1
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Uglebjerg N, Ahmadizar F, Aly DM, Cañadas-Garre M, Hill C, Naber A, Oddsson A, Singh SS, Smyth L, Trégouët DA, Chaker L, Ghanbari M, Steinthorsdottir V, Ahlqvist E, Hadjadj S, Van Hoek M, Kavousi M, McKnight AJ, Sijbrands EJ, Stefansson K, Simons M, Rossing P, Ahluwalia TS. Four missense genetic variants in CUBN are associated with higher levels of eGFR in non-diabetes but not in diabetes mellitus or its subtypes: A genetic association study in Europeans. Front Endocrinol (Lausanne) 2023; 14:1081741. [PMID: 36926036 PMCID: PMC10011651 DOI: 10.3389/fendo.2023.1081741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
AIM Rare genetic variants in the CUBN gene encoding the main albumin-transporter in the proximal tubule of the kidneys have previously been associated with microalbuminuria and higher urine albumin levels, also in diabetes. Sequencing studies in isolated proteinuria suggest that these variants might not affect kidney function, despite proteinuria. However, the relation of these CUBN missense variants to the estimated glomerular filtration rate (eGFR) is largely unexplored. We hereby broadly examine the associations between four CUBN missense variants and eGFRcreatinine in Europeans with Type 1 (T1D) and Type 2 Diabetes (T2D). Furthermore, we sought to deepen our understanding of these variants in a range of single- and aggregate- variant analyses of other kidney-related traits in individuals with and without diabetes mellitus. METHODS We carried out a genetic association-based linear regression analysis between four CUBN missense variants (rs141640975, rs144360241, rs45551835, rs1801239) and eGFRcreatinine (ml/min/1.73 m2, CKD-EPIcreatinine(2012), natural log-transformed) in populations with T1D (n ~ 3,588) or T2D (n ~ 31,155) from multiple European studies and in individuals without diabetes from UK Biobank (UKBB, n ~ 370,061) with replication in deCODE (n = 127,090). Summary results of the diabetes-group were meta-analyzed using the fixed-effect inverse-variance method. RESULTS Albeit we did not observe associations between eGFRcreatinine and CUBN in the diabetes-group, we found significant positive associations between the minor alleles of all four variants and eGFRcreatinine in the UKBB individuals without diabetes with rs141640975 being the strongest (Effect=0.02, PeGFR_creatinine=2.2 × 10-9). We replicated the findings for rs141640975 in the Icelandic non-diabetes population (Effect=0.026, PeGFR_creatinine=7.7 × 10-4). For rs141640975, the eGFRcreatinine-association showed significant interaction with albuminuria levels (normo-, micro-, and macroalbuminuria; p = 0.03). An aggregated genetic risk score (GRS) was associated with higher urine albumin levels and eGFRcreatinine. The rs141640975 variant was also associated with higher levels of eGFRcreatinine-cystatin C (ml/min/1.73 m2, CKD-EPI2021, natural log-transformed) and lower circulating cystatin C levels. CONCLUSIONS The positive associations between the four CUBN missense variants and eGFR in a large population without diabetes suggests a pleiotropic role of CUBN as a novel eGFR-locus in addition to it being a known albuminuria-locus. Additional associations with diverse renal function measures (lower cystatin C and higher eGFRcreatinine-cystatin C levels) and a CUBN-focused GRS further suggests an important role of CUBN in the future personalization of chronic kidney disease management in people without diabetes.
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Affiliation(s)
- Nicoline Uglebjerg
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Data Science & Biostatistics, Julius Global Health, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dina M. Aly
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Marisa Cañadas-Garre
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- GENYO Centre for Genomics and Oncological Research, Pfizer-University of Granada-Andalusian Regional Government, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Claire Hill
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Annemieke Naber
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Sunny S. Singh
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Laura Smyth
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - David-Alexandre Trégouët
- University of Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Bordeaux, France
| | - Layal Chaker
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Emma Ahlqvist
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Samy Hadjadj
- Nantes Université, Centre Hospitalier Universitaire Nantes, Centre National de la Recherche Scientifique, INSERM, l’institut du thorax, Nantes, France
| | - Mandy Van Hoek
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Amy Jayne McKnight
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Eric J. Sijbrands
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Kari Stefansson
- deCODE Genetics, Amgen, Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Matias Simons
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Rossing
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tarunveer S. Ahluwalia
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- The Bioinformatics Center, Department of Biology, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Tarunveer S. Ahluwalia,
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2
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Mohammedi K, Marre M, Hadjadj S, Potier L, Velho G. Redox Genetic Risk Score and the Incidence of End-Stage Kidney Disease in People with Type 1 Diabetes. Cells 2022; 11:cells11244131. [PMID: 36552894 PMCID: PMC9777489 DOI: 10.3390/cells11244131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
End-stage kidney disease (ESKD) is a multifactorial condition influenced by genetic background, but the extent to which a genetic risk score (GRS) improves ESKD prediction is unknown. We built a redox GRS on the base of previous association studies (six polymorphisms from six redox genes) and tested its relationship with ESKD in three cohorts of people with type 1 diabetes. Among 1012 participants, ESKD (hemodialysis requirement, kidney transplantation, eGFR < 15 mL/min/1.73 m2) occurred in 105 (10.4%) during a 14-year follow-up. High redox GRS was associated with increased ESKD risk (adjusted HR for the upper versus the lowest GRS tertile: 2.60 (95% CI, 1.51-4.48), p = 0.001). Each additional risk-allele was associated with a 20% increased risk of ESKD (95% CI, 8-33, p < 0.0001). High GRS yielded a relevant population attributable fraction (30%), but only a marginal enhancement in c-statistics index (0.928 [0.903-0.954]) over clinical factors 0.921 (0.892-0.950), p = 0.04). This is the first report of an independent association between redox GRS and increased risk of ESKD in type 1 diabetes. Our results do not support the use of this GRS in clinical practice but provide new insights into the involvement of oxidative stress genetic factors in ESKD risk in type 1 diabetes.
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Affiliation(s)
- Kamel Mohammedi
- Centre Hospitalier de Bordeaux, Department of Endocrinology, Diabetes and Nutrition, University Hospital of Bordeaux, 33604 Pessac, France
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8S 4L8, Canada
- Correspondence:
| | - Michel Marre
- Institut Necker-Enfants Malades, INSERM, Université de Paris, 75013 Paris, France
- Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, 44109 Nantes, France
| | - Louis Potier
- Institut Necker-Enfants Malades, INSERM, Université de Paris, 75013 Paris, France
- Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
- Service d’Endocrinologie Diabétologie Nutrition, Hôpital Bichat, AP-HP, 75013 Paris, France
| | - Gilberto Velho
- Institut Necker-Enfants Malades, INSERM, Université de Paris, 75013 Paris, France
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3
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Sanchez M, Kannengiesser C, Hoang S, Potier L, Fumeron F, Venteclef N, Scheen A, Gautier JF, Hadjadj S, Marre M, Roussel R, Mohammedi K, Velho G. Leukocyte telomere length, allelic variations in related genes and risk of coronary heart disease in people with long-standing type 1 diabetes. Cardiovasc Diabetol 2022; 21:206. [PMID: 36221106 PMCID: PMC9554968 DOI: 10.1186/s12933-022-01635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Type 1 diabetes is associated with accelerated vascular aging and advanced atherosclerosis resulting in increased rates of cardiovascular disease and premature death. We evaluated associations between Leukocyte telomere length (LTL), allelic variations (SNPs) in LTL-related genes and the incidence of coronary heart disease (CHD) in adults with long-standing type 1 diabetes. Methods We assessed associations of LTL, measured at baseline by RT–PCR, and of SNPs in 11 LTL-related genes with the risk of coronary heart disease (CHD: myocardial infarction or coronary revascularization) and all-cause death during follow-up in two multicenter French-Belgian prospective cohorts of people with long-standing type 1 diabetes. Results In logistic and Cox analyses, the lowest tertile of LTL distribution (short telomeres) at baseline was associated with the prevalence of myocardial infarction at baseline and with increased risk of CHD (Hazard ratio 3.14 (1.39–7.70), p = 0.005, for shorter vs longer tertile of LTL) and all-cause death (Hazard ratio 1.63 (95% CI 1.04–2.55), p = 0.03, for shorter vs combined intermediate and longer tertiles of LTL) during follow-up. Allelic variations in six genes related to telomere biology (TERC, NAF1, TERT, TNKS, MEN1 and BICD1) were also associated with the incidence of CHD during follow-up. The associations were independent of sex, age, duration of diabetes, and a range of relevant confounding factors at baseline. Conclusions Our results suggest that short LTL is an independent risk factor for CHD in people with type 1 diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01635-0.
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Affiliation(s)
- Manuel Sanchez
- INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France. .,UFR de Médecine, Université Paris Cité, Paris, France. .,Department of Geriatrics, Assistance Publique - Hôpitaux de Paris, Bichat University Hospital, 46 rue Henri Huchard, 75018, Paris, France.
| | - Caroline Kannengiesser
- UFR de Médecine, Université Paris Cité, Paris, France.,Department of Genetics, Assistance Publique - Hôpitaux de Paris, DHU FIRE, Bichat Hospital, Paris, France
| | - Sophie Hoang
- Department of Geriatrics, Charles-Foix University Hospital, Vitry sur Seine, France
| | - Louis Potier
- INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique - Hôpitaux de Paris, DHU FIRE, Bichat Hospital, Paris, France
| | - Frédéric Fumeron
- INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France
| | - Nicolas Venteclef
- INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France
| | - André Scheen
- Department of Diabetology, Endocrinology and Nutrition, Sart Tilman University Hospital, Liège, Belgium
| | - Jean-François Gautier
- INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique - Hôpitaux de Paris, Lariboisière University Hospital, Paris, France
| | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, CHU Nantes, Université de Nantes, Nantes, France
| | - Michel Marre
- Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Ronan Roussel
- INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique - Hôpitaux de Paris, DHU FIRE, Bichat Hospital, Paris, France
| | - Kamel Mohammedi
- INSERM U1034, Bordeaux University and Hospital, Bordeaux, France
| | - Gilberto Velho
- INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France
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4
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Camoin M, Velho G, Saulnier PJ, Potier L, Abouleka Y, Carpentier C, Dubois S, Larroumet A, Rigalleau V, Gand E, Bourron O, Bordier L, Scheen A, Hadjadj S, Roussel R, Marre M, Mohammedi K. Differential prognostic burden of cardiovascular disease and lower-limb amputation on the risk of all-cause death in people with long-standing type 1 diabetes. Cardiovasc Diabetol 2022; 21:71. [PMID: 35534880 PMCID: PMC9088124 DOI: 10.1186/s12933-022-01487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cardiovascular disease (CVD) and nontraumatic lower-limb amputation (LLA) each results in reduced life expectancy in patients with type 1 diabetes, but the differential burden between these conditions is unknown. We compared the effects of CVD and LLA on the risk of mortality in people with type 1 diabetes. Methods We used pooled data from the SURGENE, GENEDIAB, and GENESIS prospective cohorts. Data were divided into: 1/absence of CVD (myocardial infarction and/or stroke) nor LLA, 2/history of CVD alone without LLA, 3/LLA alone without CVD or 4/both conditions at baseline. Participants with baseline history of peripheral artery disease were excluded from groups 1 and 2. The study endpoint was any death occurring during follow-up, regardless of the causes. Results Among 1169 participants (male 55%, age 40 ± 13 years, diabetes duration 23 ± 11 years), CVD, LLA or both were present at baseline in 49 (4.2%), 62 (5.3%) and 20 (1.7%) subjects, respectively. All-cause death occurred in 304 (26%) participants during 17-year follow-up, corresponding to 18,426 person-years and an incidence rate of 16 (95%CI, 15–18) per 1000 person-years. The risk of death increased in individuals with baseline history of CVD (adjusted HR 2.00 [95% CI 1.34–3.01], p = 0.0008) or LLA (2.26 [1.56–3.28], p < 0.0001), versus no condition, with an additive effect in people with both conditions (5.32 [3.14–9.00], p < 0.0001). No incremental risk of death was observed in people with CVD versus LLA (0.87 [0.54–1.41]). Compared with no condition, CVD and LLA were similarly associated with reduced life expectancy during follow-up: 2.79 (95% CI 1.26–4.32) and 3.38 (1.87–4.88) years, respectively. Combined conditions expose to 7.04 (4.76–9.31) less years of life expectancy (all p < 0.0001). Conclusions CVD and LLA conferred a similar burden regarding mortality in type 1 diabetes population. Our findings encourage a careful consideration of people with type 1 diabetes and LLA as usually recommended for those with CVD, in terms of management of risk factors, treatments and prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01487-8.
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Affiliation(s)
- Marion Camoin
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France
| | | | - Pierre-Jean Saulnier
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.,Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France.,Inserm, CIC 1402, Poitiers, France
| | - Louis Potier
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France.,INEM, INSERM, Université de Paris, Paris, France
| | - Yawa Abouleka
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France
| | - Charlyne Carpentier
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Severine Dubois
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Alice Larroumet
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France
| | - Vincent Rigalleau
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France.,INSERM U1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Elise Gand
- Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
| | - Olivier Bourron
- Service de Diabétologie et Métabolisme, APHP, Groupe Hospitalier La Pitié-Salpêtrière, Sorbonne Université, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Sorbonne Université, Paris, France
| | - Lyse Bordier
- Service d'Endocrinologie, Hôpital Bégin, Saint Mandé, France
| | | | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Ronan Roussel
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France.,INEM, INSERM, Université de Paris, Paris, France
| | - Michel Marre
- INEM, INSERM, Université de Paris, Paris, France.,Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Kamel Mohammedi
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France. .,Faculty of Medicine, University of Bordeaux, Bordeaux, France. .,Biology of Cardiovascular Diseases, INSERM Unit 1034, Pessac, France.
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5
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Wonnacott A, Denby L, Coward RJM, Fraser DJ, Bowen T. MicroRNAs and their delivery in diabetic fibrosis. Adv Drug Deliv Rev 2022; 182:114045. [PMID: 34767865 DOI: 10.1016/j.addr.2021.114045] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/21/2021] [Accepted: 11/04/2021] [Indexed: 12/11/2022]
Abstract
The global prevalence of diabetes mellitus was estimated to be 463 million people in 2019 and is predicted to rise to 700 million by 2045. The associated financial and societal costs of this burgeoning epidemic demand an understanding of the pathology of this disease, and its complications, that will inform treatment to enable improved patient outcomes. Nearly two decades after the sequencing of the human genome, the significance of noncoding RNA expression is still being assessed. The family of functional noncoding RNAs known as microRNAs regulates the expression of most genes encoded by the human genome. Altered microRNA expression profiles have been observed both in diabetes and in diabetic complications. These transcripts therefore have significant potential and novelty as targets for therapy, therapeutic agents and biomarkers.
