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Abd-Elmoniem KZ, Edwan JH, Dietsche KB, Villalobos-Perez A, Shams N, Matta J, Baumgarten L, Qaddumi WN, Dixon SA, Chowdhury A, Stagliano M, Mabundo L, Wentzel A, Hadigan C, Gharib AM, Chung ST. Endothelial Dysfunction in Youth-Onset Type 2 Diabetes: A Clinical Translational Study. Circ Res 2024; 135:639-650. [PMID: 39069898 PMCID: PMC11361354 DOI: 10.1161/circresaha.124.324272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Youth-onset type 2 diabetes (Y-T2D) is associated with increased risk for coronary atherosclerotic disease, but the timing of the earliest pathological features and evidence of cardiac endothelial dysfunction have not been evaluated in this population. Endothelial function magnetic resonance imaging may detect early and direct endothelial dysfunction in the absence of classical risk factors (severe hyperglycemia, hypertension, and hyperlipidemia). Using endothelial function magnetic resonance imaging, we evaluated peripheral and coronary artery structure and endothelial function in young adults with Y-T2D diagnosed ≤5 years compared with age-matched healthy peers. We isolated and characterized plasma-derived small extracellular vesicles and evaluated their effects on inflammatory and signaling biomarkers in healthy human coronary artery endothelial cells to validate the imaging findings. METHODS Right coronary wall thickness, coronary artery flow-mediated dilation, and brachial artery flow-mediated dilation were measured at baseline and during isometric handgrip exercise using a 3.0T magnetic resonance imaging. Human coronary artery endothelial cells were treated with Y-T2D plasma-derived small extracellular vesicles. Protein expression was measured by Western blot analysis, oxidative stress was measured using the redox-sensitive probe dihydroethidium, and nitric oxide levels were measured by 4-amino-5-methylamino-2',7'-difluororescein diacetate. RESULTS Y-T2D (n=20) had higher hemoglobin A1c and high-sensitivity C-reactive protein, but similar total and LDL (low-density lipoprotein)-cholesterol compared with healthy peers (n=16). Y-T2D had greater coronary wall thickness (1.33±0.13 versus 1.22±0.13 mm; P=0.04) and impaired endothelial function: lower coronary artery flow-mediated dilation (-3.1±15.5 versus 15.9±17.3%; P<0.01) and brachial artery flow-mediated dilation (6.7±14.7 versus 26.4±15.2%; P=0.001). Y-T2D plasma-derived small extracellular vesicles reduced phosphorylated endothelial nitric oxide synthase expression and nitric oxide levels, increased reactive oxygen species production, and elevated ICAM (intercellular adhesion molecule)-mediated inflammatory pathways in human coronary artery endothelial cells. CONCLUSIONS Coronary and brachial endothelial dysfunction was evident in Y-T2D who were within 5 years of diagnosis and did not have severe hyperglycemia or dyslipidemia. Plasma-derived small extracellular vesicles induced markers of endothelial dysfunction, which corroborated accelerated subclinical coronary atherosclerosis as an early feature in Y-T2D. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02830308 and NCT01399385.
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Affiliation(s)
- Khaled Z. Abd-Elmoniem
- National Institute of Diabetes and Digestive and Kidney Diseases, Biomedical Medical and Imaging Branch (K.Z.A., J.E., N.S., J.M., L.B., W.Q., A.M.G.), National Institutes of Health, Bethesda, MD
| | - Jehad H. Edwan
- National Institute of Diabetes and Digestive and Kidney Diseases, Biomedical Medical and Imaging Branch (K.Z.A., J.E., N.S., J.M., L.B., W.Q., A.M.G.), National Institutes of Health, Bethesda, MD
| | - Katrina B. Dietsche
- Diabetes Endocrinology and Obesity Branch (K.B., A.V., S.D., A.C., M.S., L.M., S.T.C.), National Institutes of Health, Bethesda, MD
| | - Alfredo Villalobos-Perez
- Diabetes Endocrinology and Obesity Branch (K.B., A.V., S.D., A.C., M.S., L.M., S.T.C.), National Institutes of Health, Bethesda, MD
| | - Nour Shams
