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Demirer B, Yardımcı H, Erem Basmaz S. Inflammation level in type 2 diabetes is associated with dietary advanced glycation end products, Mediterranean diet adherence and oxidative balance score: A pathway analysis. J Diabetes Complications 2023; 37:108354. [PMID: 36493637 DOI: 10.1016/j.jdiacomp.2022.108354] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/15/2022]
Abstract
AIMS The aim of this study was to evaluate the effects of dietary advanced glycation end products (dAGE) intake, Mediterranean diet adherence screener (MEDAS), and oxidative balance score (OBS) on inflammation among individuals with type 2 diabetes. METHODS The study was conducted with 96 adults (aged between 32 and 64 years) with type 2 diabetes. The average daily dAGE intakes, energy and macronutrient intakes of the participants were taken with the three-day food consumption recording method. OBS and MEDAS score was used. At the same time, routine blood lipids, HbA1c, fasting blood glucose and inflammation marker C-reactive protein (CRP) were measured. RESULTS Dietary AGE intake was associated with fasting blood glucose, HbA1c, CRP and blood pressures (p < 0.01). The relationship between OBS and dAGE intake was significant (β = -0.36; 95 % Cl = -0.500, -0.220; p < 0.001). MEDAS has a negative and statistically significant effect on dAGE intake (β = -0.56; 95 % Cl = -0.696, -0.444; p < 0.001). There was a significant and positive effect of dAGE on CRP when other variables (MEDAS, OBS) affecting dAGE were also included in the analysis (β = 0.79; 95 % CI = 0.664, 0.917; p < 0.001). CONCLUSIONS Our findings may have important implications for explaining the development of inflammation in type 2 diabetes patients with high dAGE intake.
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Affiliation(s)
- Büşra Demirer
- Karabuk University, Faculty of Health Sciences, Nutrition and Dietetic, Karabuk, Turkey.
| | - Hülya Yardımcı
- Ankara University, Faculty of Health Sciences, Nutrition and Dietetic, Ankara, Turkey
| | - Seda Erem Basmaz
- Derince Training and Research Hospital, Department of Endocrinology and Metabolic Diseases, Kocaeli, Turkey
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2
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Zhao Z, Wang C, Jia J, Wang Z, Li L, Deng X, Cai Z, Yang L, Wang D, Ma S, Zhao L, Tu Z, Yuan G. Regulatory network of metformin on adipogenesis determined by combining high-throughput sequencing and GEO database. Adipocyte 2022; 11:56-68. [PMID: 34974794 PMCID: PMC8741290 DOI: 10.1080/21623945.2021.2013417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Adipose differentiation and excessive lipid accumulation are the important characteristics of obesity. Metformin, as a classic hypoglycaemic drug, has been proved to reduce body weight in type 2 diabetes, the specific mechanism has not been completely clear. A few studies have explored its effect on adipogenesis in vitro, but the existing experimental results are ambiguous. 3T3-L1 preadipocytes were used to explore the effects of metformin on the morphological and physiological changes of lipid droplets during adipogenesis. A high throughput sequencing was used to examine the effects of metformin on the transcriptome of adipogenesis. Considering the inevitable errors among independent experiments, we performed integrated bioinformatics analysis to identify important genes involved in adipogenesis and reveal potential molecular mechanisms. During the process of adipogenesis, metformin visibly relieved the morphological and functional changes. In addition, metformin reverses the expression pattern of genes related to adipogenesis at the transcriptome level. Combining with integrated bioinformatics analyses to further identify the potential targeted genes regulated by metformin during adipogenesis. The present study identified novel changes in the transcriptome of metformin in the process of adipogenesis that might shed light on the underlying mechanism by which metformin impedes the progression of obesity.
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Affiliation(s)
- Zhicong Zhao
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Chenxi Wang
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jue Jia
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhaoxiang Wang
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Lian Li
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xia Deng
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhensheng Cai
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Ling Yang
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Dong Wang
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Suxian Ma
- Department of Endocrinology, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Li Zhao
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhigang Tu
- School of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Guoyue Yuan
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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3
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Wadie W, Ahmed GS, Shafik AN, El-Sayed M. Effects of insulin and sitagliptin on early cardiac dysfunction in diabetic rats. Life Sci 2022; 299:120542. [PMID: 35395243 DOI: 10.1016/j.lfs.2022.120542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
AIMS Cardiac affection is common in diabetic patients. Although insulin exerts a cardioprotective role, it may not be enough to totally prevent this affection. The current study aimed to compare the cardioprotective effect of insulin alone or combined with sitagliptin in a rat model of type 1 diabetes mellitus. MATERIALS AND METHODS Diabetes was induced by a single intraperitoneal injection of streptozotocin (STZ; 60 mg/kg). Diabetic rats were treated with insulin (3 IU), insulin (6 IU), or insulin (3 IU) + sitagliptin (10 mg/kg) for 42 days. KEY FINDINGS Diabetic rats exhibited significant systolic and diastolic cardiac affection with significant elevation of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6) and brain natriuretic peptide (BNP) levels. Treatment with insulin prevented the deterioration of diabetes-induced cardiac condition, an effect that was significantly potentiated by the combined use of sitagliptin. SIGNIFICANCE The combined use of sitagliptin and insulin significantly improved the cardioprotective effect of insulin and prevented the early cardiac dysfunction in STZ diabetic rats.
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Affiliation(s)
- Walaa Wadie
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
| | - Gehad S Ahmed
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amani N Shafik
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El-Sayed
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Guo H, Ding D, Wang L, Yan J, Ma L, Jin Q. Metformin attenuates osteoclast-mediated abnormal subchondral bone remodeling and alleviates osteoarthritis via AMPK/NF-κB/ERK signaling pathway. PLoS One 2021; 16:e0261127. [PMID: 34914744 PMCID: PMC8675877 DOI: 10.1371/journal.pone.0261127] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/28/2021] [Indexed: 11/18/2022] Open
Abstract
This study explored the mechanism by which metformin (Met) inhibits osteoclast activation and determined its effects on osteoarthritis (OA) mice. Bone marrow-derived macrophages were isolated. Osteoclastogenesis was detected using tartrate-resistant acid phosphatase (TRAP) staining. Cell proliferation was evaluated using CCK-8, F-actin rings were detected by immunofluorescence staining, and bone resorption was detected using bone slices. Nuclear factor kappa-B (NF-κB) and nuclear factor of activated T-cell cytoplasmic 1 (NFATc1) were detected using luciferase assays, and the adenosine monophosphate-activated protein kinase (AMPK), NF-κB, and mitogen-activated protein kinase (MAPK) signaling pathways were detected using western blotting. Finally, expression of genes involved in osteoclastogenesis was measured using quantitative polymerase chain reaction. A knee OA mouse model was established by destabilization of the medial meniscus (DMM). Male C57BL/6J mice were assigned to sham-operated, DMM+vehicle, and DMM+Met groups. Met (100 mg/kg/d) or vehicle was administered from the first day postoperative until sacrifice. At 4- and 8-week post OA induction, micro-computed tomography was performed to analyze microstructural changes in the subchondral bone, hematoxylin and eosin staining and Safranin-O/Fast Green staining were performed to evaluate the degenerated cartilage, TRAP-stained osteoclasts were enumerated, and receptor activator of nuclear factor κB ligand (RANKL), AMPK, and NF-κB were detected using immunohistochemistry. BMM proliferation was not affected by Met treatment below 2 mM. Met inhibited osteoclast formation and bone resorption in a dose-dependent manner in vitro. Met suppressed RANKL-induced activation of p-AMPK, NF-κB, phosphorylated extracellular regulated protein kinases (p-ERK) and up-regulation of genes involved in osteoclastogenesis. Met reversed decreases in BV/TV, Tb.Th, Tb.N, and CD, and an increase in Tb.Sp at 4 weeks postoperatively. The number of osteoclasts and OARSI score were decreased by Met without effect on body weight or blood glucose levels. Met inhibited RANKL, p-AMPK, and NF-κB expression in early OA. The mechanism by which Met inhibits osteoclast activation may be associated with AMPK/NF-κB/ERK signaling pathway, indicating a novel strategy for OA treatment.
