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Green K, MacIver CL, Ebden S, Rees DA, Peall KJ. Pearls & Oy-sters: AARS2 Leukodystrophy-Tremor and Tribulations. Neurology 2024; 102:e209296. [PMID: 38507676 DOI: 10.1212/wnl.0000000000209296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/31/2024] [Indexed: 03/22/2024] Open
Abstract
A 35-year-old woman with a progressive, bilateral upper limb tremor, personality change, behavioral disturbance, and primary ovarian insufficiency was found to have AARS2-related leukodystrophy. She had congenital nystagmus which evolved to head titubation by age 8 years and then developed an upper limb tremor in her mid-teens. These symptoms stabilized during her 20s, but soon after this presentation at age 35 years, neurologic and behavioral disturbances progressed rapidly over a 12-month period requiring transition to an assisted living facility with care support (4 visits/day) and assistance for all activities of daily living. MRI of the brain demonstrated confluent white matter changes predominantly involving the frontal lobes consistent with a leukodystrophy. All other investigations were unremarkable. Nongenetic causes of a leukodystrophy including sexually transmitted diseases and recreational drug use were excluded. Family history was negative for similar symptoms. Gene panel testing identified compound heterozygous pathogenic AARS2 mutations. This case highlights the importance of MRI brain imaging in progressive tremor syndromes, the utility of gene panels in simultaneous testing of multiple disorders with overlapping phenotypes, and the need for awareness of comorbid endocrinological disorders in many of the genetic leukodystrophies, whose identification may aid in clinical diagnosis.
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Affiliation(s)
- Katy Green
- From the Cardiff University Brain Research Imaging Centre (CUBRIC) (K.G., C.L.M.), Cardiff University; University Hospital of Wales (S.E.), Cardiff and Vale University Health Board; and Neuroscience and Mental Health Innovation Institute (D.A.R., K.J.P.), Cardiff University, United Kingdom
| | - Claire L MacIver
- From the Cardiff University Brain Research Imaging Centre (CUBRIC) (K.G., C.L.M.), Cardiff University; University Hospital of Wales (S.E.), Cardiff and Vale University Health Board; and Neuroscience and Mental Health Innovation Institute (D.A.R., K.J.P.), Cardiff University, United Kingdom
| | - Sian Ebden
- From the Cardiff University Brain Research Imaging Centre (CUBRIC) (K.G., C.L.M.), Cardiff University; University Hospital of Wales (S.E.), Cardiff and Vale University Health Board; and Neuroscience and Mental Health Innovation Institute (D.A.R., K.J.P.), Cardiff University, United Kingdom
| | - D A Rees
- From the Cardiff University Brain Research Imaging Centre (CUBRIC) (K.G., C.L.M.), Cardiff University; University Hospital of Wales (S.E.), Cardiff and Vale University Health Board; and Neuroscience and Mental Health Innovation Institute (D.A.R., K.J.P.), Cardiff University, United Kingdom
| | - Kathryn J Peall
- From the Cardiff University Brain Research Imaging Centre (CUBRIC) (K.G., C.L.M.), Cardiff University; University Hospital of Wales (S.E.), Cardiff and Vale University Health Board; and Neuroscience and Mental Health Innovation Institute (D.A.R., K.J.P.), Cardiff University, United Kingdom
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2
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Doyle LM, Ahmed SF, Davis J, Elford S, Elhassan YS, James L, Lawrence N, Llahana S, Okoro G, Rees DA, Tomlinson JW, O'Reilly MW, Krone NP. Service evaluation suggests variation in clinical care provision in adults with congenital adrenal hyperplasia in the UK and Ireland. Clin Endocrinol (Oxf) 2024. [PMID: 38493480 DOI: 10.1111/cen.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) encompasses a rare group of autosomal recessive disorders, characterised by enzymatic defects in steroidogenesis. Heterogeneity in management practices has been observed internationally. The International Congenital Adrenal Hyperplasia registry (I-CAH, https://sdmregistries.org/) was established to enable insights into CAH management and outcomes, yet its global adoption by endocrine centres remains unclear. DESIGN We sought (1) to assess current practices amongst clinicians managing patients with CAH in the United Kingdom and Ireland, with a focus on choice of glucocorticoid, monitoring practices and screening for associated co-morbidities, and (2) to assess use of the I-CAH registry. MEASUREMENTS We designed and distributed an anonymised online survey disseminated to members of the Society for Endocrinology and Irish Endocrine Society to capture management practices in the care of patients with CAH. RESULTS Marked variability was found in CAH management, with differences between general endocrinology and subspecialist settings, particularly in glucocorticoid use, biochemical monitoring and comorbidity screening, with significant disparities in reproductive health monitoring, notably in testicular adrenal rest tumours (TARTs) screening (p = .002), sperm banking (p = .0004) and partner testing for CAH (p < .0001). Adoption of the I-CAH registry was universally low. CONCLUSIONS Differences in current management of CAH continue to exist. It appears crucial to objectify if different approaches result in different long-term outcomes. New studies such as CaHASE2, incorporating standardised minimum datasets including replacement therapies and monitoring strategies as well as longitudinal data collection, are now needed to define best-practice and standardise care.
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Affiliation(s)
- Lauren Madden Doyle
- Academic Division of Endocrinology, Department of Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | | | - Sue Elford
- CAH Support Group, Living with CAH, Cambridge, UK
| | - Yasir S Elhassan
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Lynette James
- School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Neil Lawrence
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Sofia Llahana
- School of Health and Psychological Sciences, City, University of London, UK
- Department of Diabetes & Endocrinology, University College Hospital, London, UK
| | | | - D Aled Rees
- Neuroscience and Mental Health Innovation Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology & Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Michael W O'Reilly
- Academic Division of Endocrinology, Department of Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Nils P Krone
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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El-Farhan N, Tennant S, Rees SE, Evans C, Rees DA. Salivary Cortisol Response to ACTH Stimulation Is a Reliable Alternative to Serum Cortisol in Evaluating Hypoadrenalism. J Clin Endocrinol Metab 2024; 109:e579-e588. [PMID: 37768151 PMCID: PMC10795914 DOI: 10.1210/clinem/dgad576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT The serum total cortisol response to the ACTH stimulation test is widely used to assess adrenocortical function but is affected by changes in cortisol-binding globulin (CBG) concentration. Salivary cortisol reflects free cortisol concentrations and may offer a reliable alternative. OBJECTIVES (1) To establish the salivary cortisol response to ACTH stimulation in healthy volunteers and patients with altered CBG concentrations; (2) to evaluate the performance of a lower reference limit (LRL) determined in healthy volunteers in patients with suspected hypoadrenalism (SH-patients). DESIGN A 250 µg ACTH stimulation test was undertaken in 139 healthy volunteers, 24 women taking an estradiol-containing oral contraceptive pill (OCP-females), 10 patients with low serum protein concentration (LP-patients), and 30 SH-patients. Salivary cortisol was measured by liquid chromatography-tandem mass spectrometry. Mean and LRL of the 30-minute salivary cortisol response (mean-1.96 standard deviation) were derived from log-transformed concentrations. The LRL was applied as a diagnostic cut-off in SH-patients, with comparison to the serum response. RESULTS Mean CBG concentrations (range) were 58 (42-81) mg/L, 64 (43-95) mg/L, 41 (28-60) mg/L, and 116 (84-159) mg/L in males, females, LP-patients, and OCP-females, respectively. The mean 30-minute salivary cortisol concentration was 19.3 (2.5th-97.5th percentile 10.3-36.2) nmol/L in healthy volunteers. Corresponding values were not different in OCP-females [19.7 (9.5-41.2) nmol/L; P = .59] or LP-patients [19.0 (7.7-46.9) nmol/L; P = .97]. Overall diagnostic agreement between salivary and serum responses in SH-patients was 79%. CONCLUSION Salivary cortisol response to ACTH stimulation offers a reliable alternative to serum and may be especially useful in conditions of altered CBG concentration.
