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Cahill LE, Warren RA, Carew AS, Levy AP, Sapp J, Samuel M, Selvin E, Lavallée SK, Poulter N, Marre M, Harrap S, Mancia G, Harris K, Chalmers J, Woodward M, Rimm EB. Haptoglobin Phenotype and Intensive Glycemic Control for Coronary Artery Disease Risk Reduction in People With Type 2 Diabetes: The ADVANCE Study. Diabetes Care 2024; 47:835-843. [PMID: 38484336 DOI: 10.2337/dc23-2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/01/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Intensive glycemic control reduced coronary artery disease (CAD) events among the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study participants with the haptoglobin (Hp)2-2 phenotype but not in participants without the Hp2-2 phenotype. It is unknown whether and how these results translate across different demographic/clinical characteristics and treatment strategies. RESEARCH DESIGN AND METHODS Haptoglobin phenotype was measured in available samples from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) biomarker case-cohort study. Weighted multivariable-adjusted Cox regression models were used to evaluate the association between intensive glycemic control (HbA1c target of ≤6.5%) versus standard therapy (based on local guidelines) and major CAD events among participants with (n = 1,327) and without (n = 2,077) the Hp2-2 phenotype separately and within prespecified stratifications by sex, race, previous cardiovascular disease (CVD), diabetes duration, and HDL-cholesterol. RESULTS While the hazard ratios (HRs) were in the hypothesized differing directions, compared with standard therapy, intensive glycemic control was not significantly associated with risk of CAD events among participants without (1.04, 95% CI 0.82-1.32) or with (0.84, 0.63-1.14, Pinteraction = 0.27) the Hp2-2 phenotype overall. Intensive therapy was associated with lower CAD risk among participants with the Hp2-2 phenotype who had no previous CVD (0.47, 0.29-0.76, Pinteraction = 0.01). CONCLUSIONS Our findings suggest that intensive glycemic control contributes to the prevention of major CAD events among ADVANCE participants with the Hp2-2 phenotype and no previous CVD and are in alignment with our hypothesis that intensive glycemic control may be beneficial in a subset of people with the Hp2-2 phenotype.
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Affiliation(s)
- Leah E Cahill
- Department of Medicine, Dalhousie University, Halifax, Canada
- QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel A Warren
- Department of Medicine, Dalhousie University, Halifax, Canada
- QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
| | - Allie S Carew
- Department of Medicine, Dalhousie University, Halifax, Canada
- QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Andrew P Levy
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - John Sapp
- Department of Medicine, Dalhousie University, Halifax, Canada
- QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
| | - Michelle Samuel
- Department of Medicine, Dalhousie University, Halifax, Canada
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Samantha K Lavallée
- QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Neil Poulter
- School of Public Health, Imperial College London, London, U.K
| | - Michel Marre
- Clinique Ambroise Paré, Neuilly-sur-Seine, France
- Institut Necker-Enfants Malades, INSERM, Université Paris Cité, Paris, France
| | - Stephen Harrap
- Department of Anatomy and Physiology, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia
| | | | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark Woodward
- School of Public Health, Imperial College London, London, U.K
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Eric B Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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Eriksson MI, Syreeni A, Sandholm N, Dahlström EH, Gordin D, Tatlisumak T, Putaala J, Groop PH, Martola J, Thorn LM. Haptoglobin genotype and its relation to asymptomatic cerebral small-vessel disease in type 1 diabetes. Acta Diabetol 2023; 60:749-756. [PMID: 36856861 PMCID: PMC10148779 DOI: 10.1007/s00592-023-02059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
AIM Cerebral small-vessel disease (SVD) is prevalent in type 1 diabetes and has been associated with the haptoglobin variant allele Hp1. Contrarily, the Hp2-allele has been linked to cardiovascular disease and the role of haptoglobin-genotype in asymptomatic SVD is unknown. We, therefore, aimed to evaluate the alleles' association with SVD. METHODS This cross-sectional study included 179 neurologically asymptomatic adults with type 1 diabetes (women 53%, mean age 39 ± 7 years, diabetes duration 23 ± 10 years, HbA1c 8.1 ± 3.2% [65 ± 12 mmol/mol]). Examinations included genotyping (genotypes Hp1-1, Hp2-1, Hp2-2) by polymerase chain reaction, clinical investigation, and magnetic resonance brain images assessed for SVD manifestations (white matter hyperintensities, cerebral microbleeds, and lacunar infarcts). RESULTS SVD prevalence was 34.6%. Haptoglobin genotype frequencies were 15.6% (Hp1-1), 43.6% (Hp1-2), and 40.8% (Hp2-2). Only diastolic blood pressure differed between the genotypes Hp1-1, Hp1-2, and Hp2-2 (81 [74-83], 75 [70-80], and 75 [72-81] mmHg, p = 0.019). Haptoglobin genotype frequencies by presence versus absence of SVD were 16.1%; 46.8%; 37.1% versus 15.4%; 41.9%; 42.7% (p = 0.758). Minor allele frequencies were 39.5% versus 36.3% (p = 0.553). Hp1 homozygotes and Hp2 carriers displayed equal proportions of SVD (35.7% vs 34.4%, p > 0.999) and SVD manifestations (white matter hyperintensities 14.3% vs 17.9%, p = 0.790; microbleeds 25.0% vs 21.9%, p = 0.904; lacunar infarcts 0% vs 3.6%, p > 0.999). Hp1-1 was not associated with SVD (OR 1.19, 95% CI 0.46-2.94, p = 0.712) when adjusting for age, blood pressure, and diabetic retinopathy. CONCLUSIONS Although the SVD prevalence was high, we detected no significant association between SVD and haptoglobin-genotype.