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Affiliation(s)
- Haohui Guo
- Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
| | - Dong Ding
- Clinical College, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
| | - Limei Wang
- Clinical College, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
- Medical College, Qingdao Binhai University, West Coast New District, Qingdao, Shandong, P.R. China
| | - Jiangbo Yan
- Clinical College, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
| | - Long Ma
- Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
- * E-mail: (QJ); (LM)
| | - Qunhua Jin
- Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
- Clinical College, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
- * E-mail: (QJ); (LM)
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5
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Ji L, Chan JCN, Yu M, Yoon KH, Kim SG, Choi SH, Huang C, Te Tu S, Wang C, Paldánius PM, Sheu WHH. Early combination versus initial metformin monotherapy in the management of newly diagnosed type 2 diabetes: An East Asian perspective. Diabetes Obes Metab 2021; 23:3-17. [PMID: 32991073 PMCID: PMC7756748 DOI: 10.1111/dom.14205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes (T2D) in the East Asian population is characterized by phenotypes such as low body mass index, an index of β-cell dysfunction, and higher percentage of body fat, an index of insulin resistance. These phenotypes/pathologies may predispose people to early onset of diabetes with increased risk of stroke and renal disease. Less than 50% of patients with T2D in East Asia achieve glycaemic targets recommended by national or regional guidelines, which may be attributable to knowledge and/or implementation gaps. Herein, we review the latest evidence with special reference to East Asian patients with T2D and present arguments for the need to use early combination therapy to intensify glycaemic control. This strategy is supported by the 5-year worldwide VERIFY study, which reported better glycaemic durability in newly diagnosed patients with T2D with a mean HbA1c of 6.9% treated with early combination therapy of vildagliptin plus metformin versus those treated with initial metformin monotherapy followed by addition of vildagliptin only with worsening glycaemic control. This paradigm shift of early intensified treatment is now recommended by the American Diabetes Association and the European Association for the Study of Diabetes. In order to translate these evidence to practice, increased awareness and strengthening of the healthcare system are needed to diagnose and manage patients with T2D early for combination therapy.
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Affiliation(s)
- Linong Ji
- Department of Endocrinology and MetabolismPeking University People's HospitalPekingChina
| | - Juliana C. N. Chan
- Department of Medicine and TherapeuticsHong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales HospitalHong KongChina
| | - Miao Yu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of HealthPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Kun Ho Yoon
- Department of Endocrinology and MetabolismThe Catholic University College of MedicineSeoulRepublic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal MedicineKorea University College of MedicineSeoulRepublic of Korea
| | - Sung Hee Choi
- Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Chien‐Ning Huang
- Division of Endocrinology and Metabolism, Department of Internal MedicineChung Shan Medical University Hospital, Institute of Medicine, Chung Shan Medical UniversityTaichungTaiwan
| | - Shih Te Tu
- Division of Endocrinology and Metabolism, Department of MedicineChanghua Christian HospitalChanghuaTaiwan
| | - Chih‐Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal MedicineCollege of Medicine, National Taiwan University Hospital, National Taiwan UniversityTaipeiTaiwan
| | - Päivi Maria Paldánius
- Children's Hospital, Helsinki University HospitalHelsinkiFinland
- Program for Clinical and Molecular MetabolismHelsinki UniversityHelsinkiFinland
| | - Wayne H. H. Sheu
- Division of Endocrinology and Metabolism, Department of Internal MedicineTaichung Veterans General HospitalTaiwan
- Department of Medicine, School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- Institute of Medical Technology, College of Life Science, National Chung‐Hsing UniversityTaichungTaiwan
- School of Medicine, National Defense Medical CenterTaipeiTaiwan
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6
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Aga F, Dunbar SB, Kebede T, Higgins MK, Gary R. Relationships of diabetes self-care behaviours to glycaemic control in adults with type 2 diabetes and comorbid heart failure. Nurs Open 2020; 7:1453-1467. [PMID: 32802365 PMCID: PMC7424468 DOI: 10.1002/nop2.517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/13/2020] [Accepted: 04/27/2020] [Indexed: 01/02/2023] Open
Abstract
Aim To describe the relationship between diabetes self-care behaviours and glycaemic control in patients with type 2 diabetes and comorbid heart failure. Design A cross-sectional, correlational study. Method A secondary analysis of 180 participants' baseline data from a clinical trial that tested a 6-month integrated self-care intervention was performed. Correlational and hierarchical linear regression analysis was used to assess the relationships between diabetes self-care behaviours and glycaemic control. Result The Summary of Diabetes Self-Care Activities general diet and Summary of Diabetes Self-Care Activities exercise were negatively associated with glycated haemoglobin (HbA1c), while Summary of Diabetes Self-Care Activities specific diet was positively associated. Diabetic end-organ failure, taking insulin only and taking both oral antiglycaemic and insulin, predicted higher HbA1c and fasting blood glucose. African American race and dyslipidaemia predicted higher HbA1c while taking higher total daily medication predicted higher fasting blood glucose. Longer years lived with heart failure, lower ventricular ejection fraction and exposure to chemotherapy predicted lower fasting blood glucose.
