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Kirwan JP, Heintz EC, Rebello CJ, Axelrod CL. Exercise in the Prevention and Treatment of Type 2 Diabetes. Compr Physiol 2023; 13:4559-4585. [PMID: 36815623 DOI: 10.1002/cphy.c220009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Type 2 diabetes is a systemic, multifactorial disease that is a leading cause of morbidity and mortality globally. Despite a rise in the number of available medications and treatments available for management, exercise remains a first-line prevention and intervention strategy due to established safety, efficacy, and tolerability in the general population. Herein we review the predisposing risk factors for, prevention, pathophysiology, and treatment of type 2 diabetes. We emphasize key cellular and molecular adaptive processes that provide insight into our evolving understanding of how, when, and what types of exercise may improve glycemic control. © 2023 American Physiological Society. Compr Physiol 13:1-27, 2023.
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Affiliation(s)
- John P Kirwan
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Elizabeth C Heintz
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Candida J Rebello
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Christopher L Axelrod
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Mashayekhi M, Beckman JA, Nian H, Garner EM, Mayfield D, Devin JK, Koethe JR, Brown JD, Cahill KN, Yu C, Silver H, Niswender K, Luther JM, Brown NJ. Comparative effects of weight loss and incretin-based therapies on vascular endothelial function, fibrinolysis and inflammation in individuals with obesity and prediabetes: A randomized controlled trial. Diabetes Obes Metab 2023; 25:570-580. [PMID: 36306151 PMCID: PMC10306232 DOI: 10.1111/dom.14903] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 02/02/2023]
Abstract
AIM To test the hypothesis that glucagon-like peptide-1 receptor (GLP-1R) agonists have beneficial effects on vascular endothelial function, fibrinolysis and inflammation through weight loss-independent mechanisms. MATERIALS AND METHODS Individuals with obesity and prediabetes were randomized to 14 weeks of the GLP-1R agonist liraglutide, hypocaloric diet or the dipeptidyl peptidase-4 inhibitor sitagliptin in a 2:1:1 ratio. Treatment with drug was double blind and placebo-controlled. Measurements were made at baseline, after 2 weeks prior to significant weight loss and after 14 weeks. The primary outcomes were measures of endothelial function: flow-mediated vasodilation (FMD), plasminogen activator inhibitor-1 (PAI-1) and urine albumin-to-creatinine ratio (UACR). RESULTS Eighty-eight individuals were studied (liraglutide N = 44, diet N = 22, sitagliptin N = 22). Liraglutide and diet reduced weight, insulin resistance and PAI-1, while sitagliptin did not. There was no significant effect of any treatment on endothelial vasodilator function measured by FMD. Post hoc subgroup analyses in individuals with baseline FMD below the median, indicative of greater endothelial dysfunction, showed an improvement in FMD by all three treatments. GLP-1R antagonism with exendin (9-39) increased fasting blood glucose but did not change FMD or PAI-1. There was no effect of treatment on UACR. Finally, liraglutide, but not sitagliptin or diet, reduced the chemokine monocyte chemoattractant protein-1 (MCP-1). CONCLUSION Liraglutide and diet reduce weight, insulin resistance and PAI-1. Liraglutide, sitagliptin and diet do not change FMD in obese individuals with prediabetes with normal endothelial function. Liraglutide alone lowers the pro-inflammatory and pro-atherosclerotic chemokine MCP-1, indicating that this beneficial effect is independent of weight loss.