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Affiliation(s)
- M I Eriksson
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - A Syreeni
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - N Sandholm
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - E H Dahlström
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - D Gordin
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
- Minerva Institute for Medical Research, Helsinki, Finland
| | - T Tatlisumak
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience/Neurology, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - J Putaala
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - J Martola
- Department of Clinical Neuroscience, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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3
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Warren RA, Carew AS, Andreou P, Herman C, Levy AP, Ginsberg HN, Sapp J, Rimm EB, Kirkland S, Cahill LE. Haptoglobin Phenotype Modifies the Effect of Fenofibrate on Risk of Coronary Event: ACCORD Lipid Trial. Diabetes Care 2022; 45:241-250. [PMID: 34785535 DOI: 10.2337/dc21-1429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The haptoglobin (Hp)2-2 phenotype (∼35-40% of people) is associated with increased oxidation and dysfunctional HDL in hyperglycemia and may explain why drugs designed to pharmacologically raise HDL cholesterol and lower triglycerides have not reliably prevented cardiovascular disease in diabetes. We aimed to determine whether the effect of adding fenofibrate versus placebo to simvastatin on the risk of coronary artery disease (CAD) events depends on Hp phenotype in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial. RESEARCH DESIGN AND METHODS Cox proportional hazards regression models quantified the relationship between fenofibrate therapy and CAD events in the ACCORD lipid trial in participants with the Hp2-2 phenotype (n = 1,795) separately from those without (n = 3,201). RESULTS Fenofibrate therapy successfully lowered the risk of CAD events in participants without the Hp2-2 phenotype (multivariable adjusted hazard ratio 0.74 [95% CI 0.60-0.90] compared with no fenofibrate therapy) but not in participants with the Hp2-2 phenotype (1.16 [0.87-1.56]; P interaction = 0.009). Subgroup analyses revealed that this protective effect of fenofibrate against CAD events among the non-Hp2-2 phenotype group was pronounced in participants with severe dyslipidemia (P interaction = 0.01) and in males (P interaction = 0.02) with an increased CAD risk from fenofibrate treatment observed in females with the Hp2-2 phenotype (P interaction = 0.002). CONCLUSIONS The effect of fenofibrate added to simvastatin on risk of CAD events depends on Hp phenotype in the ACCORD lipid trial.
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Affiliation(s)
- Rachel A Warren
- 1Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.,2Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada.,3Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Allie S Carew
- 1Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.,2Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada.,3Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pantelis Andreou
- 1Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Herman
- 2Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada.,4Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew P Levy
- 5Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | | | - John Sapp
- 2Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada.,3Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eric B Rimm
- 7Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,8Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Susan Kirkland
- 1Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah E Cahill
- 1Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.,2Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada.,3Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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4
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Lempiäinen J, Ijäs P, Niiranen TJ, Kaste M, Karhunen PJ, Lindsberg PJ, Erkinjuntti T, Melkas S. Haptoglobin Hp1 Variant Does Not Associate with Small Vessel Disease. Brain Sci 2019; 10:brainsci10010018. [PMID: 31905636 PMCID: PMC7016682 DOI: 10.3390/brainsci10010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/16/2019] [Accepted: 12/24/2019] [Indexed: 01/10/2023] Open
Abstract
Haptoglobin (Hp) is a plasma protein that binds free hemoglobin and protects tissues from oxidative damage. An Hp2 allele has been associated with an increased risk of cardiovascular complications. On the other hand, recent studies have suggested that Hp1 allele increases risk to develop severe cerebral small vessel disease. We aimed to replicate this finding in a first-ever stroke patient cohort. Hp was genotyped by PCR and gel electrophoresis in the Helsinki Stroke Aging Memory Study in patients with DNA and magnetic resonance imaging (MRI) available (SAM; n = 316). Lacunar infarcts and white matter lesions (WML) classified by Fazekas grading from brain MRI were associated with Hp genotypes. As population controls, we used participants of Cardiovascular diseases—a sub study of Health 2000 Survey (n = 1417). In the SAM cohort, 63.0% of Hp1-1 carriers (n = 46), 52.5% of Hp1-2 carriers (n = 141) and 51.2% of Hp2-2 carriers (n = 129) had severe WML (p = 0.372). There was no difference in severe WMLs between Hp1-1 vs. Hp1-2 and Hp2-2 carriers (p = 0.201). In addition, 68.9% of Hp1-1 carriers (n = 45), 58.5% of Hp1-2 carriers (n = 135), and 61.8% of Hp2-2 carriers (n = 126) had one or more lacunar lesions (p = 0.472). There was no difference in the number of patients with at least one lacunar infarct between Hp1-1 vs. Hp1-2 and Hp2-2 groups (p = 0.322). Neither was there any difference when diabetic patients (type I and II) were examined separately. Hp1 allele is not associated with an increased risk for cerebral small vessel disease in a well-characterized Finnish stroke patient cohort.
