimirovna Pyankova
- Laboratory of Pharmacogenomics, Institute of Chemical Biology and Fundamental Medicine, Siberian Division, Russian Academy of Sciences, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - Maxim Leonidovich Filipenko
- Laboratory of Pharmacogenomics, Institute of Chemical Biology and Fundamental Medicine, Siberian Division, Russian Academy of Sciences, Novosibirsk, Russia
- Kazan Federal University, Kazan, Russia
- * E-mail:
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Bonfanti DH, Alcazar LP, Arakaki PA, Martins LT, Agustini BC, de Moraes Rego FG, Frigeri HR. ATP-dependent potassium channels and type 2 diabetes mellitus. Clin Biochem 2015; 48:476-82. [PMID: 25583094 DOI: 10.1016/j.clinbiochem.2014.12.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus is a public health problem, which affects a millions worldwide. Most diabetes cases are classified as type 2 diabetes mellitus, which is highly associated with obesity. Type 2 diabetes is considered a multifactorial disorder, with both environmental and genetic factors contributing to its development. An important issue linked with diabetes development is the failure of the insulin releasing mechanism involving abnormal activity of the ATP-dependent potassium channel, KATP. This channel is a transmembrane protein encoded by the KCNJ11 and ABCC8 genes. Furthermore, polymorphisms in these genes have been linked to type 2 diabetes because of the role of KATP in insulin release. While several genetic variations have been reported to be associated with this disease, the E23K polymorphism is most commonly associated with this pathology, as well as to obesity. Here, we review the molecular genetics of the potassium channel and discusses its most described polymorphisms and their associations with type 2 diabetes mellitus.
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Affiliation(s)
- Dianne Heloisa Bonfanti
- Health and Biosciences School, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Larissa Pontes Alcazar
- Health and Biosciences School, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Priscila Akemi Arakaki
- Health and Biosciences School, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Laysa Toschi Martins
- Health and Biosciences School, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Bruna Carla Agustini
- Health and Biosciences School, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
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Population specific impact of genetic variants in KCNJ11 gene to type 2 diabetes: a case-control and meta-analysis study. PLoS One 2014; 9:e107021. [PMID: 25247988 PMCID: PMC4172481 DOI: 10.1371/journal.pone.0107021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/04/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Potassium inwardly rectifying channel, subfamily J, member 11 (KCNJ11) gene have a key role in insulin secretion and is of substantial interest as a candidate gene for type 2 diabetes (T2D). The current work was performed to delineate the genetic influence of KCNJ11 polymorphisms on risk of T2D in South Indian population through case-control association study along with systematic review and meta-analysis. METHODS A case-control study of 400 T2D cases and controls of South Indian origin were performed to analyze the association of KCNJ11 polymorphisms (rs5219, rs5215, rs41282930, rs1800467) and copy number variations (CNV) on the risk of T2D. In addition a systematic review and meta-analysis for KCNJ11 rs5219 was conducted in 3,831 cases and 3,543 controls from 5 published reports from South-Asian population by searching various databases. Odds ratio with 95% confidence interval (CI) was used to assess the association strength. Cochran's Q, I2 statistics were used to study heterogeneity between the eligible studies. RESULTS KCNJ11 rs5215, C-G-C-C haplotype and two loci analysis (rs5219 vs rs1800467) showed a significant association with T2D but CNV analysis did not show significant variation between T2D cases and control subjects. Lower age of disease onset (P = 0.04) and higher body mass index (BMI) (P = 0.04) were associated with rs5219 TT genotype in T2D patients. The meta-analysis of KCNJ11 rs5219 on South Asian population showed no association on susceptibility to T2D with an overall pooled OR = 0.98, 95% CI = 0.83-1.16. Stratification analysis showed East Asian population and global population were associated with T2D when compared to South Asians. CONCLUSION KCNJ11 rs5219 is not independently associated with T2D in South-Indian population and our meta-analysis suggests that KCNJ11 polymorphism (rs5219) is associated with risk of T2D in East Asian population and global population but this outcome could not be replicated in South Asian sub groups.
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Jiang YD, Chuang LM, Pei D, Lee YJ, Wei JN, Sung FC, Chang TJ. Genetic Variations in the Kir6.2 Subunit (KCNJ11) of Pancreatic ATP-Sensitive Potassium Channel Gene Are Associated with Insulin Response to Glucose Loading and Early Onset of Type 2 Diabetes in Childhood and Adolescence in Taiwan. Int J Endocrinol 2014; 2014:983016. [PMID: 25309595 PMCID: PMC4189766 DOI: 10.1155/2014/983016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/20/2014] [Indexed: 11/18/2022] Open
Abstract
To investigate the role of E23K polymorphism of the KCNJ11 gene on early onset of type 2 diabetes in school-aged children/adolescents in Taiwan, we recruited 38 subjects with type 2 diabetes (ages 18.6 ± 6.6 years; body mass index percentiles 83.3 ± 15.4) and 69 normal controls (ages 17.3 ± 3.8 years; body mass index percentiles 56.7 ± 29.0) from a national surveillance for childhood/adolescent diabetes in Taiwan. We searched for the E23K polymorphism of the KCNJ11 gene. We found that type 2 diabetic subjects had higher carrier rate of E23K polymorphism of KCNJ11 gene than control subjects (P = 0.044). After adjusting for age, gender, body mass index percentiles, and fasting plasma insulin, the E23K polymorphism contributed to an increased risk for type 2 diabetes (P = 0.047). K23-allele-containing genotypes conferring increased plasma insulin level during OGTT in normal subjects. However, the diabetic subjects with the K23-allele-containing genotypes had lower fasting plasma insulin levels after adjustment of age and BMI percentiles. In conclusion, the E23K variant of the KCNJ11 gene conferred higher susceptibility to type 2 diabetes in children/adolescents. Furthermore, in normal glucose-tolerant children/adolescents, K23 allele carriers had a higher insulin response to oral glucose loading.
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Affiliation(s)
- Yi-Der Jiang
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
- Graduate Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei 10002, Taiwan
| | - Dee Pei
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cardinal Tien Hospital, Xindian 23148, Taiwan
| | - Yann-Jinn Lee
- Department of Pediatrics, Mackay General Hospital, Taipei 10449, Taiwan
| | - Jun-Nan Wei
- Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Fung-Chang Sung
- Institute of Environmental Health, College of Public Health, China Medical University, Taichung 40447, Taiwan
| | - Tien-Jyun Chang
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
- *Tien-Jyun Chang:
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Keshavarz P, Habibipour R, Ghasemi M, Kazemnezhad E, Alizadeh M, Omami MHH. Lack of genetic susceptibility of KCNJ11 E23K polymorphism with risk of type 2 diabetes in an Iranian population. Endocr Res 2014; 39:120-5. [PMID: 24460047 DOI: 10.3109/07435800.2013.860607] [Citation(s) in RCA: 13] [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] [Indexed: 12/12/2022]
Abstract
AIMS The KCNJ11 gene has a strong effect on glucose-stimulated insulin secretion. Common polymorphism KCNJ11 E23K has been reported to be associated with type 2 diabetes in various European-descent populations. However, there were inconsistent results in previous studies in Asian populations, and no study has been carried out in the Iranian population. We examined the contribution of KCNJ11 E23K variant in the susceptibility to type 2 diabetes in the Iranian population. METHODS We undertook a population-based association study between type 2 diabetes and E23K mutation using 400 people with type 2 diabetes and 420 controls. Genotyping was performed using TaqMan technology on an ABI7300 system. RESULTS No significant difference was observed in either genotype distribution (p = 0.71) or allele frequency (p = 0.88) between individuals with and without type 2 diabetes. After adjusting for the confounding effects of age, gender and body mass index (BMI), no significant effect of genotypes on type 2 diabetes was found regarding any genetic models tested (recessive, dominant or co-dominant models). Following subgroup analysis of individuals with and without diabetes based on BMI, a nominal significant association was observed between type 2 diabetes in the presence of obesity and E23K genotype in the recessive model (p = 0.03). CONCLUSION The KCNJ11 E23K polymorphism is not associated with genetic susceptibility to type 2 diabetes in the Iranian population; however, it may play a role in disease progression in the presence of obesity.
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Affiliation(s)
- Parvaneh Keshavarz
- Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences
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ACE I/D and MTHFR C677T polymorphisms are significantly associated with type 2 diabetes in Arab ethnicity: a meta-analysis. Gene 2013; 520:166-77. [PMID: 23458876 DOI: 10.1016/j.gene.2013.02.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/28/2013] [Accepted: 02/06/2013] [Indexed: 12/14/2022]
Abstract
In this meta-analysis study, SNPs were investigated for their association with type 2 diabetes (T2D) in both Arab and Caucasian ethnicities. A total of 55 SNPs were analyzed, of which 11 fulfilled the selection criteria, and were used for analysis. It was found that TCF7L2 rs7903146 was significantly associated with a pooled OR of 1.155 (95%C.I.=1.059-1.259), p<0.0001 and I(2)=78.30% among the Arab population, whereas among Caucasians, the pooled OR was 1.45 (95%C.I.=1.386-1.516), p<0.0001 and I(2)=77.20%. KCNJ11 rs5219 was significantly associated in both the populations with a pooled OR of 1.176(1.092-1.268), p<0.0001 and I(2)=32.40% in Caucasians and a pooled OR of 1.28(1.111-1.475), p=0.001 among Arabs. The ACE I/D polymorphism was found to be significantly associated with a pooled OR of 1.992 (95%C.I.=1.774-2.236), p<0.0001 and I(2)=83.20% among the Arab population, whereas among Caucasians, the pooled OR was 1.078 (95%C.I.=0.993-1.17), p=0.073 and I(2)=0%. Similarly, MTHFR C677T polymorphism was also found to be significantly associated among Arabs with a pooled OR of 1.924 (95%C.I.=1.606-2.304), p<0.0001 and I(2)=27.20%, whereas among Caucasians, the pooled OR was 0.986 (95%C.I.=0.868-1.122), p=0.835 and I(2)=0%. Meanwhile PPARG-2 Pro12Ala, CDKN2A/2B rs10811661, IGF2BP2 rs4402960, HHEX rs7923837, CDKAL1 rs7754840, EXT2 rs1113132 and SLC30A8 rs13266634 were found to have no significant association with T2D among Arabs. In conclusion, it seems from this study that both Arabs and Caucasians have different SNPs associated with T2D. Moreover, this study sheds light on the profound necessity for further investigations addressing the question of the genetic components of T2D in Arabs.