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Affiliation(s)
- Alexa Wonnacott
- Wales Kidney Research Unit, Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - Laura Denby
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Richard J M Coward
- Bristol Renal, Dorothy Hodgkin Building, Bristol Medical School, University of Bristol, Bristol BS1 3NY, UK
| | - Donald J Fraser
- Wales Kidney Research Unit, Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - Timothy Bowen
- Wales Kidney Research Unit, Division of Infection & Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
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6
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Mohammedi K, Abouleka Y, Carpentier C, Potier L, Dubois S, Foussard N, Rigalleau V, Gautier JF, Gourdy P, Charpentier G, Roussel R, Scheen A, Bauduceau B, Hadjadj S, Alhenc-Gelas F, Marre M, Velho G. Association Between the ACE Insertion/Deletion Polymorphism and Risk of Lower-Limb Amputation in Patients With Long-Standing Type 1 Diabetes. Diabetes Care 2022; 45:407-415. [PMID: 34853028 DOI: 10.2337/dc21-0973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The ACE insertion/deletion (I/D) polymorphism has been widely studied in people with diabetes, albeit not with regard to lower-limb amputation (LLA). We examined associations among this polymorphism, plasma ACE concentration, and LLA in people with type 1 diabetes. RESEARCH DESIGN AND METHODS ACE I/D genotype and plasma ACE were assessed in three prospective cohorts of participants with type 1 diabetes. LLA was defined as minor (below-the-ankle amputation consisting of at least one ray metatarsal resection) or major (transtibial or transfemoral) amputation. Linear, logistic, and Cox regression models were computed to evaluate the likelihood of prevalent and incident LLA by ACE genotype (XD [ID or ID] vs. II) and plasma ACE, after adjusting for confounders. RESULTS Among 1,301 participants (male 54%, age 41 ± 13 years), 90 (6.9%) had a baseline history of LLA. Baseline LLA was more prevalent in XD (7.4%) than in II genotype (4.5%, odds ratio [OR] 2.17 [95 %CI 1.03-4.60]). Incident LLA occurred in 53 individuals during the 14-year follow-up and was higher in XD versus II carriers (hazard ratio 3.26 [95% CI 1.16-13.67]). This association was driven by excess risk of minor, but not major, LLA. The D allele was associated with increased prevalent LLA at the end of follow-up (OR 2.48 [1.33-4.65]). LLA was associated with higher mean (95% CI) ACE levels in II (449 [360, 539] vs. 354 [286, 423] ng/mL), but not XD (512 [454, 570] vs. 537 [488, 586]), carriers. CONCLUSIONS This report is the first of an independent association between ACE D allele and excess LLA risk, mainly minor amputations, in patients with type 1 diabetes.
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Affiliation(s)
- Kamel Mohammedi
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France.,Biology of Cardiovascular Diseases, INSERM U1034, Pessac, France
| | - Yawa Abouleka
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, AP-HP, Paris, France
| | - Charlyne Carpentier
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Louis Potier
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, AP-HP, Paris, France
| | - Severine Dubois
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Ninon Foussard
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Vincent Rigalleau
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Jean-François Gautier
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, AP-HP, Université de Paris, Paris, France
| | - Pierre Gourdy
- Service d'Endocrinologie Diabétologie Nutrition, CHU de Toulouse, Toulouse, France.,Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UPS, Université Toulouse 3, Toulouse, France
| | - Guillaume Charpentier
- 10Center for Study and Research for Improvement of the Treatment of Diabetes, Bioparc-Génopole Évry-Corbeil, Évry, France
| | - Ronan Roussel
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, AP-HP, Paris, France
| | | | | | - Samy Hadjadj
- 13Institut du Thorax, INSERM, CNRS, Université de Nantes, CHU Nantes, Nantes, France
| | - François Alhenc-Gelas
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Michel Marre
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,14Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
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7
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Abouleka Y, Mohammedi K, Carpentier C, Dubois S, Gourdy P, Gautier JF, Roussel R, Scheen A, Alhenc-Gelas F, Hadjadj S, Velho G, Marre M. ACE I/D Polymorphism, Plasma ACE Levels, and Long-term Kidney Outcomes or All-Cause Death in Patients With Type 1 Diabetes. Diabetes Care 2021; 44:1377-1384. [PMID: 33827803 PMCID: PMC8247517 DOI: 10.2337/dc20-3036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The deletion (D) allele of the ACE insertion/deletion (I/D) polymorphism is a risk factor for diabetic kidney disease. We assessed its contribution to long-term kidney outcomes and all-cause death in patients with long-standing type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 1,155 participants from three French and Belgian cohorts were monitored for a median duration of 14 (interquartile range 13) years. The primary outcome was the occurrence of end-stage kidney disease (ESKD) or a 40% drop in the estimated glomerular filtration rate (eGFR). Secondary outcomes were the individual components of the primary outcome, rapid decline in eGFR (steeper than -3 mL/min/1.73 m2 per year), incident albuminuria, all-cause death, and a composite ESKD or all-cause death. Hazard ratios (HRs) for XD versus II genotype and for baseline plasma ACE levels were computed by Cox analysis. Genotype performance in stratifying the primary outcome was tested. RESULTS Genotype distribution was 954 XD and 201 II. The primary outcome occurred in 20% of XD and 13% of II carriers: adjusted HR 2.07 (95% CI 1.32-3.40; P = 0.001). Significant associations were also observed for rapid decline in eGFR, incident albuminuria, ESKD, all-cause death, and ESKD or all-cause death. Baseline plasma ACE levels were higher in XD carriers and significantly associated with an increased risk of the primary outcome. The ACE genotype enhanced net reclassification improvement (0.154, 95% CI 0.007-0.279; P = 0.04) and integrated discrimination improvement (0.012, 95%CI 0.001-0.021; P = 0.02) for primary outcome stratification. CONCLUSIONS The D-allele of the ACE I/D polymorphism was associated with an increased risk of major kidney events and all-cause death in patients with long-standing type 1 diabetes.
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Affiliation(s)
- Yawa Abouleka
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kamel Mohammedi
- Bordeaux University and Hospital, INSERM U1219, Bordeaux, France
| | - Charlyne Carpentier
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Severine Dubois
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Pierre Gourdy
- Service d'Endocrinologie Diabétologie Nutrition, CHU de Toulouse, Toulouse, France.,Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 INSERM/UPS, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Jean-François Gautier
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Ronan Roussel
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - François Alhenc-Gelas
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, Université de Nantes, CHU Nantes, Nantes, France
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Michel Marre
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France .,Clinique Ambroise Paré, Neuilly-sur-Seine, France
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8
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El-Eshmawy MM, Shahin M. Thyroid and Eye: Where They Meet in Clinical Practice. Endocr Metab Immune Disord Drug Targets 2020; 20:39-49. [PMID: 31237221 DOI: 10.2174/1871530319666190618120107] [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: 02/05/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Thyroid Hormones (TH) are essential for normal growth, development and continued optimal function of most of the body organs including the eye. TH signaling plays a central role in the regulation of retinal development and maturation. Deficiency in TH during fetal and early postnatal development impairs growth of the eye and proliferation of all retinal cell types. The present article reviews the most important topics of the different derangements in thyroid function and structure and its relation with eye diseases. METHODS A literature search strategy was conducted for all English-language literature. RESULTS From a clinical practice viewpoint, it should be mentioned that both hypothyroidism and hyperthyroidism are accompanied by ocular diseases i.e. thyroid-associated ophthalmopathy, diabetic retinopathy and age-related macular degeneration. Although the orbit and globe are not common sites for metastatic thyroid cancers, orbital metastasis may be the primary clinical manifestation of thyroid carcinoma. Finally, some medications as amiodarone may be accompanied by both thyroid dysfunction and adverse ocular events. CONCLUSION Thyroid disorders and eye diseases are interrelated through several mechanisms thus, awareness of this relation has a great impact on early diagnosis and treatment.
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Affiliation(s)
- Mervat M El-Eshmawy
- Internal Medicine Department, Mansoura Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Maha Shahin
- Ophthalmology Department, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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9
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Potier L, Roussel R, Marre M, Bjornstad P, Cherney DZ, El Boustany R, Fumeron F, Venteclef N, Gautier JF, Hadjadj S, Mohammedi K, Velho G. Plasma Copeptin and Risk of Lower-Extremity Amputation in Type 1 and Type 2 Diabetes. Diabetes Care 2019; 42:2290-2297. [PMID: 31582427 PMCID: PMC6973542 DOI: 10.2337/dc19-1062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Diabetes is the leading cause of nontraumatic lower-extremity amputations (LEAs). Identification of patients with foot ulcers at risk for amputation remains clinically challenging. Plasma copeptin, a surrogate marker of vasopressin, is associated with the risk of cardiovascular and renal complications in diabetes. RESEARCH DESIGN AND METHODS We assessed the association between baseline plasma copeptin and risk of LEA during follow-up in four cohorts of people with type 1 (GENESIS, n = 503, and GENEDIAB, n = 207) or type 2 diabetes (DIABHYCAR, n = 3,101, and SURDIAGENE, n = 1,452) with a median duration of follow-up between 5 and 10 years. Copeptin concentration was measured in baseline plasma samples by an immunoluminometric assay. RESULTS In the pooled cohorts with type 1 diabetes (n = 710), the cumulative incidence of LEA during follow-up by increasing tertiles (tertile 1 [TER1], TER2, and TER3) of baseline plasma copeptin was 3.9% (TER1), 3.3% (TER2), and 10.0% (TER3) (P = 0.002). Cox regression analyses confirmed the association of copeptin with LEA: hazard ratio (HR) for 1 SD increment of log[copeptin] was 1.89 (95% CI 1.28-2.82), P = 0.002. In the pooled cohorts of type 2 diabetes (n = 4,553), the cumulative incidence of LEA was 1.1% (TER1), 2.9% (TER2), and 3.6% (TER3) (P < 0.0001). In Cox regression analyses, baseline plasma copeptin was significantly associated with LEA: HR for 1 SD increment of log[copeptin] was 1.42 (1.15-1.74), P = 0.001. Similar results were observed in the cohort with type 2 diabetes for lower-limb revascularization (HR 1.20 [95% CI 1.03-1.39], P = 0.02). CONCLUSIONS Baseline plasma copeptin is associated with cumulative incidence of LEA in cohorts of people with both type 1 and type 2 diabetes and may help to identify patients at risk for LEA.
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Affiliation(s)
- Louis Potier
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France .,Université de Paris, Paris, France.,INSERM, UMRS 1138, Cordeliers Research Center, Paris, France
| | - Ronan Roussel
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France.,INSERM, UMRS 1138, Cordeliers Research Center, Paris, France
| | - Michel Marre
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France.,INSERM, UMRS 1138, Cordeliers Research Center, Paris, France.,Section of Endocrinology, Department of Pediatrics, and Division of Nephrology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Petter Bjornstad
- Section of Endocrinology, Department of Pediatrics, and Division of Nephrology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - David Z Cherney
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ray El Boustany
- Department of Diabetology, Endocrinology and Nutrition, DHU FIRE, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM, UMRS 1138, Cordeliers Research Center, Paris, France
| | - Frédéric Fumeron
- Université de Paris, Paris, France.,INSERM, UMRS 1138, Cordeliers Research Center, Paris, France
| | | | - Jean-François Gautier
- Université de Paris, Paris, France.,INSERM, UMRS 1138, Cordeliers Research Center, Paris, France.,Department of Diabetes, Clinical Investigation Centre (CIC-9504), Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Samy Hadjadj
- L'Institut du thorax, INSERM, CNRS, Université de Nantes, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Kamel Mohammedi
- Department of Diabetology, Endocrinology and Nutrition, Hôpital Haut-Lévêque, Bordeaux, France.,Bordeaux University, Bordeaux, France.,INSERM U1219 "Bordeaux Population Health," Bordeaux, France
| | - Gilberto Velho
- INSERM, UMRS 1138, Cordeliers Research Center, Paris, France
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10
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Skupien J, Smiles AM, Valo E, Ahluwalia TS, Gyorgy B, Sandholm N, Croall S, Lajer M, McDonnell K, Forsblom C, Harjutsalo V, Marre M, Galecki AT, Tregouet DA, Wu CY, Mychaleckyj JC, Nickerson H, Pragnell M, Rich SS, Pezzolesi MG, Hadjadj S, Rossing P, Groop PH, Krolewski AS. Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an International Study of Patients With Type 1 Diabetes and Advanced Nephropathy. Diabetes Care 2019; 42:93-101. [PMID: 30455333 PMCID: PMC6300701 DOI: 10.2337/dc18-1369] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/27/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with type 1 diabetes and diabetic nephropathy are targets for intervention to reduce high risk of end-stage renal disease (ESRD) and deaths. This study compares risks of these outcomes in four international cohorts. RESEARCH DESIGN AND METHODS In the 1990s and early 2000s, Caucasian patients with type 1 diabetes with persistent macroalbuminuria in chronic kidney disease stages 1-3 were identified in the Joslin Clinic (U.S., 432), Finnish Diabetic Nephropathy Study (FinnDiane) (Finland, 486), Steno Diabetes Center Copenhagen (Denmark, 368), and INSERM (France, 232) and were followed for 3-18 years with annual creatinine measurements to ascertain ESRD and deaths unrelated to ESRD. RESULTS During 15,685 patient-years, 505 ESRD cases (rate 32/1,000 patient-years) and 228 deaths unrelated to ESRD (rate 14/1,000 patient-years) occurred. Risk of ESRD was associated with male sex; younger age; lower estimated glomerular filtration rate (eGFR); higher albumin/creatinine ratio, HbA1c, and systolic blood pressure; and smoking. Risk of death unrelated to ESRD was associated with older age, smoking, and higher baseline eGFR. In adjusted analysis, ESRD risk was highest in Joslin versus reference FinnDiane (hazard ratio [HR] 1.44, P = 0.003) and lowest in Steno (HR 0.54, P < 0.001). Differences in eGFR slopes paralleled risk of ESRD. Mortality unrelated to ESRD was lowest in Joslin (HR 0.68, P = 0.003 vs. the other cohorts). Competing risk did not explain international differences in the outcomes. CONCLUSIONS Despite almost universal renoprotective treatment, progression to ESRD and mortality in patients with type 1 diabetes with advanced nephropathy are still very high and differ among countries. Finding causes of these differences may help reduce risk of these outcomes.