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Affiliation(s)
- Mona Mashayekhi
- Vanderbilt University Medical Center, Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Nashville, TN
| | - Joshua A. Beckman
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Nashville, TN
| | - Hui Nian
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN
| | - Erica M. Garner
- Vanderbilt University Medical Center, Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Nashville, TN
| | - Dustin Mayfield
- Vanderbilt University Medical Center, Department of Medicine, Division of Clinical Pharmacology, Nashville, TN
| | - Jessica K. Devin
- UCHealth Endocrinology, Yampa Valley Medical Center, Steamboat Springs, CO
| | - John R. Koethe
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
- Vanderbilt University Medical Center, Department of Medicine, Division of Infectious Diseases, Nashville, TN
| | - Jonathan D. Brown
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Nashville, TN
| | - Katherine N. Cahill
- Vanderbilt University Medical Center, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN
| | - Chang Yu
- NYU Grossman School of Medicine, Department of Population Health, New York, NY
| | - Heidi Silver
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Nashville, TN
| | - Kevin Niswender
- Vanderbilt University Medical Center, Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Nashville, TN
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - James M. Luther
- Vanderbilt University Medical Center, Department of Medicine, Division of Clinical Pharmacology, Nashville, TN
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Shi M, Wang C, Mei H, Temprosa M, Florez JC, Tripputi M, Merino J, Lipworth L, Shu X, Gerszten RE, Wang TJ, Beckman JA, Gamboa JL, Mosley JD, Ferguson JF. Genetic Architecture of Plasma Alpha-Aminoadipic Acid Reveals a Relationship With High-Density Lipoprotein Cholesterol. J Am Heart Assoc 2022; 11:e024388. [PMID: 35621206 PMCID: PMC9238724 DOI: 10.1161/jaha.121.024388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
Background Elevated plasma levels of alpha-aminoadipic acid (2-AAA) have been associated with the development of type 2 diabetes and atherosclerosis. However, the nature of the association remains unknown. Methods and Results We identified genetic determinants of plasma 2-AAA through meta-analysis of genome-wide association study data in 5456 individuals of European, African, and Asian ancestry from the Framingham Heart Study, Diabetes Prevention Program, Jackson Heart Study, and Shanghai Women's and Men's Health Studies. No single nucleotide polymorphisms reached genome-wide significance across all samples. However, the top associations from the meta-analysis included single-nucleotide polymorphisms in the known 2-AAA pathway gene DHTKD1, and single-nucleotide polymorphisms in genes involved in mitochondrial respiration (NDUFS4) and macrophage function (MSR1). We used a Mendelian randomization instrumental variable approach to evaluate relationships between 2-AAA and cardiometabolic phenotypes in large disease genome-wide association studies. Mendelian randomization identified a suggestive inverse association between increased 2-AAA and lower high-density lipoprotein cholesterol (P=0.005). We further characterized the genetically predicted relationship through measurement of plasma 2-AAA and high-density lipoprotein cholesterol in 2 separate samples of individuals with and without cardiometabolic disease (N=98), and confirmed a significant negative correlation between 2-AAA and high-density lipoprotein (rs=-0.53, P<0.0001). Conclusions 2-AAA levels in plasma may be regulated, in part, by common variants in genes involved in mitochondrial and macrophage function. Elevated plasma 2-AAA associates with reduced levels of high-density lipoprotein cholesterol. Further mechanistic studies are required to probe this as a possible mechanism linking 2-AAA to future cardiometabolic risk.
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Affiliation(s)
- Mingjian Shi
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTN
| | - Chuan Wang
- Division of Cardiovascular MedicineDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Hao Mei
- Department of Data ScienceSchool of Population HealthUniversity of Mississippi Medical CenterJacksonMS
| | - Marinella Temprosa
- Department of Biostatistics and BioinformaticsMilken Institute School of Public HealthGeorge Washington UniversityRockvilleMD
| | - Jose C. Florez
- Center for Genomic Medicine and Diabetes UnitMassachusetts General HospitalBostonMA
- Programs in Metabolism and Medical & Population GeneticsBroad InstituteCambridgeMA
- Department of MedicineHarvard Medical SchoolBostonMA
| | - Mark Tripputi
- Department of Biostatistics and BioinformaticsMilken Institute School of Public HealthGeorge Washington UniversityRockvilleMD
| | - Jordi Merino
- Center for Genomic Medicine and Diabetes UnitMassachusetts General HospitalBostonMA
- Programs in Metabolism and Medical & Population GeneticsBroad InstituteCambridgeMA
- Department of MedicineHarvard Medical SchoolBostonMA
| | - Loren Lipworth
- Division of EpidemiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Xiao‐Ou Shu
- Division of EpidemiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Robert E. Gerszten
- Division of Cardiovascular MedicineBeth Israel Deaconess Medical CenterBostonMA