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Pharmacogenomic analysis of ATP-sensitive potassium channels coexpressing the common type 2 diabetes risk variants E23K and S1369A. Pharmacogenet Genomics 2012; 22:206-14. [PMID: 22209866 DOI: 10.1097/fpc.0b013e32835001e7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The common ATP-sensitive potassium (KATP) channel variants E23K and S1369A, found in the KCNJ11 and ABCC8 genes, respectively, form a haplotype that is associated with an increased risk for type 2 diabetes. Our previous studies showed that KATP channel inhibition by the A-site sulfonylurea gliclazide was increased in the K23/A1369 haplotype. Therefore, we studied the pharmacogenomics of seven clinically used sulfonylureas and glinides to determine their structure-activity relationships in KATP channels containing either the E23/S1369 nonrisk or K23/A1369 risk haplotypes. RESEARCH DESIGN AND METHODS The patch-clamp technique was used to determine sulfonylurea and glinide inhibition of recombinant human KATP channels containing either the E23/S1369 or the K23/A1369 haplotype. RESULTS KATP channels containing the K23/A1369 risk haplotype were significantly less sensitive to inhibition by tolbutamide, chlorpropamide, and glimepiride (IC50 values for K23/A1369 vs. E23/S1369=1.15 vs. 0.71 μmol/l; 4.19 vs. 3.04 μmol/l; 4.38 vs. 2.41 nmol/l, respectively). In contrast, KATP channels containing the K23/A1369 haplotype were significantly more sensitive to inhibition by mitiglinide (IC50=9.73 vs. 28.19 nmol/l for K23/A1369 vs. E23/S1369) and gliclazide. Nateglinide, glipizide, and glibenclamide showed similar inhibitory profiles in KATP channels containing either haplotype. CONCLUSION Our results demonstrate that the ring-fused pyrrole moiety in several A-site drugs likely underlies the observed inhibitory potency of these drugs on KATP channels containing the K23/A1369 risk haplotype. It may therefore be possible to tailor existing therapy or design novel drugs that display an increased efficacy in type 2 diabetes patients homozygous for these common KATP channel haplotypes.
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Fatehi M, Raja M, Carter C, Soliman D, Holt A, Light PE. The ATP-sensitive K(+) channel ABCC8 S1369A type 2 diabetes risk variant increases MgATPase activity. Diabetes 2012; 61:241-9. [PMID: 22187380 PMCID: PMC3237651 DOI: 10.2337/db11-0371] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pancreatic β-cell ATP-sensitive K(+) (K(ATP)) channels are composed of Kir6.2 and SUR1 subunits encoded by the KCNJ11 and ABCC8 genes, respectively. Although rare monogenic activating mutations in these genes cause overt neonatal diabetes, the common variants E23K (KCNJ11) and S1369A (ABCC8) form a tightly heritable haplotype that is associated with an increased susceptibility to type 2 diabetes (T2D) risk. However, the molecular mechanism(s) underlying this risk remain to be elucidated. A homology model of the SUR1 nucleotide-binding domains (NBDs) indicates that residue 1369 is in close proximity to the major MgATPase site. Therefore, we investigated the intrinsic MgATPase activity of K(ATP) channels containing these variants. Electrophysiological and biochemical techniques were used to study the MgATPase activity of recombinant human K(ATP) channels or glutathione S-transferase and NBD2 fusion proteins containing the E23/S1369 (nonrisk) or K23/A1369 (risk) variant haplotypes. K(ATP) channels containing the K23/A1369 haplotype displayed a significantly increased stimulation by guanosine triphosphate compared with the E23/S1369 haplotype (3.2- vs. 1.8-fold). This effect was dependent on the presence of the A1369 variant and was lost in the absence of Mg(2+) ions or in the presence of the MgATPase inhibitor beryllium fluoride. Direct biochemical assays also confirmed an increase in MgATPase activity in NBD2 fusion proteins containing the A1369 variant. Our findings demonstrate that the A1369 variant increases K(ATP) channel MgATPase activity, providing a plausible molecular mechanism by which the K23/A1369 haplotype increases susceptibility to T2D in humans homozygous for these variants.
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MESH Headings
- ATP-Binding Cassette Transporters/chemistry
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- ATP-Binding Cassette Transporters/physiology
- Adenosine Triphosphatases/metabolism
- Adenosine Triphosphate/metabolism
- Alanine/genetics
- Amino Acid Substitution/physiology
- Cells, Cultured
- Diabetes Mellitus, Type 2/genetics
- Enzyme Activation
- Genetic Predisposition to Disease
- Humans
- KATP Channels/chemistry
- KATP Channels/genetics
- KATP Channels/physiology
- Models, Molecular
- Polymorphism, Single Nucleotide/physiology
- Potassium Channels, Inwardly Rectifying/chemistry
- Potassium Channels, Inwardly Rectifying/genetics
- Potassium Channels, Inwardly Rectifying/metabolism
- Potassium Channels, Inwardly Rectifying/physiology
- Protein Structure, Tertiary/genetics
- Receptors, Drug/chemistry
- Receptors, Drug/genetics
- Receptors, Drug/metabolism
- Receptors, Drug/physiology
- Risk Factors
- Serine/genetics
- Sulfonylurea Receptors
- Transfection
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Yang L, Zhou X, Luo Y, Sun X, Tang Y, Guo W, Han X, Ji L. Association between KCNJ11 gene polymorphisms and risk of type 2 diabetes mellitus in East Asian populations: a meta-analysis in 42,573 individuals. Mol Biol Rep 2011; 39:645-59. [PMID: 21573802 DOI: 10.1007/s11033-011-0782-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 04/27/2011] [Indexed: 01/12/2023]
Abstract
A number of studies have been performed to identify the association between potassium inwardly-rectifying channel, subfamily J, member 11 (KCNJ11) gene and type 2 diabetes mellitus (T2DM) in East Asian populations, with inconsistent results. The main aim of this work was to evaluate more precisely the genetic influence of KCNJ11 on T2DM in East Asian populations by means of a meta-analysis. We identified 20 articles for qualitative analysis and 16 were eligible for quantitative analysis (meta-analysis) by database searching up to May 2010. The association was assessed under different genetic models, and the pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. The allelic and genotypic contrast demonstrated that the association between KCNJ11 and T2DM was significant for rs5210. However, not all results for rs5215 and rs5218 showed significant associations. For rs5219, the combined ORs (95% CIs) for allelic contrast, dominant and recessive models contrast (with allelic frequency and genotypic distribution data) were 1.139 (1.093-1.188), 1.177 (1.099-1.259) and 1.207 (1.094-1.332), respectively (random effect model). The analysis on the most completely adjusted ORs (95% CIs) by the covariates of rs5219 all presented significant associations under different genetic models. Population-stratified analysis (Korean, Japanese and Chinese) and sensitivity analysis verified the significant results. Cumulative meta-analysis including publication time and sample size illustrated the exaggerated genetic effect in the earliest studies. Heterogeneity and publication bias were assessed. Our study verified that single nucleotide polymorphisms (SNPs) of KCNJ11 gene were significantly associated with the risk of T2DM in East Asian populations.
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Affiliation(s)
- Lijuan Yang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No. 11 Xi Zhimen Nan Da Jie Main Street, Xi Cheng District, Beijing, 100044, China
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13
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Abstract
A variety of treatment modalities exist for individuals with type 2 diabetes mellitus (T2D). In addition to dietary and physical activity interventions, T2D is also treated pharmacologically with nine major classes of approved drugs. These medications include insulin and its analogues, sulfonylureas, biguanides, thiazolidinediones (TZDs), meglitinides, α-glucosidase inhibitors, amylin analogues, incretin hormone mimetics, and dipeptidyl peptidase 4 (DPP4) inhibitors. Pharmacological treatment strategies for T2D are typically based on efficacy, yet favorable responses to such therapeutics are oftentimes variable and difficult to predict. Characterization of drug response is expected to substantially enhance our ability to provide patients with the most effective treatment strategy given their individual backgrounds, yet pharmacogenetic study of diabetes medications is still in its infancy. To date, major pharmacogenetic studies have focused on response to sulfonylureas, biguanides, and TZDs. Here, we provide a comprehensive review of pharmacogenetics investigations of these specific anti-diabetes medications. We focus not only on the results of these studies, but also on how experimental design, study sample issues, and definition of 'response' can significantly impact our interpretation of findings. Understanding the pharmacogenetics of anti-diabetes medications will provide critical baseline information for the development and implementation of genetic screening into therapeutic decision making, and lay the foundation for "individualized medicine" for patients with T2D.
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Affiliation(s)
- Johanna K. DiStefano
- Metabolic Diseases Division, Translational Genomics Research Institute, 445 N. 5th Street, Phoenix, AZ 85004, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-602-343-8812; Fax: +1-602-343-8844
| | - Richard M. Watanabe
- Departments of Preventive Medicine and Physiology & Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; E-Mail: (R.M.W.)