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Affiliation(s)
- Juha Lempiäinen
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Correspondence: ; Tel.: +358-407-787-278; Fax: +358-947-185-957
| | - Petra Ijäs
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Teemu J. Niiranen
- Department of Public Health Solutions, National institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland;
- Division of Medicine, Turku University Hospital and University of Turku, 20014 Turku, Finland
| | - Markku Kaste
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Pekka J. Karhunen
- School of Medicine, University of Tampere, 33014 Tampere, Finland;
- FimLab Laboratories Ltd., Tampere University Hospital Region, 33014 Tampere, Finland
| | - Perttu J. Lindsberg
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Timo Erkinjuntti
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Susanna Melkas
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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5
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Gurung RL, Yiamunaa M, Liu S, Liu JJ, Chan C, Choo RWM, Ang K, Sum CF, Tavintharan S, Lim SC. Association of haptoglobin phenotype with incident acute myocardial infarction in Chinese patients with type 2 diabetes. Cardiovasc Diabetol 2019; 18:65. [PMID: 31146758 PMCID: PMC6542096 DOI: 10.1186/s12933-019-0867-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023] Open
Abstract
Background Haptoglobin (Hp) is an abundant plasma protein with anti-oxidant properties. Hp polymorphism is associated with cardio-metabolic dysfunction but the allele conferring risk of developing acute myocardial infarction (AMI) in type 2 diabetes (T2D) patients is unclear. This study aimed to investigate the association of Hp phenotype (Hp 1-1, 2-1 and 2-2) with incident AMI in Chinese T2D patients. Methods This prospective study included Chinese T2D participants from the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D) and Diabetic Nephropathy (DN) cohorts. Information on incidence of non-fatal AMI was collected by data linkage with the Singapore Myocardial Infarction Registry. Hp phenotype was determined using enzyme-linked immunosorbent assay. Cox proportional hazards regression models were used to evaluate the association of Hp phenotype with incident AMI, adjusted for traditional risk factors separately in two cohorts, then meta-analysed. Results In total, 2324 Chinese participants (SMART2D; N = 1034, mean age [SD] of 59 [11]) and (DN: N = 1290, mean age [SD] of 58 [12]) were included in this study. There were total of 30 (56 events per 10,000 patient-years) and 99 (128 events per 10,000 patient-years) AMI events in SMART2D and DN cohorts respectively. In meta-analysis, presence of Hp 1 allele conferred 43% (hazard ratio [HR] = 1.43 [95% CI 1.10–1.87], P = 0.008, Phet = 0.413) increased risk of incident AMI, independent of age, sex, smoking, body mass index, HbA1c, diabetes duration, lipids, hypertension, renal function and usage of insulin and RAS antagonist. In adjusted model, compared to Hp 2-2 groups, individuals with Hp 1-1 (HR = 2.18 [95% CI 1.19–3.76], P = 0.010, Phet = 0.193) and Hp 2-1 (HR = 1.45 [95% CI 0.98–2.14], P = 0.065, Phet = 0.576) were at a higher risk of incident AMI. Moreover, compared to Hp 2-2 groups, non-Hp 2-2 groups (Hp 1-1 and Hp 2-1) were at 55% increased risk of incident AMI (HR = 1.55 [95% CI 1.07–2.24], P = 0.021, Phet = 0.940). Conclusions Hp 1-1 phenotype was associated with increased risk of incident AMI, independent of traditional risk factors, in Chinese patients with T2D. Hp phenotyping may allow for identification of T2D individuals at higher risk for onset of AMI. However, further studies are needed to understand the underlying mechanism between Hp alleles and risk for AMI. Electronic supplementary material The online version of this article (10.1186/s12933-019-0867-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Resham L Gurung
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - M Yiamunaa
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sylvia Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Jian Jun Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Clara Chan
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | | | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore. .,Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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6
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Livny A, Schnaider Beeri M, Heymann A, Schmeidler J, Moshier E, Tzukran R, Tsarfaty G, Leroith D, Preiss R, Soleimani L, Guerrero-Berroa E, Silverman JM, Bendlin B, Levy A, Ravona-Springer R. The Association of Depressive Symptoms With Brain Volume Is Stronger Among Diabetic Elderly Carriers of the Haptoglobin 1-1 Genotype Compared to Non-carriers. Front Endocrinol (Lausanne) 2019; 10:68. [PMID: 30809196 PMCID: PMC6379325 DOI: 10.3389/fendo.2019.00068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/24/2019] [Indexed: 01/07/2023] Open
Abstract
Aim: Depression is highly prevalent in type 2 diabetes and is associated with lower adherence to medical treatments, worse glycemic control, and increased risk for diabetes-related complications. The mechanisms underlying depression in type 2 diabetes are unclear. The haptoglobin (Hp) genotype is associated with type 2 diabetes related complications including increased risk for cerebrovascular pathology and worse cognitive performance. Its relationship with depression is unknown. We investigated the role of Hp genotype on the association of depression with brain and white matter hyperintensities (WMH) volumes. Methods: Depressive symptoms (measured with the 15-item Geriatric Depression Scale), brain MRI, and Hp genotypes, were examined in elderly subjects with type 2 diabetes [29 (13.8%) Hp 1-1 carriers and 181 (86.2%) non-carriers]. The interaction of Hp genotype with number of depressive symptoms on regional brain measures was assessed using regression analyses. Results: The significant interactions were such that in Hp 1-1 carriers but not in non-carriers, number of depressive symptoms was associated with overall frontal cortex (p = 0.01) and WMH (p = 0.04) volumes but not with middle temporal gyrus volume (p = 0.43). Conclusions: These results suggest that subjects with type 2 diabetes carrying the Hp 1-1 genotype may have higher susceptibility to depression in the context of white matter damage and frontal lobe atrophy. The mechanisms underlying depression in diabetes may differ by Hp genotype.