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Affiliation(s)
- Nadia El-Farhan
- Department of Medical Biochemistry, Royal Gwent Hospital, Newport NP20 2UB, UK
| | - Sarah Tennant
- Department of Medical Biochemistry, Immunology and Toxicology, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - Seren E Rees
- Birmingham Medical School, University of Birmingham, Birmingham B15 2TT, UK
| | - Carol Evans
- Department of Medical Biochemistry, Immunology and Toxicology, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - D Aled Rees
- Neuroscience and Mental Health Innovation Institute, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
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Abstract
Polycystic ovary syndrome is characterised by excessive levels of androgens and ovulatory dysfunction, and is a common endocrine disorder in women of reproductive age. Polycystic ovary syndrome arises as a result of polygenic susceptibility in combination with environmental influences that might include epigenetic alterations and in utero programming. In addition to the well recognised clinical manifestations of hyperandrogenism and ovulatory dysfunction, women with polycystic ovary syndrome have an increased risk of adverse mental health outcomes, pregnancy complications, and cardiometabolic disease. Unlicensed treatments have limited efficacy, mostly because drug development has been hampered by an incomplete understanding of the underlying pathophysiological processes. Advances in genetics, metabolomics, and adipocyte biology have improved our understanding of key changes in neuroendocrine, enteroendocrine, and steroidogenic pathways, including increased gonadotrophin releasing hormone pulsatility, androgen excess, insulin resistance, and changes in the gut microbiome. Many patients with polycystic ovary syndrome have high levels of 11-oxygenated androgens, with high androgenic potency, that might mediate metabolic risk. These advances have prompted the development of new treatments, including those that target the neurokinin-kisspeptin axis upstream of gonadotrophin releasing hormone, with the potential to lessen adverse clinical sequelae and improve patient outcomes.
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Affiliation(s)
- Jiawen Dong
- Neuroscience and Mental Health Innovation Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Neuroscience and Mental Health Innovation Institute, School of Medicine, Cardiff University, Cardiff, UK
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Papanikolaou N, Millar O, Coulden A, Parker N, Sit L, Kelly C, Cox J, Dhillo WS, Meeran K, Al Memar M, Anderson R, Rees DA, Karavitaki N, Jayasena CN. Clinical characteristics of functioning gonadotroph adenoma in women presenting with ovarian hyperstimulation: Audit of UK pituitary centres. Clin Endocrinol (Oxf) 2023; 99:386-395. [PMID: 37430451 DOI: 10.1111/cen.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Functioning gonadotroph adenomas (FGAs) are rare pituitary tumours stimulating ovarian function with potential life-threatening consequences in women. However, a lack of aggregated clinical experience of FGAs impairs management in affected women. The aim of this study is to present the clinical course of FGA-induced ovarian hyperstimulation syndrome (OHSS) cases as identified by some of the largest UK pituitary endocrine tertiary centres with a view to increasing awareness and improving diagnosis and management of women with FGA. DESIGN A retrospective observational study; audit of eight UK regional pituitary centres for cases of FGAs. SETTING Specialist neuroendocrine centres in the United Kingdom. PATIENTS AND MEASUREMENTS Women diagnosed with FGA-induced OHSS. Description of their clinical course. RESULTS Seven cases of FGA were identified in women, all causing OHSS. Mean age was 33.4 years at diagnosis. Abdominal pain, irregular periods, headache, and visual disturbances were reported at presentation by 100%, 71%, 57% and 43% of women, respectively. Three of seven women underwent ovarian surgery before FGA diagnosis. Six women underwent transsphenoidal surgery (TSS) with incomplete tumour resection in five of those, but all showed improvement or resolution in symptoms and biochemistry postoperatively. CONCLUSION FGA is a rare cause of spontaneous OHSS. TSS improves clinical and biochemical features of ovarian hyperstimulation in FGAs. Improved awareness of FGA will prevent inappropriate emergency ovarian surgery.
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Affiliation(s)
| | - Ophelia Millar
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Amy Coulden
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Edgbaston, Birmingham, UK
| | - Nina Parker
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lee Sit
- The Royal Infirmary of Edinburgh Hospital, Edinburgh, UK
| | - Chris Kelly
- Department of Endocrinology, Forth Valley Royal Hospital, Larbert, UK
| | - Jeremy Cox
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Waljit S Dhillo
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Karim Meeran
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Maya Al Memar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Richard Anderson
- MRC Centre for Reproductive Health, Institute of Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Edgbaston, Birmingham, UK
| | - Channa N Jayasena
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
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Daughters K, Unwin K, Rees DA. The psychological impact of adult-onset craniopharyngioma: A qualitative study of the experience of patients and clinicians. Eur J Oncol Nurs 2023; 65:102346. [PMID: 37321130 DOI: 10.1016/j.ejon.2023.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/22/2023] [Accepted: 04/29/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Individuals who experience social and emotional difficulties struggle to maintain successful social relationships and incur an increased risk of developing mood disorders. These, in turn, have a significant impact on psychological and physical wellbeing. A small number of medical studies suggest that patients with adult-onset craniopharyngioma (AoC) report poorer quality of life, however, no in-depth psychological research has been carried out. The present study aimed to capture a rich understanding of whether patients with AoC experience a psychological impact from their diagnosis and whether psychological factors may contribute to a poorer quality of life. METHOD Both patients with AoC and clinicians with experience of working with patients with AoC were invited to take part in a semi-structured interview. Participants were recruited from three geographically disperse National Health Service (NHS) units across the United Kingdom (UK). Eight patients and 10 clinicians took part in the study. Interviews were recorded and transcribed verbatim and analysed using inductive thematic analysis. RESULTS Two key themes, with multiple subthemes, were identified: 1) Patients experience psychological impacts of AoC; and 2) Patients also experience common physical symptoms. CONCLUSIONS Patients and clinicians recognised significant psychological impact as a result of AoC, and these impacts contributed to overall poorer quality of life. Crucially, both parties also felt that further research into psychological impact of AoC was both interesting and useful.
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Affiliation(s)
- Katie Daughters
- Department of Psychology, University of Essex, Wivehoe Park, Colchester, CO4 3SQ, UK.
| | - Katy Unwin
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK
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Elhassan YS, Iqbal F, Arlt W, Baldeweg SE, Levy M, Stewart PM, Wass J, Pavord S, Aled Rees D, Ronchi CL. COVID-19-related adrenal haemorrhage: Multicentre UK experience and systematic review of the literature. Clin Endocrinol (Oxf) 2023; 98:766-778. [PMID: 36710422 DOI: 10.1111/cen.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Adrenal haemorrhage (AH) is an uncommon, usually incidental imaging finding in acutely unwell patients. AH has been reported during coronavirus disease 2019 (COVID-19) infection and following ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccination. The Society for Endocrinology (SfE) established a task force to describe the UK experience of COVID-19-related AH. DESIGN A systematic literature review was undertaken. A survey was conducted through the SfE clinical membership to identify patients with COVID-19-related AH using a standardized data collection tool. RESULTS The literature search yielded 25 cases of COVID-19-related AH (19 bilateral; 13 infection-related, and 12 vaccine-related). Eight UK centres responded to the survey with at least one case. A total of 18 cases were included in the descriptive study, including 11 from the survey and 7 UK-based patients from the systematic review. Seven patients (4 males; median age 53 (range 26-70) years), had infection-related AH (four bilateral). Median time from positive COVID-19 test to AH detection was 8 (range 1-30) days. Eleven cases of vaccine-related AH (eight bilateral) were captured (3 males; median age 47 (range 23-78) years). Median time between vaccination (nine Oxford-AstraZeneca and two Pfizer-BioNTech) and AH was 9 (range 2-27) days; 9/11 AH occurred after the first vaccine dose. Acute abdominal pain was the commonest presentation (72%) in AH of any cause. All 12 patients with bilateral AH and one patient with unilateral AH required glucocorticoid replacement. CONCLUSION Adrenal haemorrhage with consequential adrenal insufficiency can be a complication of COVID-19 infection and vaccination. Adrenal function assessment is mandatory to avoid the potentially fatal consequences of unrecognized adrenal insufficiency.