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Gene-gene interactions lead to higher risk for development of type 2 diabetes in an Ashkenazi Jewish population. PLoS One 2010; 5:e9903. [PMID: 20361036 PMCID: PMC2845632 DOI: 10.1371/journal.pone.0009903] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 03/04/2010] [Indexed: 01/08/2023] Open
Abstract
Background Evidence has accumulated that multiple genetic and environmental factors play important roles in determining susceptibility to type 2 diabetes (T2D). Although variants from candidate genes have become prime targets for genetic analysis, few studies have considered their interplay. Our goal was to evaluate interactions among SNPs within genes frequently identified as associated with T2D. Methods/Principal Findings Logistic regression was used to study interactions among 4 SNPs, one each from HNF4A[rs1884613], TCF7L2[rs12255372], WFS1[rs10010131], and KCNJ11[rs5219] in a case-control Ashkenazi sample of 974 diabetic subjects and 896 controls. Nonparametric multifactor dimensionality reduction (MDR) and generalized MDR (GMDR) were used to confirm findings from the logistic regression analysis. HNF4A and WFS1 SNPs were associated with T2D in logistic regression analyses [P<0.0001, P<0.0002, respectively]. Interaction between these SNPs were also strong using parametric or nonparametric methods: the unadjusted odds of being affected with T2D was 3 times greater in subjects with the HNF4A and WFS1 risk alleles than those without either (95% CI = [1.7–5.3]; P≤0.0001). Although the univariate association between the TCF7L2 SNP and T2D was relatively modest [P = 0.02], when paired with the HNF4A SNP, the OR for subjects with risk alleles in both SNPs was 2.4 [95% CI = 1.7–3.4; P≤0.0001]. The KCNJ11 variant reached significance only when paired with either the HNF4A or WFSI SNPs: unadjusted ORs were 2.0 [95% CI = 1.4–2.8; P≤0.0001] and 2.3 [95% CI = 1.2-4.4; P≤0.0001], respectively. MDR and GMDR results were consistent with the parametric findings. Conclusions These results provide evidence of strong independent associations between T2D and SNPs in HNF4A and WFS1 and their interaction in our Ashkenazi sample. We also observed an interaction in the nonparametric analysis between the HNF4A and KCNJ11 SNPs (P≤0.001), demonstrating that an independently non-significant variant may interact with another variant resulting in an increased disease risk.
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Yu M, Xu XJ, Yin JY, Wu J, Chen X, Gong ZC, Ren HY, Huang Q, Sheng FF, Zhou HH, Liu ZQ. KCNJ11 Lys23Glu and TCF7L2 rs290487(C/T) polymorphisms affect therapeutic efficacy of repaglinide in Chinese patients with type 2 diabetes. Clin Pharmacol Ther 2010; 87:330-5. [PMID: 20054294 DOI: 10.1038/clpt.2009.242] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study showed that the polymorphisms KCNJ11 Lys23Glu and TCF7L2 rs290487(C/T) are associated with a heightened risk of developing type 2 diabetes mellitus (T2DM). We also explored the effects of these polymorphisms on the efficacy of repaglinide therapy in Chinese patients with T2DM. A total of 259 patients with T2DM and 188 healthy controls were genotyped. Forty patients with various genotypes were randomly selected to undergo an 8-week repaglinide treatment regimen. Patients with the G allele of the KCNJ11 Lys23Glu polymorphism showed higher levels of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) (P < 0.05). After repaglinide treatment, patients with the GA or AA genotype showed higher levels of FPG, PPG, and glycated hemoglobin (HbA(1c)) compared with patients with the GG genotype (P < 0.05). Patients with the C allele of TCF7L2 rs290487(C/T) had higher total cholesterol levels and lower body mass index (BMI) (P < 0.05). In patients with the TT genotype, the drug showed better efficacy with respect to levels of fasting insulin, triglycerides, and low-density lipoprotein cholesterol (LDL-c) than in patients with the CC or CT genotype (P < 0.05). The KCNJ11 and TCF7L2 polymorphisms were associated with repaglinide efficacy.
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Affiliation(s)
- M Yu
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Hunan, People's Republic of China
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Abstract
Type 2 diabetes mellitus is a complex metabolic disease that is caused by insulin resistance and beta-cell dysfunction. Furthermore, type 2 diabetes has an evident genetic component and represents a polygenic disease. During the last decade, considerable progress was made in the identification of type 2 diabetes risk genes. This was crucially influenced by the development of affordable high-density single nucleotide polymorphism (SNP) arrays that prompted several successful genome-wide association scans in large case-control cohorts. Subsequent to the identification of type 2 diabetes risk SNPs, cohorts thoroughly phenotyped for prediabetic traits with elaborate in vivo methods allowed an initial characterization of the pathomechanisms of these SNPs. Although the underlying molecular mechanisms are still incompletely understood, a surprising result of these pathomechanistic investigations was that most of the risk SNPs affect beta-cell function. This favors a beta-cell-centric view on the genetics of type 2 diabetes. The aim of this review is to summarize the current knowledge about the type 2 diabetes risk genes and their variants' pathomechanisms.
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Affiliation(s)
- Harald Staiger
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry, University Hospital Tübingen, D-72076 Tübingen, Germany
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17
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Flanagan SE, Clauin S, Bellanné-Chantelot C, de Lonlay P, Harries LW, Gloyn AL, Ellard S. Update of mutations in the genes encoding the pancreatic beta-cell K(ATP) channel subunits Kir6.2 (KCNJ11) and sulfonylurea receptor 1 (ABCC8) in diabetes mellitus and hyperinsulinism. Hum Mutat 2009; 30:170-80. [PMID: 18767144 DOI: 10.1002/humu.20838] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The beta-cell ATP-sensitive potassium (K(ATP)) channel is a key component of stimulus-secretion coupling in the pancreatic beta-cell. The channel couples metabolism to membrane electrical events bringing about insulin secretion. Given the critical role of this channel in glucose homeostasis it is therefore not surprising that mutations in the genes encoding for the two essential subunits of the channel can result in both hypo- and hyperglycemia. The channel consists of four subunits of the inwardly rectifying potassium channel Kir6.2 and four subunits of the sulfonylurea receptor 1 (SUR1). It has been known for some time that loss of function mutations in KCNJ11, which encodes for Kir6.2, and ABCC8, which encodes for SUR1, can cause oversecretion of insulin and result in hyperinsulinism of infancy, while activating mutations in KCNJ11 and ABCC8 have recently been described that result in the opposite phenotype of diabetes. This review focuses on reported mutations in both genes, the spectrum of phenotypes, and the implications for treatment on diagnosing patients with mutations in these genes.
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Affiliation(s)
- Sarah E Flanagan
- Institute of Biomedical and Clinical Science, Peninsula Medical School, Exeter, United Kingdom
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18
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Chistiakov DA, Potapov VA, Khodirev DC, Shamkhalova MS, Shestakova MV, Nosikov VV. Genetic variations in the pancreatic ATP-sensitive potassium channel, beta-cell dysfunction, and susceptibility to type 2 diabetes. Acta Diabetol 2009; 46:43-9. [PMID: 18758683 DOI: 10.1007/s00592-008-0056-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 07/20/2008] [Indexed: 12/22/2022]
Abstract
The KCNJ11 and ABCC8 genes encode the components of the pancreatic ATP-sensitive potassium (KATP) channel, which regulates insulin secretion by beta-cells and hence could be involved in the pathogenesis of type 2 diabetes (T2D). The KCNJ11 E23K and ABCC8 exon 31 variants have been studied in 127 Russian T2D patients and 117 controls using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach. The KCNJ11 E23 variant and the ABCC8 exon 31 allele A were associated with higher risk of T2D [Odds ratio (OR) of 1.53 (P=0.023) and 2.41 (P=1.95 x 10(-5))], respectively. Diabetic carriers of the ABCC8 G/G variant had reduced 2 h glucose compared to A/A+A/G (P=0.031). The G/G genotype of ABCC8 was also significantly associated with increased both fasting and 2 h serum insulin in diabetic and non-diabetic patients. A HOMA-beta value characterizing the beta-cell homeostasis was higher in the non-diabetic carriers homozygous for G/G (98.0+/-46.9) then for other genotypes (HOMA-beta = 85.6+/-45.5 for A/A+A/G, P=0.0015). The KCNJ11 E23K and ABCC8 exon 31 variants contribute to susceptibility to T2D diabetes, glucose intolerance and altered insulin secretion in a Russian population.
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Affiliation(s)
- D A Chistiakov
- Department of Pathology, University of Pittsburgh, A709 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA.
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Chistiakov DA, Potapov VA, Khodirev DS, Shamkhalova MS, Shestakova MV, Nosikov VV. The KCNJ11 E23K and ABCC8 exon 31 variants contribute to susceptibility to type 2 diabetes, glucose intolerance and altered insulin secretion in a Russian population. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2008. [DOI: 10.1016/j.dsx.2008.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Florez JC. Newly identified loci highlight beta cell dysfunction as a key cause of type 2 diabetes: where are the insulin resistance genes? Diabetologia 2008; 51:1100-10. [PMID: 18504548 DOI: 10.1007/s00125-008-1025-9] [Citation(s) in RCA: 232] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Accepted: 04/04/2008] [Indexed: 12/13/2022]
Abstract
Although type 2 diabetes has been traditionally understood as a metabolic disorder initiated by insulin resistance, it has recently become apparent that an impairment in insulin secretion contributes to its manifestation and may play a prominent role in its early pathophysiology. The genetic dissection of Mendelian and, more recently, polygenic types of diabetes confirms the notion that primary defects in insulin synthesis, processing and/or secretion often give rise to the common form of this disorder. This concept, first advanced with the discovery and physiological characterisation of various genetic subtypes of MODY, has been extended to other forms of monogenic diabetes (e.g. neonatal diabetes). It has also led to the identification of common risk variants via candidate gene approaches (e.g. the E23K polymorphism in KCNJ11 or common variants in the MODY genes), and it has been validated by the description of the robust physiological effects conferred by polymorphisms in the TCF7L2 gene. More recently, the completion and integration of genome-wide association scans for this disease has uncovered a number of heretofore unsuspected variants, several of which also affect insulin secretion. This review provides an up-to-date account of genetic loci that influence risk of common type 2 diabetes via impairment of beta cell function, outlines their presumed mechanisms of action, and places them in the context of gene-gene and/or gene-environment interactions. Finally, a strategy for the analogous discovery of insulin resistance genes is proposed.