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Affiliation(s)
- Jan Skupien
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland .,Research Division, Joslin Diabetes Center, Boston, MA
| | - Adam M Smiles
- Research Division, Joslin Diabetes Center, Boston, MA
| | - Erkka Valo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | | | - Beata Gyorgy
- Sorbonne Université, Université Pierre-et-Marie-Curie (UPMC) Paris 06 INSERM UMR_S 1166, and Department of Genomics and Pathophysiology of Cardiovascular Diseases, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Niina Sandholm
- Folkhälsan Institute of Genetics, Folkhälsan Research Center; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | | | - Maria Lajer
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | | | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Michel Marre
- Diabetes Department, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, Université Denis Diderot Paris 7 and INSERM U1138, Paris, France
| | - Andrzej T Galecki
- Institute of Gerontology, University of Michigan Medical School, Ann Arbor, MI.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - David-Alexandre Tregouet
- Sorbonne Université, Université Pierre-et-Marie-Curie (UPMC) Paris 06 INSERM UMR_S 1166, and Department of Genomics and Pathophysiology of Cardiovascular Diseases, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Chun Yi Wu
- Institute of Gerontology, University of Michigan Medical School, Ann Arbor, MI
| | - Josyf C Mychaleckyj
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | | | | | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Marcus G Pezzolesi
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, UT
| | - Samy Hadjadj
- INSERM CIC 1402 and U 1082, and Department of Endocrinology and Diabetology, CHU Poitiers, Poitiers, France.,Department of Endocrinology, L'institut du thorax, CIC 1413 INSERM, CHU Nantes, Nantes, France
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrzej S Krolewski
- Research Division, Joslin Diabetes Center, Boston, MA .,Department of Medicine, Harvard Medical School, Boston, MA
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11
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Nicolas A, Mohammedi K, Bastard JP, Fellahi S, Bellili-Muñoz N, Roussel R, Hadjadj S, Marre M, Velho G, Fumeron F. T-cadherin gene variants are associated with nephropathy in subjects with type 1 diabetes. Nephrol Dial Transplant 2018; 32:1987-1993. [PMID: 28499019 DOI: 10.1093/ndt/gfx071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/16/2017] [Indexed: 01/08/2023] Open
Abstract
Background High plasma adiponectin levels are associated with diabetic nephropathy (DN). T-cadherin gene (CDH13) variants have been shown to be associated with adiponectin levels. We investigated associations between allelic variations of CDH13 and DN in subjects with type 1 diabetes. Methods Two CDH13 polymorphisms were analysed in 1297 Caucasian subjects with type 1 diabetes from the 'Survival Genetic Nephropathy' (SURGENE) (n = 340, 10-year follow-up), 'Genesis France-Belgium' (GENESIS) (n = 501, 5-year follow-up for n = 462) and 'Génétique de la Néphropathie Diabétique' (GENEDIAB) (n = 456, 9-year follow-up for n = 283) cohorts. Adiponectin levels were measured in plasma samples from GENESIS and GENEDIAB cohorts. Results Pooled analysis of GENEDIAB and GENESIS studies showed that baseline plasma adiponectin levels were higher in subjects with established/advanced DN at inclusion (P < 0.0001) and in subjects who developed end-stage renal disease (ESRD) at follow-up (P < 0.0001). The minor allele of rs3865188 was associated with lower adiponectin levels (P = 0.006). rs11646213 [odds ratio (OR) 1.47; 95% confidence interval (CI) 1.18-1.85; P = 0.0009] and rs3865188 (OR 0.71; 95% CI 0.57-0.90; P = 0.004) were associated with baseline prevalence of established/advanced DN. These polymorphisms were also associated with the risk of ESRD (0.006 < P < 0.03). The association between rs11646213 (but not rs3865188) and renal function remained significant after adjustment for plasma adiponectin. In SURGENE, rs11646213 [hazard ratio (HR) 1.69; 95% CI 1.01-2.71; P = 0.04] and rs3865188 (HR 0.74; 95% CI 0.55-0.99; P = 0.04) were associated with risk of renal events (defined as progression to more severe DN stages). Conclusions Plasma adiponectin levels are associated with the prevalence of DN and the incidence of ESRD in patients with type 1 diabetes. CDH13 polymorphisms are also associated with the prevalence and incidence of DN, and with the incidence of ESRD in these patients. The association between CDH13 and DN may be due to pleiotropic effects, both dependent and independent of plasma adiponectin levels.
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Affiliation(s)
- Anthony Nicolas
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1138, Centre de Recherche des Cordeliers, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Kamel Mohammedi
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Bastard
- Biochemistry and Hormonology Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Soraya Fellahi
- Biochemistry and Hormonology Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Ronan Roussel
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1138, Centre de Recherche des Cordeliers, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samy Hadjadj
- Université de Poitiers, UFR Médecine Pharmacie, CIC1402, Poitiers, France.,Department of Diabetology and Endocrinology, Pole DUNE & Centre d'investigation clinique, University Hospital, Poitiers, France.,INSERM, CIC1402, Poitiers, France
| | - Michel Marre
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilberto Velho
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France
| | - Frédéric Fumeron
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1138, Centre de Recherche des Cordeliers, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
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12
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Sanchez M, Roussel R, Hadjadj S, Moutairou A, Marre M, Velho G, Mohammedi K. Plasma concentrations of 8-hydroxy-2'-deoxyguanosine and risk of kidney disease and death in individuals with type 1 diabetes. Diabetologia 2018; 61:977-984. [PMID: 29185011 DOI: 10.1007/s00125-017-4510-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/01/2017] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS Oxidative stress is involved in the pathogenesis of diabetic kidney disease. We evaluated the association between 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of DNA oxidative damage, and end-stage renal disease (ESRD) or death in individuals with type 1 diabetes. METHODS Plasma 8-OHdG concentrations were measured at baseline in participants with type 1 diabetes from GENEDIAB (n = 348) and GENESIS (n = 571) cohorts. A follow-up was conducted in 205 and 499 participants for a mean ± SD duration of 8.9 ± 2.3 years and 5.2 ± 1.9 years, respectively. We tested associations between 8-OHdG concentrations and urinary albumin concentration (UAC) or eGFR at baseline, and the risk of ESRD or all-cause mortality during follow-up. Analyses were performed in pooled cohorts. RESULTS The highest UAC (geometric mean [95% CI]) was observed in the third 8-OHdG tertile (tertile 1, 9 [6, 13] mg/l; tertile 2, 10 [7, 16] mg/l; tertile 3, 16 [10, 25] mg/l; p = 0.36 for tertile 1 vs tertile 2 and p = 0.003 for tertile 3 vs tertile 1) after adjustment for potential confounding covariates. The lowest eGFR (mean [95% CI]) was observed in the third tertile (tertile 1, 87 [82, 93] ml min-1 1.73 m-2; tertile 2, 88 [82, 94] ml min-1 1.73 m-2; tertile 3, 74 [68, 80] ml min-1 1.73 m-2; p = 0.61 for tertile 1 vs tertile 2; p < 0.001 for tertile 3 vs tertile 1). ESRD and death occurred in 48 and 64 individuals, respectively. The HR for ESRD, but not death, was higher in the third tertile than in the first (tertile 2 vs tertile 1, 1.45 [0.45, 5.04], p = 0.54; tertile 3 vs tertile 1, 3.05 [1.16, 9.60], p = 0.02) after multiple adjustments. CONCLUSIONS/INTERPRETATION Higher plasma concentrations of 8-OHdG were independently associated with increased risk of kidney disease in individuals with type 1 diabetes, suggesting that this marker can be used to evaluate the progression of diabetic kidney disease.
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Affiliation(s)
- Manuel Sanchez
- Inserm, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Geriatric Medicine, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Ronan Roussel
- Inserm, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, 46 rue Henri Huchard, 75877, Paris Cedex 18, France
| | - Samy Hadjadj
- Department of Endocrinology and Diabetology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Inserm, Research Unit 1082, Poitiers, France
- Université de Poitiers, UFR de Médecine et Pharmacie, Poitiers, France
| | - Abdul Moutairou
- Inserm, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Michel Marre
- Inserm, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, 46 rue Henri Huchard, 75877, Paris Cedex 18, France
| | - Gilberto Velho
- Inserm, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Kamel Mohammedi
- Inserm, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.
- Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, 46 rue Henri Huchard, 75877, Paris Cedex 18, France.
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13
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Marcovecchio ML, Tossavainen PH, Owen K, Fullah C, Benitez-Aguirre P, Masi S, Ong K, Nguyen H, Chiesa ST, Dalton RN, Deanfield J, Dunger DB. Clustering of cardio-metabolic risk factors in parents of adolescents with type 1 diabetes and microalbuminuria. Pediatr Diabetes 2017; 18:947-954. [PMID: 28271589 PMCID: PMC6186416 DOI: 10.1111/pedi.12515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/12/2017] [Accepted: 02/06/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the association between a clustering of cardio-metabolic risk factors in parents and the development of microalbuminuria (MA) in their offspring with childhood-onset type 1 diabetes (T1D). METHODS The study population comprised 53 parents (mean age [±SD]: 56.7±6.2 years) of 35 T1D young people with MA (MA+) and 86 parents (age: 56.1±6.3 years) of 50 matched offspring with normoalbuminuria (MA-), who underwent clinical, biochemical and cardiovascular imaging assessments. The primary study endpoint was the difference between parents from the MA+ and MA- groups in a cardio-metabolic risk score, calculated as the average value of the standardized measures (z-scores) for waist circumference, blood pressure, fasting glucose, insulin, HDL-cholesterol and triglycerides levels. Cardiovascular parameters, including carotid intima-media thickness (cIMT), flow-mediated dilatation (FMD) and pulse wave velocity (PWV), were also assessed. A DXA scan was performed to assess body composition. RESULTS The cardio-metabolic risk score was significantly higher in parents of MA+ compared to parents of MA- offspring (mean [95% CI]: 1.066[0.076; 2.056] vs -0.268[-0.997; 0.460], P = .03). Parents of MA+ offspring had slightly higher values of waist circumference, lipids, insulin and blood pressure, although only diastolic blood pressure was statistically different between the 2 groups (P = .0085). FMD, cIMT, PWV (all P > .3), and DXA parameters (all P > .2) were not significantly different between the 2 groups. CONCLUSIONS Parents of young offspring with childhood-onset T1D and MA showed an abnormal metabolic profile, reflected by a calculated risk score. The finding supports the role of a familial predisposition to risk of developing diabetic nephropathy.
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Affiliation(s)
| | - Päivi H Tossavainen
- Department of Paediatrics, PEDEGO Research Unit and Medical Research Centre Oulu, Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Katharine Owen
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK
| | - Catherine Fullah
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, University of Sydney, Sydney, Australia
| | - Stefano Masi
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Ken Ong
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Helen Nguyen
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Scott T Chiesa
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - R Neil Dalton
- WellChild Laboratory, King's College London, Evelina Children's Hospital, London, UK
| | - John Deanfield
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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14
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Velho G, El Boustany R, Lefèvre G, Mohammedi K, Fumeron F, Potier L, Bankir L, Bouby N, Hadjadj S, Marre M, Roussel R. Plasma Copeptin, Kidney Outcomes, Ischemic Heart Disease, and All-Cause Mortality in People With Long-standing Type 1 Diabetes. Diabetes Care 2016; 39:2288-2295. [PMID: 27729425 DOI: 10.2337/dc16-1003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 09/17/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Plasma copeptin, a surrogate for vasopressin, has been associated with a decline in renal function and albuminuria in population-based studies as well as with progression of diabetic nephropathy in people with type 2 diabetes. We assessed the risk of kidney and coronary events and all-cause mortality associated with plasma copeptin in people with type 1 diabetes. RESEARCH DESIGN AND METHODS Plasma copeptin was measured in baseline samples of the GENEDIAB (n = 398; 56% male; mean ± SD age 45 ± 12 years and diabetes duration 28 ± 10 years) and GENESIS (n = 588; 52% male; age 42 ± 11 years; diabetes duration 27 ± 9 years) cohorts. Follow-up data were available for 218 GENEDIAB and 518 GENESIS participants. Median duration of follow-up was 10.2 and 5.0 years, respectively. RESULTS Upper sex-specific tertiles of copeptin were associated with a higher incidence of end-stage renal disease (ESRD) during follow-up (hazard ratio [HR] for third vs. first tertile 26.5 [95% CI 8.0-163.3; P < 0.0001]; analysis in pooled cohorts adjusted for age, sex, duration of diabetes, and cohort membership). The highest tertile of copeptin was also associated with incidence of myocardial infarction or coronary revascularization (HR 2.2 [95% CI 1.2-4.0]; P = 0.01) and all-cause mortality (HR 3.3 [95% CI 1.8-6.5]; P < 0.0001) during follow-up. CONCLUSIONS Plasma copeptin is a predictor for the risk of ESRD, coronary heart disease, and all-cause mortality in people with type 1 diabetes. Results are consistent with data from experimental and epidemiological studies, suggesting that high circulating levels of vasopressin are deleterious to renal function.
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Affiliation(s)
- Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Ray El Boustany
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Guillaume Lefèvre
- Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Est Parisien-Tenon, Service de Biochimie et Hormonologie, Paris, France
| | - Kamel Mohammedi
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Départment de Diabétologie, Endocrinologie et Nutrition, Paris, France
| | - Frédéric Fumeron
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Louis Potier
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Départment de Diabétologie, Endocrinologie et Nutrition, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Lise Bankir
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Nadine Bouby
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Samy Hadjadj
- Départment de Endocrinologie et Diabétologie, CHU de Poitiers, Poitiers, France.,INSERM, Unité de Recherche 1082, Poitiers, France.,INSERM, CIC 1402, Poitiers, France.,Université de Poitiers, UFR de Médecine et Pharmacie, Poitiers, France
| | - Michel Marre
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Départment de Diabétologie, Endocrinologie et Nutrition, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Ronan Roussel
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Départment de Diabétologie, Endocrinologie et Nutrition, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
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15
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Sandholm N, Van Zuydam N, Ahlqvist E, Juliusdottir T, Deshmukh HA, Rayner NW, Di Camillo B, Forsblom C, Fadista J, Ziemek D, Salem RM, Hiraki LT, Pezzolesi M, Trégouët D, Dahlström E, Valo E, Oskolkov N, Ladenvall C, Marcovecchio ML, Cooper J, Sambo F, Malovini A, Manfrini M, McKnight AJ, Lajer M, Harjutsalo V, Gordin D, Parkkonen M, Tuomilehto J, Lyssenko V, McKeigue PM, Rich SS, Brosnan MJ, Fauman E, Bellazzi R, Rossing P, Hadjadj S, Krolewski A, Paterson AD, Florez JC, Hirschhorn JN, Maxwell AP, Dunger D, Cobelli C, Colhoun HM, Groop L, McCarthy MI, Groop PH. The Genetic Landscape of Renal Complications in Type 1 Diabetes. J Am Soc Nephrol 2016; 28:557-574. [PMID: 27647854 DOI: 10.1681/asn.2016020231] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/17/2016] [Indexed: 12/14/2022] Open
Abstract
Diabetes is the leading cause of ESRD. Despite evidence for a substantial heritability of diabetic kidney disease, efforts to identify genetic susceptibility variants have had limited success. We extended previous efforts in three dimensions, examining a more comprehensive set of genetic variants in larger numbers of subjects with type 1 diabetes characterized for a wider range of cross-sectional diabetic kidney disease phenotypes. In 2843 subjects, we estimated that the heritability of diabetic kidney disease was 35% (P=6.4×10-3). Genome-wide association analysis and replication in 12,540 individuals identified no single variants reaching stringent levels of significance and, despite excellent power, provided little independent confirmation of previously published associated variants. Whole-exome sequencing in 997 subjects failed to identify any large-effect coding alleles of lower frequency influencing the risk of diabetic kidney disease. However, sets of alleles increasing body mass index (P=2.2×10-5) and the risk of type 2 diabetes (P=6.1×10-4) associated with the risk of diabetic kidney disease. We also found genome-wide genetic correlation between diabetic kidney disease and failure at smoking cessation (P=1.1×10-4). Pathway analysis implicated ascorbate and aldarate metabolism (P=9.0×10-6), and pentose and glucuronate interconversions (P=3.0×10-6) in pathogenesis of diabetic kidney disease. These data provide further evidence for the role of genetic factors influencing diabetic kidney disease in those with type 1 diabetes and highlight some key pathways that may be responsible. Altogether these results reveal important biology behind the major cause of kidney disease.