- Broad Institute of Harvard and MITCambridgeMA
| | - Thomas J. Wang
- Department of MedicineUT Southwestern Medical CenterDallasTX
| | - Joshua A. Beckman
- Division of Cardiovascular MedicineDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Jorge L. Gamboa
- Division of Clinical PharmacologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Jonathan D. Mosley
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTN
- Division of Clinical PharmacologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Jane F. Ferguson
- Division of Cardiovascular MedicineDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
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Chen Y, Luo Z, Sun Y, Li F, Han Z, Qi B, Lin J, Lin WW, Yao M, Kang X, Huang J, Sun C, Ying C, Guo C, Xu Y, Chen J, Chen S. Exercise improves choroid plexus epithelial cells metabolism to prevent glial cell-associated neurodegeneration. Front Pharmacol 2022; 13:1010785. [PMID: 36188600 PMCID: PMC9523215 DOI: 10.3389/fphar.2022.1010785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/29/2022] [Indexed: 02/05/2023] Open
Abstract
Recent studies have shown that physical activities can prevent aging-related neurodegeneration. Exercise improves the metabolic landscape of the body. However, the role of these differential metabolites in preventing neurovascular unit degeneration (NVU) is still unclear. Here, we performed single-cell analysis of brain tissue from young and old mice. Normalized mutual information (NMI) was used to measure heterogeneity between each pair of cells using the non-negative Matrix Factorization (NMF) method. Astrocytes and choroid plexus epithelial cells (CPC), two types of CNS glial cells, differed significantly in heterogeneity depending on their aging status and intercellular interactions. The MetaboAnalyst 5.0 database and the scMetabolism package were used to analyze and calculate the differential metabolic pathways associated with aging in the CPC. These mRNAs and corresponding proteins were involved in the metabolites (R)-3-Hydroxybutyric acid, 2-Hydroxyglutarate, 2-Ketobutyric acid, 3-Hydroxyanthranilic acid, Fumaric acid, L-Leucine, and Oxidized glutathione pathways in CPC. Our results showed that CPC age heterogeneity-associated proteins (ECHS1, GSTT1, HSD17B10, LDHA, and LDHB) might be directly targeted by the metabolite of oxidized glutathione (GSSG). Further molecular dynamics and free-energy simulations confirmed the insight into GSSG's targeting function and free-energy barrier on these CPC age heterogeneity-associated proteins. By inhibiting these proteins in CPC, GSSG inhibits brain energy metabolism, whereas exercise improves the metabolic pathway activity of CPC in NVU by regulating GSSG homeostasis. In order to develop drugs targeting neurodegenerative diseases, further studies are needed to understand how physical exercise enhances NVU function and metabolism by modulating CPC-glial cell interactions.
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Affiliation(s)
- Yisheng Chen
- Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiwen Luo
- Huashan Hospital, Fudan University, Shanghai, China
| | - Yaying Sun
- Huashan Hospital, Fudan University, Shanghai, China
| | - Fangqi Li
- Huashan Hospital, Fudan University, Shanghai, China
| | - Zhihua Han
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Beijie Qi
- Huashan Hospital, Fudan University, Shanghai, China
| | - Jinrong Lin
- Huashan Hospital, Fudan University, Shanghai, China
| | - Wei-Wei Lin
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengxuan Yao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei
| | - Xueran Kang
- Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, Hebei
| | - Jiebin Huang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Chenting Ying
- Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenyang Guo
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
- *Correspondence: Shiyi Chen, ; Jiwu Chen, ; Yuzhen Xu,
| | - Jiwu Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Shiyi Chen, ; Jiwu Chen, ; Yuzhen Xu,
| | - Shiyi Chen
- Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Shiyi Chen, ; Jiwu Chen, ; Yuzhen Xu,
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Diabetes mellitus: a primary metabolic disturbance. Metabolomics underlying vascular responses to stress and ischemia? Clin Sci (Lond) 2021; 135:589-591. [PMID: 33565585 DOI: 10.1042/cs20201299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus (DM) is a primary metabolic disorder and the impact of this entity on maladaptive tissue and organ responses may be mediated through alter metabolomic profile and signatures at steady state or at stress. To this point of view Beckman et al. (Clin. Sci. (Lond.) (2020) 134, 2369-2379), in a hypothesis-generated study, investigated how metabolomic profile is affected following branchial artery ischemia. Interestingly, they found that there is a dynamic and altered change of metabolites associated with energy substrate and with glycolysis/glyconeogenesis in patients with DM. This evidence may shed light on the impaired muscle tolerance in subjects with DM and on impaired vasoreactivity. However, these data lack the ability to be conclusive and further steps should be explored to understand how metabolomic profile is implicated in the response of muscle tissue to ischemia and to the clinical profile of subjects with DM.
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