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Affiliation(s)
- J C Florez
- Diabetes Unit and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA.
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21
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Abstract
After two decades of limited success, the genetic architecture of type 2 diabetes (T2D) is finally being revealed. Within only 2 years, an avalanche of studies identified several genes expressed in pancreatic beta cells and involved in the control of insulin secretion, such as transcription factor 7-like 2 (TCF7L2), a key element of the Wnt signaling pathway. In Europeans, genome-wide association scans showed that TCF7L2 has been the most important locus predisposing to T2D so far. For the first time, a gene is consistently involved in T2D susceptibility in all major ethnic groups. At the individual level, carrying the TCF7L2 risk allele increases T2D risk 50%. However, at the population level, the attributable risk is lower than 25% and varies with the allele frequency. The presence of the TCF7L2 rs7903146 risk allele increases TCF7L2 gene expression in beta cells, possibly impairing glucagon-like peptide-1-induced insulin secretion and/or the production of new mature beta cells. The tremendous association of TCF7L2 polymorphisms with T2D provides new insights into future genetic predisposition tests but remains the tip of the T2D genetic iceberg.
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22
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Moore AF, Florez JC. Genetic Susceptibility to Type 2 Diabetes and Implications for Antidiabetic Therapy. Annu Rev Med 2008; 59:95-111. [DOI: 10.1146/annurev.med.59.090706.135315] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Allan F. Moore
- Diabetes Unit (Department of Medicine) and Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts; the Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; and the Department of Medicine, Harvard Medical School, Boston, Massachusetts;
| | - Jose C. Florez
- Diabetes Unit (Department of Medicine) and Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts; the Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; and the Department of Medicine, Harvard Medical School, Boston, Massachusetts;
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Vaxillaire M, Veslot J, Dina C, Proença C, Cauchi S, Charpentier G, Tichet J, Fumeron F, Marre M, Meyre D, Balkau B, Froguel P. Impact of common type 2 diabetes risk polymorphisms in the DESIR prospective study. Diabetes 2008; 57:244-54. [PMID: 17977958 DOI: 10.2337/db07-0615] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The emerging picture of type 2 diabetes genetics involves differently assembled gene variants, each modestly increasing risk with environmental exposure. However, the relevance of these genes for disease prediction has not been extensively tested. RESEARCH DESIGN AND METHODS We analyzed 19 common polymorphisms of 14 known candidate genes for their contribution to prevalence and incidence of glucose intolerance in the DESIR (Data from an Epidemiological Study on the Insulin Resistance syndrome) prospective study of middle-aged Caucasian subjects, including 3,877 participants (16.8% with hyperglycemia and 7.9% with diabetes after the 9-year study). RESULTS The GCK (Glucokinase) -30A allele was associated with increased type 2 diabetes risk at the end of the follow-up study (adjusted OR 1.34 [95% CI 1.07-1.69]) under an additive model, as supported in independent French diabetic case subjects (OR 1.22, P = 0.007), with increased fasting glycemia (0.85% per A allele, P = 6 x 10(-5)) and decreased homeostasis model assessment of beta-cell function (4%, P = 0.0009). IL6 (Interleukin- 6) -174 G/C interacts with age in disease risk and modulates fasting glycemia according to age (1.36% decrease over 56 years, P = 5 x 10(-5)). These polymorphisms together with KCNJ11 (Kir6.2)-E23K and TCF7L2-rs7903146 may predict diabetes incidence in the DESIR cohort. Each additional risk allele at GCK, TCF7L2, and IL6 increased risk by 1.34 (P = 2 x 10(-6)), with an OR of 2.48 (95% CI 1.59-3.86), in carriers of at least four at-risk alleles compared with those with none or one risk allele. CONCLUSIONS Our data confirm several at-risk polymorphisms for type 2 diabetes in a general population and demonstrate that prospective studies are valuable designs to complement classical genetic approaches.
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Affiliation(s)
- Martine Vaxillaire
- UMR8090 and Institute of Biology, Lille 2 University, CNRS and Pasteur Institute, Lille, France.
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Abstract
In 1988 the task of identifying Type 2 diabetes genes was described as a nightmare. For the next 17 years this proved to be largely correct. In the meantime the prevalence of Type 2 diabetes rose sharply due to non-genetic factors, compounding the problem of trying to find genes. Despite a huge amount of effort, progress was disappointing and only two genes, PPARG and KCNJ11, were confirmed beyond doubt as Type 2 diabetes risk factors in multiple studies. The reasons for this have been well documented and mainly consist of the use of inappropriate levels of statistical inference given the many hundreds of thousands of potential risk polymorphisms in the genome and their small effect sizes. The good news is that these problems are now surmountable and prospects for finding many more genes are bright. This year saw the identification of a third gene, TCF7L2, that has a greater impact on risk than the first two and provided important lessons for Type 2 diabetes genetic studies. The most important of these lessons was that previously unsuspected genes may be involved. In this review I discuss why this year is the start of a new era in our understanding of Type 2 diabetes genes and how this may lead to improved patient care.
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Affiliation(s)
- T M Frayling
- Peninsula Medical School, University of Exeter, Exeter, UK.
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25
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Cauchi S, El Achhab Y, Choquet H, Dina C, Krempler F, Weitgasser R, Nejjari C, Patsch W, Chikri M, Meyre D, Froguel P. TCF7L2 is reproducibly associated with type 2 diabetes in various ethnic groups: a global meta-analysis. J Mol Med (Berl) 2007; 85:777-82. [PMID: 17476472 DOI: 10.1007/s00109-007-0203-4] [Citation(s) in RCA: 267] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Revised: 03/27/2007] [Accepted: 03/30/2007] [Indexed: 12/15/2022]
Abstract
TCF7L2 variants have been consistently associated with type 2 diabetes (T2D) in populations of different ethnic descent. Among them, the rs7903146 T allele is probably the best proxy to evaluate the effect of this gene on T2D risk in additional ethnic groups. In the present study, we investigated the association between the TCF7L2 rs7903146 polymorphism and T2D in Moroccans (406 normoglycemic individuals and 504 T2D subjects) and in white Austrians (1,075 normoglycemic individuals and 486 T2D subjects). Then, we systematically reviewed the association of this single nucleotide polymorphism (SNP) with T2D risk in a meta-analysis, combining our data with data from previous studies. The allelic odds ratios (ORs) for T2D were 1.56 [1.29-1.89] (p = 2.9 x 10(-6)) and 1.52 [1.29-1.78] (p = 3.0 x 10(-7)) in Moroccans and Austrians, respectively. No heterogeneity was found between these two different populations by Woolf test (chi (2) = 0.04, df = 1, p = 0.84). We found 28 original published association studies dealing with the TCF7L2 rs7903146 polymorphism in T2D. A meta-analysis was then performed on 29,195 control subjects and 17,202 cases. No heterogeneity in genotypic distribution was found (Woolf test: chi (2) = 31.5, df = 26, p = 0.21; Higgins statistic: I2 = 14.1%). A Mantel-Haenszel procedure was then performed to provide a pooled odds ratio (OR) of 1.46 [1.42-1.51] (p = 5.4 x 10(-140)). No publication bias was detected, using the conservative Egger's regression asymmetry test (t = -1.6, df = 25, p = 0.11). Compared to any other gene variants previously confirmed by meta-analysis, TCF7L2 can be distinguished by its tremendous reproducibility of association with T2D and its OR twice as high. In the near future, large-scale genome-wide association studies will fully extend the genome coverage, potentially delivering other common diabetes-susceptibility genes like TCF7L2.
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Affiliation(s)
- Stéphane Cauchi
- CNRS, 8090, Institute of Biology, Pasteur Institute, Lille, 59000, France
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26
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Koo BK, Cho YM, Park BL, Cheong HS, Shin HD, Jang HC, Kim SY, Lee HK, Park KS. Polymorphisms of KCNJ11 (Kir6.2 gene) are associated with Type 2 diabetes and hypertension in the Korean population. Diabet Med 2007; 24:178-86. [PMID: 17257281 DOI: 10.1111/j.1464-5491.2006.02050.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Kir6.2 is found in the pancreatic B-cell, cardiac and skeletal muscle and non-vascular smooth muscle. KCNJ11, encoding Kir6.2, has been shown to be associated with both Type 2 diabetes mellitus and cardiovascular disease in several populations. In this study, we investigated whether polymorphisms in KCNJ11 are associated with Type 2 diabetes and other metabolic phenotypes in the Korean population. METHODS We sequenced KCNJ11 to identify common polymorphisms using 24 Korean DNA samples. Of the 14 polymorphisms found in KCNJ11, six common ones [genomic sequence (g.)-1709A>T, g.-1525T>C, g.67G>A (E23K), g.570C>T (A190A), g.1009A>G (I337V), and g.1388C>T] were genotyped in 761 Type 2 diabetic patients and in 630 non-diabetic subjects. RESULTS All the polymorphic loci in KCNJ11 are in strong linkage disequilibrium in the Korean population and act as one haplotype block. g.67G>A and g.1009A>G were associated with an increased risk of Type 2 diabetes [age, sex, and body mass index (BMI)-adjusted odds ratios (OR) = 1.376 (1.085-1.745), P = 0.008 and 1.411 (1.111-1.791), P = 0.005, respectively], as was one haplotype (A-T-A-C-G-C in the order of polymorphisms as shown above) containing g.67A and g.1009G [OR = 1.359 (1.080-1.709), P = 0.009]. The haplotype (A-T-A-C-G-C) was also strongly associated with hypertension [OR = 1.655 (1.288-2.126), P < 0.001]. CONCLUSIONS Polymorphisms in KCNJ11 are associated with Type 2 diabetes and also with hypertension in the Korean population.