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Affiliation(s)
- Fekadu Aga
- School of Nursing & MidwiferyCollege of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGAUSA
| | - Tedla Kebede
- Diabetes & Endocrinology UnitDepartment of Internal MedicineSchool of MedicineCollege of Health SciencesTikur Anbessa Specialized HospitalAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Rebecca Gary
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGAUSA
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7
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Abstract
BACKGROUND Insulin shares a limited physiological concentration range with other endocrine hormones. Not only too low, but also too high systemic insulin levels are detrimental for body functions. MAIN BODY The physiological function and clinical relevance of insulin are usually seen in association with its role in maintaining glucose homeostasis. However, insulin is an anabolic hormone which stimulates a large number of cellular responses. Not only too low, but also excess insulin concentrations are detrimental to the physiological balance. Although the glucoregulatory activity of insulin is mitigated during hyperinsulinemia by dampening the efficiency of insulin signaling ("insulin resistance"), this is not the case for most other hormonal actions of insulin, including the promotion of protein synthesis, de novo lipogenesis, and cell proliferation; the inhibition of lipolysis, of autophagy-dependent cellular turnover, and of nuclear factor E2-related factor-2 (Nrf2)-dependent antioxidative; and other defense mechanisms. Hence, there is no general insulin resistance but selective impairment of insulin signaling which causes less glucose uptake from the blood and reduced activation of endothelial NO synthase (eNOS). Because of the largely unrestricted insulin signaling, hyperinsulinemia increases the risk of obesity, type 2 diabetes, and cardiovascular disease and decreases health span and life expectancy. In epidemiological studies, high-dose insulin therapy is associated with an increased risk of cardiovascular disease. Randomized controlled trials of insulin treatment did not observe any effect on disease risk, but these trials only studied low insulin doses up to 40 IU/day. Proof for a causal link between elevated insulin levels and cardiovascular disease risk comes from Mendelian randomization studies comparing individuals with genetically controlled low or high insulin production. CONCLUSIONS The detrimental actions of prolonged high insulin concentrations, seen also in cell culture, argue in favor of a lifestyle that limits circadian insulin levels. The health risks associated with hyperinsulinemia may have implications for treatment regimens used in type 2 diabetes.
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Mazoteras-Pardo V, Becerro-De-Bengoa-Vallejo R, Losa-Iglesias ME, Martínez-Jiménez EM, Calvo-Lobo C, Romero-Morales C, López-López D, Palomo-López P. QardioArm Blood Pressure Monitoring in a Population With Type 2 Diabetes: Validation Study. J Med Internet Res 2020; 22:e19781. [PMID: 32706672 PMCID: PMC7414407 DOI: 10.2196/19781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Home blood pressure monitoring has many benefits, even more so, in populations prone to high blood pressure, such as persons with diabetes. OBJECTIVE The purpose of this research was to validate the QardioArm mobile device in a sample of individuals with noninsulin-dependent type 2 diabetes in accordance with the guidelines of the second International Protocol of the European Society of Hypertension. METHODS The sample consisted of 33 patients with type 2 diabetes. To evaluate the validity of QardioArm by comparing its data with that obtained with a digital sphygmomanometer (Omron M3 Intellisense), two nurses collected diastolic blood pressure, systolic blood pressure, and heart rate with both devices. RESULTS The analysis indicated that the test device QardioArm met all the validation requirements using a sample population with type 2 diabetes. CONCLUSIONS This paper reports the first validation of QardioArm in a population of individuals with noninsulin-dependent type 2 diabetes. QardioArm for home monitoring of blood pressure and heart rate met the requirements of the second International Protocol of the European Society of Hypertension.
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Affiliation(s)
- Victoria Mazoteras-Pardo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Eva María Martínez-Jiménez
- Departamento de Enfermería, Facultad de Fisioterapia y Enfermería, Universidad de Castilla la Mancha, Toledo, Spain
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
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Synthesis of Organic Ligands via Reactions of 4-Benzoyl-5-phenylamino-2,3-dihydrothiophene-2,3-dione with N-Nucleophiles. HETEROATOM CHEMISTRY 2020. [DOI: 10.1155/2020/5945796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The reaction of 4-benzoyl-5-phenylamino-2,3-dihydrothiophene-2,3-dione (1) with aminoheteroaryls, lamotrigine, 1,3-diaminoheteroaryls, dapsone, NH2R (hydroxylamine, DL-1-phenylethylamine, and metformin), and 4,4′-bipyridine in THF/H2O (1 : 1) at room temperature led to 3-N-phenylthiocarbamoyl-2-butenamides 2–5, while that with naphthylamines and 1,3-phenylenediamine in ethanol at high temperature led to 5-phenylamino-2,5-dihydrothiophene-2-ones 6–8 as organic ligands in the medium to good yields. These showed the nucleophilic attacks of N-nucleophiles, except primary aromatic amines, on thioester carboxyl group (C-2) of thiophene-2,3-dione ring 1. However, the nucleophilic attacks of primary aromatic amines on the carbonyl group (C-3) of thiophene-2,3-dione 1 occurred in the form of substituted thiophenes.
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Jong CB, Li HY, Pan SL, Hsieh MY, Su FY, Chen KC, Yin WH, Chan SH, Wu YW, Wang KY, Chang KC, Hwang JJ, Wu CC. Relationship Between Body Mass Index, Antidiabetic Agents, and Midterm Mortality in Patients With Both Type 2 Diabetes Mellitus and Acute Coronary Syndrome. J Am Heart Assoc 2020; 8:e011215. [PMID: 30905254 PMCID: PMC6509713 DOI: 10.1161/jaha.118.011215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The aim of this study was to determine the influence of various antidiabetic therapies on the relationship between body mass index and all‐cause mortality in patients with diabetes mellitus and acute coronary syndrome. Methods and Results This was a prospective, observational study comprising 1193 patients diagnosed with type 2 diabetes mellitus and acute coronary syndrome. The patients were stratified into 4 body mass index categories, and their mortality rates were compared using time‐dependent Cox regression analysis using normal weight (body mass index, 18.5–23.9) as the reference. Subsequently, the influence of antidiabetic therapies on the association between BMI and mortality were analyzed. Seventy‐four patients (6.2%) died over 2 years of follow‐up. The mortality rate was lowest in the class I obese group (3.35%) and highest in the normal‐weight group (9.67%). After adjusting for covariates, class I obesity paradoxically remained significantly protective against mortality compared with normal weight (hazard ratio, 0.141; P=0.049); interaction term analysis showed that insulin therapy influenced this “obesity paradox” (P=0.045). When the patients were stratified by insulin use, the protective effect of obesity disappeared in the insulin‐treated patients but persisted in the non–insulin‐treated patients. Conclusions In patients with type 2 diabetes mellitus and acute coronary syndrome, the relationship between body mass index and mortality rate is U‐shaped, with class I obesity representing the nadir and normal weight the peak. The protective effect of obesity disappeared in patients treated with insulin.