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Affiliation(s)
- Niina Sandholm
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Natalie Van Zuydam
- Wellcome Trust Centre for Human Genetics,Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom.,Medical Research Institute
| | - Emma Ahlqvist
- Department of Clinical Sciences, Diabetes and Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | - Harshal A Deshmukh
- Division of Population Health Sciences, University of Dundee, Dundee, United Kingdom
| | - N William Rayner
- Wellcome Trust Centre for Human Genetics,Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom.,Human Genetics, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Joao Fadista
- Department of Clinical Sciences, Diabetes and Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Daniel Ziemek
- Computational Sciences, Pfizer Worldwide Research and Development, Berlin, Germany
| | - Rany M Salem
- Departments of Genetics,Programs in Metabolism and Medical and Population Genetics, Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts.,Divisions of Endocrinology and Genetics, Boston Children's Hospital, Boston, Massachusetts
| | - Linda T Hiraki
- Genetics and Genome Biology Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marcus Pezzolesi
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, Massachusetts
| | - David Trégouët
- Sorbonne Universities, Pierre et Marie Curie University (UPMC) and National Institute for Health and Medical Research, Mixed Research Unit in Health (UMR_S) 1166, Paris, France.,Institute for Cardiometabolism and Nutrition, Genomics and pathophysiology of Cardiovascular diseases, Paris, France
| | - Emma Dahlström
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Erkka Valo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Nikolay Oskolkov
- Department of Clinical Sciences, Diabetes and Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Claes Ladenvall
- Department of Clinical Sciences, Diabetes and Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | - Jason Cooper
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Francesco Sambo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Alberto Malovini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy.,Laboratory of Informatics and Systems Engineering for Clinical Research, Scientific Institute for Research, Hospitalization and Health Care, IRCCS (Instituto di Ricovero e Cura a Carattere Scientifico); Salvatore Maugeri Foundation, Pavia, Italy
| | - Marco Manfrini
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Amy Jayne McKnight
- Nephrology Research, Centre for Public Health, Queen's University of Belfast, Belfast, United Kingdom
| | - Maria Lajer
- Diabetic Complications, Steno Diabetes Center, Gentofte, Denmark
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,The Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Maija Parkkonen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | | | - Jaakko Tuomilehto
- The Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Centre for Vascular Prevention, Danube University Krems, Krems, Austria
| | - Valeriya Lyssenko
- Department of Clinical Sciences, Diabetes and Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden.,Diabetic Complications, Steno Diabetes Center, Gentofte, Denmark
| | - Paul M McKeigue
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | | | - Eric Fauman
- Computational Sciences, Pfizer Worldwide Research and Development, Cambridge, Massachusetts
| | - Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Peter Rossing
- Diabetic Complications, Steno Diabetes Center, Gentofte, Denmark.,Department of Health, Aarhus University, Aarhus, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Samy Hadjadj
- Functional Research Unit of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Department of Endocrinology-Diabetology and Center of Clinical Investigation, Poitiers University Hospital, Poitiers, France.,Institute National pour la Santé et la Recherche Médicale, National Institute for Health and Medical Research, Center of Clinical Investigation 1402 and Unit 1082, Poitiers, France
| | - Andrzej Krolewski
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, Massachusetts
| | - Andrew D Paterson
- Genetics and Genome Biology Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Jose C Florez
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts.,Diabetes Unit and Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts
| | - Joel N Hirschhorn
- Departments of Genetics,Programs in Metabolism and Medical and Population Genetics, Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts.,Divisions of Endocrinology and Genetics, Boston Children's Hospital, Boston, Massachusetts
| | - Alexander P Maxwell
- Nephrology Research, Centre for Public Health, Queen's University of Belfast, Belfast, United Kingdom.,Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom; and
| | | | - David Dunger
- Department of Paediatrics, Institute of Metabolic Science, and
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Helen M Colhoun
- Division of Population Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Leif Groop
- Department of Clinical Sciences, Diabetes and Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Mark I McCarthy
- Wellcome Trust Centre for Human Genetics,Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom.,Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Baker IDI (International Diabetes Institute) Heart and Diabetes Institute, Melbourne, Victoria, Australia
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16
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Mohammedi K, Patente TA, Bellili-Muñoz N, Driss F, Le Nagard H, Fumeron F, Roussel R, Hadjadj S, Corrêa-Giannella ML, Marre M, Velho G. Glutathione peroxidase-1 gene (GPX1) variants, oxidative stress and risk of kidney complications in people with type 1 diabetes. Metabolism 2016; 65:12-9. [PMID: 26773925 DOI: 10.1016/j.metabol.2015.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Glutathione peroxidase (GPX) is a class of antioxidant enzymes that catalyze the reduction of hydrogen peroxide to water. GPX1 is the most abundant isoform and is expressed in all kidney cells. Isoprostane and advanced oxidation protein products (AOPP) were identified as markers of oxidative stress in patients with kidney disease. We investigated associations of GPX1 genotypes with kidney complications, and with plasma concentrations of isoprostane and AOPP in type 1 diabetic patients. METHODS Four SNPs in the GPX1 gene region were genotyped in SURGENE (n=340; 10-year follow-up); GENEDIAB (n=461) and GENESIS (n=584) cohorts of type 1 diabetic patients. Subsets of GENEDIAB (n=237) and GENESIS (n=466) participants were followed up for 9 and 5years, respectively. Plasma concentrations of isoprostane and AOPP were measured at baseline in GENEDIAB. Hazard ratios (HR) were estimated for incidence of kidney complications. RESULTS In SURGENE, 98 renal events (new cases of microalbuminuria or progression to more severe stage of diabetic nephropathy) occurred during follow-up. The minor T-allele of rs3448 was associated with the incidence of renal events (HR 1.81, 95% CI 1.16-2.84, p=0.008). In GENESIS/GENEDIAB pooled study, end stage renal disease (ESRD) occurred during follow-up in 52 individuals. The same variant was associated with the incidence of ESRD (HR 3.34, 95% CI, 1.69-6.98, p=0.0004). The variant was also associated with higher plasma isoprostane concentration in GENEDIAB cohort: 2.02±0.12 (TT+CT) vs 1.75±0.13 (CC) ng/mL (p=0.009), and with higher plasma AOPP in the subset of participants with the baseline history of ESRD (TT+CT 67±6 vs CC 48±6μmol/L, p=0.006). CONCLUSIONS The minor T-allele of rs3448 was associated with kidney complications (incidences of microalbuminuria, renal events and ESRD) in patients with type 1 diabetes. The risk allele was associated with higher plasma concentrations of isoprostane and AOPP. Our results are consistent with the implication of GPX1 in the mechanism of renal protection against oxidative stress in type 1 diabetic patients.
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Affiliation(s)
- Kamel Mohammedi
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018, Paris, France
| | - Thiago A Patente
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil
| | - Naima Bellili-Muñoz
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France
| | - Fathi Driss
- INSERM, Research Unit 773, 16 rue Henri Huchard, 75018, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, Department of Biochemistry, 46 rue Henri Huchard, 75018, Paris, France
| | - Hervé Le Nagard
- INSERM, Research Unit 1137 - IAME, 16 rue Henri Huchard, 75018, Paris, France
| | - Frédéric Fumeron
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018, Paris, France
| | - Ronan Roussel
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018, Paris, France
| | - Samy Hadjadj
- Centre Hospitalier Universitaire de Poitiers, Department of Endocrinology and Diabetology, 2 rue de la Milétrie, 86021, Poitiers, France; INSERM, Research Unit 1082, 2 rue de la Milétrie, 86021, Poitiers, France; INSERM, CIC 1402, 2 rue de la Milétrie, 86021, Poitiers, France; Université de Poitiers, UFR de Médecine et Pharmacie, 6 rue de la Milétrie, 86073, Poitiers, France
| | - Maria Lúcia Corrêa-Giannella
- Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil; Centro de Terapia Celular e Molecular (NUCEL/NETCEM) da FMUSP, Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil
| | - Michel Marre
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018, Paris, France
| | - Gilberto Velho
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France.
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17
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Mohammedi K, Potier L, Belhatem N, Matallah N, Hadjadj S, Roussel R, Marre M, Velho G. Lower-extremity amputation as a marker for renal and cardiovascular events and mortality in patients with long standing type 1 diabetes. Cardiovasc Diabetol 2016; 15:5. [PMID: 26743116 PMCID: PMC4705699 DOI: 10.1186/s12933-015-0322-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated the risks of renal and cardiovascular complications, and mortality associated with lower extremity amputation (LEA) in patients with type 1 diabetes. Methods We studied two cohorts of people with long standing type 1 diabetes: GENEDIAB (n = 456) and GENESIS (n = 611). Subsets of the cohorts (n = 260, n = 544) were followed for 9 and 5 years, respectively. Outcomes were the incidence of end stage renal disease (ESRD), myocardial infarction, stroke and mortality during follow-up. Analyses were performed in pooled cohorts. Results The prevalence of LEA at baseline was 9.3 % (n = 99). A positive history of LEA was associated with the baseline prevalence of established (OR 4.50, 95 % CI 2.33–8.91, p < 0.0001) and advanced diabetic nephropathy (OR 5.50, 95 % CI 2.89–10.78, p < 0.0001), ESRD (OR 2.86, 95 % CI 1.43–5.50, p = 0.004), myocardial infarction (OR 3.25, 95 % CI 1.68–6.15, p = 0.0006) and stroke (OR 3.88, 95 % CI 1.67–8.72, p = 0.002, adjusted for sex, age, and cohort membership). A positive history of LEA at baseline was associated with the incidence during follow-up of ESRD (HR 2.69, 95 % CI 1.17–6.20, p = 0.02), and myocardial infarction (HR 3.53, 95 % CI 1.79–6.97, p = 0.0001). History of LEA was also associated with increased risk for all-cause (HR 3.55, 95 % CI 2.05–6.16, p < 0.0001), cardiovascular (HR 3.30, 95 % CI 1.36–8.02, p = 0.008), infectious disease (HR 5.18, 95 % CI 1.13–23.84, p = 0.03) and other-cause mortality (HR 2.81, 95 % CI 1.09–7.26, p = 0.03). History of LEA at baseline was associated with a 40 % reduction in the duration of survival in the subset of patients who died during follow-up. Population attributable risk of the history of LEA at baseline for total mortality during follow-up was 0.31. Conclusions Patients with LEA have a higher risk of ESRD, myocardial infarction and cardiovascular and non-cardiovascular mortality. Our results highlight the importance of LEA as a key-predictor for major vascular events and premature death in type 1 diabetic patients. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0322-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kamel Mohammedi
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. .,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France.
| | - Louis Potier
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. .,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France. .,Univ Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France.
| | - Narimène Belhatem
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. .,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France.
| | - Nadia Matallah
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. .,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France.
| | - Samy Hadjadj
- Department of Endocrinology and Diabetology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France. .,INSERM, Research Unit 1082, Poitiers, France. .,INSERM, CIC 1402, Poitiers, France. .,UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.
| | - Ronan Roussel
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. .,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France. .,Univ Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France.
| | - Michel Marre
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. .,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France. .,Univ Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France.
| | - Gilberto Velho
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.
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Chen CC, Susanto H, Chuang WH, Liu TY, Wang CH. Higher serum betatrophin level in type 2 diabetes subjects is associated with urinary albumin excretion and renal function. Cardiovasc Diabetol 2016; 15:3. [PMID: 26739836 PMCID: PMC4704426 DOI: 10.1186/s12933-015-0326-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Betatrophin is a newly identified liver-derived hormone that is associated with glucose homeostasis and lipid metabolism. Although dysregulated lipid metabolism results in diabetic nephropathy (DN) development in patients with type 2 diabetes mellitus (T2DM), it is not understood whether betatrophin is associated with urinary albumin excretion and renal function. METHODS Based on albumin/creatinine ratio (ACR), 109 T2DM patients were divided into normoalbuminuria (ACR <30 mg/g), microalbuminuria (ACR between 30 and 300 mg/g), and macroalbuminuria (ACR > 300 mg/g). Serum betatrophin levels of 109 T2DM patients and 32 healthy subjects were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS Serum level of betatrophin was significantly increased in T2DM patients with normoalbuminuria, microalbuminuria, and macroalbuminuria as compared with healthy subjects (P < 0.001). Serum betatrophin level was positively correlated with sex, duration of diabetes, systolic blood pressure (SBP), body mass index (BMI), ACR, and triglyceride, whereas it was inversely correlated with estimated glomerular filtration rate (eGFR), total cholesterol, and high-density lipoprotein cholesterol (HDL-C) (P < 0.001). Furthermore, multivariate regression analysis showed the betatrophin was significantly and positively independent with triglyceride and low-density lipoprotein cholesterol (LDL-C) (P < 0.05), whereas it was inversely independent with eGFR, total cholesterol, and low-density lipoprotein cholesterol (HDL-C) (P < 0.05). In addition, the betatrophin had higher odds of having DN [odds ratio (OR) = 5.65, 95 % confidence interval (CI) 2.17-14.57, P < 0.001]. CONCLUSION Betatrophin is significantly increased in T2DM patients with different stages of albuminuria. Betatrophin may be a novel endocrine regulator involved in DN development.
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Affiliation(s)
- Chang-Chiang Chen
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan
| | - Hendra Susanto
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan
| | - Wen-Han Chuang
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan
| | - Ta-Yu Liu
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan
| | - Chih-Hong Wang
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan.
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19
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Hadjadj S, Cariou B, Fumeron F, Gand E, Charpentier G, Roussel R, Kasmi AA, Gautier JF, Mohammedi K, Gourdy P, Saulnier PJ, Feigerlova E, Marre M. Death, end-stage renal disease and renal function decline in patients with diabetic nephropathy in French cohorts of type 1 and type 2 diabetes. Diabetologia 2016; 59:208-216. [PMID: 26486355 DOI: 10.1007/s00125-015-3785-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS Microvascular complications are a common feature of diabetes but additional research is needed regarding diabetic nephropathy endpoints in type 1 and type 2 diabetes. METHODS We compared 277 type 1 diabetes patients with 942 type 2 diabetes patients, with clinical proteinuria and no endstage renal disease (ESRD) at baseline, prospectively followed for death, ESRD and decline in estimated glomerular filtration rate (eGFR, all available measures). RESULTS The incidence rate of death was 67.0 (95% CI 59.2, 74.8) vs. 24.6 (95% CI, 19.0, 30.2) per 1,000 patient-years, in type 2 diabetes and type 1 diabetes, respectively. Unadjusted risk for death was greater for type 2 diabetes patients (HR 3.423; 95% CI, 2.501, 4.683; p<0.0001), but the difference did not persist after adjustment for age (HRage-adj 0.859; 95% CI 0.581, 1.269; p=0.445). The incidence rate of ESRD was 18.4 (95% CI 14.2, 22.5) vs. 47.1 (95%CI 38.4, 55.9) per 1,000 patient-years, in type 2 diabetes and type 1 diabetes, respectively. Unadjusted risk for ESRD was lower in type 2 diabetes (HR 0.399; 95% CI 0.287, 0.554; p<0.0001), but the difference did not persist after adjustment for sex, age and baseline serum creatinine (HRadj 0.989; 95% CI 0.597, 1.639; p=0.965). In a mixed linear model, eGFR decline was not significantly different in type 2 vs. type 1 diabetes (difference in slope −0.19 [0.28] ml min(−1) 1.73 m(−2) year(−1); p=0.512). CONCLUSIONS/INTERPRETATION In diabetic nephropathy, once baseline risk factors were taken into account the risk for death, ESRD and renal function decline did not significantly differ between type 1 diabetes and type 2 diabetes.
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Affiliation(s)
- Samy Hadjadj
- Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France.