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Affiliation(s)
- B K Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Chongno-Gu, Seoul, Korea
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27
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Florez JC, Jablonski KA, Kahn SE, Franks PW, Dabelea D, Hamman RF, Knowler WC, Nathan DM, Altshuler D. Type 2 diabetes-associated missense polymorphisms KCNJ11 E23K and ABCC8 A1369S influence progression to diabetes and response to interventions in the Diabetes Prevention Program. Diabetes 2007; 56:531-6. [PMID: 17259403 PMCID: PMC2267937 DOI: 10.2337/db06-0966] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The common polymorphisms KCNJ11 E23K and ABCC8 A1369S have been consistently associated with type 2 diabetes. We examined whether these variants are also associated with progression from impaired glucose tolerance (IGT) to diabetes and responses to preventive interventions in the Diabetes Prevention Program. We genotyped both variants in 3,534 participants and performed Cox regression analysis using genotype, intervention, and their interactions as predictors of diabetes incidence over approximately 3 years. We also assessed the effect of genotype on insulin secretion and insulin sensitivity at 1 year. As previously shown in other studies, lysine carriers at KCNJ11 E23K had reduced insulin secretion at baseline; however, they were less likely to develop diabetes than E/E homozygotes. Lysine carriers were less protected by 1-year metformin treatment than E/E homozygotes (P < 0.02). Results for ABCC8 A1369S were essentially identical to those for KCNJ11 E23K. We conclude that the lysine variant in KCNJ11 E23K leads to diminished insulin secretion in individuals with IGT. Given our contrasting results compared with case-control analyses, we hypothesize that its effect on diabetes risk may occur before the IGT-to-diabetes transition. We further hypothesize that the diabetes-preventive effect of metformin may interact with the impact of these variants on insulin regulation.
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Affiliation(s)
- Jose C Florez
- Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA.
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Gloyn AL, Siddiqui J, Ellard S. Mutations in the genes encoding the pancreatic beta-cell KATP channel subunits Kir6.2 (KCNJ11) and SUR1 (ABCC8) in diabetes mellitus and hyperinsulinism. Hum Mutat 2006; 27:220-31. [PMID: 16416420 DOI: 10.1002/humu.20292] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The beta-cell ATP-sensitive potassium channel is a key component of stimulus-secretion coupling in the pancreatic beta-cell. The channel couples metabolism to membrane electrical events, bringing about insulin secretion. Given the critical role of this channel in glucose homeostasis, it is not surprising that mutations in the genes encoding for the two essential subunits of the channel can result in both hypo- and hyperglycemia. The channel consists of four subunits of the inwardly rectifying potassium channel Kir6.2 and four subunits of the sulfonylurea receptor 1. It has been known for some time that loss of function mutations in KCNJ11, which encodes for Kir6.2, and ABCC8, which encodes for SUR1, can cause oversecretion of insulin and result in hyperinsulinemia (HI) of infancy; however, heterozygous activating mutations in KCNJ11 that result in the opposite phenotype of diabetes have recently been described. This review focuses on reported mutations in both genes, the spectrum of phenotypes, and the implications for treatment when patients are diagnosed with mutations in these genes.
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Affiliation(s)
- Anna L Gloyn
- Diabetes Research Laboratories, Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom.
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Gloyn AL, Mackay DJG, Weedon MN, McCarthy MI, Walker M, Hitman G, Knight BA, Owen KR, Hattersley AT, Frayling TM. Assessment of the role of common genetic variation in the transient neonatal diabetes mellitus (TNDM) region in type 2 diabetes: a comparative genomic and tagging single nucleotide polymorphism approach. Diabetes 2006; 55:2272-6. [PMID: 16873690 DOI: 10.2337/db06-0216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Recent evidence supports the strong overlap between genes implicated in monogenic diabetes and susceptibility to type 2 diabetes. Transient neonatal diabetes mellitus (TNDM) is a rare disorder associated with overexpression of genes at a paternally expressed imprinted locus on chromosome 6q24. There are two overlapping genes in this region: the transcription factor zinc finger protein associated with cell cycle control and apoptosis (ZAC also known as PLAGL1) and HYMA1, which encodes an untranslated mRNA. Several type 2 diabetes linkage studies have reported linkage to chromosome 6q22-25. We hypothesized that common genetic variation at this TNDM region influences type 2 diabetes susceptibility. In addition to the coding regions, we used comparative genomic analysis to identify conserved noncoding regions, which were resequenced for single nucleotide polymorphism (SNP) discovery in 47 individuals. Twenty-six SNPs were identified. Fifteen tag SNPs (tSNPs) were successfully genotyped in a large case-control (n = 3,594) and family-based (n = 1,654) study. We did not find any evidence of association or overtransmission of any tSNP to affected offspring or of a parent-of-origin effect. Using a study sufficiently powered to detect odds ratios of <1.2, we conclude that common variation in the TNDM region does not play an important role in the genetic susceptibility to type 2 diabetes.
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Affiliation(s)
- Anna L Gloyn
- Diabetes Research Laboratories, Oxford Centre for Diabetes, Endocrinology & Metabolism, Oxford, UK
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Sesti G, Laratta E, Cardellini M, Andreozzi F, Del Guerra S, Irace C, Gnasso A, Grupillo M, Lauro R, Hribal ML, Perticone F, Marchetti P. The E23K variant of KCNJ11 encoding the pancreatic beta-cell adenosine 5'-triphosphate-sensitive potassium channel subunit Kir6.2 is associated with an increased risk of secondary failure to sulfonylurea in patients with type 2 diabetes. J Clin Endocrinol Metab 2006; 91:2334-9. [PMID: 16595597 DOI: 10.1210/jc.2005-2323] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
CONTEXT Several studies suggest that genetic factors may play a role in the different responses to antidiabetic therapy; however, conclusive evidence is still lacking. OBJECTIVE The objective of the study was to investigate whether diabetic patients carrying the E23K variant in KCNJ11 are at increased risk for secondary sulfonylurea failure. DESIGN Secondary sulfonylurea failure was defined as fasting plasma glucose greater than 300 mg/dl despite sulfonylurea-metformin combined therapy and appropriate diet, in the absence of other conditions causing hyperglycemia. SETTING The study was conducted in an ambulatory care facility. PATIENTS A total of 525 Caucasian type 2 diabetic patients were enrolled in the study. INTERVENTION Sulfonylurea treatment was followed by sulfonylurea-metformin combined therapy and then insulin treatment. MAIN OUTCOME MEASURE Secondary failure was the main outcome measure. RESULTS Of the diabetic patients enrolled in the study, 38.5% were E23E homozygous, 51.4% were E23K heterozygous, and 10.1% were K23K homozygous. The frequency of carriers of the K allele was 58 and 66.8% among patients treated with oral therapy or secondary sulfonylurea failure, respectively (odds ratio, 1.45; 95% confidence interval, 1.01-2.09; P = 0.04). Adjustment for age, gender, fasting glycemia, glycosylated hemoglobin, age at diagnosis, and duration of diabetes in a logistic regression analysis did not change this association (odds ratio, 1.69; 95% confidence interval, 1.02-2.78; P = 0.04). Islets isolated from carriers of the K allele showed no differences in glucose-stimulated insulin secretion and a tendency toward reduced response upon glibenclamide stimulation (P = 0.09). After 24-h exposure to high (16.7 mmol/liter) glucose concentration, impairment of glibenclamide-induced insulin release was significantly (P = 0.01) worse with the E23K variant. CONCLUSIONS These data suggest that the E23K variant in KCNJ11 may influence the variability in the response of patients to sulfonylureas, thus representing an example of pharmacogenetics in type 2 diabetes.
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Affiliation(s)
- Giorgio Sesti
- Dipartimento di Medicina Sperimentale e Clinica, Università Magna Graecia, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy.
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Abstract
Most valuable breakthroughs in the genetics of type 2 diabetes mellitus have arisen from familial linkage analysis of maturity-onset diabetes of the young, an autosomal dominant form of diabetes typically occurring before 25 years of age and caused by primary insulin-secretion defects. Despite its low prevalence, MODY is not a single entity but presents genetic, metabolic, and clinical heterogeneity. MODY can result from mutations in at least six different genes;one encodes the glycolytic enzyme glucokinase, which is an important glucose sensor, whereas all the others encode transcription factors that participate in a regulatory network essential for adult beta cell function. Additional genes, yet unidentified, may explain the other MODY cases unlinked to a mutation in the known genes.
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Affiliation(s)
- Martine Vaxillaire
- CNRS UMR8090 Unit, Institute of Biology and Pasteur Institute of Lille, 1 rue du Professeur Calmette BP 245 59019, Lille, France.