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Affiliation(s)
- Chien-Boon Jong
- 1 Department of Internal Medicine National Taiwan University Hospital Hsin-Chu Taiwan
| | - Hung-Yuan Li
- 2 Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Shin-Liang Pan
- 3 Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan.,6 Department of Physical Medicine and Rehabilitation National Taiwan University College of Medicine Taipei Taiwan
| | - Mu-Yang Hsieh
- 1 Department of Internal Medicine National Taiwan University Hospital Hsin-Chu Taiwan
| | - Fang-Ying Su
- 4 Biotechology R&D Center National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Kuan-Chun Chen
- 7 Institute of Emergency and Critical Care Medicine School of Medicine National Yang-Ming University Taipei Taiwan.,9 Division of Cardiology Heart Center Cheng Hsin General Hospital Taipei Taiwan
| | - Wei-Hsian Yin
- 9 Division of Cardiology Heart Center Cheng Hsin General Hospital Taipei Taiwan.,10 Faculty of Medicine School of Medicine National Yang Ming University Taipei Taiwan
| | - Shih-Hung Chan
- 11 Department of Internal Medicine National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan
| | - Yen-Wen Wu
- 8 School of Medicine National Yang-Ming University Taipei Taiwan.,12 Cardiology Division of Cardiovascular Medical Center Far Eastern Memorial Hospital New Taipei City Taiwan
| | - Kuo-Yung Wang
- 13 Department of Medicine Cardiovascular Center Taichung Veterans General Hospital Taichung Taiwan.,14 College of Medicine China and Chung Shan Medical University Taichung Taiwan
| | - Kuan-Cheng Chang
- 15 Graduate Institute of Biomedical Sciences China Medical University Taichung Taiwan.,16 Division of Cardiovascular Medicine China Medical University Hospital Taichung Taiwan
| | - Juey-Jen Hwang
- 17 Division of Cardiovascular Department of Internal Medicine National Taiwan University College of Medicine and Hospital Taipei Taiwan.,18 College of Medicine National Taiwan University Taipei Taiwan
| | - Chih-Cheng Wu
- 5 Cardiovascular Center National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan.,18 College of Medicine National Taiwan University Taipei Taiwan.,19 Institute of Biomedical Engineering National Tsing-Hua University Hsin-Chu Taiwan
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11
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Paneni F, Costantino S, Hamdani N. Regression of left ventricular hypertrophy with SGLT2 inhibitors. Eur Heart J 2020; 41:3433-3436. [DOI: 10.1093/eurheartj/ehaa530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich, Switzerland
- Department of Research and Education, University Hospital Zurich, Switzerland
| | - Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Switzerland
| | - Nazha Hamdani
- Institute of Physiology, Ruhr University, Bochum, Germany
- Molecular and Experimental Cardiology, Ruhr University, Bochum, Germany
- Department of Cardiology, St-Josef Hospital, Ruhr University, Bochum, Germany
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12
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Costantino S, Mohammed SA, Ambrosini S, Paneni F. The vascular epigenome in patients with obesity and type 2 diabetes: opportunities for personalized therapies. VASCULAR BIOLOGY 2020; 2:H19-H28. [PMID: 32923971 PMCID: PMC7439922 DOI: 10.1530/vb-20-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023]
Abstract
Our genetic background provides limited information on individual risk of developing vascular complications overtime. New biological layers, namely epigenetic modifications, are now emerging as potent regulators of gene expression thus leading to altered transcriptional programs and vascular disease phenotypes. Such epigenetic modifications, defined as changes to the genome that do not involve changes in DNA sequence, are generally induced by environmental factors and poor lifestyle habits. Of note, adverse epigenetic signals acquired during life can be transmitted to the offspring thus leading to premature alterations of the epigenetic and transcriptional landscape eventually leading to early endothelial dysfunction and vascular senescence. Modifications of the epigenome play a pivotal role in the pathophysiology of cardiometabolic disturbances such as obesity and type 2 diabetes. In these patients, changes of DNA methylation and chromatin structure contribute to alter pathways regulating insulin sensitivity, glucose homeostasis, adipogenesis and vascular function. In this perspective, unveiling the 'epigenetic landscape' in cardiometabolic patients may help to identify new players implicated in obesity and diabetes-related vascular dysfunction and may pave the way for personalized therapies in this setting. In the present review, we discuss current knowledge of the epigenetic routes implicated in vascular damage and cardiovascular disease in patients with metabolic alterations.
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Affiliation(s)
- Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Shafeeq A Mohammed
- Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Samuele Ambrosini
- Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland.,University Heart Center, Cardiology, University Hospital Zurich, Zürich, Switzerland.,Department of Research and Education, University Hospital Zurich, Zürich, Switzerland
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13
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Bartlett F, January S, Pottebaum A, Horwedel T, Malone AF. Impact of metformin on malignancy in solid organ transplantation. Clin Transplant 2020; 34:e13851. [PMID: 32159875 DOI: 10.1111/ctr.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/11/2020] [Accepted: 02/28/2020] [Indexed: 11/27/2022]
Abstract
Malignancy after solid organ transplant is a common occurrence that is associated with increased morbidity and mortality. Literature in the general diabetic population has identified possible antineoplastic properties of metformin. This retrospective study aims to determine if metformin results in a malignancy risk reduction in a cohort of diabetic kidney, liver, and heart transplant recipients. The population included transplant recipients without use of metformin at any time point (DMO arm, n = 147) and those with use of metformin (DMM arm, n = 172); the two arms were matched based on organ type and transplant date prior to application of exclusion criteria. Recipients with prior malignancy, malignancy before diabetes diagnosis, and metformin duration <30 days were excluded. The primary endpoint of malignancy first occurrence post-transplant was not found to be statistically significant at 1, 5, 10, and 15 years. In the subgroup of heart transplant recipients, there was a significant reduction in malignancy at 15 years post-transplant. Older age and Caucasian race were identified as significant risk factors for malignancy, while never smoker was a protective factor. Metformin use in this solid organ transplant cohort was not found to significantly reduce malignancy risk compared to use of other anti-diabetic agents.
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Affiliation(s)
- Felicia Bartlett
- Department of Pharmacy, Medical University of South Carolina, Charleston, South Carolina
| | - Spenser January
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri
| | - April Pottebaum
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri
| | | | - Andrew F Malone
- Division of Nephrology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Effect of empagliflozin beyond glycemic control: Cardiovascular benefit in patients with type 2 diabetes and established cardiovascular disease. Rev Port Cardiol 2020; 38:721-735. [PMID: 31892455 DOI: 10.1016/j.repc.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/16/2019] [Accepted: 02/03/2019] [Indexed: 11/22/2022] Open
Abstract
The prevalence of type 2 diabetes (T2D) continues to increase, and its association with cardiovascular (CV) disease has led to the inclusion of CV endpoints in clinical trials on the treatment of T2D. This article explores the various trials already performed and under development in this field, with particular focus on the EMPA-REG OUTCOME trial. In this trial, empagliflozin, a sodium-glucose co-transporter 2 inhibitor, demonstrated a reduction in CV risk in patients with T2D and established CV disease, in addition to CV safety and a decrease in glycated hemoglobin. This represents a paradigm shift that has led to changes in the international guidelines for the treatment of T2D. These results were maintained in subsequent subgroup analysis for heart failure, chronic kidney disease and peripheral arterial disease, although there are many questions concerning the mechanisms involved in these effects, including whether they are hemodynamic, metabolic or due to decreased myocardial cytoplasmic sodium concentrations. With this reduction in risk for major CV events in patients with T2D, the EMPA-REG OUTCOME trial demonstrated CV protection from a hypoglycemic drug for the first time, and opened a new era in the treatment and management of T2D. This study has led to the development of ongoing trials that will establish which patients will benefit most from this therapy, particularly with regard to comorbidities.