- CHU de Poitiers, Service d'Endocrinologie-Diabetologie, Rue de la milétrie, 86000, Poitiers, France.
- CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France.
- Inserm, CIC1402 and U1082, Poitiers, France.
- CHU de Poitiers, Service d'Endocrinologie-Diabetologie and Centre d'Investigation Clinique, Rue de la Milétrie, 86000, Poitiers, France.
| | - Bertrand Cariou
- Department of Endocrinology, University Hospital of Nantes, Nantes, France
- Inserm, UMR1087-CNRS UMR6291, Institut du Thorax, Nantes, France
| | - Frederic Fumeron
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France
- Diabetologie, Endocrinologie Nutrition, DHU FIRE, Hopital Bichat, AP-HP, Paris, France
| | - Elise Gand
- CHU de Poitiers, Pôle Dune, Poitiers, France
| | | | - Ronan Roussel
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France
- Diabetologie, Endocrinologie Nutrition, DHU FIRE, Hopital Bichat, AP-HP, Paris, France
| | - Ahmed-Amine Kasmi
- Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France
- CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France
- Inserm, CIC1402 and U1082, Poitiers, France
| | - Jean-François Gautier
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, Paris, France
| | - Kammel Mohammedi
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France
- Diabetologie, Endocrinologie Nutrition, DHU FIRE, Hopital Bichat, AP-HP, Paris, France
| | - Pierre Gourdy
- CHU de Toulouse, Service de Diabétologie, Maladies Métaboliques et Nutrition, Toulouse, France
- Inserm, UMR1048/I2MC, Toulouse, France
- Université Paul Sabatier, UMR1048/I2MC, Toulouse, France
| | - Pierre-Jean Saulnier
- Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France
- CHU de Poitiers, Service d'Endocrinologie-Diabetologie, Rue de la milétrie, 86000, Poitiers, France
- CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France
- Inserm, CIC1402 and U1082, Poitiers, France
| | - Eva Feigerlova
- Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France
- CHU de Poitiers, Service d'Endocrinologie-Diabetologie, Rue de la milétrie, 86000, Poitiers, France
- CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France
- Inserm, CIC1402 and U1082, Poitiers, France
| | - Michel Marre
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France
- Diabetologie, Endocrinologie Nutrition, DHU FIRE, Hopital Bichat, AP-HP, Paris, France
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Patente TA, Mohammedi K, Bellili-Muñoz N, Driss F, Sanchez M, Fumeron F, Roussel R, Hadjadj S, Corrêa-Giannella ML, Marre M, Velho G. Allelic variations in the CYBA gene of NADPH oxidase and risk of kidney complications in patients with type 1 diabetes. Free Radic Biol Med 2015; 86:16-24. [PMID: 25862415 DOI: 10.1016/j.freeradbiomed.2015.04.002] [Citation(s) in RCA: 11] [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: 09/02/2014] [Revised: 03/03/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
Oxidative stress plays a pivotal role in the pathophysiology of diabetic nephropathy, and the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system is an important source of reactive oxygen species in hyperglycemic conditions in the kidney. Plasma concentration of advanced oxidation protein products (AOPP), a marker of oxidative stress, is increased in patients with diabetic nephropathy. We investigated associations of variants in the CYBA gene, encoding the regulatory subunit p22(phox) of NADPH oxidase, with diabetic nephropathy and plasma AOPP and myeloperoxidase (MPO) concentrations in type 1 diabetic patients. Seven SNPs in the CYBA region were analyzed in 1357 Caucasian subjects with type 1 diabetes from the SURGENE (n=340), GENEDIAB (n=444), and GENESIS (n=573) cohorts. Duration of follow-up was 10, 9, and 6 years, respectively. Cox proportional hazards and logistic regression analyses were used to estimate hazard ratios (HR) or odds ratios (OR) for incidence and prevalence of diabetic nephropathy. The major G-allele of rs9932581 was associated with the incidence of renal events defined as new cases of microalbuminuria or the progression to a more severe stage of nephropathy during follow-up (HR 1.59, 95% CI 1.17-2.18, P=0.003) in SURGENE. The same allele was associated with established/advanced nephropathy (OR 1.52, 95% CI 1.22-1.92, P=0.0001) and with the incidence of end-stage renal disease (ESRD) (HR 2.01, 95% CI 1.30-3.24, P=0.001) in GENEDIAB/GENESIS pooled studies. The risk allele was also associated with higher plasma AOPP concentration in subsets of SURGENE and GENEDIAB, with higher plasma MPO concentration in a subset of GENEDIAB, and with lower estimated glomerular filtration rate (eGFR) in the three cohorts. In conclusion, a functional variant in the promoter of the CYBA gene was associated with lower eGFR and with prevalence and incidence of diabetic nephropathy and ESRD in type 1 diabetic patients. These results are consistent with a role for NADPH oxidase in the pathophysiology of kidney complications of diabetes.
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Affiliation(s)
- Thiago A Patente
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil
| | - Kamel Mohammedi
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018 Paris, France
| | - Naïma Bellili-Muñoz
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France
| | - Fathi Driss
- INSERM, Research Unit 773, 16 rue Henri Huchard, 75018 Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, Department of Biochemistry, 46 rue Henri Huchard, 75018 Paris, France
| | - Manuel Sanchez
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France
| | - Frédéric Fumeron
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018 Paris, France
| | - Ronan Roussel
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018 Paris, France
| | - Samy Hadjadj
- Centre Hospitalier Universitaire de Poitiers, Department of Endocrinology and Diabetology, 2 Rue de la Milétrie, 86021 Poitiers, France; INSERM, Research Unit 1082, 2 Rue de la Milétrie, 86021 Poitiers, France; INSERM, CIC 1402, 2 Rue de la Milétrie, 86021 Poitiers, France; Université de Poitiers, UFR de Médecine et Pharmacie, 6 Rue de la Milétrie, 86073 Poitiers, France
| | - Maria Lúcia Corrêa-Giannella
- Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil; Centro de Terapia Celular e Molecular (NUCEL/NETCEM) da FMUSP, Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil
| | - Michel Marre
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018 Paris, France
| | - Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France.
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Lu H, Huang D, Yao K, Li C, Chang S, Dai Y, Sun A, Zou Y, Qian J, Ge J. Insulin enhances dendritic cell maturation and scavenger receptor-mediated uptake of oxidised low-density lipoprotein. J Diabetes Complications 2015; 29:465-71. [PMID: 25813675 DOI: 10.1016/j.jdiacomp.2015.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/07/2015] [Accepted: 03/09/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The prevalence of atherosclerotic cardiovascular disease is increased in patients with type 2 diabetes. The role of hyperinsulinaemia as an independent participant in the atherogenic process is controversial. Therefore, we examined whether insulin regulates the expression of scavenger receptors responsible for oxidised low-density lipoprotein (oxLDL) uptake in dendritic cells (DCs). In addition, we investigated the impact of insulin on DC maturation with regard to changes in phenotype and cytokine secretion. METHODS Immature DCs were cultured with different concentrations of insulin (1nmol/L, 10nmol/L, 50nmol/L, and 100nmol/L) in the absence or presence of LY294002 or PD98059 for 24h. The expression of the scavenger receptors SR-A and CD36 was determined by real-time PCR and Western blot analysis. Furthermore, DCs were incubated with 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI)-labelled oxLDL. The DiI-oxLDL-incorporated fraction was investigated by flow cytometry. Finally, flow cytometry was used to investigate immunophenotypic protein expression (CD83, CD86, and CD11a). Supernatant cytokine measurements were used as indicators of immune function. RESULTS The incubation of DCs with insulin enhanced SR-A and CD36 gene and protein expression in a dose-dependent manner. This effect was partially abolished by PD98059, which is an extracellular signal-regulated kinase (ERK) inhibitor. However, LY294002 did not inhibit the effect of insulin on scavenger receptor expression. A high concentration of insulin increased the oxLDL-uptake capacity of DCs. Inhibition of the scavenger receptors SR-A and CD36 significantly reduced oxLDL uptake. Furthermore, a high concentration of insulin induced DC maturation. The pro-atherosclerotic chemokines IL-6 and IL-12 were induced by a high concentration of insulin, whereas the release of anti-atherosclerotic IL-10 was reduced. CONCLUSION This study suggests that hyperinsulinaemia can promote DC activation and up-regulate the expression of the scavenger receptors SR-A and CD36, which can increase the oxLDL-uptake capacity of DCs. The results of the present study indicate that one of the mechanisms by which insulin promotes atherogenesis is mediated by its effects on DCs.
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Affiliation(s)
- Hao Lu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Shufu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Yuxiang Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Aijun Sun
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Yunzeng Zou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, China, 200032.
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Zhang Y, Meng N, Lv Z, Li H, Qu Y. The gene polymorphisms of UCP1 but not PPAR γ and TCF7L2 are associated with diabetic retinopathy in Chinese type 2 diabetes mellitus cases. Acta Ophthalmol 2015; 93:e223-9. [PMID: 25274455 DOI: 10.1111/aos.12542] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 07/23/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was designed to investigate the association between the polymorphisms in three insulin resistance-related genes, uncoupling protein-1 (UCP1), peroxisome proliferator-activated receptor γ (PPARγ) and transcription factor 7-like 2 (TCF7L2) and the susceptibility to diabetic retinopathy (DR) in a Chinese type 2 diabetes mellitus (T2DM) cohort. METHODS A total of 792 patients with T2DM were enrolled and categorized into two groups: (1) the DR group consisted of 448 patients, which was further subclassified into a proliferative DR (PDR) group with 220 patients and a non-proliferative DR (NPDR) group with 228 patients; (2) the diabetes without retinopathy (DNR) group, comprised 344 patients who had no signs of DR. Single-nucleotide polymorphisms (SNPs), rs1800592 in the UCP1 gene, rs1801282, rs3856806 and rs1249719 in the PPARγ gene and rs11196205 in the TCF7L2 gene were genotyped in this study. RESULTS For SNP rs1800592 of the UCP1 gene, the frequency of allele G and genotype GG was significantly higher in the PDR group than in the DNR group (allele OR: 1.32, 95% CI: 1.03-1.68, p = 0.03; genotype OR: 1.72, 95%CI: 1.06-2.79, p = 0.03). No evident association was found between the allele frequencies and genotype distributions of any individual SNP in the PPARγ or TCF7L2 genes and DR, PDR or NPDR. Haplotype analyses of the PPARγ gene did not provide any evidence for an association with DR, PDR or NPDR in this Chinese T2DM cohort. CONCLUSIONS This study suggests that the SNP rs1800592 in the UCP1 gene is associated with increased risk of PDR in the Chinese T2DM population.
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Affiliation(s)
- Yue Zhang
- Department of Health Care, Qilu Hospital of Shandong University, Jinan, China
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23
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Mohammedi K, Bellili-Muñoz N, Marklund SL, Driss F, Le Nagard H, Patente TA, Fumeron F, Roussel R, Hadjadj S, Marre M, Velho G. Plasma extracellular superoxide dismutase concentration, allelic variations in the SOD3 gene and risk of myocardial infarction and all-cause mortality in people with type 1 and type 2 diabetes. Cardiovasc Diabetol 2015; 14:845. [PMID: 25855220 PMCID: PMC4324771 DOI: 10.1186/s12933-014-0163-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/10/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Oxidative stress is involved in development of diabetes complications. Extracellular superoxide dismutase (EC-SOD, SOD3) is a major extracellular antioxidant enzyme and is highly expressed in arterial walls. Advanced oxidation protein products (AOPP) and 8-iso-prostaglandin (isoprostane) are markers of oxidative stress. We investigated association of SOD3 gene variants, plasma concentrations of EC-SOD, AOPP and isoprostane with myocardial infarction and mortality in diabetic patients. METHODS We studied three cohorts designed to evaluate the vascular complications of diabetes: the GENEDIAB study (469 participants with type 1 diabetes at baseline; follow-up data for 259 participants), the GENESIS study (603 participants with type 1 diabetes at baseline; follow-up data for 525 participants) and the DIABHYCAR study (3137 participants with type 2 diabetes at baseline and follow-up). Duration of follow-up was 9, 5, and 5 years, respectively. Main outcome measures were incidence of myocardial infarction, and cardiovascular and total mortality during follow-up. Six single nucleotide polymorphisms in the SOD3 locus were genotyped in the three cohorts. Plasma concentrations of EC-SOD, AOPP, and isoprostane were measured in baseline samples of GENEDIAB participants. RESULTS In GENEDIAB/GENESIS pooled cohorts, the minor T-allele of rs2284659 variant was inversely associated with the prevalence at baseline (Odds Ratio 0.48, 95% CI 0.29-0.78, p = 0.004) and the incidence during follow-up of myocardial infarction (Hazard Ratio 0.58, 95% CI 0.40-0.83, p = 0.003) and with cardiovascular (HR 0.33, 95% CI 0.08-0.74, p = 0.004) and all-cause mortality (HR 0.44, 95% CI 0.21-0.73, p = 0.0006). The protective allele was associated with higher plasma EC-SOD and lower plasma AOPP concentrations in GENEDIAB. It was also inversely associated with incidence of myocardial infarction (HR 0.75, 95% CI 0.59-0.94, p = 0.01) and all-cause mortality (HR 0.87, 95% CI 0.79-0.97, p = 0.008) in DIABHYCAR. CONCLUSIONS The T-allele of rs2284659 in the promoter of SOD3 was associated with a more favorable plasma redox status and with better cardiovascular outcomes in diabetic patients. Our results suggest that EC-SOD plays an important role in the mechanisms of vascular protection against diabetes-related oxidative stress.
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Filippone EJ, Abubacker F, Farber JL. Posttransplantation normoglycemic diabetic nephropathy: the role of the allograft insulin resistance--a case report. Transplant Proc 2014; 46:2381-5. [PMID: 24984885 DOI: 10.1016/j.transproceed.2014.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/27/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The pathogenesis of diabetic nephropathy is incompletely understood. Although the role of hyperglycemia is well-established, the participation of insulin resistance is increasingly appreciated. Podocytes are insulin responsive cells and require normal insulin signaling for sustained viability. CASE REPORT We have presented a renal transplant recipient with lupus nephritis who received a deceased donor kidney from a patient with diabetes mellitus (DM). The kidney functioned well initially. Within 2 years, however, nephrotic range proteinuria developed, and a biopsy revealed diabetic nephropathy that had clearly evolved in comparison with the implantation biopsy. The recipient was repeatedly normoglycemic with normal glycated hemoglobin and glucose tolerance, and she was found to be quite insulin sensitive on the basis of a low homeostasis model assessment of insulin resistance. CONCLUSIONS We argue that the nephropathy developed in the allograft owing to impaired insulin signaling from intrinsic donor-derived insulin resistance that was exacerbated by low insulin levels in the insulin-sensitive recipient. This case has implications for the most appropriate utilization of kidneys from donors with DM.
