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Wang RC, Lee EE, De Simone N, Kathote G, Primeaux S, Avila A, Yu DM, Johnson M, Good LB, Jakkamsetti V, Sarode R, Holland AA, Pascual JM. Red blood cells as glucose carriers to the human brain: Modulation of cerebral activity by erythrocyte exchange transfusion in Glut1 deficiency (G1D). J Cereb Blood Flow Metab 2023; 43:357-368. [PMID: 36523131 PMCID: PMC9941860 DOI: 10.1177/0271678x221146121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
Red blood cells circulating through the brain are briefly but closely apposed to the capillary endothelium. We hypothesized that this contact provides a nearly direct pathway for metabolic substrate transfer to neural cells that complements the better characterized plasma to endothelium transfer. While brain function is considered independent of normal fluctuations in blood glucose concentration, this is not borne out by persons with glucose transporter I (GLUT1) deficiency (G1D). In them, encephalopathy is often ameliorated by meal or carbohydrate administration, and this enabled us to test our hypothesis: Since red blood cells contain glucose, and since the red cells of G1D individuals are also deficient in GLUT1, replacing them with normal donor cells via exchange transfusion could augment erythrocyte to neural cell glucose transport via mass action in the setting of unaltered erythrocyte count or plasma glucose abundance. This motivated us to perform red blood cell exchange in 3 G1D persons. There were rapid, favorable and unprecedented changes in cognitive, electroencephalographic and quality-of-life measures. The hypothesized transfer mechanism was further substantiated by in vitro measurement of direct erythrocyte to endothelial cell glucose flux. The results also indicate that the adult intellect is capable of significant enhancement without deliberate practice. ClinicalTrials.gov registration: NCT04137692 https://clinicaltrials.gov/ct2/show/NCT04137692.
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Affiliation(s)
- Richard C Wang
- Department of Dermatology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Eunice E Lee
- Department of Dermatology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Nicole De Simone
- Department of Pathology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Gauri Kathote
- Rare Brain Disorders Program, The University of Texas
Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Sharon Primeaux
- Rare Brain Disorders Program, The University of Texas
Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Adrian Avila
- Rare Brain Disorders Program, The University of Texas
Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Dong-Min Yu
- Department of Dermatology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Mark Johnson
- Department of Neurology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Levi B Good
- Rare Brain Disorders Program, The University of Texas
Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Vikram Jakkamsetti
- Rare Brain Disorders Program, The University of Texas
Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Ravi Sarode
- Departments of Pathology and Internal Medicine, The University
of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alice Ann Holland
- Department of Psychiatry, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Juan M Pascual
- Rare Brain Disorders Program, The University of Texas
Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
- Department of Physiology, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
- Department of Pediatrics, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
- Eugene McDermott Center for Human Growth &
Development/Center for Human Genetics, The University of Texas Southwestern
Medical Center, Dallas, Texas, USA
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2
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Abstract
A high hemoglobin glycation index (HGI) has been repeatedly associated with greater risk for hypoglycemia in people with diabetes and greater risk for chronic vascular disease in people with or without diabetes. This review explores how different sources of analytical and biological variation in HbA1c and blood glucose individually and collectively affect the clinical information value of HGI. We conclude that HGI is a complex quantitative trait that is a clinically practical biomarker of risk for both hypoglycemia and chronic vascular disease.
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Affiliation(s)
- James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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3
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Wang Y, Yang P, Yan Z, Liu Z, Ma Q, Zhang Z, Wang Y, Su Y. The Relationship between Erythrocytes and Diabetes Mellitus. J Diabetes Res 2021; 2021:6656062. [PMID: 33728350 PMCID: PMC7935596 DOI: 10.1155/2021/6656062] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/10/2021] [Accepted: 02/20/2021] [Indexed: 12/16/2022] Open
Abstract
High blood glucose level (hyperglycemia) is a leading indicator of diabetes mellitus (DM). Erythrocytes are the most abundant cells in the circulation and the first to perceive changes in plasma composition. Long-lasting hyperglycemia affects the structure and function of erythrocytes. The detection of erythrocyte-related indicators can provide a valuable reference for the prevention, diagnosis, and treatment of DM and its complications. This paper reviews the normal structure and function of erythrocytes, the changes in erythrocytes in patients with diabetes, and the role of erythrocytes in the development of diabetic complications to provide more indicators for the early prevention of DM complications and to monitor the therapeutic effect of DM.