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Affiliation(s)
- Abigail Livny
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Department of Diagnostic Imaging, Sheba Medical Center affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Interdisciplinary Center, Baruch Ivcher School of Psychology, Herzliya, Israel
| | - Anthony Heymann
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabi Health Services, Tel Aviv, Israel
| | - James Schmeidler
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erin Moshier
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ruth Tzukran
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Galia Tsarfaty
- Department of Diagnostic Imaging, Sheba Medical Center affiliated to Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Derek Leroith
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Laili Soleimani
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Jeremy M. Silverman
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Barbara Bendlin
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Andrew Levy
- Rambam Medical Center, Technion Institute of Technology, Haifa, Israel
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Psychiatric Division, Sheba Medical Center, Ramat Gan, Israel
- *Correspondence: Ramit Ravona-Springer
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7
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Beeri MS, Lin HM, Sano M, Ravona-Springer R, Liu X, Bendlin BB, Gleason CE, Guerrero-Berroa E, Soleimani L, Launer LJ, Ehrenberg S, Lache O, Seligman YK, Levy AP. Association of the Haptoglobin Gene Polymorphism With Cognitive Function and Decline in Elderly African American Adults With Type 2 Diabetes: Findings From the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Study. JAMA Netw Open 2018; 1:e184458. [PMID: 30646354 PMCID: PMC6324406 DOI: 10.1001/jamanetworkopen.2018.4458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE African American individuals have higher dementia risk than individuals of white race/ethnicity. They also have higher rates of type 2 diabetes, which may contribute to this elevated risk. This study examined the association of the following 2 classes of alleles at the haptoglobin (Hp) locus that are associated with poor cognition, cardiovascular disease, and mortality: Hp 1-1 (associated with poor cognition and cerebrovascular disease) and Hp 2-1 and Hp 2-2 (associated with greater risk of myocardial infarction and mortality). An additional polymorphism in the promoter region of the Hp 2 allele, restricted to individuals of African descent, yields a fourth genotype, Hp 2-1m. African American adults have a higher prevalence of Hp 1-1 (approximately 30%) compared with individuals of white race/ethnicity (approximately 14%), but the potential role of the Hp genotype in cognition among elderly African American individuals with type 2 diabetes is unknown. OBJECTIVE To assess the association of the Hp genotypes with cognitive function and decline in elderly African American adults with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used publicly available data and specimens from the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) study to investigate the association of the Hp genotypes with cognitive function and decline in 466 elderly African American participants with type 2 diabetes. The hypothesis was that the Hp 1-1 genotype compared with the other genotypes would be associated with more cognitive impairment and faster cognitive decline in elderly African American adults with type 2 diabetes. The initial ACCORD trial was performed from October 28, 1999, to September 15, 2014. This was a multicenter clinical study performed in an academic setting. EXPOSURES The Hp genotypes were determined from serum samples by polyacrylamide gel electrophoresis and by enzyme-linked immunosorbent assay. MAIN OUTCOMES AND MEASURES The Mini-Mental State Examination (MMSE) was used to measure cognitive function and change after 40 months. The MMSE score ranges from 0 to 30 points; higher scores represent better cognition. Associations were examined with analysis of covariance and linear regression, adjusting for age, sex, education, baseline glycated hemoglobin level, systolic blood pressure, diastolic blood pressure, cholesterol level, creatinine level, and treatment arm (intensive vs standard). The cognitive change model adjusted also for the baseline MMSE score. RESULTS Among 466 African American study participants (mean [SD] age, 62.3 [5.7] years), 64.8% were women, and the genotype prevalences were 29.4% (n = 137) for Hp 1-1, 36.1% (n = 168) for Hp 2-1, 10.9% (n = 51) for Hp 2-1m, and 23.6% (n = 110) for Hp 2-2. The groups differed in their baseline MMSE scores (P = .006): Hp 1-1 had the lowest MMSE score (mean [SE], 25.68 [0.23]), and Hp 2-1m had the highest MMSE score (mean [SE], 27.15 [0.36]). Using the least squares method, the 40-month decline was significant for Hp 1-1 (mean [SE], -0.41 [0.19]; P = .04) and for Hp 2-2 (mean [SE], -0.68 [0.21]; P = .001). However, the overall comparison across the 4 groups did not reach statistical significance for the fully adjusted model. The interaction of age with the Hp 1-1 genotype on MMSE score decline estimate per year change was significant (mean [SE], -0.87 [0.37]; P = .005), whereas it was not significant for Hp 2-1 (mean [SE], 0.06 [0.37]; P = .85), Hp 2-1m (mean [SE], -0.06 [0.51]; P = .89), and Hp 2-2 (mean [SE], -0.44 [0.41]; P = .29), indicating that cognitive decline in Hp 1-1 carriers was accentuated in older ages, whereas it was not significant for the other Hp genotypes. CONCLUSIONS AND RELEVANCE In this study, the Hp 1-1 genotype, which is 2-fold (approximately 30%) more prevalent among African American individuals than among individuals of white race/ethnicity, was associated with poorer cognitive function and greater cognitive decline than the other Hp genotypes. The Hp gene polymorphism may explain the elevated dementia risk in African American adults. The neuropathological substrates and mechanisms for these associations merit further investigation.