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Affiliation(s)
- E J Filippone
- Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - F Abubacker
- Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - J L Farber
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Mohammedi K, Bellili-Muñoz N, Driss F, Roussel R, Seta N, Fumeron F, Hadjadj S, Marre M, Velho G. Manganese superoxide dismutase (SOD2) polymorphisms, plasma advanced oxidation protein products (AOPP) concentration and risk of kidney complications in subjects with type 1 diabetes. PLoS One 2014; 9:e96916. [PMID: 24819633 PMCID: PMC4018399 DOI: 10.1371/journal.pone.0096916] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/14/2014] [Indexed: 11/23/2022] Open
Abstract
Aims Oxidative stress is involved in the pathophysiology of diabetic nephropathy. Manganese superoxide dismutase (SOD2) catalyses the dismutation of superoxide, regulates the metabolism of reactive oxygen species in the mitochondria and is highly expressed in the kidney. Plasma concentration of advanced oxidation protein products (AOPP), a marker of oxidative stress, was found to be increased in patients with kidney disease. We investigated associations of SOD2 allelic variations, plasma SOD activity and AOPP concentration with diabetic nephropathy in type 1 diabetic subjects. Methods Eight SNPs in the SOD2 region were analysed in 1285 Caucasian subjects with type 1 diabetes from the SURGENE prospective study (n = 340; 10-year follow-up), GENESIS (n = 501) and GENEDIAB (n = 444) cross-sectional studies. Baseline plasma concentration of AOPP and SOD activity were measured in GENEDIAB participants. Hazard ratio (HR) and odds ratio (OR) were determined for incidence and prevalence of nephropathy. Analyses were adjusted or stratified by retinopathy stages. Results In the SURGENE cohort, the T-allele of rs4880 (V16A) was associated with the incidence of renal events (new cases, or the progression to a more severe stage of nephropathy; HR 1.99, 95% CI 1.24–3.12, p = 0.004) and with the decline in estimated glomerular filtration rate (eGFR) during follow-up. Similar associations were observed for rs2758329 and rs8031. Associations were replicated in GENESIS/GENEDIAB cohorts, in the subset of participants without proliferative retinopathy, and were confirmed by haplotype analyses. Risk allele and haplotype were also associated with higher plasma AOPP concentration and lower SOD activity. Conclusions SOD2 allelic variations were associated with the incidence and the progression of diabetic nephropathy, with a faster decline in eGFR and with plasma AOPP concentration and SOD activity in subjects with type 1 diabetes. These results are consistent with a role for SOD2 in the protection against oxidative stress and kidney disease in type 1 diabetes.
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Affiliation(s)
- Kamel Mohammedi
- Research Unit 1138, INSERM, Paris, France; Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France
| | | | - Fathi Driss
- Research Unit 773, INSERM, Paris, France; Department of Biochemistry, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France
| | - Ronan Roussel
- Research Unit 1138, INSERM, Paris, France; Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France; UFR de Médecine, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nathalie Seta
- Department of Biochemistry, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France; UFR de Pharmacie, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Frédéric Fumeron
- Research Unit 1138, INSERM, Paris, France; UFR de Médecine, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Samy Hadjadj
- Department of Endocrinology and Diabetology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; Research Unit 1082, INSERM, Poitiers, France; Centre d'Investigation Clinique (CIC) 0802, INSERM, Poitiers, France; UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
| | - Michel Marre
- Research Unit 1138, INSERM, Paris, France; Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France; UFR de Médecine, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
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Monteiro MB, Patente TA, Mohammedi K, Queiroz MS, Azevedo MJ, Canani LH, Parisi MC, Marre M, Velho G, Corrêa-Giannella ML. Sex-specific associations of variants in regulatory regions of NADPH oxidase-2 (CYBB) and glutathione peroxidase 4 (GPX4) genes with kidney disease in type 1 diabetes. Free Radic Res 2013; 47:804-10. [PMID: 23919599 DOI: 10.3109/10715762.2013.828347] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Oxidative stress is involved in the pathophysiology of diabetic nephropathy. The superoxide-generating nicotinamide adenine dinucleotide phosphate-oxidase 2 (NOX2, encoded by the CYBB gene) and the antioxidant enzyme glutathione peroxidase 4 (GPX4) play opposing roles in the balance of cellular redox status. In the present study, we investigated associations of single nucleotide polymorphisms (SNPs) in the regulatory regions of CYBB and GPX4 with kidney disease in patients with type 1 diabetes. Two functional SNPs, rs6610650 (CYBB promoter region, chromosome X) and rs713041 (GPX4 3'untranslated region, chromosome 19), were genotyped in 451 patients with type 1 diabetes from a Brazilian cohort (diabetic nephropathy: 44.6%) and in 945 French/Belgian patients with type 1 diabetes from Genesis and GENEDIAB cohorts (diabetic nephropathy: 62.3%). The minor A-allele of CYBB rs6610650 was associated with lower estimated glomerular filtration rate (eGFR) in Brazilian women, and with the prevalence of established/advanced nephropathy in French/Belgian women (odds ratio 1.75, 95% CI 1.11-2.78, p = 0.016). The minor T-allele of GPX4 rs713041 was inversely associated with the prevalence of established/advanced nephropathy in Brazilian men (odds ratio 0.30, 95% CI 0.13-0.68, p = 0.004), and associated with higher eGFR in French/Belgian men. In conclusion, these heterogeneous results suggest that neither CYBB nor GPX4 are major genetic determinants of diabetic nephropathy, but nevertheless, they could modulate in a gender-specific manner the risk for renal disease in patients with type 1 diabetes.
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Affiliation(s)
- M B Monteiro
- Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo , São Paulo-SP , Brazil
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Drapeau N, Lizotte F, Denhez B, Guay A, Kennedy CR, Geraldes P. Expression of SHP-1 induced by hyperglycemia prevents insulin actions in podocytes. Am J Physiol Endocrinol Metab 2013; 304:E1188-98. [PMID: 23531619 DOI: 10.1152/ajpendo.00560.2012] [Citation(s) in RCA: 28] [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] [Indexed: 11/22/2022]
Abstract
Renal podocyte apoptosis is an early event of diabetic nephropathy progression. Insulin action is critical for podocyte survival. Previous studies demonstrated that Src homology-2 domain-containing phosphatase-1 (SHP-1) is elevated in renal cortex of type 1 diabetic mice; we hypothesized that hyperglycemia-induced SHP-1 expression may affect insulin actions in podocytes. Type 1 diabetic Akita mice (Ins2(+/C96Y)) developed elevated foot process effacement and podocyte apoptosis compared with control littermate mice (Ins2(+/+)). In contrast to Ins2(+/+) mice, insulin-stimulated protein kinase B (Akt) and extracellular signal-regulated kinase (ERK) phosphorylation were remarkably reduced in renal podocytes of Akita mice. This renal insulin resistance was associated with elevated SHP-1 expression in the glomeruli. Cultured podocytes exposed to high glucose concentration (HG; 25 mM) for 96 h exhibited high levels of apoptotic markers and caspase-3/7 enzymatic activity. HG exposure raised mRNA and protein levels of SHP-1 and reduced the insulin-signaling pathway in podocytes. Overexpression of dominant-negative SHP-1 in podocytes prevented HG effects and restored insulin actions. Elevated SHP-1 expression induced by high glucose levels was directly associated with insulin receptor-β in vitro and in vivo to prevent insulin-stimulated Akt and ERK phosphorylation. In conclusion, our results showed that high levels of SHP-1 expression in glomeruli cause insulin resistance and podocyte loss, thereby contributing to diabetic nephropathy.
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Affiliation(s)
- Nicolas Drapeau
- Clinical Research Center Étienne Le-Bel and Division of Endocrinology, Departments of Medicine, Université de Sherbrooke, Québec, Canada
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Abstract
Ninety-one years ago insulin was discovered, which was one of the most important medical discoveries in the past century, transforming the lives of millions of diabetic patients. Initially insulin was considered only important for rapid control of blood glucose by its action on a restricted number of tissues; however, it has now become clear that this hormone controls an array of cellular processes in many different tissues. The present review will focus on the role of insulin in the kidney in health and disease.
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Marcovecchio ML, Tossavainen PH, Heywood JJ, Dalton RN, Dunger DB. An independent effect of parental lipids on the offspring lipid levels in a cohort of adolescents with type 1 diabetes. Pediatr Diabetes 2012; 13:463-9. [PMID: 22369206 DOI: 10.1111/j.1399-5448.2012.00860.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/01/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Genetic factors modulate lipid levels and an intrafamilial aggregation of abnormal lipid profiles has been reported in the general population. As dyslipidemia is common among people with diabetes and has been related to diabetic nephropathy, we investigated whether parental lipid levels were related to lipids and albumin excretion in young offspring with childhood-onset type 1 diabetes (T1D). METHODS Non-fasting blood samples were collected from 895 offspring, 808 mothers and 582 fathers. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and non-HDL-C were measured. Three early morning urinary albumin-creatinine ratios (ACR), hemoglobin A1C (HbA1c) and anthropometric parameters were also assessed. RESULTS The offspring's mean age (±SD) was 14.5 ± 2.2 yr, mean diabetes duration 5.5 ± 3.7 yr; the fathers' age was 45.7 ± 6.1 yr and the mothers' age was 42.8 ± 5.5 yr. After adjusting for the offspring age, gender, body mass index, HbA1c, maternal (TC: β = 0.242; TG: β = 0.152; HDL-C: β = 0.285; LDL-C: β = 0.278; non-HDL-C: β = 0.253; all p < 0.001) and paternal lipid levels (TC: β = 0.188; TG: β = 0.108; HDL-C: β = 0.253; LDL-C: β = 0.187; non-HDL-C: β = 0.173; all p < 0.001) were significantly associated with the offspring's lipid parameters. In contrast, no significant association was found between parental lipid levels and the offspring's ACR. CONCLUSIONS In the present study, parental lipid levels were independently associated with the same traits in the offspring, suggesting a role of genetic influences and/or shared environmental factors in modulating the metabolic profile of adolescents with T1D. In contrast, there was no significant association between parental lipid levels and the offspring's albumin excretion.
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Mohammedi K, Maimaitiming S, Emery N, Bellili-Muñoz N, Roussel R, Fumeron F, Hadjadj S, Marre M, Velho G. Allelic variations in superoxide dismutase-1 (SOD1) gene are associated with increased risk of diabetic nephropathy in type 1 diabetic subjects. Mol Genet Metab 2011; 104:654-60. [PMID: 21963083 DOI: 10.1016/j.ymgme.2011.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Oxidative stress is involved in the pathophysiology of diabetic nephropathy. The superoxide dismutase (SOD) enzymes play a major role in detoxification of reactive oxygen species and have a protective effect against diabetic nephropathy. We investigated associations of allelic variations in SOD1 gene with nephropathy in patients with type 1 diabetes. METHODS Seven SNPs in SOD1 region were analyzed in 1285 type 1 European Caucasian diabetic patients from the SURGENE prospective study (n=340; ten year follow-up), and the Genesis France-Belgium (n=501) and GENEDIAB (n=444) cross-sectional studies. Cox proportional hazards and logistic regression analyses were used to estimate hazard ratios or odds ratios for incidence and prevalence of diabetic nephropathy. RESULTS In the SURGENE study, the T-allele of rs1041740 was associated with the prevalence of incipient (OR 5.75, 95% CI 1.78-19.39, p=0.004) and established/advanced nephropathy at baseline (OR 8.95, 95% CI 1.51-58.42, p=0.02), and with the incidence of incipient nephropathy during follow-up (HR 1.46, 95% C.I. 1.13-1.90, p=0.004). The variant was also associated with decreased estimated glomerular filtration rate (eGFR) throughout the study. In cross-sectional study of Genesis/GENEDIAB cohorts, the G-allele of rs17880135 was associated with incipient (OR 7.53, 95% CI 2.30-25.45, p=0.001), established (OR 6.04, 95% CI 1.52-23.91, p=0.01) and advanced nephropathy (OR 10.03, 95% CI 2.95-35.44, p=0.0003). CONCLUSIONS SOD1 allelic variations were associated with the prevalence of diabetic nephropathy, with the incidence of microalbuminuria and with decreased eGFR in type 1 diabetic subjects. These results are consistent with an implication of oxidative stress in the pathophysiology of diabetic nephropathy and with the major role for antioxidant enzymes as a mechanism of renal protection.
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Wessman M, Forsblom C, Kaunisto MA, Söderlund J, Ilonen J, Sallinen R, Hiekkalinna T, Parkkonen M, Maxwell AP, Tarnow L, Parving HH, Hadjadj S, Marre M, Peltonen L, Groop PH. Novel susceptibility locus at 22q11 for diabetic nephropathy in type 1 diabetes. PLoS One 2011; 6:e24053. [PMID: 21909410 PMCID: PMC3164698 DOI: 10.1371/journal.pone.0024053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/03/2011] [Indexed: 01/02/2023] Open
Abstract
Background Diabetic nephropathy (DN) affects about 30% of patients with type 1 diabetes (T1D) and contributes to serious morbidity and mortality. So far only the 3q21–q25 region has repeatedly been indicated as a susceptibility region for DN. The aim of this study was to search for new DN susceptibility loci in Finnish, Danish and French T1D families. Methods and Results We performed a genome-wide linkage study using 384 microsatellite markers. A total of 175 T1D families were studied, of which 94 originated from Finland, 46 from Denmark and 35 from France. The whole sample set consisted of 556 individuals including 42 sib-pairs concordant and 84 sib-pairs discordant for DN. Two-point and multi-point non-parametric linkage analyses were performed using the Analyze package and the MERLIN software. A novel DN locus on 22q11 was identified in the joint analysis of the Finnish, Danish and French families by genome-wide multipoint non-parametric linkage analysis using the Kong and Cox linear model (NPLpairs LOD score 3.58). Nominal or suggestive evidence of linkage to this locus was also detected when the three populations were analyzed separately. Suggestive evidence of linkage was found to six additional loci in the Finnish and French sample sets. Conclusions This study identified a novel DN locus at chromosome 22q11 with significant evidence of linkage to DN. Our results suggest that this locus may be of importance in European populations. In addition, this study supports previously indicated DN loci on 3q21–q25 and 19q13.