- National Institute of Diabetes and Digestive and Kidney Diseases, Biomedical Medical and Imaging Branch (K.Z.A., J.E., N.S., J.M., L.B., W.Q., A.M.G.), National Institutes of Health, Bethesda, MD
| | - Jatin Matta
- National Institute of Diabetes and Digestive and Kidney Diseases, Biomedical Medical and Imaging Branch (K.Z.A., J.E., N.S., J.M., L.B., W.Q., A.M.G.), National Institutes of Health, Bethesda, MD
| | - Leilah Baumgarten
- National Institute of Diabetes and Digestive and Kidney Diseases, Biomedical Medical and Imaging Branch (K.Z.A., J.E., N.S., J.M., L.B., W.Q., A.M.G.), National Institutes of Health, Bethesda, MD
| | - Waleed N. Qaddumi
- National Institute of Diabetes and Digestive and Kidney Diseases, Biomedical Medical and Imaging Branch (K.Z.A., J.E., N.S., J.M., L.B., W.Q., A.M.G.), National Institutes of Health, Bethesda, MD
| | - Sydney A. Dixon
- Diabetes Endocrinology and Obesity Branch (K.B., A.V., S.D., A.C., M.S., L.M., S.T.C.), National Institutes of Health, Bethesda, MD
| | - Aruba Chowdhury
- Diabetes Endocrinology and Obesity Branch (K.B., A.V., S.D., A.C., M.S., L.M., S.T.C.), National Institutes of Health, Bethesda, MD
| | - Michael Stagliano
- Diabetes Endocrinology and Obesity Branch (K.B., A.V., S.D., A.C., M.S., L.M., S.T.C.), National Institutes of Health, Bethesda, MD
| | - Lilian Mabundo
- Diabetes Endocrinology and Obesity Branch (K.B., A.V., S.D., A.C., M.S., L.M., S.T.C.), National Institutes of Health, Bethesda, MD
| | - Annemarie Wentzel
- Hypertension in Africa Research Team (A.W.), North-West University, Potchefstroom
- South African Medical Research Council, Unit for Hypertension and Cardiovascular Disease (A.W.), North-West University, Potchefstroom
| | - Colleen Hadigan
- Clinical Center (C.H.), National Institutes of Health, Bethesda, MD
| | - Ahmed M. Gharib
- National Institute of Diabetes and Digestive and Kidney Diseases, Biomedical Medical and Imaging Branch (K.Z.A., J.E., N.S., J.M., L.B., W.Q., A.M.G.), National Institutes of Health, Bethesda, MD
| | - Stephanie T. Chung
- Diabetes Endocrinology and Obesity Branch (K.B., A.V., S.D., A.C., M.S., L.M., S.T.C.), National Institutes of Health, Bethesda, MD
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Christoforidis A, Georeli I, Dimitriadou M, Galli-Tsinopoulou A, Stabouli S. Arterial stiffness indices in children and adolescents with type 1 diabetes mellitus: A meta-analysis. Diabetes Metab Res Rev 2022; 38:e3555. [PMID: 35675380 DOI: 10.1002/dmrr.3555] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/09/2022]
Abstract
AIMS Cardiovascular disease (CVD) represents the most frequent cause of morbidity and mortality among patients with type 1 diabetes mellitus (T1DM). Our aim was to review the evidence and conduct a meta-analysis assessing measures of arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx) in children and adolescents with T1DM compared to healthy controls. METHODS PubMed and the Cochrane Library were searched for relevant studies published up to 10 May 2021. RESULTS Twenty-one studies were finally included in the meta-analysis. The T1DM group had significantly higher carotid to femoral PWV levels than that of the control group (mean difference [d]: 0.53 CI: 0.35-0.71, P < 0.00001) but with a fair heterogeneity (I 2:73%). By omitting one study with marked heterogeneity, mean difference in cfPWV remained significantly increased in the T1DM group compared to the control group (mean difference [d]: 0.37 CI: 0.27-0.48, P < 0.00001) but with improved heterogeneity (I2 = 26%). Regarding Aix, the T1DM group had a significantly higher AI@75 index than that of the control group (mean difference [d]: 0.28 CI: 0.17-0.39, P < 0.00001) and with no heterogeneity (I 2 = 8%). CONCLUSIONS Youths with T1DM show increased arterial stiffness, either as increased carotid-femoral pulse wave velocity or increased augmentation index, early in their course of life compared to healthy controls. PROSPERO REGISTRATION NUMBER CRD42021253236.