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Affiliation(s)
- Yasir S Elhassan
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental sciences, University of Birmingham, Birmingham, UK
| | - Fizzah Iqbal
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff, UK
| | - Wiebke Arlt
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental sciences, University of Birmingham, Birmingham, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, Department of Experimental & Translational Medicine, Division of Medicine, University College London Hospitals & Centre for Obesity & Metabolism, University College London, London, UK
| | - Miles Levy
- Department of Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Paul M Stewart
- Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - John Wass
- Department of Endocrinology, Oxford Centre for Endocrinology, Diabetes and Metabolism, Churchill Hospital, Oxford, UK
| | - Sue Pavord
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff, UK
| | - Cristina L Ronchi
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental sciences, University of Birmingham, Birmingham, UK
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Tschaidse L, Reisch N, Arlt W, Brac de la Perriere A, Linden Hirschberg A, Juul A, Mallappa A, Merke DP, Newell-Price JDC, Perry CG, Prete A, Rees DA, Stikkelbroeck NMML, Touraine PA, Coope H, Porter J, Ross RJM, Quinkler M. Modified-release hydrocortisone is associated with lower plasma renin activity in patients with salt-wasting congenital adrenal hyperplasia. Eur J Endocrinol 2023; 188:6991929. [PMID: 36654495 DOI: 10.1093/ejendo/lvac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/06/2022] [Accepted: 11/30/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Poorly controlled salt-wasting (SW) congenital adrenal hyperplasia (CAH) patients often require high 9α-fluorocortisol doses as they show high levels of 17-hydroxyprogesterone (17OHP), which is a mineralocorticoid (MC)-receptor antagonist. DESIGN We investigated the renin-angiotensin-aldosterone system in patients with SW-CAH receiving twice daily modified-release hydrocortisone (MR-HC, Efmody) compared with standard glucocorticoid (GC) therapy. METHODS Data were analyzed from the 6-month, phase 3 study of MR-HC (n = 42) versus standard GC therapy (n = 41). MC replacement therapy remained unchanged throughout the study. Blood pressure, serum potassium, serum sodium, plasma renin activity (PRA), and serum 17OHP and androstenedione concentrations were analyzed at baseline, 4, 12, and 24 weeks. RESULTS The median serum 17OHP in the morning was significantly lower on MR-HC compared with standard GC at 24 weeks (2.5 nmol L-1 (IQR 8.3) versus 10.5 nmol L-1 (IQR 55.2), P = .001). PRA decreased significantly from baseline to 24 weeks in patients on MR-HC (0.83 ng L-1 s-1 (IQR 1.0) to 0.48 ng L-1 s-1 (IQR 0.61), P = .012) but not in patients on standard GC (0.53 ng L-1 s-1 (IQR 0.66) to 0.52 ng L-1 s-1 (IQR 0.78), P = .613). Serum sodium concentrations increased from baseline to 24 weeks in patients on MR-HC (138.8 ± 1.9 mmol L-1 to 139.3 ± 1.8 mmol L-1, P = .047), but remained unchanged on standard GC (139.8 ± 1.6 mmol L-1 to 139.3 ± 1.9 mmol L-1, P = .135). No significant changes were seen in systolic and diastolic blood pressure and serum potassium levels. CONCLUSION 6 months of MR-HC therapy decreased PRA and increased sodium levels indicating a greater agonist action of the 9α-fluorocortisol dose, which may be due to the decreased levels of the MC-receptor antagonist 17OHP.
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Affiliation(s)
- Lea Tschaidse
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, United Kingdom
| | - Aude Brac de la Perriere
- Hospices Civils de Lyon, Fédération d'Endocrinologie, Groupement hospitalier Est, Bron Cedex, France
| | - Angelica Linden Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ashwini Mallappa
- AstraZeneca, Gaithersburg, Maryland, United States
- National Institutes of Health Clinical Center, Bethesda, Maryland, United States
| | - Deborah P Merke
- National Institutes of Health Clinical Center, Bethesda, Maryland, United States
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | | | - Colin G Perry
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alessandro Prete
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - Philippe A Touraine
- University Hospitals Pitié Salpêtrière - Charles Foix, Center for Rare Endocrine and Gynecological Disorders, Paris, France
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Panagiotou G, Taylor PN, Rees DA, Okosieme OE. Late offspring effects of antenatal thyroid screening. Br Med Bull 2022; 143:16-29. [PMID: 35868487 DOI: 10.1093/bmb/ldac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroid dysfunction in pregnancy is associated with adverse offspring outcomes and recent birth-cohort studies suggest that even mild degrees of thyroid dysfunction may be linked with a range of late cognitive and behavioural effects in childhood and adolescence. SOURCES OF DATA This review summarizes recent literature of observational studies and critically appraises randomized controlled trials (RCTs) of antenatal thyroid screening and Levothyroxine intervention. AREAS OF AGREEMENT Overt hypothyroidism and hyperthyroidism carry significant risks for unfavourable offspring outcomes and should be appropriately corrected in pregnancy. AREAS OF CONTROVERSY The significance of subclinical hypothyroidism and hypothyroxinaemia is still unclear. Meta-analyses of birth-cohort studies show associations of maternal subclinical hypothyroidism and hypothyroxinaemia with intellectual deficits, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders, while hyperthyroidism and high-normal FT4 were linked with ADHD. RCTs have shown no benefits of screening on neurodevelopmental outcomes although Levothyroxine could have been initiated too late in pregnancy in these trials. GROWING POINTS A small number of studies have shown inconsistent associations of maternal thyroid dysfunction with offspring cardiometabolic indices including blood pressure and body weight. Correction of maternal thyroid dysfunction was, however, associated with favourable long-term metabolic profiles in mothers, including lipid profiles, fat mass and body mass index. Antenatal thyroid screening may therefore present opportunities for optimizing a wider range of outcomes than envisaged. AREAS FOR DEVELOPING RESEARCH Future trials with early antenatal thyroid screening and intervention are necessary to clarify the impact of screening on late offspring and maternal effects.
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Affiliation(s)
| | - Peter N Taylor
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Onyebuchi E Okosieme
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK.,Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Gurnos Estate, Merthyr Tydfil, UK
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10
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Daughters K, Rees DA, Hunnikin L, Wells A, Hall J, van Goozen S. Oxytocin administration versus emotion training in healthy males: considerations for future research. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210056. [PMID: 35858104 PMCID: PMC9272145 DOI: 10.1098/rstb.2021.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Identifying emotions correctly is essential for successful social interaction. There is therefore a keen interest in designing therapeutic interventions to improve emotion recognition in individuals who struggle with social interaction. The neuropeptide oxytocin has been proposed as a potential physiological intervention due to its important role in emotion recognition and other aspects of social cognition. However, there are a number of caveats to consider with the current form of intranasal oxytocin commonly used in the literature. Psychological interventions, on the other hand, do not carry the same caveats, and there is, therefore, a need to understand how intranasal oxytocin administration compares to psychological interventions designed to target the same psychological phenomena; and whether a combined intervention approach may provide additive benefits. Here we present a pilot, proof-of-concept study in healthy volunteers comparing the effect of intranasal oxytocin against a validated emotion training programme, finding that the psychological intervention, and not intranasal oxytocin, improved emotion recognition specifically for angry expressions. We discuss the theoretical implications of the research for future clinical trials. This article is part of the theme issue 'Interplays between oxytocin and other neuromodulators in shaping complex social behaviours'.