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15
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Monteiro P, Aguiar C, Matos P, Silva-Nunes J, Birne R, Branco P, Calado J, Melo M, Polónia J. Effect of empagliflozin beyond glycemic control: Cardiovascular benefit in patients with type 2 diabetes and established cardiovascular disease. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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16
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Vaccaro O, Lucisano G, Masulli M, Bonora E, Del Prato S, Rivellese AA, Giorda CB, Mocarelli P, Squatrito S, Maggioni AP, Riccardi G, Nicolucci A. Cardiovascular Effects of Pioglitazone or Sulfonylureas According to Pretreatment Risk: Moving Toward Personalized Care. J Clin Endocrinol Metab 2019; 104:3296-3302. [PMID: 31058962 DOI: 10.1210/jc.2019-00361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/30/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT Hypoglycemic drugs with proven cardiovascular (CV) benefits are recommended for patients with type 2 diabetes and CV disease. Whether the beneficial effects extend to those at lower risk remains unclear. AIM We investigated the long-term CV effects of pioglitazone or sulfonylureas (SUs) across the spectrum of pretreatment CV risk. METHODS Among 2820 participants of the TOSCA.IT trial, four subgroups with different risk of outcome-a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, urgent coronary revascularization-were identified by the RECursive Partitioning and AMalgamation (RECPAM) method. Within each group, the effect of SUs or pioglitazone on the outcome was evaluated. RESULTS Sex was the first splitting variable, followed by urinary albumin-to-creatinine ratio (UACR) (>9 mg/g or ≤9 mg/g) and body mass index (BMI) (>28.7 or ≤28.7 kg/m2). Female patients had the lowest risk (reference); male patients with UACR >9 mg/g and BMI >28.7 kg/m2 had the highest risk [hazard ratio (HR), 5.58; 95% CI, 3.32 to 9.69]. Patients in this group present a cluster of conditions suggestive of marked insulin resistance (higher BMI, waist circumference, triglycerides, blood pressure, and UACR and lower high-density lipoprotein cholesterol) than the other groups. Treatment with pioglitazone in this group was associated with a significantly lower occurrence of the outcome than SUs (HR, 0.48; 95% CI, 0.25 to 0.76). No significant difference between study treatments was observed in the other RECPAM classes. CONCLUSIONS It is possible to identify patients with type 2 diabetes early in the stage of their disease and who are largely free from evident CV disease in whom add-on pioglitazone to metformin confers CV protection as compared with SUs.
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Affiliation(s)
- Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Paolo Mocarelli
- University Department of Laboratory Medicine, Hospital of Desio, Desio (MB), Italy
| | | | | | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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Chastain CA, Klopfenstein N, Serezani CH, Aronoff DM. A Clinical Review of Diabetic Foot Infections. Clin Podiatr Med Surg 2019; 36:381-395. [PMID: 31079605 DOI: 10.1016/j.cpm.2019.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
"Diabetic foot infections (DFIs) are a common cause of morbidity and mortality. This article summarizes current knowledge regarding DFI epidemiology, disease pathogenesis, and the impact of antimicrobial resistance among DFI. An evidence-based approach to clinical assessment, diagnosing osteomyelitis, as well as medical and surgical treatment is discussed, including a review of empiric and directed antibiotic treatment recommendations. The current state and needs of the clinical literature are identified throughout, with a discussion of the supporting role of infectious diseases specialists as well as future directions of the field."
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Affiliation(s)
- Cody A Chastain
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, A-2200 Medical Center North, Nashville, TN 37232-2582, USA
| | - Nathan Klopfenstein
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, A-2200 Medical Center North, Nashville, TN 37232-2582, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-2200 Medical Center North, Nashville, TN 37232-2582, USA
| | - Carlos H Serezani
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, A-2200 Medical Center North, Nashville, TN 37232-2582, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-2200 Medical Center North, Nashville, TN 37232-2582, USA. https://twitter.com/HSerezani
| | - David M Aronoff
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, A-2200 Medical Center North, Nashville, TN 37232-2582, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-2200 Medical Center North, Nashville, TN 37232-2582, USA.
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18
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De Sensi F, Costantino S, Limbruno U, Paneni F. Atrial fibrillation in the cardiometabolic patient. Minerva Med 2019; 110:157-167. [DOI: 10.23736/s0026-4806.18.05882-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Santos Cavaiola T, Kiriakov Y, Reid T. Primary Care Management of Patients With Type 2 Diabetes: Overcoming Inertia and Advancing Therapy With the Use of Injectables. Clin Ther 2019; 41:352-367. [PMID: 30655008 DOI: 10.1016/j.clinthera.2018.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/07/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes (T2D) is a progressive disease caused by insulin resistance and associated progressive β-cell functional decline, as well as multiple other related metabolic and pathophysiologic changes. Left unchecked, T2D increases the risk of long-term microvascular and cardiovascular complications and is associated with excess morbidity and mortality. Despite multiple effective options for reducing hyperglycemia, patients are not optimally managed, largely due to delays in appropriate and timely advancement of therapy. Glucagon-like peptide-1 receptor agonists and basal insulin are recommended by treatment guidelines as effective options for advancing therapy to achieve glycemic control. However, injected therapies often face resistance from patients and clinicians. Glucagon-like peptide-1 receptor agonists are associated with weight loss, low risk of hypoglycemia, and potential beneficial cardiovascular effects. The class is recommended for patients across the spectrum of disease severity and represents an attractive option to add to basal insulin therapy when additional control is needed. Newer second-generation basal insulin analogues offer advantages over first-generation basal insulins in terms of lower hypoglycemia rates and greater flexibility in dosing. Incorporating injectable therapy into patient care in a timely manner has the potential to improve outcomes and must not be overlooked. Primary care clinicians play a significant role in managing patients with T2D, and they must be able to address and overcome patient resistance and their own barriers to advancing therapy if optimal treatment outcomes are to be achieved. The purpose of this expert opinion article was to provide a commentary on the key principle of advancing therapy with injectables to control hyperglycemia.
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Affiliation(s)
| | - Yan Kiriakov
- Abington-Jefferson Urgent Care, Willow Grove, PA, United States
| | - Timothy Reid
- Mercy Diabetes Center, Janesville, WI, United States
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20
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Claggett B, Lachin JM, Hantel S, Fitchett D, Inzucchi SE, Woerle HJ, George JT, Zinman B. Long-Term Benefit of Empagliflozin on Life Expectancy in Patients With Type 2 Diabetes Mellitus and Established Cardiovascular Disease. Circulation 2018; 138:1599-1601. [DOI: 10.1161/circulationaha.118.033810] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (B.C.)
| | - John M. Lachin
- Biostatistics Center, George Washington University, Rockville, MD (J.M.L.)
| | - Stefan Hantel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany (S.H.)
| | - David Fitchett
- St. Michael’s Hospital, Division of Cardiology (D.F.), Canada
- University of Toronto (D.F., B.Z.), Canada
| | - Silvio E. Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT (S.E.I.)
| | - Hans J. Woerle
- Boehringer Ingelheim International GmbH, Germany (H.J.W., J.T.G.)
| | | | - Bernard Zinman
- University of Toronto (D.F., B.Z.), Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (B.Z.)