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Affiliation(s)
| | - Irene Georeli
- Department of Paediatric, Aristotle University, Ippokration General Hospital, Thessaloniki, Greece
| | - Meropi Dimitriadou
- Department of Paediatric, Aristotle University, Ippokration General Hospital, Thessaloniki, Greece
| | | | - Stella Stabouli
- Department of Paediatric, Aristotle University, Ippokration General Hospital, Thessaloniki, Greece
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Minhas AS, Michos ED, Hays AG. Is Vasospastic Coronary Disease More Common Than We Realize? JACC Case Rep 2022; 4:298-300. [PMID: 35257106 PMCID: PMC8897046 DOI: 10.1016/j.jaccas.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hays AG, Schär M, Bonanno G, Lai S, Meyer J, Afework Y, Steinberg A, Stradley S, Gerstenblith G, Weiss RG. Randomized Trial of Anti-inflammatory Medications and Coronary Endothelial Dysfunction in Patients With Stable Coronary Disease. Front Cardiovasc Med 2021; 8:728654. [PMID: 34722661 PMCID: PMC8553961 DOI: 10.3389/fcvm.2021.728654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/14/2021] [Indexed: 12/03/2022] Open
Abstract
Aims: Inflammation plays a critical role in the pathogenesis of coronary artery disease (CAD), however the impact of anti-inflammatory therapies to reduce those processes which promote atherosclerosis in CAD patients is unknown. We aimed to test the hypothesis that anti-inflammatory approaches improve impaired coronary endothelial function (CEF), a driver of coronary atherosclerosis, in stable CAD patients. Methods and Results: We performed a single-center, randomized, placebo-controlled, double-blinded trial to assess whether low dose methotrexate (MTX), low dose colchicine (LDC), and/or their combination (MTX+LDC), improves CEF using non-invasive MRI measures in patients with stable CAD (N = 94). The primary endpoint was the MRI-detected change in coronary cross-sectional area from rest to isometric handgrip exercise (IHE), a predominantly nitric oxide-dependent endothelial dependent stressor. Coronary and systemic endothelial endpoints, and serum inflammatory markers, were collected at baseline, 8 and 24 weeks. Anti-inflammatory study drugs were well-tolerated. There were no significant differences in any of the CEF parameters among the four groups (MTX, LDC, MTX+LDC, placebo) at 8 or 24 weeks. Serum markers of inflammation and systemic endothelial function measures were also not significantly different among the groups. Conclusion: This is the first study to examine the effects of the anti-inflammatory approaches using MTX, LDC, and/or the combination in stable CAD patients on CEF, a marker of vascular health and the primary endpoint of the study. Although these anti-inflammatory approaches were relatively well-tolerated, they did not improve coronary endothelial function in patients with stable CAD. Clinical Trial Registration:www.clinicaltrials.gov, identifier: NCT02366091.
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Affiliation(s)
- Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Schär
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gabriele Bonanno
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shenghan Lai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joseph Meyer
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yohannes Afework
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Angela Steinberg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Samuel Stradley
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert G Weiss
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Beeraka NM, Tomilova IK, Batrak GA, Zhaburina MV, Nikolenko VN, Sinelnikov MY, Mikhaleva LM. Recent Insights into the Nutritional Antioxidant Therapy in Prevention and Treatment of Diabetic Vascular Complications - A comprehensive Review. Curr Med Chem 2021; 29:1920-1935. [PMID: 34375177 DOI: 10.2174/0929867328666210810142527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
Abstract
Diabetes mellitus (DM) and DM-induced vascular complications are a significant global healthcare problem causing a decrease in patient quality of life. The main reason for the disability and mortality of patients is rapidly progressing micro- and macroangiopathies. Currently, free radical oxidation is recognized as one of the main mechanisms in the development of DM and associated complications. Under normal physiological conditions, the level of free radicals and antioxidant defense capabilities is balanced. However, imbalance occurs between the antioxidant defense system and pro-oxidants during chronic hyperglycemia and may invoke formation of excess free radicals, leading to activation of lipid peroxidation and accumulation of highly toxic products of free radical oxidation. This is accompanied by varying degrees of insulin deficiency and insulin resistance in DM patients. Simultaneously with the activation of free radical generation, a decrease in the activity of antioxidant defense factors (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, vitamins C and E) and an acceleration of diabetic complications is seen. Therefore, we hypothesize that antioxidants may play a positive role in the treatment of DM patients to prevent DM-induced vascular complications. However this has not been sufficiently studied. In this review, we discuss recent insights into the potential underlying mechanisms of oxidative stress induced diabetic complications, and implications of antioxidants in mitigation of DM-induced vascular complications.