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Affiliation(s)
- Michal S. Beeri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Hung-Mo Lin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- The Memory and Psychogeriatric Clinic, Sheba Medical Center, Tel Hashomer, Israel
| | - Xiaoyu Liu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara B. Bendlin
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Carey E. Gleason
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Elizabeth Guerrero-Berroa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Psychology, Lehman College, The City University of New York, Bronx
| | - Laili Soleimani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Scott Ehrenberg
- currently a student at Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Orit Lache
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yaakov K. Seligman
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Andrew P. Levy
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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8
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Dalan R, Liuh Ling G. The protean role of haptoglobin and haptoglobin genotypes on vascular complications in diabetes mellitus. Eur J Prev Cardiol 2018; 25:1502-1519. [PMID: 29799294 DOI: 10.1177/2047487318776829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction and background Haptoglobin (Hp) is considered to be an antioxidant and protective against cardiovascular complications. Polymorphisms in the Hp gene interact with diabetes mellitus to affect the risk of vascular complications. Methods We review the updated literature about the protean role of Hp and Hp genotypes spanning genomics, molecular, translational and clinical studies. We searched Pubmed, SCOPUS and Google Scholar for all articles using the keywords: haptoglobin and/or haptoglobin polymorphism and diabetes. We review the diverse Hp genotypes, phenotypes and the impact on diabetes complications, including lessons from animal models and in vitro models. We describe the clinical studies on the associations of Hp genotypes with vascular complications in type 1 and type 2 diabetes comprehensively. We review the studies looking at vitamin E supplementation in a personalized manner in Hp2-2 diabetes individuals. Results and conclusion Hp genotypes have evolved as a result of deletions in the traditional Hp genes. The Hp genotypes have been associated with microvascular and macrovascular complications in type 1 diabetes mellitus but the association in type 2 diabetes is more consistent with cardiovascular complications. A preferential benefit of vitamin E and other antioxidants in the Hp2-2 genotype for cardiovascular complications in type 2 diabetes has been seen presumably secondary to interaction with high-density lipoprotein function. Hence, the Hp genotype can be used to personalize antioxidant therapeutics in diabetes patients. These results need to be corroborated in large, global, pragmatic, prospective, cardiovascular outcome trials in type 2 diabetes patients.
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Affiliation(s)
- Rinkoo Dalan
- 1 Tan Tock Seng Hospital, Singapore.,2 NTU-Lee Kong Chian School of Medicine, Singapore.,3 Yong Loo Lin School of Medicine, Singapore
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9
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Livny A, Ravona-Springer R, Heymann A, Priess R, Kushnir T, Tsarfaty G, Rabinov L, Moran R, Tik N, Moshier E, Cooper I, Greenbaum L, Silverman J, Levy A, Sano M, Bendlin BB, Buchman AS, Schnaider-Beeri M. Haptoglobin 1-1 Genotype Modulates the Association of Glycemic Control With Hippocampal Volume in Elderly Individuals With Type 2 Diabetes. Diabetes 2017; 66:2927-2932. [PMID: 28860127 PMCID: PMC5652603 DOI: 10.2337/db16-0987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/23/2017] [Indexed: 01/28/2023]
Abstract
Recent evidence suggests that glycemic control is associated with cognitive function in older patients with type 2 diabetes who are carriers of the haptoglobin (Hp) 1-1 genotype compared with noncarriers. We assessed whether poor glycemic control in Hp 1-1 carriers is more strongly associated with smaller hippocampal volume than in noncarriers. Hippocampal volume was generated from high-resolution structural T1 MRI obtained for 224 participants (28 Hp 1-1 carriers [12.5%] and 196 noncarriers [87.5%]) from the Israel Diabetes and Cognitive Decline (IDCD) study, who had a mean (SD) number of years in the Maccabi Healthcare Services (MHS) registry of 8.35 (2.63) and a mean (SD) HbA1c level of 6.66 (0.73)% [49 mmol/mol]. A stronger negative association between right hippocampal volume and HbA1c was found in patients with the Hp 1-1 genotype, with a 0.032-mL decrease in right hippocampal volume per 14% increase in HbA1c (P = 0.0007) versus a 0.009-mL decrease in Hp 1-1 noncarriers (P = 0.047), after adjusting for total intracranial volume, age, sex, follow-up years in the registry, and cardiovascular factor (interaction, P = 0.025). This indicates that 29.66% of the total variance in right hippocampal volume is explained by HbA1c levels among Hp 1-1 carriers and that 3.22% is explained by HbA1c levels among Hp 1-1 noncarriers. Our results suggest that the hippocampus of Hp 1-1 carriers may be more vulnerable to the insults of poor glycemic control.