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Affiliation(s)
- Katie Daughters
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Laura Hunnikin
- Centre for Human Developmental Science, Cardiff University, Cardiff, UK
| | - Amy Wells
- Centre for Human Developmental Science, Cardiff University, Cardiff, UK
| | - Jeremy Hall
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
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Zhang L, Rai P, Miwa S, Draman MS, Rees DA, Haridas AS, Morris DS, Tee AR, Ludgate M, Turnbull DM, Dayan CM. The Role of Mitochondria-Linked Fatty-Acid Uptake-Driven Adipogenesis in Graves Orbitopathy. Endocrinology 2021; 162:6362764. [PMID: 34473251 PMCID: PMC8848742 DOI: 10.1210/endocr/bqab188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Depot-specific expansion of orbital adipose tissue (OAT) in Graves orbitopathy (GO; an autoimmune condition producing proptosis, visual impairment and reduced quality of life) is associated with fatty acid (FA)-uptake-driven adipogenesis in preadipocytes/fibroblasts (PFs). OBJECTIVE This work sought a role for mitochondria in OAT adipogenesis in GO. METHODS Confluent PFs from healthy OAT (OAT-H), OAT from GO (OAT-GO) and white adipose tissue in culture medium compared with culture medium containing a mixed hormonal cocktail as adipogenic medium (ADM), or culture-medium containing FA-supplementation, oleate:palmitate:linoleate (45:30:25%) with/without different concentration of mitochondrial biosubstrate adenosine 5'-diphosphate/guanosine 5'-diphosphate (ADP/GDP), AICAR (adenosine analogue), or inhibitor oligomycin-A for 17 days. Main outcome measures included oil-red-O staining and foci count of differentiated adipocytes for in vitro adipogenesis, flow cytometry, relative quantitative polymerase chain reaction, MTS-assay/106 cells, total cellular-ATP detection kit, and Seahorse-XFe96-Analyzer for mitochondria and oxidative-phosphorylation (OXPHOS)/glycolysis-ATP production analysis. RESULTS During early adipogenesis before adipocyte formation (days 0, 4, and7), we observed OAT-specific cellular ATP production via mitochondrial OXPHOS in PFs both from OAT-H and OAT-GO, and substantially disrupted OXPHOS-ATP/glycolysis-ATP production in PFs from OAT-GO, for example, a 40% reduction in OXPHOS-ATP and trend-increased glycolysis-ATP production on days 4 and 7 compared with day 0, which contrasted with the stable levels in OAT-H. FA supplementation in culture-medium triggered adipogenesis in PFs both from OAT-H and OAT-GO, which was substantially enhanced by 1-mM GDP reaching 7% to 18% of ADM adipogenesis. The FA-uptake-driven adipogenesis was diminished by oligomycin-A but unaffected by treatment with ADP or AICAR. Furthermore, we observed a significant positive correlation between FA-uptake-driven adipogenesis by GDP and the ratios of OXPHOS-ATP/glycolysis-ATP through adipogenesis of PFs from OAT-GO. CONCLUSION Our study confirmed that FA uptake can drive OAT adipogenesis and revealed a fundamental role for mitochondria-OXPHOS in GO development, which provides potential for therapeutic interventions.
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Affiliation(s)
- Lei Zhang
- School of Medicine, Cardiff University, Heath Park Hospital, Cardiff, CF14 4XN, UK
- Correspondence: Lei Zhang, PhD, School of Medicine, Cardiff University, Heath Park Hospital, Rm 260, C2 link, Cardiff, CF14 4XN, UK.
| | - Pavandeep Rai
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, NE2 4HH, UK
| | - Satomi Miwa
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Mohd Shazli Draman
- School of Medicine, Cardiff University, Heath Park Hospital, Cardiff, CF14 4XN, UK
| | - D Aled Rees
- School of Medicine, Cardiff University, Heath Park Hospital, Cardiff, CF14 4XN, UK
| | - Anjana S Haridas
- Department of Ophthalmology, Cardiff & Vale University Health Board, Heath Park Hospital, Cardiff CF14 4XW, UK
| | - Daniel S Morris
- Department of Ophthalmology, Cardiff & Vale University Health Board, Heath Park Hospital, Cardiff CF14 4XW, UK
| | - Andrew R Tee
- School of Medicine, Cardiff University, Heath Park Hospital, Cardiff, CF14 4XN, UK
| | - Marian Ludgate
- School of Medicine, Cardiff University, Heath Park Hospital, Cardiff, CF14 4XN, UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, NE2 4HH, UK
| | - Colin M Dayan
- School of Medicine, Cardiff University, Heath Park Hospital, Cardiff, CF14 4XN, UK
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12
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Cauldwell M, Steer PJ, Adamson D, Alexander C, Allen L, Bhagra C, Bolger A, Bonner S, Calanchini M, Carroll A, Casey R, Curtis S, Head C, English K, Hudsmith L, James R, Joy E, Keating N, MacKiliop L, McAuliffe F, Morris RK, Mohan A, Von Klemperer K, Kaler M, Rees DA, Shetty A, Siddiqui F, Simpson L, Stocker L, Timmons P, Vause S, Turner HE. Pregnancies in women with Turner Syndrome: A retrospective multicentre UK study. BJOG 2021; 129:796-803. [PMID: 34800331 DOI: 10.1111/1471-0528.17025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the characteristics and outcomes of pregnancy in women with Turner Syndrome DESIGN: Retrospective 20-year cohort study (2000-2020) SETTING: 16 tertiary referral maternity units in the UK POPULATION OR SAMPLE: 81 women with Turner syndrome who became pregnant METHODS: Retrospective chart analysis MAIN OUTCOME MEASURES: Mode of conception, pregnancy outcomes RESULTS: We obtained data on 127 pregnancies in 81 women with a Turner phenotype. All non-spontaneous pregnancies (54/127 (42.5%)) were by egg donation. Only 9/31 (29%) of pregnancies in women with karyotype 45,X were spontaneous, compared with 53/66 (80.3%) with mosaic karyotype 45,X/46,XX (p<0.0001). Women with mosaic 45,X/46,XX were younger at first pregnancy by 5.5-8.5 years compared to other TS-karyotype groups (p<0.001), and more likely to have a spontaneous menarche (75.8% vs 50% or less, p=0.008). There were 17 miscarriages, 3 terminations of pregnancy, 2 stillbirths and 105 livebirths. Two women had aortic dissection (2.5%); both were 45,X karyotype, with bicuspid aortic valves and ovum donation pregnancies, one died. Another woman had an aortic root replacement within six months of delivery. 10/106 (9.4%) births with gestational age data were preterm and 22/96 (22.9%) with singleton birthweight/gestational age data weighed <10th centile. The caesarean section rate was 72/107 (67.3%). In only 73/127 (57.4%) of pregnancies was there documentation of cardiovascular imaging within 24 months prior to conceiving. CONCLUSIONS Pregnancy in women with TS is associated with major maternal cardiovascular risks and deserve thorough cardiovascular assessment and counselling prior to assisted or spontaneous pregnancy managed by a specialist team.