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Affiliation(s)
- Yaqi Wang
- Department of Biochemistry and Molecular Biology, Baotou Medical College, Baotou, 014040 Inner Mongolia, China
| | - Peiyuan Yang
- Department of Biochemistry and Molecular Biology, Baotou Medical College, Baotou, 014040 Inner Mongolia, China
| | - Zhaoli Yan
- Department of Endocrinology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050 Inner Mongolia, China
| | - Zhi Liu
- Department of Biochemistry and Molecular Biology, Baotou Medical College, Baotou, 014040 Inner Mongolia, China
| | - Qiang Ma
- Department of Biochemistry and Molecular Biology, Baotou Medical College, Baotou, 014040 Inner Mongolia, China
| | - Zehong Zhang
- Department of Biochemistry and Molecular Biology, Baotou Medical College, Baotou, 014040 Inner Mongolia, China
| | - Yunxia Wang
- Department of Biochemistry and Molecular Biology, Baotou Medical College, Baotou, 014040 Inner Mongolia, China
| | - Yan Su
- Department of Biochemistry and Molecular Biology, Baotou Medical College, Baotou, 014040 Inner Mongolia, China
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4
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Guizouarn H, Allegrini B. Erythroid glucose transport in health and disease. Pflugers Arch 2020; 472:1371-1383. [PMID: 32474749 DOI: 10.1007/s00424-020-02406-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022]
Abstract
Glucose transport is intimately linked to red blood cell physiology. Glucose is the unique energy source for these cells, and defects in glucose metabolism or transport activity are associated with impaired red blood cell morphology and deformability leading to reduced lifespan. In vertebrate erythrocytes, glucose transport is mediated by GLUT1 (in humans) or GLUT4 transporters. These proteins also account for dehydroascorbic acid (DHA) transport through erythrocyte membrane. The peculiarities of glucose transporters and the red blood cell pathologies involving GLUT1 are summarized in the present review.
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Affiliation(s)
- Hélène Guizouarn
- Université Côte d'Azur, CNRS, Inserm, Institut de Biologie Valrose, 28 av. Valrose, 06100, Nice, France.
| | - Benoit Allegrini
- Université Côte d'Azur, CNRS, Inserm, Institut de Biologie Valrose, 28 av. Valrose, 06100, Nice, France
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Hornung TC, Biesalski HK. Glut-1 explains the evolutionary advantage of the loss of endogenous vitamin C-synthesis: The electron transfer hypothesis. EVOLUTION MEDICINE AND PUBLIC HEALTH 2019; 2019:221-231. [PMID: 31857900 PMCID: PMC6915226 DOI: 10.1093/emph/eoz024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 07/30/2019] [Indexed: 12/27/2022]
Abstract
Introduction During evolution, some species including humans, monkeys and fruit bats lost the ability for ascorbic acid (AA) biosynthesis due to inactivation of the enzyme l-gulono-lactone oxidase (GLO) and subsequently became dependent on dietary vitamin C. There are four current hypotheses in relation to the benefit of vitamin C dependence in the context of adaptation and reproduction. Here we advance and test a new ‘electron transfer hypothesis’, which focusses on the role of the expression of glucose transporter 1 (Glut-1) in red blood cells (RBCs) in recycling vitamin C, thereby increasing the efficiency of micronutrient uptake. Methods To evaluate the benefit of Glut-1 expression, we determined vitamin C uptake into RBCs and potential release from two different species, humans with l-Gulono-lactone-oxidase (GLO-loss) and pigs with functional GLO. Results The oxidized form of vitamin C (dehydroascorbate, DHA) was transported into human RBCs via Glut-1. There was no transport of either the reduced (AA) or the oxidized vitamin in pig erythrocytes. Conclusion We propose that the transport of vitamin C increases an intracellular electron pool, which transfers electrons from intracellular ascorbate to extracellular substances like ascorbyl free radical or DHA, resulting in 100-fold smaller daily requirement of this essential redox sensitive micronutrient. This would be an advantage during seasonal changes of the availability from food and may be the key for the survival of individuals without vitamin C biosynthesis. Lay Summary 40 million years ago some individuals lost the ability to synthesize vitamin C. Why did they survive such as humans until now? Individuals with a specific glucose transporter Glut-1 on their erythrocytes which transports vitamin C need less and are protected from scarcity due to seasons and food competitors.