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Affiliation(s)
- Maija Wessman
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
- Biomedicum Helsinki, Research Program in Molecular Medicine and Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
- * E-mail: (MW); (P-HG)
| | - Carol Forsblom
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Mari A. Kaunisto
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
- Biomedicum Helsinki, Research Program in Molecular Medicine and Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Jenny Söderlund
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Jorma Ilonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
- Immunogenetics Laboratory, University of Turku, Turku, Finland
| | - Riitta Sallinen
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
| | - Tero Hiekkalinna
- Biomedicum Helsinki, Research Program in Molecular Medicine and Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
- Unit of Public Health Genomics, National Institute for Health and Welfare, Helsinki, Finland
| | - Maija Parkkonen
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Alexander P. Maxwell
- Nephrology Research Group, Centre for Public Health, Queen's University of Belfast, Belfast, Northern Ireland, United Kingdom
| | | | - Hans-Henrik Parving
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health Science, Aarhus University, Aarhus, Denmark
| | - Samy Hadjadj
- Service de Médecine Interne, Endocrinologie et Maladies Métaboliques, Centre d'Investigation Clinique, Inserm CIC0802, CHU de Poitiers, Poitiers, France and Université de Poitiers, Poitiers, France
| | - Michel Marre
- Department of Endocrinology, Diabetology and Nutrition, Bichat-Claude Bernard University Hospital, Paris, France
| | - Leena Peltonen
- Biomedicum Helsinki, Research Program in Molecular Medicine and Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
- Unit of Public Health Genomics, National Institute for Health and Welfare, Helsinki, Finland
- Department of Human Genetics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hingston, United Kingdom
| | - Per-Henrik Groop
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- * E-mail: (MW); (P-HG)
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Giordano C, Amato MC, Ciresi A, Citarrella R, Mantione L, Accidenti M, Pantò F, Guarnotta V, Allotta ML, Criscimanna A, Galluzzo A. Predictors of microvascular complications in type 1 diabetic patients at onset: the role of metabolic memory. Eur J Intern Med 2011; 22:266-74. [PMID: 21570646 DOI: 10.1016/j.ejim.2011.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 02/04/2011] [Accepted: 02/07/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several epidemiological studies showed a close association between metabolic control and microvascular complications in type 1 Diabetes Mellitus (T1DM). The aim of our longitudinal observational study was to evaluate the predictive role of the main clinical and biochemical parameters in determining microvascular complications. METHODS 376 T1DM patients, hospitalized in our division from 1991 to 2005 (mean follow-up=10.93±4.26 years) were studied. Stepwise Cox regression analysis was used to identify the influence of residual ß-cell function, ß-cell autoimmunity, HbA1c levels and other clinical and laboratory parameters in the development of microalbuminuria and retinopathy. RESULTS The probability of developing microalbuminuria was higher in males than in females (HR 1.82; 95% CI 1.01-3.28; p=0.044), in patients with higher mean HbA1c values (HR 2.80; 95% CI 1.63-4.83; p<0.001), longer duration of disease (HR 1.98; 95% CI 1.10-3.57; p=0.022) and younger age of diabetes onset (HR 0.53; 95% CI 0.03-0.92; p=0.026). An increased probability of developing retinopathy was found in patients with higher mean HbA1c levels during follow-up (HR 2.35; 95% CI 1.34-4.12, p=0.003), as well as at onset (HR 1.85; 95% CI 1.06-3.24; p=0.030). CONCLUSIONS Our study suggests that among the clinical, metabolic, immunological and biochemical factors evaluated at onset, only HbA1c is predictive for the microangiopathy development in T1DM.
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Affiliation(s)
- Carla Giordano
- Section of Endocrinology, Centro di Riferimento Regionale per la Diagnosi e Cura delle Endocrinopatie Autoimmuni e del Diabete di Tipo 1, Dipartimento di Medicina Interna e Medicina Sperimentale (DIBIMIS), Università degli Studi di Palermo, Italy.
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Kim BY, Kim CH, Jung CH, Mok JO, Suh KI, Kang SK. Association between subclinical hypothyroidism and severe diabetic retinopathy in Korean patients with type 2 diabetes. Endocr J 2011; 58:1065-70. [PMID: 21931224 DOI: 10.1507/endocrj.ej11-0199] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The association between subclinical hypothyroidism (SCH) and microvascular complications of type 2 diabetes is unclear. We examined whether SCH is associated with diabetic retinopathy or nephropathy in Korean patients with type 2 diabetes. Data from 489 patients who visited the diabetes clinic at a university hospital between 2001 and 2007 were analyzed retrospectively. Participants were evaluated for glycemic control, thyroid function, and diabetic retinopathy and nephropathy. Diabetic retinopathy was classified into five grades. Diabetic nephropathy was assessed by the presence of albuminuria. Patients in the SCH group had a higher proportion of women, older age, longer duration of diabetes, higher systolic and diastolic blood pressure, and higher insulin resistance index compared with the euthyroid group. No significant difference in family history of diabetes or body mass index was found between groups. The prevalence of severe diabetic retinopathy (severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy) was significantly higher in the SCH group than the euthyroid group (32.8% vs. 19.6%, P = 0.036), whereas no between-group difference was found in the prevalence of diabetic nephropathy. After adjustment for potential confounding factors (HbA1c, BMI, duration of diabetes, diabetic nephropathy, and hypertension) by multivariate logistic regression analysis, SCH remained significantly associated with severe diabetic retinopathy (odds ratio 2.086 (95% CI, 1.010-4.307), P = 0.047). These results suggest that SCH was independently associated with severe diabetic retinopathy in patients with type 2 diabetes. Further prospective studies are required to confirm the association between SCH and diabetic retinopathy.
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Affiliation(s)
- Bo-Yeon Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Alkhalaf A, Bakker SJL, Bilo HJG, Gans ROB, Navis GJ, Postmus D, Forsblom C, Groop PH, Vionnet N, Hadjadj S, Marre M, Parving HH, Rossing P, Tarnow L. A polymorphism in the gene encoding carnosinase (CNDP1) as a predictor of mortality and progression from nephropathy to end-stage renal disease in type 1 diabetes mellitus. Diabetologia 2010; 53:2562-8. [PMID: 20711718 PMCID: PMC2974933 DOI: 10.1007/s00125-010-1863-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 07/05/2010] [Indexed: 12/31/2022]
Abstract
AIMS/HYPOTHESIS Homozygosity for a five leucine repeat (5L-5L) in the carnosinase gene (CNDP1) has been found to be cross-sectionally associated with a low frequency of diabetic nephropathy (DN), mainly in type 2 diabetes. We prospectively investigated in patients with type 1 diabetes whether: (1) 5L-5L is associated with mortality; (2) there is an interaction of 5L-5L with DN or sex for prediction of mortality; and (3) 5L-5L is associated with progression to end-stage renal disease (ESRD). METHODS In this prospective study in white European patients with type 1 diabetes, individuals with DN were defined by persistent albuminuria ≥ 300 mg/24 h. Controls without nephropathy were defined by persistent (>15 years) normoalbuminuria < 30 mg/24 h. Leucine repeats were assessed with a fluorescent DNA analysis system. Onset of ESRD was defined by need to start chronic dialysis or kidney transplantation. RESULTS The study involved 916 patients with DN and 1,170 controls. During follow-up for 8.8 years, 107 patients (14%) with 5L-5L died compared with 182 patients (13.8%) with other genotypes (p = 0.99). There was no significant interaction of 5L-5L with DN for prediction of mortality (p = 0.57), but a trend towards interaction with sex (p = 0.08). In patients with DN, HR for ESRD in 5L-5L vs other genotypes was not constant over time, with increased risk for 5L-5L beyond 8 years of follow-up (p = 0.03). CONCLUSIONS/INTERPRETATION CNDP1 polymorphism was not associated with mortality, and nor was there an interaction of this polymorphism with DN for prediction of mortality in patients with type 1 diabetes. CNDP1 polymorphism predicts progression to ESRD in patients with DN, but only late after baseline measurements.
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Affiliation(s)
- A Alkhalaf
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Welsh GI, Hale LJ, Eremina V, Jeansson M, Maezawa Y, Lennon R, Pons DA, Owen RJ, Satchell SC, Miles MJ, Caunt CJ, McArdle CA, Pavenstädt H, Tavaré JM, Herzenberg AM, Kahn CR, Mathieson PW, Quaggin SE, Saleem MA, Coward RJM. Insulin signaling to the glomerular podocyte is critical for normal kidney function. Cell Metab 2010; 12:329-340. [PMID: 20889126 PMCID: PMC4949331 DOI: 10.1016/j.cmet.2010.08.015] [Citation(s) in RCA: 331] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 05/21/2010] [Accepted: 07/07/2010] [Indexed: 12/21/2022]
Abstract
Diabetic nephropathy (DN) is the leading cause of renal failure in the world. It is characterized by albuminuria and abnormal glomerular function and is considered a hyperglycemic "microvascular" complication of diabetes, implying a primary defect in the endothelium. However, we have previously shown that human podocytes have robust responses to insulin. To determine whether insulin signaling in podocytes affects glomerular function in vivo, we generated mice with specific deletion of the insulin receptor from their podocytes. These animals develop significant albuminuria together with histological features that recapitulate DN, but in a normoglycemic environment. Examination of "normal" insulin-responsive podocytes in vivo and in vitro demonstrates that insulin signals through the MAPK and PI3K pathways via the insulin receptor and directly remodels the actin cytoskeleton of this cell. Collectively, this work reveals the critical importance of podocyte insulin sensitivity for kidney function.
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Affiliation(s)
- Gavin I Welsh
- Academic Renal Unit, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Lorna J Hale
- Academic Renal Unit, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Vera Eremina
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Marie Jeansson
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Yoshiro Maezawa
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Rachel Lennon
- Academic Renal Unit, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Deborah A Pons
- Academic Renal Unit, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Rachel J Owen
- School of Physics, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Simon C Satchell
- Academic Renal Unit, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Mervyn J Miles
- School of Physics, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Christopher J Caunt
- Department of Molecular Pharmacology, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Craig A McArdle
- Department of Molecular Pharmacology, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Hermann Pavenstädt
- Department of Internal Medicine D, Nephrology and Hypertension, University Clinics Muenster, Muenster 48149, Germany
| | - Jeremy M Tavaré
- School of Biochemistry, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Andrew M Herzenberg
- Department of Pathology, University Health Network and University of Toronto, Ontario M5G 2C4, Canada
| | - C Ronald Kahn
- Joslin Diabetes Center and Harvard Medical School, Boston, MA 02215, USA
| | - Peter W Mathieson
- Academic Renal Unit, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Susan E Quaggin
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Moin A Saleem
- Academic Renal Unit, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Richard J M Coward
- Academic Renal Unit, School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK; Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario M5G 1X5, Canada.
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Anan F, Masaki T, Ito Y, Eto T, Umeno Y, Eshima N, Saikawa T, Yoshimatsu H. Diabetic retinopathy is associated with visceral fat accumulation in Japanese type 2 diabetes mellitus patients. Metabolism 2010; 59:314-9. [PMID: 20004426 DOI: 10.1016/j.metabol.2009.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 06/04/2009] [Accepted: 06/16/2009] [Indexed: 12/13/2022]
Abstract
The presence of diabetic retinopathy (DR) and increased of visceral fat accumulation (VFA) are associated with high mortality in type 2 diabetes mellitus patients. This preliminary study was therefore designed to test the hypothesis that DR is associated with insulin resistance and VFA in type 2 diabetes mellitus patients without insulin treatment. A total of 102 type 2 diabetes mellitus patients were divided into 2 groups: DR group (age, 60 +/- 6 years [mean +/- SD]; n = 31) and no diabetic retinopathy (NDR) group (59 +/- 5 years, n = 71). The level of blood glucose was assessed by fasting plasma glucose, fasting immunoreactive insulin, homeostasis model assessment index, and hemoglobin A(1c). The fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. The body mass index and waist circumference were higher in the DR group than in the NDR group (P < .001 and P < .0005, respectively). Plasma levels of triglyceride were higher, whereas high-density lipoprotein cholesterol was lower, in the DR group than in the NDR group (P < .005 and P < .0001, respectively). Fasting plasma glucose (P < .0005), insulin concentrations (P < .0001), homeostasis model assessment index (P < .0001), and VFA (P < .0001) levels were higher in the DR group than in the NDR group. Multivariate logistic analysis revealed that DR was independently predicted by high VFA and insulin resistance. The results of this preliminary study indicate that the presence of DR was associated with high VFA and insulin resistance in Japanese patients with type 2 diabetes mellitus.
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Affiliation(s)
- Futoshi Anan
- Department of Cardiology, Oita Red Cross Hospital, Oita 870-0033, Japan.
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Santos CE, Schrank Y, Kupfer R. Análise crítica dos critérios da OMS, IDF e NCEP para síndrome metabólica em pacientes portadores de diabetes melito tipo 1. ACTA ACUST UNITED AC 2009; 53:1096-102. [DOI: 10.1590/s0004-27302009000900006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 09/04/2009] [Indexed: 12/31/2022]
Abstract
OBJETIVO: Avaliar a frequência de síndrome metabólica (SM) em portadores de diabetes melito tipo 1 (DMT1) maiores de 18 anos, de acordo com os critérios da International Diabetes Federation (IDF), do National Cholesterol Education Program (NCEP) e da Organização Mundial da Saúde (OMS), que foram analisados comparativamente. Secundariamente, verificou-se a associação da síndrome com complicações microvasculares, idade, tempo de duração do diabetes e controle glicêmico. MÉTODOS: Trata-se de estudo transversal com 101 pacientes. RESULTADOS: Foram classificados como tendo SM pelas definições da OMS, IDF e NCEP, respectivamente, 32%, 32% e 26% dos pacientes. Observou-se marcado aumento de SM em pacientes com microalbuminúria (MAU) quando comparado a pacientes sem MAU - aumento este mais significativo com o critério da OMS. CONCLUSÕES: A SM é um achado frequente em portadores de DMT1 e, entre os critérios utilizados para defini-la, o sugerido pela OMS parece ser o mais adequado neste grupo de pacientes.
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Gogg S, Smith U, Jansson PA. Increased MAPK activation and impaired insulin signaling in subcutaneous microvascular endothelial cells in type 2 diabetes: the role of endothelin-1. Diabetes 2009; 58:2238-45. [PMID: 19581418 PMCID: PMC2750225 DOI: 10.2337/db08-0961] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To establish a method for isolation and culture of subcutaneous microvascular endothelial cells (MVEC) from small human tissue biopsies to compare gene and protein expression of insulin signaling molecules in MVEC from insulin-resistant and healthy control subjects. RESEARCH DESIGN AND METHODS Stromavascular cells from subcutaneous needle biopsies of type 2 diabetic and control subjects were expanded in culture and the endothelial cells selected with magnetic immune separation. Western blots and RT-PCR were used for protein and gene expression assays. RESULTS At least 99% of the expanded primary MVEC could be characterized as endothelial cells. The expression of insulin receptors was low, but insulin increased tyrosine phosphorylation of both the insulin receptor and insulin receptor substrate (IRS)-1 and activated protein kinase B (PKB). The IRS-1 protein expression was reduced and the serine phosphorylation of PKB in response to insulin attenuated whereas basal and insulin-stimulated phosphorylation of extracellular signal-related kinase (ERK)1/2 was increased in type 2 diabetes MVEC. Endothelin (ET)-1 mRNA levels were significantly higher in type 2 diabetes cells. The addition of ET-1 increased the phosphorylation of mitogen-activated protein kinase (MAPK), an effect antagonized by the MEK-1 inhibitor PD98059. Furthermore, the endothelin ET(A) and ET(B) receptor antagonists BQ123 and BQ788 decreased basal MAPK activity in type 2 diabetes MVEC and prevented the ET-1-induced activation. CONCLUSIONS We developed a system for isolation and culture of human MVEC from small needle biopsies. Our observations support the concept of "selective" insulin resistance, involving IRS-1 and the PI3kinase pathway, as an underlying factor for a dysregulated microvascular endothelium in type 2 diabetes. Our data also support a role of ET-1 for the increased MAPK activity seen in nonstimulated type 2 diabetes MVEC.