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Affiliation(s)
- Matthew Cauldwell
- Department of Obstetrics, Maternal Medicine Service, St George's Hospital, Blackshaw Road, London, SW17 0QT
| | - Philip J Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, United Kingdom
| | - Dawn Adamson
- Department of Cardiology, University Hospitals Coventry and Warwickshire, United Kingdom
| | | | - Lowri Allen
- Department of Endocrinology, Cardiff, Vale University Health Board
| | - Catriona Bhagra
- Department of Cardiology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Aidan Bolger
- Department of Adult Congenital Heart Disease, Glenfield Hospital, Leicester, United Kingdom
| | - Samantha Bonner
- Saint Mary's Managed Clinical Service, Manchester University Foundation Trust, Manchester
| | - Matilde Calanchini
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust
| | - Aisling Carroll
- Department of Congenital Cardiology, University Hospital Southampton NHS Foundation Trust
| | - Ruth Casey
- Department of Endocrinology, Addenbrookes Hospital, Cambridge
| | - Stephanie Curtis
- Adult Congenital Heart Disease Service, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Catherine Head
- Cardiology Department, Norwich University Hospital, Norfolk
| | - Kate English
- Department of Adult Congenital Heart Disease, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Lucy Hudsmith
- Department of Adult Congenital Heart Disease, University Hospitals Birmingham
| | - Rachael James
- Department of Cardiology, University Hospitals Sussex, Brighton
| | - Eleanor Joy
- Department of Adult Congenital Heart Disease, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Niamh Keating
- Department of Obstetrics, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Lucy MacKiliop
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Fionnuala McAuliffe
- Department of Obstetrics, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - R Katie Morris
- Academic Department of Obstetrics, Birmingham Women's and Children's NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2TG, UK
| | - Aarthi Mohan
- Department of Obstetrics, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | | | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Asha Shetty
- Department of Obstetrics, Aberdeen Royal Infirmary, Scotland
| | - Farah Siddiqui
- Department of Obstetrics, Royal Leicester Infirmary, Leicester, United Kingdom
| | | | | | - Paul Timmons
- Department of Obstetrics, Queen Anne Hospital, Southampton
| | - Sarah Vause
- Department of Adult Congenital Heart Disease, Glenfield Hospital, Leicester, United Kingdom
| | - Helen E Turner
- Saint Mary's Managed Clinical Service, Manchester University Foundation Trust, Manchester
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Draman MS, Grennan-Jones F, Taylor P, Muller I, Evans S, Haridas A, Morris DS, Rees DA, Lane C, Dayan C, Zhang L, Ludgate M. Expression of Endogenous Putative TSH Binding Protein in Orbit. Curr Issues Mol Biol 2021; 43:1794-1804. [PMID: 34889904 PMCID: PMC8928972 DOI: 10.3390/cimb43030126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Thyroid stimulating antibodies (TSAB) cause Graves’ disease and contribute to Graves’ Orbitopathy (GO) pathogenesis. We hypothesise that the presence of TSH binding proteins (truncated TSHR variants (TSHRv)) and/or nonclassical ligands such as thyrostimulin (α2β5) might provide a mechanism to protect against or exacerbate GO. We analysed primary human orbital preadipocyte-fibroblasts (OF) from GO patients and people free of GO (non-GO). Transcript (QPCR) and protein (western blot) expression levels of TSHRv were measured through an adipogenesis differentiation process. Cyclic-AMP production by TSHR activation was studied using luciferase-reporter and RIA assays. After differentiation, TSHRv levels in OF from GO were significantly higher than non-GO (p = 0.039), and confirmed in ex vivo analysis of orbital adipose samples. TSHRv western blot revealed a positive signal at 46 kDa in cell lysates and culture media (CM) from non-GO and GO-OF. Cyclic-AMP decreased from basal levels when OF were stimulated with TSH or Monoclonal TSAB (M22) before differentiation protocol, but increased in differentiated cells, and was inversely correlated with the TSHRv:TSHR ratio (Spearman correlation: TSH r = −0.55, p = 0.23, M22 r = 0.87, p = 0.03). In the bioassay, TSH/M22 induced luciferase-light was lower in CM from differentiated GO-OF than non-GO, suggesting that secreted TSHRv had neutralised their effects. α2 transcripts were present but reduced during adipogenesis (p < 0.005) with no difference observed between non-GO and GO. β5 transcripts were at the limit of detection. Our work demonstrated that TSHRv transcripts are expressed as protein, are more abundant in GO than non-GO OF and have the capacity to regulate signalling via the TSHR.
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Affiliation(s)
- Mohd Shazli Draman
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
- KPJ Healthcare University College, Kota Seriemas, Nilai 71800, Malaysia
| | - Fiona Grennan-Jones
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
| | - Peter Taylor
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
| | - Ilaria Muller
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Department of Endocrinology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 28, 20122 Milan, Italy
| | - Sam Evans
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (S.E.); (A.H.); (D.S.M.); (C.L.)
| | - Anjana Haridas
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (S.E.); (A.H.); (D.S.M.); (C.L.)
| | - Daniel S. Morris
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (S.E.); (A.H.); (D.S.M.); (C.L.)
| | - D. Aled Rees
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
| | - Carol Lane
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (S.E.); (A.H.); (D.S.M.); (C.L.)
| | - Colin Dayan
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
| | - Lei Zhang
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
- Correspondence: ; Tel.: +44-292-074-2343; Fax: +44-292-0744-671
| | - Marian Ludgate
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
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14
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Richards CT, Meah VL, James PE, Rees DA, Lord RN. HIIT'ing or MISS'ing the Optimal Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of High- Versus Moderate-Intensity Exercise Prescription. Front Physiol 2021; 12:715881. [PMID: 34483969 PMCID: PMC8415631 DOI: 10.3389/fphys.2021.715881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/19/2021] [Indexed: 01/16/2023] Open
Abstract
Introduction: Polycystic Ovary syndrome (PCOS) is a metabolic disorder associated with increased cardiovascular disease risk. Exercise is an effective treatment strategy to manage symptoms and reduce long-term health risk. High-intensity interval training (HIIT) has been suggested as a more efficient exercise mode in PCOS; however, it is not clear whether HIIT is superior to moderate intensity steady state exercise (MISS). Methods: We synthesized available data through a systematic review and meta-analysis to compare the effectiveness of isolated HIIT and MISS exercise interventions. Our primary outcome measures were cardiorespiratory fitness and insulin resistance, measured using V˙O2max and HOMA-IR respectively. Results: A total of 16 studies were included. Moderate-quality evidence from 16 studies identified significant improvements in V˙O2max following MISS (Δ = 1.081 ml/kg/min, p < 0.001, n = 194), but not HIIT (Δ = 0.641 ml/kg/min, p = 0.128, n = 28). Neither HIIT nor MISS improved HOMA-IR [(Δ = −0.257, p = 0.374, n = 60) and (Δ = −0.341, p = 0.078, n = 159), respectively]. Discussion: A significant improvement in V˙O2max was evident following MISS, but not HIIT exercise in women with PCOS. This contrasts with previous literature in healthy and clinical cohorts that report superior benefits of HIIT. Therefore, based on available moderate-quality evidence, HIIT exercise does not provide superior outcomes in V˙O2max compared with MISS, although larger high-quality interventions are needed to fully address this. Additional dietary/pharmacological interventions may be required in conjunction with exercise to improve insulin sensitivity.
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Affiliation(s)
- Cory T Richards
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Philip E James
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Rachel N Lord
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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15
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Connolly KD, Rees DA, James PE. Role of adipocyte-derived extracellular vesicles in vascular inflammation. Free Radic Biol Med 2021; 172:58-64. [PMID: 34052345 DOI: 10.1016/j.freeradbiomed.2021.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Abstract
Extracellular vesicles (EVs) are nanometre-sized vesicles released from most cells, including adipocytes. Relatively little is known about adipocyte-derived EVs (ADEVs) in comparison to other EV subtypes, though interest in ADEVs as potential paracrine and endocrine communicators of adipose tissue in obesity is building. Current evidence indicates that ADEVs contribute to the development of adipose tissue dysfunction; a key feature of obese adipose tissue that it is associated with obesity-related comorbidities including cardiovascular disease (CVD). This review summarises our current knowledge of ADEVs in the development of adipose tissue dysfunction and the potential of ADEVs to disrupt redox signalling and exert vascular effects that may exacerbate CVD in obesity.
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Affiliation(s)
- Katherine D Connolly
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2YB, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, United Kingdom
| | - Philip E James
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2YB, United Kingdom.
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16
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Berni TR, Morgan CL, Rees DA. Women With Polycystic Ovary Syndrome Have an Increased Risk of Major Cardiovascular Events: a Population Study. J Clin Endocrinol Metab 2021; 106:e3369-e3380. [PMID: 34061968 PMCID: PMC8372630 DOI: 10.1210/clinem/dgab392] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Indexed: 01/02/2023]
Abstract
CONTEXT The effects of polycystic ovary syndrome (PCOS) on cardiovascular morbidity and mortality are unclear. OBJECTIVE This work aims to establish the relative risk of myocardial infarction (MI), stroke, angina, revascularization, and cardiovascular mortality for women with PCOS. METHODS Data were extracted from the Clinical Practice Research Datalink Aurum database. Patients with PCOS were matched to controls (1:1) by age, body mass index (BMI) category, and primary care practice. The primary outcome was the time to major adverse cardiovascular event (MACE); a composite end point incorporating MI, stroke, angina, revascularization and cardiovascular mortality. Secondary outcomes were the individual MACE end points. RESULTS Of 219 034 individuals with a diagnosis of PCOS, 174 660 (79.7%) met the eligibility criteria and were matched. Crude rates of the composite end point, MI, stroke, angina, revascularization, and cardiovascular mortality were respectively 82.7, 22.7, 27.4, 32.8, 10.5, and 6.97 per 100 000 patient-years for cases, and 64.3, 15.9, 25.7, 19.8, 7.13, and 7.75 per 100 000 patient-years for controls. In adjusted Cox proportional hazard models (CPHMs), the hazard ratios (HRs) were 1.26 (95% CI, 1.13-1.41), 1.38 (95% CI, 1.11-1.72), 1.60 (95% CI, 1.32-1.94), and 1.50 (95% CI, 1.08-2.07) for the composite outcome, MI, angina, and revascularization, respectively. In a time-dependent CPHM, weight gain (HR 1.01; 1.00-1.01), prior type 2 diabetes mellitus (T2DM) (HR 2.40; 1.76-3.30), and social deprivation (HR 1.53; 1.11-2.11) increased risk of progression to the composite end point. CONCLUSION The risk of incident MI, angina, and revascularization is increased in young women with PCOS. Weight and T2DM are potentially modifiable risk factors amenable to intervention.
