Metabolite differences in the lenticular nucleus in type 2 diabetes mellitus shown by proton MR spectroscopy

Change in medial frontal cerebral metabolite concentrations following bariatric surgery

Obesity is associated with adverse effects on brain health, including an increased risk of neurodegenerative diseases. Changes in cerebral metabolism may underlie or precede structural and functional brain changes. While bariatric surgery is known to be effective in inducing weight loss and improving obesity-related medical comorbidities, few studies have examined whether it may be able to improve brain metabolism. In the present study, we examined changes in cerebral metabolite concentrations in participants with obesity who underwent bariatric surgery. Thirty-five patients with obesity (body mass index ≥ 35 kg/m2 ) were recruited from a bariatric surgery candidate nutrition class. They completed single voxel proton magnetic resonance spectroscopy at baseline (presurgery) and within 1 year postsurgery. Spectra were obtained from a large medial frontal brain region using a PRESS sequence on a 3-T Siemens Verio scanner. The acquisition parameters were TR = 3000 ms and TE = 37 ms. Tissue-corrected metabolite concentrations were determined using Osprey. Paired t-tests were used to examine within-subject change in metabolite concentrations, and correlations were used to relate these changes to other health-related outcomes, including weight loss and glycated hemoglobin (HbA1c ), a measure of blood sugar levels. Bariatric surgery was associated with a reduction in cerebral choline-containing compounds (Cho; t [34] = - 3.79, p < 0.001, d = -0.64) and myo-inositol (mI; t [34] = - 2.81, p < 0.01, d = -0.47) concentrations. There were no significant changes in N-acetyl-aspartate, creatine, or glutamate and glutamine concentrations. Reductions in Cho were associated with greater weight loss (r = 0.40, p < 0.05), and reductions in mI were associated with greater reductions in HbA1c (r = 0.44, p < 0.05). In conclusion, participants who underwent bariatric surgery exhibited reductions in cerebral Cho and mI concentrations, which were associated with improvements in weight loss and glycemic control. Given that elevated levels of Cho and mI have been implicated in neuroinflammation, reduction in these metabolites after bariatric surgery may reflect amelioration of obesity-related neuroinflammatory processes. As such, our results provide evidence that bariatric surgery may improve brain health and metabolism in individuals with obesity.

Differentiation of Urine-Derived Induced Pluripotent Stem Cells to Neurons, Astrocytes, and Microvascular Endothelial Cells from a Diabetic Patient

Complications of central nervous system in type 2 diabetes mellitus (T2DM) often lead to cognitive impairment and seriously affect the quality of life. However, there is no individualized disease model. Urine-derived stem cells can be an ideal source for generating human induced pluripotent stem cells (hiPSCs) and progenitors, as they are easily accessible, noninvasive, and universally available. In our research, we differentiated urine-derived hiPSCs into neuron (N), astrocyte (A), and microvascular endothelial cells (E) from a T2DM patient. Next step, we intend to coculture these three cells together in a 3D system to create a new disease model in vitro, which may simulate the cerebral microenvironment of DM, for future study of its pathogenesis and precision medical treatment.

Plasma N-Acetylaspartate Is Related to Age, Obesity, and Glucose Metabolism: Effects of Antidiabetic Treatment and Bariatric Surgery

Background: N-acetylaspartate (NAA) is synthesized only by neurons and is involved in neuronal metabolism and axonal myelination. NAA is the strongest signal on brain magnetic resonance spectroscopy, and its concentration have been associated with cognitive dysfunction in neurodegenerative diseases, obesity, and type 2 diabetes (T2D). Materials and Methods: We explored the impact of obesity and T2D on circulating NAA as well as the impact of bariatric surgery and antidiabetic treatments. We developed an LC-MS method for the accurate measurements of fasting plasma NAA levels in 505 subjects (156 subjects with normal glucose tolerance, 24 subjects with impaired glucose tolerance, and 325 patients with T2D) to examine the associations of NAA with obesity and dysglycemia. To validate cross-sectional findings, plasma NAA was measured 6 months after Roux-en-Y Gastric Bypass (RYGB) in 55 morbidly obese subjects, and after 1 year of antidiabetic treatment (with dapagliflozin, exenatide, or dapagliflozin plus exenatide) in 192 T2D patients. Results: In the whole population, NAA was associated with age (r = 0.31, p <0.0001) and BMI (r = -0.20, p <0.0001). Independently of age and BMI, NAA was reciprocally related to HbA1c and fasting plasma glucose (partial r = -0.13, both p = 0.01). Surgically-induced weight loss raised NAA (by 18 nmol/L on average, p <0.02). Glucose lowering treatment increased NAA in proportion to the drop in HbA1c (r = 0.31, p <0.0001) regardless of the agent used. Conclusions: Circulating NAA concentrations are modulated by age, obesity, and glycemic control. Whether they may mark for the corresponding metabolic effects on brain function remains to be established by joint measurements of spectroscopic signal and cognitive function.

