1
|
Benedini S, Ermetici F, Briganti S, Codella R, Terruzzi I, Maffi P, Caldara R, Secchi A, Nano R, Piemonti L, Alejandro R, Ricordi C, Luzi L. Insulin-mimetic effects of short-term rapamycin in type 1 diabetic patients prior to islet transplantation. Acta Diabetol 2018; 55:715-722. [PMID: 29654388 DOI: 10.1007/s00592-018-1141-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The immunosuppressive drug rapamycin may influence insulin sensitivity in insulin-responsive tissues. AIMS This study aimed at evaluating the effectiveness of rapamycin pre-treatment before pancreatic islet allotransplantation (ITx) in patients with type 1 diabetes mellitus (T1DM). METHODS Forty-one T1DM patients were studied. Thirteen patients with poor glycemic control underwent a short-term rapamycin treatment before ITx (Group 1), and they were compared to 28 patients undergoing ITx without rapamycin pre-treatment (Group 2). Outcomes were daily insulin requirement (DIR), fasting blood glucose, HbA1c, C-peptide and the SUITO index of beta-cell function. A subgroup of patients pre-treated with rapamycin before ITx underwent euglycemic hyperinsulinemic clamp with [6,6-2H2] glucose before and after ITx to evaluate insulin sensitivity. RESULTS We found a significant reduction in DIR after rapamycin pre-treatment (- 8 ± 6 U/day, mean ± SD, p < 0.001) and 1 year after ITx. DIR reduction 1 year after ITx was greater in Group 1 as compared to Group 2 (- 37 ± 15 vs. - 19 ± 13 U/day, p = 0.005) and remained significant after adjusting for gender, age, glucose and baseline HbA1c (beta = 18.2 ± 5.9, p = 0.006). Fasting glucose and HbA1c significantly decreased 1 year after ITx in Group 1 (HbA1c: - 2.1 ± 1.4%, p = 0.002), while fasting C-peptide (+0.5 ± 0.3 nmol/l, p = 0.002) and SUITO index increased (+57.4 ± 39.7, p = 0.016), without differences between the two groups. Hepatic glucose production decreased after rapamycin pre-treatment (- 1.1 ± 1.1 mg/kg/min, p = 0.04) and after ITx (- 1.6 ± 0.6 mg/kg/min, p = 0.015), while no changes in peripheral glucose disposal were observed. CONCLUSIONS Rapamycin pre-treatment before ITx succeeds in reducing insulin requirement, enhancing hepatic insulin sensitivity. This treatment may improve short-term ITx outcomes, possibly in selected patients with T1DM complicated by insulin resistance. CLINICAL TRIAL Clinicaltrials.gov NCT01060605; NCT00014911.
Collapse
Affiliation(s)
- Stefano Benedini
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - Federica Ermetici
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy
| | - Silvia Briganti
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy
| | - Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ileana Terruzzi
- Diabetes Research Institute, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Maffi
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Rossana Caldara
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Secchi
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Rita Nano
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Piemonti
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Rodolfo Alejandro
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Camillo Ricordi
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Livio Luzi
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
2
|
Prenner G, Wasler A, Fahrleinter-Pammer A, Werkgartner G, Mischinger HJ, Koter S, Roller R, Wagner D. The role of serum albumin in the prediction of malnutrition in patients at least five yr after heart transplantation. Clin Transplant 2014; 28:737-42. [DOI: 10.1111/ctr.12370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Günther Prenner