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Affiliation(s)
| | | | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK
- Correspondence: D. Aled Rees, MB BCh, PhD, Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Heath Park, Cardiff CF24 4HQ, UK.
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17
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Thomas M, Berni E, Jenkins-Jones S, Wensley S, Poole CD, Currie CJ, Brownrigg J, Ayuk J, Rees DA. Insulin-like growth factor-1, growth hormone and disease outcomes in acromegaly: A population study. Clin Endocrinol (Oxf) 2021; 95:143-152. [PMID: 33749903 DOI: 10.1111/cen.14468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT A lack of consensus remains about the relative importance of insulin-like growth factor-1 (IGF-1) and growth hormone (GH) in predicting adverse outcomes in patients with acromegaly. OBJECTIVE To describe the differing association between IGF-1 and GH and major disease outcomes in acromegaly. DESIGN Retrospective cohort study. PATIENTS United Kingdom National Health Service patients with acromegaly who had an IGF-1 and/or a GH measurement recorded following diagnosis, prior to December 2019. MEASUREMENTS A composite endpoint including all-cause mortality (ACM), type 2 diabetes (DM), major adverse cardiovascular events (MACE) or cancer was the primary outcome. These outcomes were also analysed individually. Follow-up period was capped at 5 years. RESULTS A maximum of 417 cases and 332 cases were eligible for the IGF-1 and GH analyses, respectively, comprising 1041.5 and 938.9 years of follow-up. There was a direct association between increased IGF-1 concentration and adjusted event risk for the composite endpoint (hazard ratio [HR] = 1.2; 95% confidence interval [CI] = 1.02-1.5); in GH, the HR was 1.1 (1.0-1.2). For the individual endpoints in relation to IGF-1 level, the HRs were ACM (1.2; 0.93-1.5), MACE (1.2; 0.64-2.1), DM (1.53; 1.09-2.2) and cancer (1.3; 0.95-1.7). For GH, the HRs were ACM (1.1; 0.97-1.2), MACE (0.99; 0.73-1.3), DM (1.1; 0.99-1.2) and cancer (0.90; 0.66-1.2). CONCLUSIONS In this contemporary data set with extended follow-up, IGF-1 and GH concentrations showed an association with major adverse outcomes from acromegaly.
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Affiliation(s)
| | | | | | | | | | - Craig J Currie
- Pharmatelligence, Cardiff, UK
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - John Ayuk
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
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Merke DP, Mallappa A, Arlt W, Brac de la Perriere A, Lindén Hirschberg A, Juul A, Newell-Price J, Perry CG, Prete A, Rees DA, Reisch N, Stikkelbroeck N, Touraine P, Maltby K, Treasure FP, Porter J, Ross RJ. Modified-Release Hydrocortisone in Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2021; 106:e2063-e2077. [PMID: 33527139 PMCID: PMC8063257 DOI: 10.1210/clinem/dgab051] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Standard glucocorticoid therapy in congenital adrenal hyperplasia (CAH) regularly fails to control androgen excess, causing glucocorticoid overexposure and poor health outcomes. OBJECTIVE We investigated whether modified-release hydrocortisone (MR-HC), which mimics physiologic cortisol secretion, could improve disease control. METHODS A 6-month, randomized, phase 3 study was conducted of MR-HC vs standard glucocorticoid, followed by a single-arm MR-HC extension study. Primary outcomes were change in 24-hour SD score (SDS) of androgen precursor 17-hydroxyprogesterone (17OHP) for phase 3, and efficacy, safety and tolerability of MR-HC for the extension study. RESULTS The phase 3 study recruited 122 adult CAH patients. Although the study failed its primary outcome at 6 months, there was evidence of better biochemical control on MR-HC, with lower 17OHP SDS at 4 (P = .007) and 12 (P = .019) weeks, and between 07:00h to 15:00h (P = .044) at 6 months. The percentage of patients with controlled 09:00h serum 17OHP (< 1200 ng/dL) was 52% at baseline, at 6 months 91% for MR-HC and 71% for standard therapy (P = .002), and 80% for MR-HC at 18 months' extension. The median daily hydrocortisone dose was 25 mg at baseline, at 6 months 31 mg for standard therapy, and 30 mg for MR-HC, and after 18 months 20 mg MR-HC. Three adrenal crises occurred in phase 3, none on MR-HC and 4 in the extension study. MR-HC resulted in patient-reported benefit including menses restoration in 8 patients (1 on standard therapy), and 3 patient and 4 partner pregnancies (none on standard therapy). CONCLUSION MR-HC improved biochemical disease control in adults with reduction in steroid dose over time and patient-reported benefit.
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Affiliation(s)
- Deborah P Merke
- National Institutes of Health Clinical Center, Bethesda, Maryland, USA
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Ashwini Mallappa
- National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aude Brac de la Perriere
- Hospices Civils de Lyon, Fédération d’Endocrinologie, Groupement hospitalier Est, Bron Cedex, France
| | - Angelica Lindén Hirschberg
- Department of Women’s and Children’s Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Alessandro Prete
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Nicole Reisch
- Medizinische Klinik IV, Klinikum der Universität München, Munich, Germany
| | | | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Pitie Salpêtriere Hospital, France
- Sorbonne University, Center for Rare Endocrine and Gynecological Disorders, Paris, France
| | | | | | | | - Richard J Ross
- University of Sheffield, Sheffield, UK
- Diurnal Ltd, Cardiff, UK
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Ellins EA, Watkins S, Rees DA, Datta DBN, Halcox JP. Acute effect of a single session of lipoprotein apheresis on central haemodynamics in patients with familial hypercholesterolaemia. Atherosclerosis 2021; 325:121-123. [PMID: 33883085 DOI: 10.1016/j.atherosclerosis.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Elizabeth A Ellins
- Institute of Life Science, Swansea University Medical School, Singleton Park, Swansea, UK.
| | | | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Dev B N Datta
- Lipid Unit, University Hospital Llandough, Cardiff, UK
| | - Julian P Halcox
- Institute of Life Science, Swansea University Medical School, Singleton Park, Swansea, UK
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Chambers T, Anney R, Taylor PN, Teumer A, Peeters RP, Medici M, Caseras X, Rees DA. Effects of Thyroid Status on Regional Brain Volumes: A Diagnostic and Genetic Imaging Study in UK Biobank. J Clin Endocrinol Metab 2021; 106:688-696. [PMID: 33274371 PMCID: PMC7947746 DOI: 10.1210/clinem/dgaa903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Thyroid hormone is essential for optimal human neurodevelopment and may modify the risk of attention-deficit/hyperactivity disorder (ADHD). However, the brain structures involved are unknown and it is unclear if the adult brain is also susceptible to changes in thyroid status. METHODS We used International Classification of Disease-10 codes, polygenic thyroid scores at different thresholds of association with thyroid traits (PT-values), and image-derived phenotypes in UK Biobank (n = 18 825) to investigate the effects of a recorded diagnosis of thyroid disease and genetic risk for thyroid status on cerebellar and subcortical gray matter volume. Regional genetic pleiotropy between thyroid status and ADHD was explored using the GWAS-pairwise method. RESULTS A recorded diagnosis of hypothyroidism (n = 419) was associated with significant reductions in total cerebellar and pallidum gray matter volumes (β [95% CI] = -0.14[-0.23, -0.06], P = 0.0005 and β [95%CI] = -0.12 [-0.20, -0.04], P = 0.0042, respectively), mediated in part by increases in body mass index. While we found no evidence for total cerebellar volume alterations with increased polygenic scores for any thyroid trait, opposing influences of increased polygenic scores for hypo- and hyperthyroidism were found in the pallidum (PT < 1e-3: β [95% CI] = -0.02 [-0.03, -0.01], P = 0.0003 and PT < 1e-7: β [95% CI] = 0.02 [0.01, 0.03], P = 0.0003, respectively). Neither hypo- nor hyperthyroidism showed evidence of regional genetic pleiotropy with ADHD. CONCLUSIONS Thyroid status affects gray matter volume in adults, particularly at the level of the cerebellum and pallidum, with potential implications for the regulation of motor, cognitive, and affective function.