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Cheyssac C, Dina C, Leprêtre F, Vasseur-Delannoy V, Dechaume A, Lobbens S, Balkau B, Ruiz J, Charpentier G, Pattou F, Joly E, Prentki M, Hansen T, Pedersen O, Vaxillaire M, Froguel P. EIF4A2 is a positional candidate gene at the 3q27 locus linked to type 2 diabetes in French families. Diabetes 2006; 55:1171-6. [PMID: 16567544 DOI: 10.2337/diabetes.55.04.06.db05-1298] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
One of the most replicated loci influencing type 2 diabetes-related quantitative traits (quantitative trait loci [QTL]) is on chromosome 3q27 and modulates both type 2 diabetes-and metabolic syndrome-associated phenotypes. A QTL for type 2 diabetes age of onset (logarithm of odds [LOD] score = 3.01 at D3S3686, P = 0.0001) was identified in a set of French families. To assess genetic variation underlying both age-of-onset QTL and our previous type 2 diabetes linkage in a 3.87-Mb interval, we explored 36 single nucleotide polymorphisms (SNPs) in two biologically relevant candidate genes for glucose homeostasis, kininogen (KNG1), and eukaryotic translation initiation factor 4alpha2 (EIF4A2). Analysis of 148 families showed significant association of a frequent SNP, rs266714, located 2.47 kb upstream of EIF4A2, with familial type 2 diabetes (family-based association test, P = 0.0008) and early age of onset (P = 0.0008). This SNP also contributes to both age-of-onset QTL (1.13 LOD score decrease P = 0.02) and type 2 diabetes linkage (genotype identical-by-descent sharing test, P = 0.02). However, no association was observed in three independent European diabetic cohorts. EIF4A2 controls specific mRNA translation and protein synthesis rate in pancreatic beta-cells, and our data indicates that EIF4A2 is downregulated by high glucose in rat beta-INS832/13 cells. The potential role of EIF4A2 in glucose homeostasis and its putative contribution to type 2 diabetes in the presence of metabolic stress will require further investigation.
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Affiliation(s)
- Claire Cheyssac
- CNRS UMR 8090, Biology Institute & Pasteur Institute of Lille, 1 rue du Professeur Calmette, BP 245, 59019 Lille, France
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33
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Xiong C, Zheng F, Wan J, Zhou X, Yin Z, Sun X. The E23K polymorphism in Kir6.2 gene and coronary heart disease. Clin Chim Acta 2006; 367:93-7. [PMID: 16455067 DOI: 10.1016/j.cca.2005.11.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 11/25/2005] [Accepted: 11/26/2005] [Indexed: 02/02/2023]
Abstract
BACKGROUND The G to A mutation in the Kir 6.2, the ATP-sensitive potassium channel subunit, resulted a glutamate (E) to lysine (K) substitution at codon 23, and the A allele was shown to have a relationship with high risk to type 2 diabetes in previous study. Their role in coronary heart disease (CHD) has not been evaluated. We hypothesized that the polymorphism would be associated with increased susceptibility to CHD. METHODS The E23K gene polymorphism of Kir6.2 gene was analyzed by PCR-restriction site polymorphism (PCR-RSP) methods in 101 controls and 119 CHD patients. Serum lipids and C reactive protein concentrations were measured in all subjects. RESULTS Among the CHD patients, the frequency of the G allele was higher (63.4% vs. 56.9%, P>0.05) and the frequency of the A allele was lower (36.6% vs. 43.1%, P>0.05) than among controls. No significant differences were found in allele frequencies between CHD and controls (P>0.05), but there were significant differences in GG and combined (GA+AA) genotypes frequencies (42.0% vs. 28.7%, and 58.0% vs. 71.3%, P<0.050). CONCLUSIONS The E23K gene polymorphism in Kir6.2 gene appeared to be related to high susceptibility to CHD.
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Affiliation(s)
- Chenling Xiong
- Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
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34
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Abstract
The ATP-sensitive K+ channel (K ATP channel) senses metabolic changes in the pancreatic beta-cell, thereby coupling metabolism to electrical activity and ultimately to insulin secretion. When K ATP channels open, beta-cells hyperpolarize and insulin secretion is suppressed. The prediction that K ATP channel "overactivity" should cause a diabetic state due to undersecretion of insulin has been dramatically borne out by recent genetic studies implicating "activating" mutations in the Kir6.2 subunit of K ATP channel as causal in human diabetes. This article summarizes the emerging picture of K ATP channel as a major cause of neonatal diabetes and of a polymorphism in K ATP channel (E23K) as a type 2 diabetes risk factor. The degree of K ATP channel "overactivity" correlates with the severity of the diabetic phenotype. At one end of the spectrum, polymorphisms that result in a modest increase in K ATP channel activity represent a risk factor for development of late-onset diabetes. At the other end, severe "activating" mutations underlie syndromic neonatal diabetes, with multiple organ involvement and complete failure of glucose-dependent insulin secretion, reflecting K ATP channel "overactivity" in both pancreatic and extrapancreatic tissues.
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Affiliation(s)
- Joseph C Koster
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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35
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Abstract
Conventional genetic analysis focuses on the genes that account for specific phenotypes, while traditional epidemiology is more concerned with the environmental causes and risk factors related to traits. Genetic epidemiology is an alliance of the 2 fields that focuses on both genetics, including allelic variants in different populations, and environment, in order to explain exactly how genes convey effects in different environmental contexts and to arrive at a more complete comprehension of the etiology of complex traits. In this review, we discuss the epidemiology of diabetes and the current understanding of the genetic bases of obesity and diabetes and provide suggestions for accelerated accumulation of clinically useful genetic information.
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Affiliation(s)
- M Alan Permutt
- Department of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri 63110-1010, USA.
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36
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Wolford JK, Vozarova de Courten B. Genetic basis of type 2 diabetes mellitus: implications for therapy. ACTA ACUST UNITED AC 2005; 3:257-67. [PMID: 16026108 DOI: 10.2165/00024677-200403040-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Type 2 diabetes mellitus represents a multifactorial, heterogeneous group of disorders, which result from defects in insulin secretion, insulin action, or both. The prevalence of type 2 diabetes has increased dramatically worldwide over the past several decades, a trend that has been heavily influenced by the relatively recent changes in diet and physical activity levels. There is also strong evidence supporting a genetic component to type 2 diabetes susceptibility and several genes underlying monogenic forms of diabetes have already been identified. However, common type 2 diabetes is likely to result from the contribution of many genes interacting with different environmental factors to produce wide variation in the clinical course of the disease. Not surprisingly, the etiologic complexity underlying type 2 diabetes has made identification of the contributing genes difficult. Current therapies in the management of type 2 diabetes include lifestyle intervention through diet modification and exercise, and oral or injected hypoglycemic agents; however, not all individuals with type 2 diabetes respond in the same way to these treatments. Because of variability in the clinical course of the disease and in the responsiveness to pharmacologic therapies, identification and characterization of the genetic variants underlying type 2 diabetes susceptibility will be important in the development of individualized treatment. Findings from linkage analyses, candidate gene studies, and animal models will be valuable in the identification of novel pathways involved in the regulation of glucose homeostasis, and will augment our understanding of the gene-gene and gene-environment interactions, which impact on type 2 diabetes etiology and pathogenesis. In addition, identification of genetic variants that determine differences in antidiabetic drug responsiveness will be useful in assessing a first-line pharmacologic therapy for diabetic patients.
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Affiliation(s)
- Johanna K Wolford
- Genetic Basis of Human Disease Division, Translational Genomics Research Institute, Phoenix, Arizona 85004, USA.
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37
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Hansen SK, Nielsen EMD, Ek J, Andersen G, Glümer C, Carstensen B, Mouritzen P, Drivsholm T, Borch-Johnsen K, Jørgensen T, Hansen T, Pedersen O. Analysis of separate and combined effects of common variation in KCNJ11 and PPARG on risk of type 2 diabetes. J Clin Endocrinol Metab 2005; 90:3629-37. [PMID: 15797964 DOI: 10.1210/jc.2004-1942] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The separate and combined effects of the PPARG Pro(12)Ala polymorphism and the KCNJ11 Glu(23)Lys polymorphisms on risk of type 2 diabetes were investigated in relatively large-scale, case-control studies. Separate effects of the variants were examined among 1187/1461 type 2 diabetic patients and 4791/4986 middle-aged, glucose-tolerant subjects. The combined analysis involved 1164 type 2 diabetic patients and 4733 middle-aged, glucose-tolerant subjects. In the separate analyses, the K allele of the KCNJ11 Glu(23)Lys associated with type 2 diabetes (odds ratio, 1.19; P = 0.0002), whereas the PPARG Pro(12)Ala showed no significant association with type 2 diabetes. The combined analysis indicated that the two polymorphisms acted in an additive manner to increase the risk of type 2 diabetes, and we found no evidence for a synergistic interaction between them. Analysis of a model with equal additive effects of the two variants showed that the odds ratio for type 2 diabetes increased with 1.14/risk allele (P = 0.003). Together, the two polymorphisms conferred a population-attributable risk for type 2 diabetes of 28%. In conclusion, our results showed no evidence of a synergistic interaction between the KCNJ11 Glu(23)Lys and PPARG Pro(12)Ala polymorphisms, but indicated that they may act in an additive manner to increase the risk of type 2 diabetes.
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Affiliation(s)
- Sara K Hansen
- Steno Diabetes Center and Hagedorn Research Institute, Niels Steensens Vej 2, DK-2820 Gentofte, Denmark
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38
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Abstract
Type 2 diabetes (T2D) has become a health-care problem worldwide, with the rise in disease prevalence being all the more worrying as it not only affects the developed world but also developing nations with fewer resources to cope with yet another major disease burden. Furthermore, the problem is no longer restricted to the ageing population, as young adults and children are also being diagnosed with T2D. In recent years, there has been a surge in the number of genetic studies of T2D in attempts to identify some of the underlying risk factors. In this review, I highlight the main genes known to cause uncommon monogenic forms of diabetes (e.g. maturity-onset diabetes of the young--MODY--and insulin resistance syndromes), as well as describe some of the main approaches used to identify genes involved in the more common forms of T2D that result from the interaction between environmental risk factors and predisposing genotypes. Linkage and candidate gene studies have been highly successful in the identification of genes that cause the monogenic variants of diabetes and, although progress in the more common forms of T2D has been slow, a number of genes have now been reproducibly associated with T2D risk in multiple studies. These are discussed, as well as the main implications that the diabetes gene discoveries will have in diabetes treatment and prevention.
