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Webster G, Puckelwartz MJ, Pesce LL, Dellefave-Castillo LM, Vanoye CG, Potet F, Page P, Kearns SD, Pottinger T, White S, Arunkumar P, Olson R, Kofman A, Ibrahim N, Ing A, Brew C, Yap KL, Kadri S, George AL, McNally EM. Genomic Autopsy of Sudden Deaths in Young Individuals. JAMA Cardiol 2021; 6:1247-1256. [PMID: 34379075 DOI: 10.1001/jamacardio.2021.2789] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Postmortem genetic testing of young individuals with sudden death has previously identified pathogenic gene variants. However, prior studies primarily considered highly penetrant monogenic variants, often without detailed decedent and family clinical information. Objective To assess genotype and phenotype risk in a diverse cohort of young decedents with sudden death and their families. Design, Setting, and Participants Pathological and whole-genome sequence analysis was conducted in a cohort referred from a national network of medical examiners. Cases were accrued prospectively from May 2015 to March 2019 across 24 US states. Analysis began September 2016 and ended November 2020. Exposures Evaluation of autopsy and clinical data integrated with whole-genome sequence data and family member evaluation. Results A total of 103 decedents (mean [SD] age at death, 23.7 [11.9] years; age range, 1-44 years), their surviving family members, and 140 sex- and genetic ancestry-matched controls were analyzed. Among 103 decedents, autopsy and clinical data review categorized 36 decedents with postmortem diagnoses, 23 decedents with findings of uncertain significance, and 44 with sudden unexplained death. Pathogenic/likely pathogenic (P/LP) genetic variants in arrhythmia or cardiomyopathy genes were identified in 13 decedents (12.6%). A multivariable analysis including decedent phenotype, ancestry, and sex demonstrated that younger decedents had a higher burden of P/LP variants and select variants of uncertain significance (effect size, -1.64; P = .001). These select, curated variants of uncertain significance in cardiac genes were more common in decedents than controls (83 of 103 decedents [86%] vs 100 of 140 controls [71%]; P = .005), and decedents harbored more rare cardiac variants than controls (2.3 variants per individual vs 1.8 in controls; P = .006). Genetic testing of 31 parent-decedent trios and 14 parent-decedent dyads revealed 8 transmitted P/LP variants and 1 de novo P/LP variant. Incomplete penetrance was present in 6 of 8 parents who transmitted a P/LP variant. Conclusions and Relevance Whole-genome sequencing effectively identified P/LP variants in cases of sudden death in young individuals, implicating both arrhythmia and cardiomyopathy genes. Genomic analyses and familial phenotype association suggest potentially additive, oligogenic risk mechanisms for sudden death in this cohort.
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Affiliation(s)
- Gregory Webster
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan J Puckelwartz
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lorenzo L Pesce
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa M Dellefave-Castillo
- Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Carlos G Vanoye
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Franck Potet
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick Page
- Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samuel D Kearns
- Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tess Pottinger
- Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Steven White
- Cook County Medical Examiner's Office, Chicago, Illinois
| | | | - Rachael Olson
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Amber Kofman
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nora Ibrahim
- Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexander Ing
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Casey Brew
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kai Lee Yap
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sabah Kadri
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Alfred L George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth M McNally
- Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Section Editor, JAMA Cardiology
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Hyltén-Cavallius L, Iepsen EW, Wewer Albrechtsen NJ, Svendstrup M, Lubberding AF, Hartmann B, Jespersen T, Linneberg A, Christiansen M, Vestergaard H, Pedersen O, Holst JJ, Kanters JK, Hansen T, Torekov SS. Patients With Long-QT Syndrome Caused by Impaired hERG-Encoded K v11.1 Potassium Channel Have Exaggerated Endocrine Pancreatic and Incretin Function Associated With Reactive Hypoglycemia. Circulation 2017; 135:1705-1719. [PMID: 28235848 PMCID: PMC5412733 DOI: 10.1161/circulationaha.116.024279] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 02/14/2017] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Loss-of-function mutations in hERG (encoding the Kv11.1 voltage-gated potassium channel) cause long-QT syndrome type 2 (LQT2) because of prolonged cardiac repolarization. However, Kv11.1 is also present in pancreatic α and β cells and intestinal L and K cells, secreting glucagon, insulin, and the incretins glucagon-like peptide-1 (GLP-1) and GIP (glucose-dependent insulinotropic polypeptide), respectively. These hormones are crucial for glucose regulation, and long-QT syndrome may cause disturbed glucose regulation. We measured secretion of these hormones and cardiac repolarization in response to glucose ingestion in LQT2 patients with functional mutations in hERG and matched healthy participants, testing the hypothesis that LQT2 patients have increased incretin and β-cell function and decreased α-cell function, and thus lower glucose levels. Methods: Eleven patients with LQT2 and 22 sex-, age-, and body mass index–matched control participants underwent a 6-hour 75-g oral glucose tolerance test with ECG recording and blood sampling for measurements of glucose, insulin, C-peptide, glucagon, GLP-1, and GIP. Results: In comparison with matched control participants, LQT2 patients had 56% to 78% increased serum insulin, serum C-peptide, plasma GLP-1, and plasma GIP responses (P=0.03–0.001) and decreased plasma glucose levels after glucose ingestion (P=0.02) with more symptoms of hypoglycemia (P=0.04). Sixty-three percent of LQT2 patients developed hypoglycemic plasma glucose levels (<70 mg/dL) versus 36% control participants (P=0.16), and 18% patients developed serious hypoglycemia (<50 mg/dL) versus none of the controls. LQT2 patients had defective glucagon responses to low glucose, P=0.008. β-Cell function (Insulin Secretion Sensitivity Index-2) was 2-fold higher in LQT2 patients than in controls (4398 [95% confidence interval, 2259–8562] versus 2156 [1961–3201], P=0.03). Pharmacological Kv11.1 blockade (dofetilide) in rats had similar effect, and small interfering RNA inhibition of hERG in β and L cells increased insulin and GLP-1 secretion up to 50%. Glucose ingestion caused cardiac repolarization disturbances with increased QTc intervals in both patients and controls, but with a 122% greater increase in QTcF interval in LQT2 patients (P=0.004). Conclusions: Besides a prolonged cardiac repolarization phase, LQT2 patients display increased GLP-1, GIP, and insulin secretion and defective glucagon secretion, causing decreased plasma glucose and thus increased risk of hypoglycemia. Furthermore, glucose ingestion increased QT interval and aggravated the cardiac repolarization disturbances in LQT2 patients. Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifier: NCT02775513.
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Affiliation(s)
- Louise Hyltén-Cavallius
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Eva W Iepsen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Nicolai J Wewer Albrechtsen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Mathilde Svendstrup
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Anniek F Lubberding
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Bolette Hartmann
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Thomas Jespersen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Allan Linneberg
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Michael Christiansen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Henrik Vestergaard
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Oluf Pedersen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Jens J Holst
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Jørgen K Kanters
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Torben Hansen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.).
| | - Signe S Torekov
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.).
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