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Affiliation(s)
- Abigail Livny
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel
- Memory Clinic, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anthony Heymann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Tammar Kushnir
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Tsarfaty
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leeron Rabinov
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
| | - Reut Moran
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
| | - Niv Tik
- Department of Diagnostic Imaging, Sheba Medical Center, Tel HaShomer, Israel
| | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Itzik Cooper
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel
- Interdisciplinary Center Herzliya, Baruch Ivcher School of Psychology, Herzliya, Israel
| | - Lior Greenbaum
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel HaShomer, Israel
| | - Jeremy Silverman
- Icahn School of Medicine at Mount Sinai, New York, NY
- James J. Peters VA Medical Center, Bronx, NY
| | - Andrew Levy
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Michal Schnaider-Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel
- Icahn School of Medicine at Mount Sinai, New York, NY
- Interdisciplinary Center Herzliya, Baruch Ivcher School of Psychology, Herzliya, Israel
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10
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Abstract
OBJECTIVE Psychomotor slowing is a common cognitive complication in type 1 diabetes (T1D), but its neuroanatomical correlates and risk factors are unclear. In nondiabetic adults, smaller gray matter volume (GMV) and presence of white matter hyperintensities are associated with psychomotor slowing. We hypothesize that smaller GMV in prefronto-parietal regions explains T1D-related psychomotor slowing. We also inspect the contribution of microvascular disease and hyperglycemia. METHODS GMV, white matter hyperintensities (WMH), and glucose levels were measured concurrently with a test of psychomotor speed (Digit Symbol Substitution Test [DSST]) in 95 adults with childhood-onset T1D (mean age/duration = 49/41 years) and 135 similarly aged non-T1D adults. Linear regression models tested associations between DSST and regional GMV, controlling for T1D, sex, and education; a bootstrapping method tested whether regional GMV explained between-group differences in DSST. For the T1D cohort, voxel-based and a priori regions-of-interest methods further tested associations between GMV and DSST, adjusting for WMH, hyperglycemia, and age. RESULTS Bilateral putamen, but no other regions examined, significantly attenuated DSST differences between the cohorts (bootstrapped unstandardized indirect effects: -3.49, -3.26; 95% confidence interval = -5.49 to -1.80, -5.29 to -1.44, left and right putamen, respectively). Among T1D, DSST was positively associated with GMV of bilateral putamen and left thalamus. Neither WMH, hyperglycemia, age, nor other factors substantially modified these relationships. CONCLUSIONS For middle-aged adults with T1D and cerebral microvascular disease, GMV of basal ganglia may play a critical role in regulating psychomotor speed, as measured via DSST. Studies to quantify the impact of basal ganglia atrophy concurrent with WMH progression on psychomotor slowing are warranted.
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11
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Andersen CBF, Stødkilde K, Sæderup KL, Kuhlee A, Raunser S, Graversen JH, Moestrup SK. Haptoglobin. Antioxid Redox Signal 2017; 26:814-831. [PMID: 27650279 DOI: 10.1089/ars.2016.6793] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Haptoglobin (Hp) is an abundant human plasma protein that tightly captures hemoglobin (Hb) during hemolysis. The Hb-Hp complex formation reduces the oxidative properties of heme/Hb and promotes recognition by the macrophage scavenger receptor CD163. This leads to Hb-Hp breakdown and heme catabolism by heme oxygenase and biliverdin reductase. Gene duplications of a part of or the entire Hp gene in the primate evolution have led to variant Hp gene products that collectively may be designated "the haptoglobins (Hps)" as they all bind Hb. These variant products include the human-specific multimeric Hp phenotypes in individuals, which are hetero- or homozygous for an Hp2 gene allele. The Hp-related protein (Hpr) is another Hp duplication product in humans and other primates. Alternative functions of the variant Hps are indicated by numerous reports on association between Hp phenotypes and disease as well as the elucidation of a specific role of Hpr in the innate immune defense. Recent Advances: Recent functional and structural information on Hp and receptor systems for Hb removal now provides insight on how Hp carries out essential functions such as the Hb detoxification/removal, and how Hpr, by acting as an Hp-lookalike, can sneak a lethal toxin into trypanosome parasites that cause mammalian sleeping sickness. Critical Issues and Future Directions: The new structural insight may facilitate ongoing attempts of developing Hp derivatives for prevention of Hb toxicity in hemolytic diseases such as sickle cell disease and other hemoglobinopathies. Furthermore, the new structural knowledge may help identifying yet unknown functions based on other disease-relevant biological interactions involving Hps. Antioxid. Redox Signal. 26, 814-831.