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Affiliation(s)
- I Barroso
- Metabolic Disease Group, The Wellcome Trust Sanger Institute, Cambridge, UK.
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39
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van Dam RM, Hoebee B, Seidell JC, Schaap MM, de Bruin TWA, Feskens EJM. Common variants in the ATP-sensitive K+ channel genes KCNJ11 (Kir6.2) and ABCC8 (SUR1) in relation to glucose intolerance: population-based studies and meta-analyses. Diabet Med 2005; 22:590-8. [PMID: 15842514 DOI: 10.1111/j.1464-5491.2005.01465.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIMS To evaluate the relation between common variants in the ATP-sensitive K+ channel genes and glucose intolerance. METHODS We conducted a meta-analysis of reported association studies in Caucasian populations for common variants in the ABCC8 (exons 16 and 18) and the KCNJ11 (E23K) gene and examined sources of heterogeneity in the results. The meta-analysis was based on 7768-10216 subjects (depending on the gene variant), and included two new population-based studies in the Netherlands with 725 cases and 742 controls. RESULTS For the KCNJ11 variant, the summary odds ratio (OR) for glucose intolerance was 1.12 (1.01-1.23, P=0.03) for the EK genotype and 1.44 (1.17-1.78, P=0.0007) for the KK genotype, as compared with the EE genotype. For the ABCC8 exon 16 variant, the OR was 1.06 (0.94-1.19, P=0.34) for ct and 0.93 (0.71-1.20, P=0.56) for tt, as compared with the cc genotype. For ABCC8 exon 18, the OR was 1.20 (0.97-1.49, P=0.10) for CT/TT, as compared with the CC genotype. Studies of the ABCC8 variants that were published first or had smaller sample sizes (for the exon 18 variant) showed stronger associations, which may indicate publication bias. For the ABCC8 exon 18 and the KCNJ11 variant, associations were stronger for studies of clinical diabetes than newly detected glucose intolerance. The population attributable risk for clinical Type 2 diabetes was 6.2% for the KCNJ11 KK genotype and 10.1% for the KCNJ11 EK and KK genotype combined. CONCLUSIONS The common KCNJ11 E23K gene variant, but not the ABCC8 exon 16 or exon 18 variant, was consistently associated with Type 2 diabetes.
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Affiliation(s)
- R M van Dam
- Centre of Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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40
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Abstract
Genes influence susceptibility to type 2 diabetes mellitus (T2DM), and both positional cloning and candidate gene approaches have been used to identify these genes. Linkage analysis has generated evidence for T2DM-predisposing variants on chromosome 20q in studies of Caucasians, Asians, and Africans, and fine-mapping recently identified a likely susceptibility gene, hepatocyte nuclear factor 4-alpha (HNF4A). Rare loss-of-function mutations in HNF4A cause maturity-onset diabetes of the young and now common noncoding variants have been found to be associated with T2DM.
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Affiliation(s)
- Karen L Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27599-7264, USA.
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41
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Neve B, Fernandez-Zapico ME, Ashkenazi-Katalan V, Dina C, Hamid YH, Joly E, Vaillant E, Benmezroua Y, Durand E, Bakaher N, Delannoy V, Vaxillaire M, Cook T, Dallinga-Thie GM, Jansen H, Charles MA, Clément K, Galan P, Hercberg S, Helbecque N, Charpentier G, Prentki M, Hansen T, Pedersen O, Urrutia R, Melloul D, Froguel P. Role of transcription factor KLF11 and its diabetes-associated gene variants in pancreatic beta cell function. Proc Natl Acad Sci U S A 2005; 102:4807-12. [PMID: 15774581 PMCID: PMC554843 DOI: 10.1073/pnas.0409177102] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
KLF11 (TIEG2) is a pancreas-enriched transcription factor that has elicited significant attention because of its role as negative regulator of exocrine cell growth in vitro and in vivo. However, its functional role in the endocrine pancreas remains to be established. Here, we report, for the first time, to our knowledge, the characterization of KLF11 as a glucose-inducible regulator of the insulin gene. A combination of random oligonucleotide binding, EMSA, luciferase reporter, and chromatin immunoprecipitation assays shows that KLF11 binds to the insulin promoter and regulates its activity in beta cells. Genetic analysis of the KLF11 gene revealed two rare variants (Ala347Ser and Thr220Met) that segregate with diabetes in families with early-onset type 2 diabetes, and significantly impair its transcriptional activity. In addition, analysis of 1,696 type 2 diabetes mellitus and 1,776 normoglycemic subjects show a frequent polymorphic Gln62Arg variant that significantly associates with type 2 diabetes mellitus in North European populations (OR = 1.29, P = 0.00033). Moreover, this variant alters the corepressor mSin3A-binding activity of KLF11, impairs the activation of the insulin promoter and shows lower levels of insulin expression in pancreatic beta cells. In addition, subjects carrying the Gln62Arg allele show decreased plasma insulin after an oral glucose challenge. Interestingly, all three nonsynonymous KLF11 variants show increased repression of the catalase 1 promoter, suggesting a role in free radical clearance that may render beta cells more sensitive to oxidative stress. Thus, both functional and genetic analyses reveal that KLF11 plays a role in the regulation of pancreatic beta cell physiology, and its variants may contribute to the development of diabetes.
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Affiliation(s)
- Bernadette Neve
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8090, Institute Pasteur de Lille, F-59019 Lille, France
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42
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Abstract
Throughout the last decade, molecular genetic studies of non-autoimmune diabetes mellitus have contributed significantly to our present understanding of this disease's complex aetiopathogenesis. Monogenic forms of diabetes (maturity-onset diabetes of the young, MODY) have been identified and classified into MODY1-6 according to the mutated genes that by being expressed in the pancreatic beta-cells confirm at the molecular level the clinical presentation of MODY as a predominantly insulin secretory deficient form of diabetes mellitus. Genomewide linkage studies of presumed polygenic type 2 diabetic populations indicate that loci on chromosomes 1q, 5q, 8p, 10q, 12q and 20q contain susceptibility genes. Yet, so far, the only susceptibility gene, calpain-10 (CAPN10), which has been identified using genomewide linkage studies, is located on chromosome 2q37. Mutation analyses of selected 'candidate' susceptibility genes in various populations have also identified the widespread Pro12Ala variant of the peroxisome proliferator-activated receptor-gamma and the common Glu23Lys variant of the ATP-sensitive potassium channel, Kir6.2 (KCNJ11). These variants may contribute significantly to the risk type 2 diabetes conferring insulin resistance of liver, muscle and fat (Pro12Ala) and a relative insulin secretory deficiency (Glu23Lys). It is likely that, in the near future, the recent more detailed knowledge of the human genome and insights into its haploblocks together with the developments of high-throughput and cheap genotyping will facilitate the discovery of many more type 2 diabetes gene variants in study materials, which are statistically powered and phenotypically well characterized. The results of these efforts are likely to be the platform for major progress in the development of personalized antidiabetic drugs with higher efficacy and few side effects.
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43
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Gloyn AL, Reimann F, Girard C, Edghill EL, Proks P, Pearson ER, Temple IK, Mackay DJG, Shield JPH, Freedenberg D, Noyes K, Ellard S, Ashcroft FM, Gribble FM, Hattersley AT. Relapsing diabetes can result from moderately activating mutations in KCNJ11. Hum Mol Genet 2005; 14:925-34. [PMID: 15718250 DOI: 10.1093/hmg/ddi086] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neonatal diabetes can either remit and hence be transient or else may be permanent. These two phenotypes were considered to be genetically distinct. Abnormalities of 6q24 are the commonest cause of transient neonatal diabetes (TNDM). Mutations in KCNJ11, which encodes Kir6.2, the pore-forming subunit of the ATP-sensitive potassium channel (K(ATP)), are the commonest cause of permanent neonatal diabetes (PNDM). In addition to diabetes, some KCNJ11 mutations also result in marked developmental delay and epilepsy. These mutations are more severe on functional characterization. We investigated whether mutations in KCNJ11 could also give rise to TNDM. We identified the three novel heterozygous mutations (G53S, G53R, I182V) in three of 11 probands with clinically defined TNDM, who did not have chromosome 6q24 abnormalities. The mutations co-segregated with diabetes within families and were not found in 100 controls. All probands had insulin-treated diabetes diagnosed in the first 4 months and went into remission by 7-14 months. Functional characterization of the TNDM associated mutations was performed by expressing the mutated Kir6.2 with SUR1 in Xenopus laevis oocytes. All three heterozygous mutations resulted in a reduction in the sensitivity to ATP when compared with wild-type (IC(50) approximately 30 versus approximately 7 microM, P-value for is all <0.01); however, this was less profoundly reduced than with the PNDM associated mutations. In conclusion, mutations in KCNJ11 are the first genetic cause for remitting as well as permanent diabetes. This suggests that a fixed ion channel abnormality can result in a fluctuating glycaemic phenotype. The multiple phenotypes associated with activating KCNJ11 mutations may reflect their severity in vitro.
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Affiliation(s)
- Anna L Gloyn
- Institute of Biomedical and Clinical Science, Peninsula Medical School, Barrack Road, Exeter EX2 5DW, USA
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44
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Abstract
The intensive search for genetic variants that predispose to type 2 diabetes was launched with optimism, but progress has been slower than was hoped. Even so, major advances have been made in the understanding of monogenic forms of the disease which together represent a substantial health burden, and a few common gene variants that influence susceptibility have now been unequivocally identified. Armed with a better understanding of the tools needed to detect such genes, it seems inevitable that the rate of progress will increase and the relevance of genetic information to the diagnosis, treatment, and prevention of diabetes will become increasingly tangible.