Altered Intrinsic Brain Activities in Patients with Diabetic Retinopathy Using Amplitude of Low-frequency Fluctuation: A Resting-state fMRI Study

OBJECTIVE

The current study aimed to apply the amplitude of low-frequency fluctuation (ALFF) method for investigating the spontaneous brain activity alterations and their relationships with clinical features in patients with diabetic retinopathy (DR).

PATIENTS AND METHODS

In total, 35 patients with DR (18 males and 17 females) and 38 healthy control (HC) subjects (18 males and 20 females) were enrolled in this study. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning, respectively. The ALFF method was used to assess the spontaneous brain activity, while the mean ALFF signal values of patients with DR and HCs were classified by the receiver operating characteristic (ROC) curve. Correlation analysis was performed to calculate the relationship between the observed mean ALFF values of the altered regions in patients with DR and their clinical features.

RESULTS

Compared with the HCs, patients with DR had significantly lower ALFF values in the left and right middle occipital gyrus (MOG). In contrast, patients with DR showed higher ALFF values in the left cerebellum (CER), left inferior temporal gyrus (ITG) and left hippocampus (Hipp). However, no relationship was observed between the mean ALFF signal values of the altered regions and clinical manifestations in the patients with DR.

CONCLUSION

We mainly found that patients with DR showed abnormal intrinsic brain activities in the left and right MOG, left CER, left ITG and left Hipp, which might provide useful information for explaining neural mechanisms in patients with DR.

Pathological and cognitive changes in patients with type 2 diabetes mellitus and comorbid MCI and protective hypoglycemic therapies: a narrative review

Type 2 diabetes mellitus (T2DM) is becoming a significant health issue worldwide. Many studies support the hypothesis that patients with T2DM have a higher-than-expected incidence of mild cognitive impairment (MCI) than individuals without diabetes. Based on the results from recent studies, MCI might be associated with the effects of T2DM on glucose metabolism and brain atrophy. As a narrative review, we will illuminate pathological and cognitive changes in patients with T2DM and comorbid MCI and protective hypoglycemic therapies. The early abnormal signs of cognition must be elucidated, and extensive investigations are needed to develop improved therapies for use in the clinic.

Molecular imaging of diabetes and diabetic complications: Beyond pancreatic β-cell targeting

Diabetes is a chronic non-communicable disease affecting over 400 million people worldwide. Diabetic patients are at a high risk of various complications, such as cardiovascular, renal, and other diseases. The pathogenesis of diabetes (both type 1 and type 2 diabetes) is associated with a functional impairment of pancreatic β-cells. Consequently, most efforts to manage and prevent diabetes have focused on preserving β-cells and their function. Advances in imaging techniques, such as magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography, and single-photon-emission computed tomography, have enabled noninvasive and quantitative detection and characterization of the population and function of β-cells in vivo. These advantages aid in defining and monitoring the progress of diabetes and determining the efficacy of anti-diabetic therapies. Beyond β-cell targeting, molecular imaging of biomarkers associated with the development of diabetes, e.g., lymphocyte infiltration, insulitis, and metabolic changes, may also be a promising strategy for early detection of diabetes, monitoring its progression, and occurrence of complications, as well as facilitating exploration of new therapeutic interventions. Moreover, molecular imaging of glucose uptake, production and excretion in specified tissues is critical for understanding the pathogenesis of diabetes. In the current review, we summarize and discuss recent advances in noninvasive imaging technologies for imaging of biomarkers beyond β-cells for early diagnosis of diabetes, investigation of glucose metabolism, and precise diagnosis and monitoring of diabetic complications for better management of diabetic patients.