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Affiliation(s)
| | | | - Kirstine Lindhardt Sæderup
- 2 Cancer and Inflammation, Department of Molecular Medicine, University of Southern Denmark , Odense C, Denmark
| | - Anne Kuhlee
- 3 Department of Structural Biochemistry, Max-Planck Institute of Molecular Physiology , Dortmund, Germany
| | - Stefan Raunser
- 3 Department of Structural Biochemistry, Max-Planck Institute of Molecular Physiology , Dortmund, Germany
| | - Jonas H Graversen
- 2 Cancer and Inflammation, Department of Molecular Medicine, University of Southern Denmark , Odense C, Denmark
| | - Søren Kragh Moestrup
- 1 Department of Biomedicine, University of Aarhus , Aarhus C, Denmark .,2 Cancer and Inflammation, Department of Molecular Medicine, University of Southern Denmark , Odense C, Denmark .,4 Department of Clinical Biochemistry and Pharmacology, Odense University Hospital , Odense C, Denmark
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12
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Orchard TJ, Costacou T. Cardiovascular complications of type 1 diabetes: update on the renal link. Acta Diabetol 2017; 54:325-334. [PMID: 27995339 DOI: 10.1007/s00592-016-0949-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/25/2016] [Indexed: 12/22/2022]
Abstract
AIMS Despite recent findings of increased life expectancy among individuals with type 1 diabetes, mortality remains greatly increased compared to the general population. As this is largely the result of cardiovascular and renal complications, we aimed to review recent findings surrounding these diseases in type 1 diabetes. METHODS We reviewed published findings concerning the cardiovascular complications of type 1 diabetes, with a particular focus on links with renal disease. RESULTS The cardiovascular and renal complications of type 1 diabetes share many features including insulin resistance, oxidative damage, and genetic associations with the Haptoglobin genotype, and both are strongly affected by glycemic control. CONCLUSIONS Although current knowledge on predictors of type 1 diabetes cardiovascular and renal complications has increased, further investigation is required to understand the mechanisms leading to cardio-renal complications in this population.
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Affiliation(s)
- Trevor J Orchard
- Department of Epidemiology, Diabetes and Lipid Research Clinic, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Tina Costacou
- Department of Epidemiology, Diabetes and Lipid Research Clinic, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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13
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Hardigan T, Ward R, Ergul A. Cerebrovascular complications of diabetes: focus on cognitive dysfunction. Clin Sci (Lond) 2016; 130:1807-22. [PMID: 27634842 PMCID: PMC5599301 DOI: 10.1042/cs20160397] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/11/2015] [Indexed: 01/01/2023]
Abstract
The incidence of diabetes has more than doubled in the United States in the last 30 years and the global disease rate is projected to double by 2030. Cognitive impairment has been associated with diabetes, worsening quality of life in patients. The structural and functional interaction of neurons with the surrounding vasculature is critical for proper function of the central nervous system including domains involved in learning and memory. Thus, in this review we explore cognitive impairment in patients and experimental models, focusing on links to vascular dysfunction and structural changes. Lastly, we propose a role for the innate immunity-mediated inflammation in neurovascular changes in diabetes.
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Affiliation(s)
- Trevor Hardigan
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA 30912, U.S.A
| | - Rebecca Ward
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, U.S.A
| | - Adviye Ergul
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA 30912, U.S.A. Charlie Norwood Veterans Administration Medical Center, Augusta, GA 30912, U.S.A.
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14
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Costacou T, Orchard TJ. The Haptoglobin genotype predicts cardio-renal mortality in type 1 diabetes. J Diabetes Complications 2016; 30:221-6. [PMID: 26684170 PMCID: PMC4761325 DOI: 10.1016/j.jdiacomp.2015.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/26/2015] [Accepted: 11/11/2015] [Indexed: 12/23/2022]
Abstract
AIMS The Haptoglobin (HP) 2-2 genotype increases cardiovascular diabetes complication incidence. In type 1 diabetes, HP 2-2 also predicts declining kidney function and end-stage renal disease. We investigated whether HP 2-2 predisposes to cardio-renal mortality, while considering other causes of death as competing risks. METHODS Individuals with type 1 diabetes and HP data available (n=486; mean baseline age, 27 and duration, 19 years) were selected for study. Vital status was assessed as of 8/31/2014. The underlying cause of death was determined and classified based on standardized procedures. RESULTS During 25 years of follow-up, 79 (16.3%) cardio-renal deaths and 43 (8.8%) deaths related to other causes occurred. Although total mortality did not differ by HP (25.4% with HP 1 versus 24.6% with HP 2-2, p=0.84), a greater proportion of HP 2-2 carriers exhibited a cardio-renal death (19.0 versus 14.2, p=0.05). In time-to-event analyses, HP 2-2 was associated with a statistically significant increase of the sub-distribution hazard ratio for cardio-renal mortality (HR=1.64, p=0.03), although this effect was somewhat attenuated after multivariable adjustment (HR=1.58, p=0.05). CONCLUSIONS Our results suggest that in addition to predicting the incidence of cardio-renal complications, HP 2-2 also increases susceptibility for cardio-renal mortality in type 1 diabetes. These findings require validation in other cohorts.