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Affiliation(s)
- Stephen O'Rahilly
- University of Cambridge, Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
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Bryan J, Vila-Carriles WH, Zhao G, Babenko AP, Aguilar-Bryan L. Toward linking structure with function in ATP-sensitive K+ channels. Diabetes 2004; 53 Suppl 3:S104-12. [PMID: 15561897 DOI: 10.2337/diabetes.53.suppl_3.s104] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Advances in understanding the overall structural features of inward rectifiers and ATP-binding cassette (ABC) transporters are providing novel insight into the architecture of ATP-sensitive K+ channels (KATP channels) (KIR6.0/SUR)4. The structure of the K(IR) pore has been modeled on bacterial K+ channels, while the lipid-A exporter, MsbA, provides a template for the MDR-like core of sulfonylurea receptor (SUR)-1. TMD0, an NH2-terminal bundle of five alpha-helices found in SURs, binds to and activates KIR6.0. The adjacent cytoplasmic L0 linker serves a dual function, acting as a tether to link the MDR-like core to the KIR6.2/TMD0 complex and exerting bidirectional control over channel gating via interactions with the NH2-terminus of the KIR. Homology modeling of the SUR1 core offers the possibility of defining the glibenclamide/sulfonylurea binding pocket. Consistent with 30-year-old studies on the pharmacology of hypoglycemic agents, the pocket is bipartite. Elements of the COOH-terminal half of the core recognize a hydrophobic group in glibenclamide, adjacent to the sulfonylurea moiety, to provide selectivity for SUR1, while the benzamido group appears to be in proximity to L0 and the KIR NH2-terminus.
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Affiliation(s)
- Joseph Bryan
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA.
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Riedel MJ, Steckley DC, Light PE. Current status of the E23K Kir6.2 polymorphism: implications for type-2 diabetes. Hum Genet 2004; 116:133-45. [PMID: 15565284 DOI: 10.1007/s00439-004-1216-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Accepted: 10/13/2004] [Indexed: 12/22/2022]
Abstract
The ATP-sensitive potassium (KATP) channel couples membrane excitability to cellular metabolism and is a critical mediator in the process of glucose-stimulated insulin secretion. Increasing numbers of KATP channel polymorphisms are being described and linked to altered insulin secretion indicating that genes encoding this ion channel could be susceptibility markers for type-2 diabetes. Genetic variation of KATP channels may result in altered beta-cell electrical activity, glucose homeostasis, and increased susceptibility to type-2 diabetes. Of particular interest is the Kir6.2 E23K polymorphism, which is linked to increased susceptibility to type-2 diabetes in Caucasian populations and may also be associated with weight gain and obesity, both of which are major diabetes risk factors. This association highlights the potential contribution of both genetic and environmental factors to the development and progression of type-2 diabetes. In addition, the common occurrence of the E23K polymorphism in Caucasian populations may have conferred an evolutionary advantage to our ancestors. This review will summarize the current status of the association of KATP channel polymorphisms with type-2 diabetes, focusing on the possible mechanisms by which these polymorphisms alter glucose homeostasis and offering insights into possible evolutionary pressures that may have contributed to the high prevalence of KATP channel polymorphisms in the Caucasian population.
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Affiliation(s)
- Michael J Riedel
- Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada, T6G 2H7
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Florez JC, Burtt N, de Bakker PIW, Almgren P, Tuomi T, Holmkvist J, Gaudet D, Hudson TJ, Schaffner SF, Daly MJ, Hirschhorn JN, Groop L, Altshuler D. Haplotype structure and genotype-phenotype correlations of the sulfonylurea receptor and the islet ATP-sensitive potassium channel gene region. Diabetes 2004; 53:1360-8. [PMID: 15111507 DOI: 10.2337/diabetes.53.5.1360] [Citation(s) in RCA: 238] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The genes for the sulfonylurea receptor (SUR1; encoded by ABCC8) and its associated islet ATP-sensitive potassium channel (Kir6.2; encoded by KCNJ11) are adjacent to one another on human chromosome 11. Multiple studies have reported association of the E23K variant of Kir6.2 with risk of type 2 diabetes. Whether and how E23K itself-or other variant(s) in either of these two closely linked genes-influences type 2 diabetes remains to be fully determined. To better understand genotype-phenotype correlation at this important candidate gene locus, we 1) characterized haplotype structures across the gene region by typing 77 working, high-frequency markers spanning 207 kb and both genes; 2) performed association studies of E23K and nearby markers in >3,400 patients (type 2 diabetes and control) not previously reported in the literature; and 3) analyzed the resulting data for measures of insulin secretion. These data independently replicate the association of E23K with type 2 diabetes with an odds ratio (OR) in the new data of 1.17 (P = 0.003) as compared with an OR of 1.14 provided by meta-analysis of previously published, nonoverlapping data (P = 0.0002). We find that the E23K variant in Kir6.2 demonstrates very strong allelic association with a coding variant (A1369S) in the neighboring SUR1 gene (r(2) > 0.9) across a range of population samples, making it difficult to distinguish which gene and polymorphism in this region are most likely responsible for the reported association. We show that E23K is also associated with decreased insulin secretion in glucose-tolerant control subjects, supporting a mechanism whereby beta-cell dysfunction contributes to the common form of type 2 diabetes. Like peroxisome proliferator-activated receptor gamma, the SUR1/Kir6.2 gene region both contributes to the inherited risk of type 2 diabetes and encodes proteins that are targets for hypoglycemic medications, providing an intriguing link between the underlying mechanism of disease and validated targets for pharmacological treatment.
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Affiliation(s)
- Jose C Florez
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA
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Affiliation(s)
- Frances M Ashcroft
- University Laboratory of Physiology, Parks Road, Oxford OX1 3PT, England
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Weedon MN, Schwarz PEH, Horikawa Y, Iwasaki N, Illig T, Holle R, Rathmann W, Selisko T, Schulze J, Owen KR, Evans J, del Bosque-Plata L, Hitman G, Walker M, Levy JC, Sampson M, Bell GI, McCarthy MI, Hattersley AT, Frayling TM. Meta-analysis and a large association study confirm a role for calpain-10 variation in type 2 diabetes susceptibility. Am J Hum Genet 2003; 73:1208-12. [PMID: 14574648 PMCID: PMC1180500 DOI: 10.1086/379285] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Michael N. Weedon
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Peter E. H. Schwarz
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Yukio Horikawa
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Naoko Iwasaki
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Thomas Illig
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Rolf Holle
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Wolfgang Rathmann
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Thomas Selisko
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Jan Schulze
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Katherine R. Owen
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Julie Evans
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Laura del Bosque-Plata
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Graham Hitman
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Mark Walker
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Jonathan C. Levy
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Mike Sampson
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Graeme I. Bell
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Mark I. McCarthy
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Andrew T. Hattersley
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
| | - Timothy M. Frayling
- Department of Diabetes Research & Vascular Medicine, Peninsula Medical School, Exeter; Department of Endocrinopathies and Metabolic Diseases, Medical Faculty Carl-Gustav-Carus of the Technical University, Dresden; Department of Cell Biology, Institute for Molecular and Cellular Regulation, Gunma University, Gunma, Japan; Diabetes Center, Tokyo Women’s Medical University, Tokyo; GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg; GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; German Diabetes Research Institute, Department of Biometrics and Epidemiology, Düsseldorf; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago; Department of Diabetes & Metabolic Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, University of London, London; Department of Medicine, School of Medicine, Newcastle upon Tyne; The Diabetes Research Laboratories, Radcliffe Infirmary, University of Oxford, Oxford; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; and Diabetes Centre, Norwich, United Kingdom
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Barroso I, Luan J, Middelberg RPS, Harding AH, Franks PW, Jakes RW, Clayton D, Schafer AJ, O'Rahilly S, Wareham NJ. Candidate gene association study in type 2 diabetes indicates a role for genes involved in beta-cell function as well as insulin action. PLoS Biol 2003; 1:E20. [PMID: 14551916 PMCID: PMC212698 DOI: 10.1371/journal.pbio.0000020] [Citation(s) in RCA: 226] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2003] [Accepted: 08/08/2003] [Indexed: 01/24/2023] Open
Abstract
Type 2 diabetes is an increasingly common, serious metabolic disorder with a substantial inherited component. It is characterised by defects in both insulin secretion and action. Progress in identification of specific genetic variants predisposing to the disease has been limited. To complement ongoing positional cloning efforts, we have undertaken a large-scale candidate gene association study. We examined 152 SNPs in 71 candidate genes for association with diabetes status and related phenotypes in 2,134 Caucasians in a case-control study and an independent quantitative trait (QT) cohort in the United Kingdom. Polymorphisms in five of 15 genes (33%) encoding molecules known to primarily influence pancreatic beta-cell function-ABCC8 (sulphonylurea receptor), KCNJ11 (KIR6.2), SLC2A2 (GLUT2), HNF4A (HNF4alpha), and INS (insulin)-significantly altered disease risk, and in three genes, the risk allele, haplotype, or both had a biologically consistent effect on a relevant physiological trait in the QT study. We examined 35 genes predicted to have their major influence on insulin action, and three (9%)-INSR, PIK3R1, and SOS1-showed significant associations with diabetes. These results confirm the genetic complexity of Type 2 diabetes and provide evidence that common variants in genes influencing pancreatic beta-cell function may make a significant contribution to the inherited component of this disease. This study additionally demonstrates that the systematic examination of panels of biological candidate genes in large, well-characterised populations can be an effective complement to positional cloning approaches. The absence of large single-gene effects and the detection of multiple small effects accentuate the need for the study of larger populations in order to reliably identify the size of effect we now expect for complex diseases.
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