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Affiliation(s)
- Tom Chambers
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
| | - Richard Anney
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Peter N Taylor
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Robin P Peeters
- Department of Internal Medicine and Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marco Medici
- Department of Internal Medicine and Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
- Correspondence: D. Aled Rees, FRCP, PhD, Neuroscience and Mental Health Research Institute, Hadyn Ellis Building, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom.
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21
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Zhang L, Evans A, von Ruhland C, Draman MS, Edkins S, Vincent AE, Berlinguer-Palmini R, Rees DA, Haridas AS, Morris D, Tee AR, Ludgate M, Turnbull DM, Karpe F, Dayan CM. Distinctive Features of Orbital Adipose Tissue (OAT) in Graves' Orbitopathy. Int J Mol Sci 2020; 21:E9145. [PMID: 33266331 PMCID: PMC7730568 DOI: 10.3390/ijms21239145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/20/2020] [Accepted: 11/28/2020] [Indexed: 12/12/2022] Open
Abstract
Depot specific expansion of orbital-adipose-tissue (OAT) in Graves' Orbitopathy (GO) is associated with lipid metabolism signaling defects. We hypothesize that the unique adipocyte biology of OAT facilitates its expansion in GO. A comprehensive comparison of OAT and white-adipose-tissue (WAT) was performed by light/electron-microscopy, lipidomic and transcriptional analysis using ex vivo WAT, healthy OAT (OAT-H) and OAT from GO (OAT-GO). OAT-H/OAT-GO have a single lipid-vacuole and low mitochondrial number. Lower lipolytic activity and smaller adipocytes of OAT-H/OAT-GO, accompanied by similar essential linoleic fatty acid (FA) and (low) FA synthesis to WAT, revealed a hyperplastic OAT expansion through external FA-uptake via abundant SLC27A6 (FA-transporter) expression. Mitochondrial dysfunction of OAT in GO was apparent, as evidenced by the increased mRNA expression of uncoupling protein 1 (UCP1) and mitofusin-2 (MFN2) in OAT-GO compared to OAT-H. Transcriptional profiles of OAT-H revealed high expression of Iroquois homeobox-family (IRX-3&5), and low expression in HOX-family/TBX5 (essential for WAT/BAT (brown-adipose-tissue)/BRITE (BRown-in-whITE) development). We demonstrated unique features of OAT not presented in either WAT or BAT/BRITE. This study reveals that the pathologically enhanced FA-uptake driven hyperplastic expansion of OAT in GO is associated with a depot specific mechanism (the SLC27A6 FA-transporter) and mitochondrial dysfunction. We uncovered that OAT functions as a distinctive fat depot, providing novel insights into adipocyte biology and the pathological development of OAT expansion in GO.
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Affiliation(s)
- Lei Zhang
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
| | - Anna Evans
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
| | - Chris von Ruhland
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
| | - Mohd Shazli Draman
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
| | - Sarah Edkins
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
| | - Amy E. Vincent
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle NE2 4HH, UK; (A.E.V.); (D.M.T.)
| | | | - D. Aled Rees
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
| | - Anjana S Haridas
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (A.S.H.); (D.M.)
| | - Dan Morris
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (A.S.H.); (D.M.)
| | - Andrew R. Tee
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
| | - Marian Ludgate
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
| | - Doug M. Turnbull
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle NE2 4HH, UK; (A.E.V.); (D.M.T.)
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7LE, UK;
- NIHR Oxford Biomedical Research Center, OUH Foundation Trust, Oxford OX4 2PG, UK
| | - Colin M. Dayan
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (A.E.); (C.v.R.); (M.S.D.); (S.E.); (D.A.R.); (A.R.T.); (M.L.); (C.M.D.)
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22
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Muller I, Taylor PN, Daniel RM, Hales C, Scholz A, Candler T, Pettit RJ, Evans WD, Shillabeer D, Draman MS, Dayan CM, Tang HKC, Okosieme O, Gregory JW, Lazarus JH, Rees DA, Ludgate ME. CATS II Long-term Anthropometric and Metabolic Effects of Maternal Sub-optimal Thyroid Function in Offspring and Mothers. J Clin Endocrinol Metab 2020; 105:5836234. [PMID: 32396189 DOI: 10.1210/clinem/dgaa129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/01/2020] [Indexed: 01/04/2023]
Abstract
CONTEXT AND OBJECTIVES The Controlled Antenatal Thyroid Screening Study I (CATS-I) was a randomized controlled trial investigating the effects of levothyroxine therapy for suboptimal gestational thyroid function (SGTF), comparing outcomes in children of treated (SGTF-T) with untreated (SGTF-U) women during pregnancy. This follow-up study, CATS-II, reports the long-term effects on anthropometric, bone, and cardiometabolic outcomes in mothers and offspring and includes a group with normal gestational thyroid function (NGTF). DESIGN & PARTICIPANTS 332 mothers (197 NGTF, 56 SGTF-U, 79 SGTF-T) aged 41.2±5.3 years (mean±SD) and 326 paired children assessed 9.3±1.0 years after birth for (i) body mass index (BMI); (ii) lean, fat, and bone mass by dual-energy X-ray absorptiometry; (iii) blood pressure, augmentation index, and aortic pulse-wave-velocity; and (iv) thyroid function, lipids, insulin, and adiponectin. The difference between group means was compared using linear regression. RESULTS Offspring's measurements were similar between groups. Although maternal BMI was similar between groups at CATS-I, after 9 years (at CATS-II) SGTF-U mothers showed higher BMI (median [interquartile ratio] 28.3 [24.6-32.6] kg/m2) compared with NGTF (25.8 [22.9-30.0] kg/m2; P = 0.029), driven by fat mass increase. At CATS-II SGTF-U mothers also had higher thyroid-stimulating hormone (TSH) values (2.45 [1.43-3.50] mU/L) than NGTF (1.54 [1.12-2.07] mU/L; P = 0.015), since 64% had never received levothyroxine. At CATS-II, SGTF-T mothers had BMI (25.8 [23.1-29.8] kg/m2, P = 0.672) and TSH (1.68 [0.89-2.96] mU/L; P = 0.474) values similar to NGTF mothers. CONCLUSIONS Levothyroxine supplementation of women with SGTF did not affect long-term offspring anthropometric, bone, and cardiometabolic measurements. However, absence of treatment was associated with sustained long-term increase in BMI and fat mass in women with SGTF.