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Affiliation(s)
- Tabea C Hornung
- Department of Nutrition, University of Hohenheim, Garbenstrasse 30, Stuttgart 70593, Germany
| | - Hans-Konrad Biesalski
- Department of Nutrition, University of Hohenheim, Garbenstrasse 30, Stuttgart 70593, Germany
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6
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Abstract
STUDY DESIGN An experimental laboratory study. OBJECTIVE To investigate the pathogenesis of intervertebral disc degeneration (IDD) in a murine model of type 1 diabetes mellitus (DM), namely nonobese diabetic (NOD) mouse. SUMMARY OF BACKGROUND DATA IDD is a leading contributor of low back pain, which represents one of the most disabling symptoms within the adult population. DM is a chronic metabolic disease currently affecting one in 10 adults in the United States. It is associated with an increased risk of developing IDD, but the underlying process remains poorly understood. METHODS Total disc glycosaminoglycan content, proteoglycan synthesis, aggrecan fragmentation, glucose transporter gene expression, and apoptosis were assessed in NOD mice and wild-type euglycemic control mice. Spinal structural and molecular changes were analyzed by micro-computed tomography, histological staining (Safranin-O and fast green), and quantitative immunofluorescence (anti-ADAMTS-4 and -5 antibodies). RESULTS Compared with euglycemic controls, NOD mice showed increased disc apoptosis and matrix aggrecan fragmentation. Disc glycosaminoglycan content and histological features of NOD mice did not significantly differ from those of euglycemic littermates. CONCLUSION These data demonstrate that DM may contribute to IDD by increasing aggrecan degradation and promoting cell apoptosis, which may represent early indicators of the involvement of DM in the pathogenesis of IDD. LEVEL OF EVIDENCE N/A.
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Maggiotto LV, Sondhi M, Shin BC, Garg M, Devaskar SU. Circulating blood cellular glucose transporters - Surrogate biomarkers for neonatal hypoxic-ischemic encephalopathy assessed by novel scoring systems. Mol Genet Metab 2019; 127:166-173. [PMID: 31182397 PMCID: PMC8230733 DOI: 10.1016/j.ymgme.2019.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/03/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We examined Red Blood Cell (RBC) Glucose Transporter isoform 1 (GLUT1) and White Blood Cell (WBC) Glucose Transporter isoform 3 (GLUT3) protein concentrations to assess their potential as surrogate biomarkers for the presence of hypoxic-ischemic encephalopathy (HIE) and response to therapeutic hypothermia (TH), with respect to the neurodevelopmental prognosis. STUDY DESIGN A prospective feasibility study of 10 infants with HIE and 8 age-matched control subjects was undertaken. Following parental consent, blood samples were obtained at baseline before institution of TH (<6 h of life), during TH, at rewarming and post-TH in the HIE group with a baseline sample from the control group. GLUT1 and GLUT3 were measured by Enzyme-linked immunosorbent assay (ELISA) with brain biomarkers, Neuron-Specific Enolase (NSE) and Glial Fibrillary Acidic Protein (GFAP). Novel "HIE-high risk" and "Neurological" scores were developed to help identify HIE and to assess severity and prognosis, respectively. RESULTS RBC GLUT1 concentrations were increased at the baseline pre-TH time point in HIE versus control subjects (p = .006), normalizing after TH (p = .05). An association between GLUT1 and NSE concentrations (which was reflective of the HIE-high risk and the Neuro-scores) in controls and HIE pre-TH was seen (R2 = 0.36, p = .008), with GLUT1 demonstrating 90% sensitivity and 88% specificity for presence of HIE identified by Sarnat Staging. WBC GLUT3 concentrations were low and no different in HIE versus control, and GFAP concentrations trended higher during re-warming (p = .11) and post-TH (p = .16). We demonstrated a significant difference between HIE and controls for both the "HIE-high risk" and the "Neurological" Scores. The latter score revealing the severity of clinical neurological illness correlated with the corresponding RBC GLUT1 (R2 value = 0.39; p = .006). CONCLUSION Circulating RBC GLUT1 concentrations with NSE demonstrate a significant potential in reflecting the severity of HIE pre-TH and gauging effectiveness of TH. In contrast, the low neonatal WBC GLUT3 concentrations make discerning differences between degrees of HIE as well as assessing effectiveness of TH difficult. The HIE-high risk and Neurological scores may extend the "Sarnat staging" towards assessing severity and neuro-developmental prognosis of HIE.
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Affiliation(s)
- Liesbeth V Maggiotto
- Department of Pediatrics, Division of Neonatology & Developmental Biology, The Neonatal Research Center of the Children's Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA 90095-1752, United States of America
| | - Monica Sondhi
- Department of Pediatrics, Division of Neonatology & Developmental Biology, The Neonatal Research Center of the Children's Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA 90095-1752, United States of America
| | - Bo-Chul Shin
- Department of Pediatrics, Division of Neonatology & Developmental Biology, The Neonatal Research Center of the Children's Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA 90095-1752, United States of America
| | - Meena Garg
- Department of Pediatrics, Division of Neonatology & Developmental Biology, The Neonatal Research Center of the Children's Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA 90095-1752, United States of America
| | - Sherin U Devaskar
- Department of Pediatrics, Division of Neonatology & Developmental Biology, The Neonatal Research Center of the Children's Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA 90095-1752, United States of America.