Altered brain metabolites in patients with diabetes mellitus and related complications - evidence from 1H MRS study

In recent years, diabetes mellitus (DM) has been acknowledged as an important factor for brain disorders. Significant alterations in brain metabolism have been demonstrated during the development of DM and its complications. Magnetic resonance spectroscopy (MRS), a cutting-edge technique used in biochemical analyses, non-invasively provides insights into altered brain metabolite levels in vivo This review aims to discuss current MRS data describing brain metabolite levels in DM patients with or without complications. Cerebral metabolites including N-acetylaspartate (NAA), creatine (Cr), choline (Cho), myo-inositol (mI), glutamate, and glutamine were significantly altered in DM patients, suggesting that energy metabolism, neurotransmission, and lipid membrane metabolism might be disturbed during the progression of DM. Changes in brain metabolites may be non-invasive biomarkers for DM and DM-related complications. Different brain regions presented distinct metabolic signatures, indicating region-specific diabetic brain damages. In addition to serving as biomarkers, MRS data on brain metabolites can also shed light on diabetic treatment monitoring. For example, exercise may restore altered brain metabolite levels and has beneficial effects on cognition in DM patients. Future studies should validate the above findings in larger populations and uncover the mechanisms of DM-induced brain damages.

Early effects of a high-caloric diet and physical exercise on brain volumetry and behavior: a combined MRI and histology study in mice

Excessive intake of high-caloric diets as well as subsequent development of obesity and diabetes mellitus may exert a wide range of unfavorable effects on the central nervous system (CNS) in the long-term. The potentially harmful effects of such diets were suggested to be mitigated by physical exercise. Here, we conducted a study investigating early effects of a cafeteria-diet on gray and white brain matter volume by means of voxel-based morphometry (VBM) and region-of-interest (ROI) analysis. Half of the mice performed voluntary wheel running to study if regular physical exercise prevents unfavorable effects of a cafeteria-diet. In addition, histological analyses for myelination and neurogenesis were performed. As expected, wheel running resulted in a significant increase of gray matter volume in the CA1-3 areas, the dentate gyrus and stratum granulosum of the hippocampus in the VBM analysis, while a positive effect of the cafeteria-diet was shown for the whole hippocampal CA1-3 area only in the ROI analysis, indicating a regional volume effect. It was earlier found that hippocampal neurogenesis may be related to volume increases after exercise. Interestingly, while running resulted in a significant increase in neurogenesis assessed by doublecortin (DCX)-labeling, this was not true for cafeteria diet. This indicates different underlying mechanisms for gray matter increase. Moreover, animals receiving cafeteria diet only showed mild deficits in long-term memory assessed by the puzzle-box paradigm, while executive functioning and short term memory were not affected. Our data therefore highlight that high caloric diet impacts on the brain and behavior. Physical exercise seems not to interact with these mechanisms.

Metabolic profile of visual cortex in diabetic rats measured with in vivo proton MRS

The purpose of the present study was to characterize the metabolic profile of the visual cortex in streptozotocin-induced Type 1 diabetic rats by means of in vivo proton MRS. Several metabolite concentration ratios in the visual cortex were calculated. In addition, postmortem histologic analyses for retinal ganglion cell (RGC) loss, optic nerve injury and visual cortex alterations were monitored. The results showed that diabetes induced several changes in visual cortex metabolites, such as reduced N-acetylaspartate, glutamate, γ-aminobutyric acid, taurine and choline-containing compound levels. Nevertheless, myo-inositol levels increased significantly as compared with controls. Remarkable RGC loss and optic nerve degeneration were observed by morphological analysis. Moreover, the results showed significant neuronal loss and glial activation in the visual cortex. These findings indicated that, besides vascular abnormalities, neuronal loss and degeneration in the visual pathway were induced due to disrupted glucose homeostasis in diabetes. Metabolic or functional abnormalities were induced in cerebral neurons of the visual cortex by diabetes.