- Division for Transplantation; Department of Surgery; Medical University of Graz; Graz Austria
| | - Andrä Wasler
- Division for Transplantation; Department of Surgery; Medical University of Graz; Graz Austria
| | - Astrid Fahrleinter-Pammer
- Division for Endocrinology and Nuclear Medicine; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Georg Werkgartner
- Division for General Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Hans Jörg Mischinger
- Division for General Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Stephan Koter
- Division for Vascular Surgery; Department of Sugery; Medical University of Graz; Graz Austria
| | - Regina Roller
- Division for Geriatrics; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Doris Wagner
- Division for General Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| |
Collapse
|
3
|
Guida B, Perrino NR, Laccetti R, Trio R, Nastasi A, Pesola D, Maiello C, Marra C, De Santo LS, Cotrufo M. Role of dietary intervention and nutritional follow-up in heart transplant recipients. Clin Transplant 2009; 23:101-7. [DOI: 10.1111/j.1399-0012.2008.00915.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
4
|
Benedini S, Ruffini E, Terruzzi I, Mancuso M, Luzi L. Glucose and Leucine Metabolism in Lung Tranplanted Patients on Low Dose of Steroids for Immunosuppressive Therapy. Transplant Proc 2008; 40:1566-71. [DOI: 10.1016/j.transproceed.2008.03.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 10/18/2007] [Accepted: 03/06/2008] [Indexed: 11/28/2022]
|
5
|
Benedini S, Fiocchi R, Battezzati A, Serení Piceni L, Gamba A, Mammana C, Bevilacqua M, Perseghin G, Luzi L. Atrial Natriuretic Peptide in Diabetic and Nondiabetic Patients With and Without Heart Transplantation. Transplant Proc 2007; 39:1580-5. [PMID: 17580193 DOI: 10.1016/j.transproceed.2007.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 04/12/2007] [Indexed: 01/16/2023]
Abstract
BACKGROUND Natriuretic peptides are useful markers for risk stratification of patients with heart disease. However, conflicting results have been reported about circulating atrial natriuretic peptide (ANP) concentration in heart transplant recipients. METHODS To ascertain the effects of diabetes and acute insulin administration on plasma ANP concentrations in a model of heart denervation, we studied 12 diabetic (D-OHT) and 6 nondiabetic heart-transplanted (OHT) patients using the euglycemic-hyperinsulinemic clamp and oral glucose tolerance tests. Five patients with type 2 diabetes without heart transplantation (D) and 9 healthy subjects (NOR) matched for anthropometric features served as the controls. RESULTS Means baseline plasma ANP concentration was higher in D-OHT (82 +/- 15 pg/mL) than in OHT or NOR (27 +/- 4 or 30 +/- 5; P < .01), but was not different than D (69 +/- 12; P = .82). During the clamp plasma ANP showed similar increases in all groups (49 +/- 4, 39 +/- 3, 59 +/- 4, and 49 +/- 3% in D-OHT, OHT, D, and NOR; P < .02 vs basal, P = NS among groups). Plasma osmolarity and catecholamines were also not different among groups and did not increase during the clamp. Fasting plasma ANP concentrations correlated with plasma glucose concentrations measured 120 minutes after oral glucose tolerance testing. CONCLUSIONS Among heart transplantation recipients fasting plasma ANP concentrations were not different at 5 to 6 years after the surgical procedure than in nondiabetic controls. Increased ANP concentrations were observed among recipients with diabetes and among nontransplanted diabetic patients. Although the insulin-induced increment in ANP concentrations was not different among groups, circulating ANP was strongly associated with glucose tolerance status.