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8
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Van Dyken P, Lacoste B. Impact of Metabolic Syndrome on Neuroinflammation and the Blood-Brain Barrier. Front Neurosci 2018; 12:930. [PMID: 30618559 PMCID: PMC6297847 DOI: 10.3389/fnins.2018.00930] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022] Open
Abstract
Metabolic syndrome, which includes diabetes and obesity, is one of the most widespread medical conditions. It induces systemic inflammation, causing far reaching effects on the body that are still being uncovered. Neuropathologies triggered by metabolic syndrome often result from increased permeability of the blood-brain-barrier (BBB). The BBB, a system designed to restrict entry of toxins, immune cells, and pathogens to the brain, is vital for proper neuronal function. Local and systemic inflammation induced by obesity or type 2 diabetes mellitus can cause BBB breakdown, decreased removal of waste, and increased infiltration of immune cells. This leads to disruption of glial and neuronal cells, causing hormonal dysregulation, increased immune sensitivity, or cognitive impairment depending on the affected brain region. Inflammatory effects of metabolic syndrome have been linked to neurodegenerative diseases. In this review, we discuss the effects of obesity and diabetes-induced inflammation on the BBB, the roles played by leptin and insulin resistance, as well as BBB changes occurring at the molecular level. We explore signaling pathways including VEGF, HIFs, PKC, Rho/ROCK, eNOS, and miRNAs. Finally, we discuss the broader implications of neural inflammation, including its connection to Alzheimer's disease, multiple sclerosis, and the gut microbiome.
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Affiliation(s)
- Peter Van Dyken
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Baptiste Lacoste
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
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9
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Mäe MA, Li T, Bertuzzi G, Raschperger E, Vanlandewijck M, He L, Nahar K, Dalheim A, Hofmann JJ, Laviña B, Keller A, Betsholtz C, Genové G. Prolonged systemic hyperglycemia does not cause pericyte loss and permeability at the mouse blood-brain barrier. Sci Rep 2018; 8:17462. [PMID: 30498224 PMCID: PMC6265246 DOI: 10.1038/s41598-018-35576-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/07/2018] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is associated with cognitive impairment and various central nervous system pathologies such as stroke, vascular dementia, or Alzheimer’s disease. The exact pathophysiology of these conditions is poorly understood. Recent reports suggest that hyperglycemia causes cerebral microcirculation pathology and blood-brain barrier (BBB) dysfunction and leakage. The majority of these reports, however, are based on methods including in vitro BBB modeling or streptozotocin-induced diabetes in rodents, opening questions regarding the translation of the in vitro findings to the in vivo situation, and possible direct effects of streptozotocin on the brain vasculature. Here we used a genetic mouse model of hyperglycemia (Ins2AKITA) to address whether prolonged systemic hyperglycemia induces BBB dysfunction and leakage. We applied a variety of methodologies to carefully evaluate BBB function and cellular integrity in vivo, including the quantification and visualization of specific tracers and evaluation of transcriptional and morphological changes in the BBB and its supporting cellular components. These experiments did neither reveal altered BBB permeability nor morphological changes of the brain vasculature in hyperglycemic mice. We conclude that prolonged hyperglycemia does not lead to BBB dysfunction, and thus the cognitive impairment observed in diabetes may have other causes.
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Affiliation(s)
- Maarja Andaloussi Mäe
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
| | - Tian Li
- Integrated Cardio-Metabolic Centre, Department of Medicine, Karolinska Institute, Huddinge, Sweden
| | - Giacomo Bertuzzi
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.,University of Oxford; Physiology, Anatomy & Genetics, The Sherrington Building, Parks Road, Oxford, United Kingdom
| | - Elisabeth Raschperger
- Integrated Cardio-Metabolic Centre, Department of Medicine, Karolinska Institute, Huddinge, Sweden
| | - Michael Vanlandewijck
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.,Integrated Cardio-Metabolic Centre, Department of Medicine, Karolinska Institute, Huddinge, Sweden
| | - Liqun He
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.,Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Khayrun Nahar
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Annika Dalheim
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.,Department of Surgery, Cardinal Bernardin Cancer Center, Loyola University Chicago, Illinois, United States
| | - Jennifer J Hofmann
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.,Concordia University, Austin, Texas, United States
| | - Bàrbara Laviña
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Annika Keller
- Department of Neurosurgery, Clinical Neurocenter, Zürich University Hospital, Zürich University, Zürich, Switzerland
| | - Christer Betsholtz
- Department of Immunology, Genetics, and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.,Integrated Cardio-Metabolic Centre, Department of Medicine, Karolinska Institute, Huddinge, Sweden
| | - Guillem Genové
- Integrated Cardio-Metabolic Centre, Department of Medicine, Karolinska Institute, Huddinge, Sweden.
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