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21
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Scheen AJ. Cardiovascular outcome studies in type 2 diabetes: Comparison between SGLT2 inhibitors and GLP-1 receptor agonists. Diabetes Res Clin Pract 2018; 143:88-100. [PMID: 29944969 DOI: 10.1016/j.diabres.2018.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/14/2018] [Accepted: 06/13/2018] [Indexed: 12/22/2022]
Abstract
Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are two pharmacological classes that have proven their efficacy to reduce major cardiovascular events (MACEs) in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease in large prospective cardiovascular outcome trials (CVOTs): EMPA-REG OUTCOME (empagliflozin), CANVAS (canagliflozin), LEADER (liraglutide) and SUSTAIN 6 (semaglutide). Some heterogeneity appears to exist between the various agents within the two pharmacological classes. Whether these positive results could be extrapolated to patients without cardiovascular disease is still unknown. The underlying mechanisms remain a matter of debate but appear to differ between SGLT2is and GLP-1RAs. One crucial question is which patient's characteristics should be taken into account to guide the choice between a SGLT2i or a GLP-1RA according to a personalized approach. Heart failure should encourage the use of a SGLT2i whereas moderate to severe chronic kidney disease should favour the prescription of a GLP-1RA. Despite the results of recent CVOTs, numerous patients who are good candidates for benefiting of these agents do not receive them in clinical practice. Currently, there is a paradigm shift in T2DM management, moving from a primary objective of glucose control to a cardiovascular and renal protection.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, Liège, Belgium; Clinical Pharmacology Unit, CHU Liège, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
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22
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Hamza AA, Fikry EM, Abdallah W, Amin A. Mechanistic insights into the augmented effect of bone marrow mesenchymal stem cells and thiazolidinediones in streptozotocin-nicotinamide induced diabetic rats. Sci Rep 2018; 8:9827. [PMID: 29959408 PMCID: PMC6026169 DOI: 10.1038/s41598-018-28029-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/12/2018] [Indexed: 02/06/2023] Open
Abstract
This study was designed to assess whether the protective effects of bone marrow-derived mesenchymal stem cells (MSCs) against diabetes could be enhanced by pioglitazone (PIO), a PPARγ agonist. Combined MSCs and PIO treatments markedly improved fasting blood glucose, body weight, lipid profile levels, insulin level, insulin resistance, β cell function. Those protective effects also attenuated both pancreatic lesions and fibrosis in diabetic rats and decreased the depletion of pancreatic mediators of glycemic and lipid metabolism including peroxisome proliferator-activated receptor alpha (PPARα), PGC-1α, GLP-1 and IRS-2. Cardiac biogenesis of diabetic groups was also improved with MSCs and/or PIO treatments as reflected by the enhanced up-regulation of the expressions of cardiac IRS1, Glucose transporter 4, PGC-1, PPARα and CPT-1 genes and the down-regulated expression of lipogenic gene SREBP. The combination of MSCs and PIO also potentiated the decrease of abnormal myocardial pathological lesions in diabetic rats. Similarly, the inhibitory effects of MSCs on diabetic cardiac fibrosis and on the up regulations of TGF-β, collagen I and III gene expressions were partial but additive when combined with PIO. Therefore, combined therapy with PIO and BMCs transplantation could further potentiate the protective benefit of MSCs against diabetes and cardiac damage compared to MSCs monotherapy.
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Affiliation(s)
- Alaaeldin Ahmed Hamza
- Hormone Evaluation Department, National Organization for Drug Control and Research (NODCAR), Giza, Egypt.
| | | | | | - Amr Amin
- Biology Department, College of Science, UAE University, Al-Ain, UAE.
- Department of Zoology, Faculty of Science, Cairo University, Giza, Egypt.
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23
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Arrieta F, Iglesias P, Pedro-Botet J, Becerra A, Ortega E, Obaya JC, Nubiola A, Maldonado GF, Campos MDM, Petrecca R, Pardo JL, Sánchez-Margalet V, Alemán JJ, Navarro J, Duran S, Tébar FJ, Aguilar M, Escobar F. Diabetes mellitus y riesgo cardiovascular. Actualización de las recomendaciones del Grupo de Trabajo de Diabetes y Riesgo Cardiovascular de la Sociedad Española de Diabetes (SED, 2018). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 30:137-153. [DOI: 10.1016/j.arteri.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/28/2018] [Accepted: 03/09/2018] [Indexed: 12/24/2022]
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Antidiabéticos en prevención de ictus en pacientes con diabetes tipo 2. El punto de vista del neurólogo. Med Clin (Barc) 2018; 150:275-281. [DOI: 10.1016/j.medcli.2017.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 08/26/2017] [Accepted: 09/04/2017] [Indexed: 12/20/2022]
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25
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Qiao H, Ren H, Du H, Zhang M, Xiong X, Lv R. Liraglutide repairs the infarcted heart: The role of the SIRT1/Parkin/mitophagy pathway. Mol Med Rep 2018; 17:3722-3734. [PMID: 29328405 PMCID: PMC5802177 DOI: 10.3892/mmr.2018.8371] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/16/2017] [Indexed: 12/18/2022] Open
Abstract
Liraglutide is glucagon‑like peptide‑1 receptor agonist used for treating patients with type 2 diabetes mellitus. The present study aimed to investigate the role and mechanism of liraglutide in repairing the infarcted heart following myocardial infarction. The results of the present study demonstrated that amplification of the dose of liraglutide for ~28 days was able to reduce cardiac fibrosis, inflammatory responses and myocardial death in the post‑infarcted heart. In vitro, liraglutide protected cardiomyocyte mitochondria against the chronic hypoxic damage, inhibiting the mitochondrial apoptosis pathways. Mechanistically, liraglutide elevated the expression of NAD‑dependent protein deacetylase sirtuin‑1 (SIRT1), which increased the expression of Parkin, leading to mitophagy activation. Protective mitophagy reversed cellular adenosine 5'‑triphosphate production, reduced cellular oxidative stress and balanced the redox response, sustaining mitochondrial homeostasis. Notably, following blockade of glucagon‑like peptide 1 receptor or knockdown of Parkin, the beneficial effects of liraglutide on mitochondria disappeared. In conclusion, the results of the present study illustrated the protective role of liraglutide in repairing the infarcted heart via regulation of the SIRT1/Parkin/mitophagy pathway.