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Affiliation(s)
- Tina Costacou
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Trevor J Orchard
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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15
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Hwang M, Tudorascu DL, Nunley K, Karim H, Aizenstein HJ, Orchard TJ, Rosano C. Brain Activation and Psychomotor Speed in Middle-Aged Patients with Type 1 Diabetes: Relationships with Hyperglycemia and Brain Small Vessel Disease. J Diabetes Res 2016; 2016:9571464. [PMID: 26998494 PMCID: PMC4779538 DOI: 10.1155/2016/9571464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 01/26/2023] Open
Abstract
Slower psychomotor speed is very common in patients with type 1 diabetes mellitus (T1D), but the underlying mechanisms are not clear. We propose that hyperglycemia is associated with slower psychomotor speed via disruption of brain activation. Eighty-five adults (48% women, mean age: 49.0 years, mean duration: 40.8) with childhood onset T1D were recruited for this cross-sectional study. Median response time in seconds (longer = worse performance) and brain activation were measured while performing a psychomotor speed task. Exposure to hyperglycemia, measured as glycosylated hemoglobin A1c, was associated with longer response time and with higher activation in the inferior frontal gyrus and primary sensorimotor and dorsal cingulate cortex. Higher activation in inferior frontal gyrus, primary sensorimotor cortex, thalamus, and cuneus was related to longer response times; in contrast, higher activation in the superior parietal lobe was associated with shorter response times. Associations were independent of small vessel disease in the brain or other organs. In this group of middle-aged adults with T1D, the pathway linking chronic hyperglycemia with slower processing speed appears to include increased brain activation, but not small vessel disease. Activation in the superior parietal lobe may compensate for dysregulation in brain activation in the presence of hyperglycemia.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, University of Pittsburgh, 3600 Forbes Avenue, Plaza Level, Pittsburgh, PA 15213, USA
| | - Dana L. Tudorascu
- Department of Internal Medicine, Department of Psychiatry, and Department of Biostatistics, University of Pittsburgh, 200 Meyran Avenue, Suite 326, Pittsburgh, PA 15213, USA
| | - Karen Nunley
- Department of Epidemiology, University of Pittsburgh, 130 N. Bellefield Avenue, Suite 443, Pittsburgh, PA 15213, USA
| | - Helmet Karim
- Department of Bioengineering, University of Pittsburgh, 253 Sterling Plaza, Pittsburgh, PA 15213, USA
| | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Trevor J. Orchard
- Department of Epidemiology, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, 130 N. Bellefield Avenue, Suite 467, Pittsburgh, PA 15213, USA
- *Caterina Rosano:
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16
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Abstract
Cardiovascular disease (CVD) is the most common cause of death and disability worldwide. Therefore, great importance has been placed on the discovery of novel risk factors and metabolic pathways relevant in the prevention and management of CVD. Such research is ongoing and may continue to lead to better risk stratification of individuals and/or the development of new intervention targets and treatment options. This review highlights emerging biomarkers related to lipid metabolism, glycemia, inflammation, and cardiac damage, some of which show promising associations with CVD risk and provide further understanding of the underlying pathophysiology. However, their measurement methodology and assays will require validation and standardization, and it will take time to accumulate evidence of their role in CVD in various population settings in order to fully assess their clinical utility. Several of the novel biomarkers represent intriguing, potentially game-changing targets for therapy.
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Affiliation(s)
- Leah E Cahill
- Department of Medicine, Dalhousie University, 5790 University Ave, Halifax, NS, B3H 1V7, Canada.
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Monica L Bertoia
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Sarah A Aroner
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, 1309 Beacon Street, 2nd Floor, Brookline, Boston, MA, USA.
| | - Majken K Jensen
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
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17
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Cahill LE, Jensen MK, Chiuve SE, Shalom H, Pai JK, Flint AJ, Mukamal KJ, Rexrode KM, Levy AP, Rimm EB. The Risk of Coronary Heart Disease Associated With Glycosylated Hemoglobin of 6.5% or Greater Is Pronounced in the Haptoglobin 2-2 Genotype. J Am Coll Cardiol 2015; 66:1791-1799. [PMID: 26483103 PMCID: PMC4616252 DOI: 10.1016/j.jacc.2015.07.076] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/15/2015] [Accepted: 07/27/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Research targeting glycosylated hemoglobin A1c (HbA1c) to <6.5% to prevent coronary heart disease (CHD) events has conflicting results. We previously observed the haptoglobin (Hp) Hp2-2 genotype is associated with a ∼10-fold increased CHD risk among individuals with HbA1c ≥6.5%, and thus might be useful in identifying those at high risk of CHD who would benefit from maintaining HbA1c <6.5%. OBJECTIVES This study sought to model whether HbA1c ≥ 6.5% in the Hp2-2 genotype is associated with CHD in a prospective case-control study nested within the Health Professionals Follow-Up Study (HPFS). METHODS HbA1c concentration and Hp genotype were determined for 695 incident cases of CHD from 1994 to 2010 and matched control participants. Logistic regression models calculated relative risk (RR) and 95% CI, for the first and second halves of follow-up, adjusting for confounding variables. A dataset from the Nurses' Health Study served as a replication cohort. RESULTS The prevalence of the Hp2-2 genotype in HPFS was 39%. Compared with HbA1c <6.5%, the RR of CHD for HbA1c ≥6.5% for the Hp2-2 genotype over full follow-up was 3.07 (95% CI: 1.37 to 6.86) to 3.88 (95% CI: 1.31 to 11.52) during the first half of follow-up and 2.16 (95% CI: 0.61 to 7.61) in the second half. The corresponding RRs for the Hp1-1 + Hp2-1 genotypes were: full follow-up, 2.19 (95% CI: 1.14 to 4.24); first half, 1.60 (95% CI: 0.73 to 3.53); and second half, 4.72 (95% CI: 1.26 to 17.65). CONCLUSIONS In 2 independent cohorts, the risk of CHD associated with HbA1c ≥6.5% is pronounced in the Hp2-2 genotype, particularly in early cases. The Hp2-2 genotype may identify individuals at greatest CHD risk from hyperglycemia.
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Affiliation(s)
- Leah E Cahill
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
| | - Majken K Jensen
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Stephanie E Chiuve
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Hadar Shalom
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Jennifer K Pai
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Alan J Flint
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kathryn M Rexrode
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Andrew P Levy
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Eric B Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Affiliation(s)
- Amanda I Adler
- Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K.
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