Collapse
Affiliation(s)
- S Benedini
- Nutrition and Metabolism Unit, San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Lattuada G, Sereni LP, Ruggieri D, Scollo A, Benedini S, Ragogna F, Costantino F, Battezzati A, Luzi L, Perseghin G. Postabsorptive and insulin-stimulated energy homeostasis and leucine turnover in offspring of type 2 diabetic patients. Diabetes Care 2004; 27:2716-22. [PMID: 15505010 DOI: 10.2337/diacare.27.11.2716] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study was performed to ascertain whether insulin resistance with respect to protein metabolism is an additional primary metabolic abnormality affecting insulin-resistant offspring of type 2 diabetic parents, along with insulin resistance with respect to glucose and lipid metabolism. RESEARCH DESIGN AND METHODS We studied 18 young, nonobese offspring of type 2 diabetic parents and 27 healthy matched (by means of dual-energy X-ray absorption) individuals with the bolus plus continuous infusion of [6,6-(2)H(2)]glucose and [1-(13)C]leucine in combination with the insulin clamp (40 mU x m(-2) x min(-1)). RESULTS Fasting plasma leucine, phenylalanine, alanine, and glutamine concentrations, as well as the glucose and leucine turnover (reciprocal pool model: 155 +/- 10 vs. 165 +/- 5 micromol x kg lean body mass(-1) x h(-1) in offspring of type 2 diabetic patients and healthy matched individuals, respectively), were also not different. During the clamp, glucose turnover rates were significantly reduced in offspring of type 2 diabetic patients (7.1 +/- 0.5) in comparison with healthy matched individuals (9.9 +/- 0.6 mg x kg lean body mass(-1) x min(-1); P < 0.01). Also, the suppression of leucine turnover was impaired in offspring of type 2 diabetic patients (12 +/- 1%) in comparison with healthy matched individuals (17 +/- 1%; P = 0.04) and correlated with the degree of the impairment of insulin-stimulated glucose metabolism (R(2) = 0.13; P = 0.02). CONCLUSIONS Nonobese, nondiabetic, insulin-resistant offspring of type 2 diabetic patients were characterized by an impairment of insulin-dependent suppression of protein breakdown, which was proportional to the impairment of glucose metabolism. These results demonstrate that in humans, a primary in vivo impairment of insulin action affects glucose and fatty acid metabolism as previously shown and also protein/amino acid metabolism.
Collapse
Affiliation(s)
- Guido Lattuada
- Istituto Scientifico H San Raffaele, Internal Medicine, Section of Nutrition/Metabolism & Unit of Clinical Spectroscopy via Olgettina 60, 20132, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Luzi L, Picena Sereni L, Battezzati A, Elli A, Soulillou JP, Cantarovich D. Metabolic effects of a corticosteroid-free immunosuppressive regimen in recipients of pancreatic transplant. Transplantation 2003; 75:2018-23. [PMID: 12829904 DOI: 10.1097/01.tp.0000065177.18714.2e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A corticosteroid (CS)-free immunosuppressive regimen may be considered less diabetogenic than treatments including CSs principally after pancreas transplantation. METHODS To test whether a CS-free immunosuppressive treatment is metabolically superior to a regimen including CSs, we prospectively studied 19 CS-free simultaneous pancreas and kidney (SPK) transplant recipients (body mass index=22+/-1 kg/m2; cyclosporine dose=400+/-19 mg/kg/day; azathioprine dose=77+/-8 mg/day; basal plasma C-peptide=1.3+/-0.12 ng/mL) and 12 matched CS-treated SPK transplant recipients (prednisone dose=9+/-1 mg/day; basal C-peptide=2.2+/-0.2 ng/mL) by means of the 6,6-2H(2)-glucose infusion and the euglycemic insulin clamp (1 mU/kg/min, insulin infusion rate). In addition, six renal transplant recipients receiving a CS-free regimen were also studied as a control group. RESULTS In the postabsorptive state, CS-treated SPK transplant recipients demonstrated comparable plasma glucose levels but higher plasma insulin levels than CS-free SPK transplant recipients. Plasma triglyceride levels were significantly higher in CS-treated SPK patients than in CS-free SPK patients (1.16+/-0.16 mg/dL vs. 0.88+/-0.08; P<0.05). High-density lipoprotein and apoprotein A(1) levels were similar in both groups. No difference was observed in pyruvate, lactate, beta-OH-butyrate, and basal endogenous glucose production in all three groups of patients studied. During euglycemic hyperinsulinemia, the inhibition of endogenous glucose production and the stimulation of tissue glucose disposal were not statistically different among the three groups. CONCLUSIONS SPK recipients receiving chronic low-dose CS maintenance therapy do not present a lower glucose disposal than CS-free recipients. Nonetheless, this is obtained at the expense of a higher endogenous insulin secretion, which can cause an alteration of the triglyceride profile.
Collapse
Affiliation(s)
- Livio Luzi
- Department of Medicine, San Raffaele Scientific Institute, Milan, Italy.
| | | | | | | | | | | |
Collapse
|