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Affiliation(s)
- Huiying Qiao
- Department of Geriatric, Wujiang District No. 1 People's Hospital, Suzhou, Jiangsu 215200, P.R. China
| | - Haiyan Ren
- Central Laboratory of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - He Du
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, P.R. China
| | - Minfang Zhang
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, P.R. China
| | - Xiaofang Xiong
- Department of Cardiovascular Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, P.R. China
| | - Rong Lv
- Department of Geriatric, Wujiang District No. 1 People's Hospital, Suzhou, Jiangsu 215200, P.R. China
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26
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Cersosimo E, Johnson EL, Chovanes C, Skolnik N. Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach. Diabetes Obes Metab 2018; 20:497-507. [PMID: 28862799 DOI: 10.1111/dom.13108] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/18/2017] [Accepted: 08/26/2017] [Indexed: 12/13/2022]
Abstract
There is clear evidence that achieving glycaemic targets reduces the risk of developing complications as a result of type 2 diabetes (T2D). Many patients, however, continue to have suboptimal glycaemic control because of issues that include unclear advice on how to achieve these targets as well as clinical inertia. The two management approaches recommended for patients newly diagnosed with T2D are stepwise and combination therapy, each of which has advantages and disadvantages. Stepwise therapy may result in good patient adherence and allow greater individualization of therapy, and minimization of side effects and cost, and so may be appropriate for patients who are closer to goal. Stepwise therapy, however, may also lead to frequent delays in achieving glycaemic goals and longer exposure to hyperglycaemia. Combination therapy, which is now emerging as an important therapy option, has a number of potential advantages over stepwise therapy, including reduction in clinical inertia and earlier and more frequent achievement of glycated haemoglobin goals by targeting multiple pathogenic mechanisms simultaneously, which may more effectively delay disease progression. Compared with stepwise therapy, the disadvantages of combination therapy include reduced patient adherence resulting from complex, multi-drug regimens, difficulty determining the cause of poor efficacy and/or side effects, patient refusal to accept disease, and higher cost. Fixed-dose and fixed-ratio combinations are novel therapeutic approaches which may help address several issues of treatment complexity and patient burden associated with combination therapy comprising individual drugs. The choice of which drugs to administer and the decision to use stepwise vs combination therapy, however, should always be made on an individualized basis.
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Affiliation(s)
- Eugenio Cersosimo
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Eric L Johnson
- Department of Family and Community Medicine, University of North Dakota, Grand Forks, North Dakota
| | | | - Neil Skolnik
- Abington Family Medicine, Jenkintown, Pennsylvania
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27
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Padilla J, Carpenter AJ, Das NA, Kandikattu HK, López-Ongil S, Martinez-Lemus LA, Siebenlist U, DeMarco VG, Chandrasekar B. TRAF3IP2 mediates high glucose-induced endothelin-1 production as well as endothelin-1-induced inflammation in endothelial cells. Am J Physiol Heart Circ Physiol 2018; 314:H52-H64. [PMID: 28971844 PMCID: PMC5866390 DOI: 10.1152/ajpheart.00478.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/11/2017] [Accepted: 09/25/2017] [Indexed: 01/15/2023]
Abstract
Hyperglycemia-induced production of endothelin (ET)-1 is a hallmark of endothelial dysfunction in diabetes. Although the detrimental vascular effects of increased ET-1 are well known, the molecular mechanisms regulating endothelial synthesis of ET-1 in the setting of diabetes remain largely unidentified. Here, we show that adapter molecule TRAF3 interacting protein 2 (TRAF3IP2) mediates high glucose-induced ET-1 production in endothelial cells and ET-1-mediated endothelial cell inflammation. Specifically, we found that high glucose upregulated TRAF3IP2 in human aortic endothelial cells, which subsequently led to activation of JNK and IKKβ. shRNA-mediated silencing of TRAF3IP2, JNK1, or IKKβ abrogated high-glucose-induced ET-converting enzyme 1 expression and ET-1 production. Likewise, overexpression of TRAF3IP2, in the absence of high glucose, led to activation of JNK and IKKβ as well as increased ET-1 production. Furthermore, ET-1 transcriptionally upregulated TRAF3IP2, and this upregulation was prevented by pharmacological inhibition of ET-1 receptor B using BQ-788, or inhibition of NADPH oxidase-derived reactive oxygen species using gp91ds-tat and GKT137831. Notably, we found that knockdown of TRAF3IP2 abolished ET-1-induced proinflammatory and adhesion molecule (IL-1β, TNF-α, monocyte chemoattractant protein 1, ICAM-1, VCAM-1, and E-selectin) expression and monocyte adhesion to endothelial cells. Finally, we report that TRAF3IP2 is upregulated and colocalized with CD31, an endothelial marker, in the aorta of diabetic mice. Collectively, findings from the present study identify endothelial TRAF3IP2 as a potential new therapeutic target to suppress ET-1 production and associated vascular complications in diabetes. NEW & NOTEWORTHY This study provides the first evidence that the adapter molecule TRAF3 interacting protein 2 mediates high glucose-induced production of endothelin-1 by endothelial cells as well as endothelin-1-mediated endothelial cell inflammation. The findings presented herein suggest that TRAF3 interacting protein 2 may be an important therapeutic target in diabetic vasculopathy characterized by excess endothelin-1 production.