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Affiliation(s)
- Narasimha M Beeraka
- Center of Excellence in Regenerative Medicine and Molecular Biology (CEMR), Department of Biochemistry, JSS Academy of Higher Education & Research (JSS AHER),Mysuru, Karnataka, India
| | - Irina K Tomilova
- Federal State Budgetary Educational Institution of Higher Education Ivanovo State Medical Academy, Ministry of Health of the Russian Federation, Ivanovo. Russian Federation
| | - Galina A Batrak
- Center of Excellence in Regenerative Medicine and Molecular Biology (CEMR), Department of Biochemistry, JSS Academy of Higher Education & Research (JSS AHER),Mysuru, Karnataka, India
| | - Maria V Zhaburina
- Center of Excellence in Regenerative Medicine and Molecular Biology (CEMR), Department of Biochemistry, JSS Academy of Higher Education & Research (JSS AHER),Mysuru, Karnataka, India
| | - Vladimir N Nikolenko
- Sechenov First Moscow State Medical University (Sechenov University), Moscow 119146. Russian Federation
| | - Mikhail Y Sinelnikov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow 119146. Russian Federation
| | - Liudmila M Mikhaleva
- Research Institute of Human Morphology, Russian Academy of Medical Science, Moscow 117418. Russian Federation
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Lespagnol E, Tagougui S, Fernandez BO, Zerimech F, Matran R, Maboudou P, Berthoin S, Descat A, Kim I, Pawlak-Chaouch M, Boissière J, Boulanger E, Feelisch M, Fontaine P, Heyman E. Circulating biomarkers of nitric oxide bioactivity and impaired muscle vasoreactivity to exercise in adults with uncomplicated type 1 diabetes. Diabetologia 2021; 64:325-338. [PMID: 33219433 DOI: 10.1007/s00125-020-05329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/29/2020] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS Early compromised endothelial function challenges the ability of individuals with type 1 diabetes to perform normal physical exercise. The exact mechanisms underlying this vascular limitation remain unknown, but may involve either formation or metabolism of nitric oxide (NO), a major vasodilator, whose activity is known to be compromised by oxidative stress. METHODS Muscle microvascular reactivity (near-infrared spectroscopy) to an incremental exhaustive bout of exercise was assessed in 22 adults with uncomplicated type 1 diabetes (HbA1c 64.5 ± 15.7 mmol/mol; 8.0 ± 1.4%) and in 21 healthy individuals (18-40 years of age). NO-related substrates/metabolites were also measured in the blood along with other vasoactive compounds and oxidative stress markers; measurements were taken at rest, at peak exercise and after 15 min of recovery. Demographic characteristics, body composition, smoking status and diet were comparable in both groups. RESULTS Maximal oxygen uptake was impaired in individuals with type 1 diabetes compared with in healthy participants (35.6 ± 7.7 vs 39.6 ± 6.8 ml min-1 kg-1, p < 0.01) despite comparable levels of habitual physical activity (moderate to vigorous physical activity by accelerometery, 234.9 ± 160.0 vs 280.1 ± 114.9 min/week). Compared with non-diabetic participants, individuals with type 1 diabetes also displayed a blunted exercise-induced vasoreactivity (muscle blood volume at peak exercise as reflected by ∆ total haemoglobin, 2.03 ± 5.82 vs 5.33 ± 5.54 μmol/l; interaction 'exercise' × 'group', p < 0.05); this was accompanied by lower K+ concentration (p < 0.05), reduced plasma L-arginine (p < 0.05)-in particular when HbA1c was high (mean estimation: -4.0, p < 0.05)-and lower plasma urate levels (p < 0.01). Nonetheless, exhaustive exercise did not worsen lipid peroxidation or other oxidative stress biomarkers, and erythrocytic enzymatic antioxidant resources were mobilised to a comparable extent in both groups. Nitrite and total nitrosation products, which are potential alternative NO sources, were similarly unaltered. Graphical abstract CONCLUSIONS/INTERPRETATION: Participants with uncomplicated type 1 diabetes displayed reduced availability of L-arginine, the essential substrate for enzymatic nitric oxide synthesis, as well as lower levels of the major plasma antioxidant, urate. Lower urate levels may reflect a defect in the activity of xanthine oxidase, an enzyme capable of producing NO from nitrite under hypoxic conditions. Thus, both canonical and non-canonical NO production may be reduced. However, neither of these changes exacerbated exercise-induced oxidative stress. TRIAL REGISTRATION clinicaltrials.gov NCT02051504.
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Affiliation(s)
- Elodie Lespagnol
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Sémah Tagougui
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Farid Zerimech
- CHU Lille, Institut Pasteur de Lille, ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Université Lille, Lille, France
| | - Régis Matran
- CHU Lille, Institut Pasteur de Lille, ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Université Lille, Lille, France
| | - Patrice Maboudou
- CHU de Lille, Laboratoire de Biochimie et Biologie Moléculaire, Pôle de Biologie Pathologie Génétique, Lille, France
| | - Serge Berthoin
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Amandine Descat
- CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Université Lille, Lille, France
| | - Isabelle Kim
- CHU de Lille, Laboratoire de Biochimie et Biologie Moléculaire, Pôle de Biologie Pathologie Génétique, Lille, France
| | - Mehdi Pawlak-Chaouch
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Julien Boissière
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France
| | - Eric Boulanger
- Inserm, CHU Lille, Pasteur Institute of Lille, U1167 - RID-AGE, Université Lille, Lille, France
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Pierre Fontaine
- Department of Diabetology, Lille University Hospital, EA 4489, Lille, France
| | - Elsa Heyman
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université Lille, Université Artois, Université Littoral Côte d'Opale, Lille, France.
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