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Affiliation(s)
- Silvia Gogg
- Lundberg Laboratory for Diabetes Research, Center of Excellence for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Diabetic retinopathy is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Hypertens Res 2009; 32:299-305. [PMID: 19262488 DOI: 10.1038/hr.2009.8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Diabetic retinopathy (DR) and cardiovascular autonomic dysfunction are associated with high mortality in type 2 diabetic patients. This preliminary study was therefore designed to test the hypothesis that DR is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients without insulin treatment. Seventy persons were diagnosed to have type 2 diabetes in the examination from June 2004 to May 2006. The study group consisted of 29 type 2 diabetic patients with DR (age: 58+/-6 years, mean+/-s.d.) and 41 type 2 diabetic patients with no DR (NDR) (n=41, 58+/-5 years). Cardiovascular autonomic function was assessed by baroreflex sensitivity (BRS), heart rate variability, plasma norepinephrine concentration and cardiac (123)I-metaiodobenzylguanidine (MIBG) scintigraphic findings. DR patients had lower BRS, early and delayed (123)I-MIBG myocardial uptake values and higher percent washout rate (WR) of (123)I-MIBG than the NDR patients. With respect to metabolic findings, DR patients had higher fasting plasma insulin concentration (P<0.0001) and higher homeostasis model assessment (HOMA) index (P<0.00001) than the NDR patients. Multiple logistic regression analysis revealed that the presence of DR was independently predicted by HOMA index and the percent WR of (123)I-MIBG (P<0.01 and P<0.05, respectively). Our results suggest that DR is associated with depressed cardiovascular autonomic function and insulin resistance and that HOMA index and the percent WR of (123)I-MIBG are independently associated with DR in Japanese patients with type 2 diabetes mellitus.
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Chauveau P, Rigalleau V, Aparicio M. Insulinorésistance et insuffisance rénale chronique. Nephrol Ther 2008; 4:568-74. [DOI: 10.1016/j.nephro.2008.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 03/09/2008] [Accepted: 03/10/2008] [Indexed: 02/04/2023]
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Thorn LM, Forsblom C, Fagerudd J, Pettersson-Fernholm K, Kilpikari R, Groop PH. Clustering of risk factors in parents of patients with type 1 diabetes and nephropathy. Diabetes Care 2007; 30:1162-7. [PMID: 17337502 DOI: 10.2337/dc06-2033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of parental risk factors for diabetic nephropathy. RESEARCH DESIGN AND METHODS This cross-sectional study included 2,355 type 1 diabetic patients from the FinnDiane (Finnish Diabetic Nephropathy) study. Diabetic nephropathy was defined as macroalbuminuria (urinary albumin excretion rate >200 microg/min or >300 mg/24 h) or end-stage renal disease. Information was available from 4,676 parents. Parental scores were calculated based on the number of various traits in the parents. RESULTS Patients with diabetic nephropathy, compared with those without diabetic nephropathy, had a higher prevalence of maternal (41 vs. 35%, P = 0.046) and parental (62 vs. 55%, P = 0.044) hypertension, maternal stroke (7.6 vs. 5.1%, P = 0.044), and maternal (1.4 vs. 0.7%, P = 0.058) and parental (4.3 vs. 2.9%, P = 0.030) type 1 diabetes. If both, compared with none, of the parents had hypertension, the adjusted odds ratio (OR) for diabetic nephropathy in offspring was 1.56 (95% CI 1.13-2.15). The adjusted OR for diabetic nephropathy was 2.13 (1.36-3.33) for the parental hypertension-diabetes score (3-4 vs. 0 points) and 2.13 (1.37-3.33) for the parental hypertension-cardiovascular disease (CVD)-diabetes score (4-6 vs. 0 points). Fathers of patients with diabetic nephropathy, compared with those without diabetic nephropathy, had reduced overall survival (log-rank P = 0.04) and reduced cardiovascular survival (log-rank P = 0.03). CONCLUSIONS A cluster of parental hypertension, CVD, and diabetes is associated with diabetic nephropathy in type 1 diabetes, as is paternal mortality.
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Affiliation(s)
- Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, POB 63, FIN-00014, University of Helsinki, Helsinki, Finland
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Hadjadj S, Tarnow L, Forsblom C, Kazeem G, Marre M, Groop PH, Parving HH, Cambien F, Tregouet DA, Gut IG, Théva A, Gauguier D, Farrall M, Cox R, Matsuda F, Lathrop M, Hager-Vionnet N. Association between angiotensin-converting enzyme gene polymorphisms and diabetic nephropathy: case-control, haplotype, and family-based study in three European populations. J Am Soc Nephrol 2007; 18:1284-91. [PMID: 17376814 DOI: 10.1681/asn.2006101102] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Angiotensin 1-converting enzyme gene (ACE) is a risk factor for diabetic nephropathy (DN) in patients with type 1 diabetes. The selection of this candidate gene is supported by cross-sectional and follow-up studies, but no convincing family-based studies are available. Recruited were 1057 patients (with DN: persistent albuminuria with or without renal failure) and 1127 control subjects (long-standing [> or =15 yr] normoalbuminuric patients with type 1 diabetes) in Denmark, Finland, and France and 532 family trios that were composed of 244 trios with DN probands and 288 trios with non-DN probands. Five ACE polymorphisms were studied. In the case-control analysis, the rs1800764-C, rs4311-T, Insertion/deletion (I/D or rs1799752)-D, rs4366-G, and rs12449782-G alleles were associated with an increased risk for DN, homogeneously across populations, with allelic odds ratios of 1.11 (95% confidence interval 1.00 to 1.22), 1.18 (1.04 to 1.33), 1.13 (1.02 to 1.23), 1.10 (0.99 to 1.20), and 1.12 (1.01 to 1.23), respectively. Haplotype analysis further demonstrated that the haplotype defined by the D, rs4366_G and rs12449782_G alleles was associated with a greater risk for DN. Even though no significant allelic overtransmission to DN or non-DN probands was detected, the family-based study provided consistent results with the case-control analysis. In a large case-control study, it was shown that the ACE polymorphisms were associated with DN; these findings were not confirmed in a family-based association study. This study population is suitable to search for additional candidate genes for DN.
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Affiliation(s)
- Samy Hadjadj
- CHU de Poitiers, Department of Diabetology, Poitiers University Hospital, Poitiers, France.
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Hadjadj S, Duengler F, Torremocha F, Faure-Gerard G, Bridoux F, Boissonnot M, Mauco G, Guilhot J, Maréchaud R. Maternal history of type 2 diabetes is associated with diabetic nephropathy in type 1 diabetic patients. DIABETES & METABOLISM 2007; 33:37-43. [PMID: 17258929 DOI: 10.1016/j.diabet.2006.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 09/02/2006] [Indexed: 10/23/2022]
Abstract
AIMS Insulin resistance is a key feature of type 2 diabetes. It is also involved in the development and progression of microvascular complications. We analysed the relationship between parental history of diabetes, insulin resistance and diabetic nephropathy (DN) and assessed the specific maternal and paternal influences of history of type 2 diabetes on DN in type 1 diabetic offspring. METHODS We recorded information regarding family history of type 2 diabetes and of cardiovascular disease in 160 consecutive, unrelated type 1 diabetic patients. Insulin resistance was assessed using a validated estimation of the glucose disposal rate (eGDR). RESULTS Type 1 diabetic patients with a maternal history of type 2 diabetes were more likely to be insulin-resistant (P=0.043) and to have renal complications (P=0.0041) than those from the reference group (without parental history of diabetes), while patients with a paternal history were not different from those from the reference group, regarding eGDR and DN. Time to development of abnormal albuminuria was significantly affected by maternal history of type 2 diabetes (log-rank=12.66; P=0.0004) and by familial history of premature cardiovascular disease (log-rank=5.48; P=0.0234). In multivariate analysis, a maternal history of type 2 diabetes was independently associated with nephropathy after adjustment for sex, diabetes duration and familial history of premature cardiovascular disease. CONCLUSION Maternal history of type 2 diabetes is independently associated with DN in type 1 diabetic patients. This might suggest the transmission of a maternal trait related to microvascular complications, raising the hypothesis of imprinted genes predisposing to diabetic renal disease.
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Affiliation(s)
- S Hadjadj
- Inserm EO 324, CHU de Poitiers, BP 577, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
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Vionnet N, Tregouët D, Kazeem G, Gut I, Groop PH, Tarnow L, Parving HH, Hadjadj S, Forsblom C, Farrall M, Gauguier D, Cox R, Matsuda F, Heath S, Thévard A, Rousseau R, Cambien F, Marre M, Lathrop M. Analysis of 14 candidate genes for diabetic nephropathy on chromosome 3q in European populations: strongest evidence for association with a variant in the promoter region of the adiponectin gene. Diabetes 2006; 55:3166-74. [PMID: 17065357 DOI: 10.2337/db06-0271] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Linkage studies have mapped loci for diabetic nephropathy and associated phenotypes on chromosome 3q. We studied 14 plausible candidate genes in the linkage region because of their potential role in vascular complications. In a large-scale study of patients from Denmark, Finland, and France who have type 1 diabetes, 1,057 case and 1,127 control subjects, as well as 532 trios, were investigated for association with diabetic nephropathy. We analyzed 69 haplotype-tagging single nucleotide polymorphisms and nonsynonymous variants that were identified by sequencing. Polymorphisms in three genes, glucose transporter 2 (SLC2A2), kininogen (KNG1), and adiponectin (ADIPOQ), showed nominal association with diabetic nephropathy in single-point analysis. The T-allele of SLC2A2_16459CT was associated with a decreased risk of diabetic nephropathy (odds ratio 0.79 [95% CI 0.66-0.96], P = 0.016), whereas the T-allele of KNG_7965CT and the A-allele of ADIPOQ_prom2GA were associated with increased risk of nephropathy (1.17 [1.03-1.32], P = 0.016; 1.46 [1.11-1.93], P = 0.006, respectively). Analyses of the transmission disequilibrium test showed similar trends only for ADIPOQ_prom2GA with the overtransmission of the A-allele to patients with diabetic nephropathy (1.52 [0.86-2.66], P = NS) and of the G-allele to patients without diabetic nephropathy (0.50 [0.27-0.92], P = 0.026). The overall significance for this variant (nominal P = 0.011) suggests that ADIPOQ might be involved in the development of diabetic nephropathy.
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Affiliation(s)
- Nathalie Vionnet
- INSERM U525, Centre National de Génotypage, 2, Rue Gaston Crémieux, 91006 Evry Cedex, France.
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Herrero P, Peterson LR, McGill JB, Matthew S, Lesniak D, Dence C, Gropler RJ. Increased myocardial fatty acid metabolism in patients with type 1 diabetes mellitus. J Am Coll Cardiol 2006; 47:598-604. [PMID: 16458143 DOI: 10.1016/j.jacc.2005.09.030] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 08/15/2005] [Accepted: 09/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this study was to determine if myocardial fatty acid utilization (MFAU) and myocardial fatty acid oxidation (MFAO) are increased in diabetic patients. BACKGROUND Experimental models of diabetes mellitus demonstrate that MFAU and MFAO are increased, and that this dependence on myocardial fatty acid metabolism may be detrimental to cardiac function. Whether similar metabolic changes occur in humans with diabetes mellitus is unclear. METHODS Eleven healthy non-diabetic control patients (5 women, ages 25 +/- 5 years) and 11 otherwise healthy patients with type 1 diabetes mellitus (T1DM) (8 women, ages 36 +/- 10 years, HbA1c 8.4 +/- 1.9%) underwent positron emission tomography for the determination of myocardial blood flow (MBF); myocardial oxygen consumption (MVO2); myocardial glucose utilization (MGU); and MFAU, MFAO, and %MFAO. RESULTS Plasma lactate, insulin, and MBF levels were similar between the two groups. However, plasma glucose (5.71 +/- 0.98 mumol/ml vs. 5.28 +/- 0.65 mumol/ml, p = 0.04), free fatty acid levels (0.60 +/- 0.24 mumol/ml vs. 0.19 +/- 0.07 mumol/ml, p < 0.0001), and MVO2 (6.64 +/- 2.21 vs. 4.51 +/- 1.39 mumol/g/min, p = 0.007) levels were higher in the T1DM subjects. Furthermore, compared with control patients, T1DM subjects exhibited higher MFAU (213 +/- 135 nmol/g/min vs. 57 +/- 28 nmol/g/min, p = 0.0004), MFAO (206 +/- 131 nmol/g/min s. 50 +/- 26 nmol/g/min, p = 0.0002), and %MFAO (94 +/- 6% vs. 81 +/- 19%, respectively, p = 0.04). In contrast, MGU was lower in T1DM subjects than in controls (207 +/- 108 nmol/g/min vs. 403 +/- 191 nmol/g/min, p = 0.0008). CONCLUSIONS Humans with diabetes mellitus exhibit increased MFAU and MFAO and reduced MGU consistent with observations obtained in experimental models of diabetes.
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Affiliation(s)
- Pilar Herrero
- Division of Radiological Sciences, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Groop PH, Forsblom C, Thomas MC. Mechanisms of Disease: pathway-selective insulin resistance and microvascular complications of diabetes. ACTA ACUST UNITED AC 2005; 1:100-10. [PMID: 16929378 DOI: 10.1038/ncpendmet0046] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 09/27/2005] [Indexed: 11/09/2022]
Abstract
Resistance to the actions of insulin is strongly associated with the microvascular complications of diabetes. To the extent that insulin resistance leads to hyperglycemia, dyslipidemia and hypertension, this association is not surprising. It is now clear that insulin also has direct actions in the microvasculature that influence the development and progression of microvascular disease. In the healthy state, insulin appears to have only minor effects on vascular function, because of the activation of opposing mediators such as nitric oxide and endothelin-1. Diabetes and obesity, however, are associated with selective insulin resistance in the phosphatidylinositol-3-kinase signaling pathway, which leads to reduced synthesis of nitric oxide, impaired metabolic control and compensatory hyperinsulinemia. By contrast, insulin signaling via extracellular signal-regulated kinase dependent pathways is relatively unaffected in diabetes, tipping the balance of insulin's actions so that they favor abnormal vasoreactivity, angiogenesis, and other pathways implicated in microvascular complications and hypertension. In addition, preferential impairment of nonoxidative glucose metabolism leads to increased intracellular formation of advanced glycation end products, oxidative stress and activation of other pathogenic mediators. Despite a strong temporal association, a causal link between pathway-selective insulin resistance and microvascular damage remains to be established. It is possible that this association reflects a common genotype or phenotype. Nonetheless, insulin resistance remains an important marker of risk and a key target for intervention, because those patients who achieve a greater improvement of insulin sensitivity achieve better microvascular outcomes.
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Abstract
PURPOSE OF REVIEW Most uraemic patients are insulin resistant. This review focuses on the occurrence, mechanisms and consequences of this insulin resistance. Hypoglycaemia is also possible in a minority of uraemic patients; its causes are discussed at the end of the review. RECENT FINDINGS Insulin resistance is detectable when the glomerular filtration rate is below 50 ml/min per 1.73 m in non-diabetic uraemic individuals. Uraemia can alter insulin sensitivity even in diabetic patients; familial insulin resistance may favour the occurrence of diabetic nephropathy. Although reduced glucose non-oxidative disposal is the most evident defect of carbohydrate metabolism, abnormal glucose oxidation, endogenous glucose production and insulin secretion are also contributors. The accumulation of nitrogenous compounds is the most important mechanism of a specific state of insulin resistance in uraemia. Their identification is progressing, particularly in the field of carbamoylated amino acids. The consequences of chronic renal failure such as anaemia, metabolic acidosis and secondary hyperparathyroidism also indirectly play a role. SUMMARY The treatment of uraemia by renal replacement therapies or low-protein diets improves insulin sensitivity. However, patients still have a high cardiovascular risk. The identification of the accumulating molecular species that specifically alter insulin sensitivity is therefore of great interest. The favourable effect of non-specific insulin sensitizers such as glitazone may also help to reduce this risk.
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Current literature in diabetes. Diabetes Metab Res Rev 2005; 21:382-9. [PMID: 15959871 DOI: 10.1002/dmrr.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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