Effects of a high-caloric diet and physical exercise on brain metabolite levels: a combined proton MRS and histologic study

Excessive intake of high-caloric diets as well as subsequent development of obesity and diabetes mellitus may exert a wide range of unfavorable effects on the central nervous system (CNS). It has been suggested that one mechanism in this context is the promotion of neuroinflammation. The potentially harmful effects of such diets were suggested to be mitigated by physical exercise. Here, we conducted a study investigating the effects of physical exercise in a cafeteria-diet mouse model on CNS metabolites by means of in vivo proton magnetic resonance spectroscopy ((1)HMRS). In addition postmortem histologic and real-time (RT)-PCR analyses for inflammatory markers were performed. Cafeteria diet induced obesity and hyperglycemia, which was only partially moderated by exercise. It also induced several changes in CNS metabolites such as reduced hippocampal glutamate (Glu), choline-containing compounds (tCho) and N-acetylaspartate (NAA)+N-acetyl-aspartyl-glutamic acid (NAAG) (tNAA) levels, whereas opposite effects were seen for running. No association of these effects with markers of central inflammation could be observed. These findings suggest that while voluntary wheel running alone is insufficient to prevent the unfavorable peripheral sequelae of the diet, it counteracted many changes in brain metabolites. The observed effects seem to be independent of neuroinflammation.

Brain imaging in type 2 diabetes

Type 2 diabetes mellitus (T2DM) is associated with cognitive dysfunction and dementia. Brain imaging may provide important clues about underlying processes. This review focuses on the relationship between T2DM and brain abnormalities assessed with different imaging techniques: both structural and functional magnetic resonance imaging (MRI), including diffusion tensor imaging and magnetic resonance spectroscopy, as well as positron emission tomography and single-photon emission computed tomography. Compared to people without diabetes, people with T2DM show slightly more global brain atrophy, which increases gradually over time compared with normal aging. Moreover, vascular lesions are seen more often, particularly lacunar infarcts. The association between T2DM and white matter hyperintensities and microbleeds is less clear. T2DM has been related to diminished cerebral blood flow and cerebrovascular reactivity, particularly in more advanced disease. Diffusion tensor imaging is a promising technique with respect to subtle white matter involvement. Thus, brain imaging studies show that T2DM is associated with both degenerative and vascular brain damage, which develops slowly over the course of many years. The challenge for future studies will be to further unravel the etiology of brain damage in T2DM, and to identify subgroups of patients that will develop distinct progressive brain damage and cognitive decline.

EFFECT OF TYPE 2 DIABETES MELLITUS ON BRAIN METABOLITES BY USING PROTON MAGNETIC RESONANCE SPECTROSCOPY-A SYSTEMATIC REVIEW

Cerebral metabolism will be affected in T2DM either by chronic hyperglycemia or by chronic hypoxia. Proton magnetic resonance spectroscopy (¹H-MRS) of the brain provides detailed information about the structure, dynamics, reaction state and chemical environment of molecules. It also measures the levels of brain metabolites such as myo-inositol (mI), N acetyl aspartate (NAA), creatine (Cr), choline (Cho), glutamate (Glu), glutamine (Gln) and gamma amino butyric acid (GABA). Several studies suggest that people with type 2 diabetes mellitus (T2DM) are at an increased risk of cognitive impairment in comparison with the general population. The altered metabolites may cause cognitive dysfunction in T2DM. This review article concludes that in T2DM, metabolite levels were altered in different regions of brain.

Neurocognitive changes and their neural correlates in patients with type 2 diabetes mellitus

As the prevalence and life expectancy of type 2 diabetes mellitus (T2DM) continue to increase, the importance of effective detection and intervention for the complications of T2DM, especially neurocognitive complications including cognitive dysfunction and dementia, is receiving greater attention. T2DM is thought to influence cognitive function through an as yet unclear mechanism that involves multiple factors such as hyperglycemia, hypoglycemia, and vascular disease. Recent developments in neuroimaging methods have led to the identification of potential neural correlates of T2DM-related neurocognitive changes, which extend from structural to functional and metabolite alterations in the brain. The evidence indicates various changes in the T2DM brain, including global and regional atrophy, white matter hyperintensity, altered functional connectivity, and changes in neurometabolite levels. Continued neuroimaging research is expected to further elucidate the underpinnings of cognitive decline in T2DM and allow better diagnosis and treatment of the condition.