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Affiliation(s)
- Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri , Columbia, Missouri
- Department of Child Health, University of Missouri , Columbia, Missouri
- Dalton Cardiovascular Research Center, University of Missouri , Columbia, Missouri
| | - Andrea J Carpenter
- Cardiothoracic Surgery, University of Texas Health Science Center , San Antonio, Texas
| | - Nitin A Das
- Cardiothoracic Surgery, University of Texas Health Science Center , San Antonio, Texas
| | - Hemanth Kumar Kandikattu
- Research Service, Harry S. Truman Memorial Veterans' Hospital , Columbia, Missouri
- Division of Cardiovascular Medicine, Department of Medicine, University of Missouri , Columbia, Missouri
| | - Susana López-Ongil
- Research Unit, Fundación para la Investigación Biomédica del Hospital Universitario Prıncipe de Asturias, Alcala de Henares, Madrid , Spain
- Instituto Reina Sofıa de Investigación Nefrológica, IRSIN, Madrid , Spain
| | - Luis A Martinez-Lemus
- Dalton Cardiovascular Research Center, University of Missouri , Columbia, Missouri
- Department of Medical Pharmacology and Physiology, University of Missouri , Columbia, Missouri
| | - Ulrich Siebenlist
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland
| | - Vincent G DeMarco
- Research Service, Harry S. Truman Memorial Veterans' Hospital , Columbia, Missouri
- Department of Medical Pharmacology and Physiology, University of Missouri , Columbia, Missouri
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri , Columbia, Missouri
- Division of Endocrinology, Department of Medicine, University of Missouri , Columbia, Missouri
| | - Bysani Chandrasekar
- Dalton Cardiovascular Research Center, University of Missouri , Columbia, Missouri
- Research Service, Harry S. Truman Memorial Veterans' Hospital , Columbia, Missouri
- Division of Cardiovascular Medicine, Department of Medicine, University of Missouri , Columbia, Missouri
- Department of Medical Pharmacology and Physiology, University of Missouri , Columbia, Missouri
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Ferdinand KC, Mahata I. Cardiovascular outcome studies with glucagon-like peptide 1 receptor agonists-what will REWIND add? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:476. [PMID: 29285509 DOI: 10.21037/atm.2017.10.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Keith C Ferdinand
- Department of Medicine, Tulane School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA, USA
| | - Indrajeet Mahata
- Department of Medicine, Tulane School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA, USA
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Costantino S, Paneni F, Battista R, Castello L, Capretti G, Chiandotto S, Tanese L, Russo G, Pitocco D, Lanza GA, Volpe M, Lüscher TF, Cosentino F. Impact of Glycemic Variability on Chromatin Remodeling, Oxidative Stress, and Endothelial Dysfunction in Patients With Type 2 Diabetes and With Target HbA 1c Levels. Diabetes 2017. [PMID: 28634176 DOI: 10.2337/db17-0294] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Intensive glycemic control (IGC) targeting HbA1c fails to show an unequivocal reduction of macrovascular complications in type 2 diabetes (T2D); however, the underlying mechanisms remain elusive. Epigenetic changes are emerging as important mediators of cardiovascular damage and may play a role in this setting. This study investigated whether epigenetic regulation of the adaptor protein p66Shc, a key driver of mitochondrial oxidative stress, contributes to persistent vascular dysfunction in patients with T2D despite IGC. Thirty-nine patients with uncontrolled T2D (HbA1c >7.5%) and 24 age- and sex-matched healthy control subjects were consecutively enrolled. IGC was implemented for 6 months in patients with T2D to achieve a target HbA1c of ≤7.0%. Brachial artery flow-mediated dilation (FMD), urinary 8-isoprostaglandin F2α (8-isoPGF2α), and epigenetic regulation of p66Shc were assessed at baseline and follow-up. Continuous glucose monitoring was performed to determine the mean amplitude of glycemic excursion (MAGE) and postprandial incremental area under the curve (AUCpp). At baseline, patients with T2D showed impaired FMD, increased urinary 8-isoPGF2α, and p66Shc upregulation in circulating monocytes compared with control subjects. FMD, 8-isoPGF2α, and p66Shc expression were not affected by IGC. DNA hypomethylation and histone 3 acetylation were found on the p66Shc promoter of patients with T2D, and IGC did not change such adverse epigenetic remodeling. Persistent downregulation of methyltransferase DNMT3b and deacetylase SIRT1 may explain the observed p66Shc-related epigenetic changes. MAGE and AUCpp but not HbA1c were independently associated with the altered epigenetic profile on the p66Shc promoter. Hence, glucose fluctuations contribute to chromatin remodeling and may explain persistent vascular dysfunction in patients with T2D with target HbA1c levels.
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Affiliation(s)
- Sarah Costantino
- Cardiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Cardiology, University of Zurich, and University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Paneni
- Cardiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Cardiology, University of Zurich, and University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Lorenzo Castello
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuliana Capretti
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Sergio Chiandotto
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Luigi Tanese
- Diabetes Care Unit, Internal Medicine, Catholic University, Rome, Italy
| | - Giulio Russo
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Internal Medicine, Catholic University, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Massimo Volpe
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, and University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
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30
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Nakatsu Y, Kokubo H, Bumdelger B, Yoshizumi M, Yamamotoya T, Matsunaga Y, Ueda K, Inoue Y, Inoue MK, Fujishiro M, Kushiyama A, Ono H, Sakoda H, Asano T. The SGLT2 Inhibitor Luseogliflozin Rapidly Normalizes Aortic mRNA Levels of Inflammation-Related but Not Lipid-Metabolism-Related Genes and Suppresses Atherosclerosis in Diabetic ApoE KO Mice. Int J Mol Sci 2017; 18:ijms18081704. [PMID: 28777298 PMCID: PMC5578094 DOI: 10.3390/ijms18081704] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 12/22/2022] Open
Abstract
Recent clinical studies have revealed the treatment of diabetic patients with sodium glucose co-transporter2 (SGLT2) inhibitors to reduce the incidence of cardiovascular events. Using nicotinamide and streptozotocin (NA/STZ) -treated ApoE KO mice, we investigated the effects of short-term (seven days) treatment with the SGLT2 inhibitor luseogliflozin on mRNA levels related to atherosclerosis in the aorta, as well as examining the long-term (six months) effects on atherosclerosis development. Eight-week-old ApoE KO mice were treated with NA/STZ to induce diabetes mellitus, and then divided into two groups, either untreated, or treated with luseogliflozin. Seven days after the initiation of luseogliflozin administration, atherosclerosis-related mRNA levels in the aorta were compared among four groups; i.e., wild type C57/BL6J, native ApoE KO, and NA/STZ-treated ApoE KO mice, with or without luseogliflozin. Short-term luseogliflozin treatment normalized the expression of inflammation-related genes such as F4/80, TNFα, IL-1β, IL-6, ICAM-1, PECAM-1, MMP2 and MMP9 in the NA/STZ-treated ApoE KO mice, which showed marked elevations as compared with untreated ApoE KO mice. In contrast, lipid metabolism-related genes were generally unaffected by luseogliflozin treatment. Furthermore, after six-month treatment with luseogliflozin, in contrast to the severe and widely distributed atherosclerotic changes in the aortas of NA/STZ-treated ApoE KO mice, luseogliflozin treatment markedly attenuated the progression of atherosclerosis, without affecting serum lipid parameters such as high density lipoprotein, low density lipoprotein and triglyceride levels. Given that luseogliflozin normalized the aortic mRNA levels of inflammation-related, but not lipid-related, genes soon after the initiation of treatment, it is not unreasonable to speculate that the anti-atherosclerotic effect of this SGLT2 inhibitor emerges rapidly, possibly via the prevention of inflammation rather than of hyperlipidemia.
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Affiliation(s)
- Yusuke Nakatsu
- Department of Medical Science, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Hiroki Kokubo
- Department of Cardiovascular Physiology and Medicine, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Batmunkh Bumdelger
- Department of Cardiovascular Physiology and Medicine, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Masao Yoshizumi
- Department of Cardiovascular Physiology and Medicine, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Takeshi Yamamotoya
- Department of Medical Science, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yasuka Matsunaga
- Department of Medical Science, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
- Center for Translational Research in Infection & Inflammation, School of Medicine, Tulane University, New Orleans, LA 70118, USA.
| | - Koji Ueda
- Department of Medical Science, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuki Inoue
- Department of Medical Science, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Masa-Ki Inoue
- Department of Medical Science, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Midori Fujishiro
- Division of Diabetes and Metabolic Diseases, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan.
| | - Akifumi Kushiyama
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo 103-0002, Japan.
| | - Hiraku Ono
- Department of Clinical Cell Biology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.
| | - Hideyuki Sakoda
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
| | - Tomoichiro Asano
- Department of Medical Science, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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