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Affiliation(s)
- Ilaria Muller
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Department of Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Peter N Taylor
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Rhian M Daniel
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Charlotte Hales
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Scholz
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Toby Candler
- MRC The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca J Pettit
- Radiology, Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK
| | - William D Evans
- Radiology, Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK
| | - Dionne Shillabeer
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Mohd S Draman
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Faculty of Medicine, University Sultan Zainal Abidin, Terengganu, Malaysia
| | - Colin M Dayan
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Hiu K C Tang
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Department of Oncology, Nottingham University NHS Trust, Nottingham, UK
| | - Onyebuchi Okosieme
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - John H Lazarus
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Marian E Ludgate
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Napier C, Gan EH, Mitchell AL, Gilligan LC, Rees DA, Moran C, Chatterjee K, Vaidya B, James RA, Mamoojee Y, Ashwell S, Arlt W, Pearce SHS. Residual Adrenal Function in Autoimmune Addison's Disease-Effect of Dual Therapy With Rituximab and Depot Tetracosactide. J Clin Endocrinol Metab 2020; 105:5682802. [PMID: 31863094 PMCID: PMC7067544 DOI: 10.1210/clinem/dgz287] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/19/2019] [Indexed: 01/07/2023]
Abstract
CONTEXT In autoimmune Addison's disease (AAD), exogenous glucocorticoid (GC) therapy is an imperfect substitute for physiological GC secretion. Patients on long-term steroid replacement have increased morbidity, reduced life expectancy, and poorer quality of life. OBJECTIVE The objective of this article is to restore adrenocortical steroidogenic function in recent-onset AAD. DESIGN An open-label, multicenter trial of immunotherapy and trophic stimulation in new-onset AAD was conducted. Serial measurement of serum and urine corticosteroids at baseline and throughout a 72-week follow-up period was performed. SETTING This study was conducted at the. UNLABELLED endocrine departments and clinical research facilities at 5 UK tertiary centers. PATIENTS Thirteen participants (9 female, 4 male; age 19-64 years) were included with AAD confirmed by high adrenocorticotropin, low circulating cortisol (basal < 100 nmol/L or post-tetracosactide < 300 nmol/L), and positive serum 21-hydroxylase antibodies. INTERVENTION All participants received dual therapy with B-lymphocyte-depleting immunotherapy (rituximab 1 g given twice) and repeated depot tetracosactide (1 mg on alternate days for 12 weeks). MAIN OUTCOME MEASURE Restoration of normal GC secretion (stimulated cortisol > 550 nmol/L) at week 48 was the main outcome measure. RESULTS Ten of 13 (77%) participants had detectable stimulated serum cortisol (26-265 nmol/L) at trial entry. Following intervention, 7 of 13 (54%) had an increase in stimulated cortisol measurement, with a peak response of 325 nmol/L at week 18 in 1 participant. Increased steroid metabolites, assayed by urine gas chromatography-mass spectrometry at week 12 and week 48, was detected in 8 of 13 (62%) individuals, reflecting an increase in endogenous steroidogenesis. Four of 13 had residual adrenal function at 72 weeks. CONCLUSION Combined treatment with rituximab and depot tetracosactide did not restore normal adrenal function. Nevertheless, adrenocortical plasticity is demonstrated in some patients, and this has the potential to be exploited to improve adrenal function.
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Affiliation(s)
- Catherine Napier
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, UK
| | - Earn H Gan
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, UK
| | - Anna L Mitchell
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, UK
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Carla Moran
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Krishna Chatterjee
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Bijay Vaidya
- Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter, UK
| | - R Andrew James
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, UK
| | - Yaasir Mamoojee
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, UK
| | - Simon Ashwell
- The James Cook University Hospital, Middlesbrough, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon H S Pearce
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, UK
- Correspondence: Catherine Napier, MBBS, MRCP, PhD, Endocrine Unit, Leazes Wing, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals, Queen Victoria Rd, NE1 4LP, UK. E-mail:
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24
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Hales C, Taylor PN, Channon S, McEwan K, Thapar A, Langley K, Muller I, Draman MS, Dayan C, Gregory JW, Okosieme O, Lazarus JH, Rees DA, Ludgate M. Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Behavior. J Clin Endocrinol Metab 2020; 105:5608609. [PMID: 31665323 DOI: 10.1210/clinem/dgz098] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT & OBJECTIVES The Controlled Antenatal Thyroid Screening (CATS) study was the first randomized controlled trial to investigate effects of treating suboptimal gestational thyroid function (SGTF) on child cognition. Since observational studies indicated that SGTF may also increase symptoms of autism and attention-deficit/hyperactivity disorder (ADHD), the CATS cohort was used to investigate whether treatment of mothers affected their children's behavior. DESIGN & PARTICIPANTS Mothers (N = 475) completed 3 questionnaires: the Strengths and Difficulties Questionnaire (SDQ), the Child ADHD Questionnaire, and the Social Communication Questionnaire (SCQ, used as a screen for autism spectrum disorder [ASD]), about their children (mean age 9.5 years). Group comparisons of total scores, numbers of children above clinical thresholds, and association between high maternal free thyroxine (FT4) (> 97.5th percentile of the UK cohort, "overtreated") and child neurodevelopment were reported. RESULTS There were no differences in total scores between normal gestational thyroid function (GTF) (n = 246), treated (n = 125), and untreated (n = 104) SGTF groups. More children of treated mothers scored above clinical thresholds, particularly the overtreated. Scores were above thresholds in SDQ conduct (22% vs 7%), SCQ total scores (7% vs 1%), and ADHD hyperactivity (17% vs 5%) when comparing overtreated (n = 40) and untreated (N = 100), respectively. We identified significantly higher mean scores for SDQ conduct (adjusted mean difference [AMD] 0.74; 95% confidence interval [CI], 0.021-1.431; P = 0.040, effect size 0.018) and ADHD hyperactivity (AMD 1.60, 95% CI, 0.361-2.633; P = 0.003, effect size 0.028) comparing overtreated with normal-GTF children. CONCLUSIONS There was no overall association between SGTF and offspring ADHD, ASD, or behavior questionnaire scores. However, children of "overtreated" mothers displayed significantly more ADHD symptoms and behavioral difficulties than those of normal-GTF mothers. Thyroxine supplementation during pregnancy requires monitoring to avoid overtreatment.
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Affiliation(s)
- Charlotte Hales
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Peter N Taylor
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Wales, UK
| | - Kirsten McEwan
- Centre for Trials Research, Cardiff University, Wales, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Wales, UK
| | - Kate Langley
- School of Psychology, Cardiff University, Wales, UK
| | - Ilaria Muller
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Mohd S Draman
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Colin Dayan
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - John W Gregory
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Onyebuchi Okosieme
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - John H Lazarus
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Wales, UK
| | - Marian Ludgate
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
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Ellins EA, Shipley MJ, Rees DA, Kemp A, Deanfield JE, Brunner EJ, Halcox JP. Associations of depression-anxiety and dyslipidaemia with subclinical carotid arterial disease: Findings from the Whitehall II Study. Eur J Prev Cardiol 2019; 27:800-807. [PMID: 31529992 DOI: 10.1177/2047487319876230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS There is mixed evidence for an association between depression and/or anxiety and carotid intima-media thickness, and limited information on the related role of dyslipidaemia. Here we report associations between depression and/or anxiety and intima-media thickness in the Whitehall II cohort, considering the moderating effects of sex and dyslipidaemia. METHODS A total of 2822 men and 1112 women (61 ± 6 years) were studied during phase 7 (2002-2004) of the Whitehall II study. Intima-media thickness and lipid levels were assessed, and questionnaires (general health questionnaire and the Centre for Epidemiologic Studies depression scale) were completed. Linear regression was used to explore relationships between depression and/or anxiety and intima-media thickness and the moderating effects of sex and dyslipidaemia. RESULTS A total of 1461 participants were categorised with depression and/or anxiety. The association between depression and/or anxiety and intima-media thickness differed between men and women so analyses were undertaken separately by sex. In men, intima-media thickness was significantly associated with dyslipidaemia (P = 0.002) but not depression and/or anxiety (P = 0.29). In women, both dyslipidaemia and depression and/or anxiety were independently associated with intima-media thickness (P = 0.028 and P = 0.031). The greatest intima-media thickness was in women with both depression and/or anxiety and dyslipidaemia. These results were replicated when the general health questionnaire score was substituted for depression and/or anxiety and non-high-density lipoprotein cholesterol for dyslipidaemia. CONCLUSIONS Depression and/or anxiety is associated with increased intima-media thickness in women but not in men. Dyslipidaemia is associated with intima-media thickness in both men and women. Women with both depression and/or anxiety and dyslipidaemia are potentially at the greatest risk of cardiovascular disease.
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Affiliation(s)
| | - Martin J Shipley
- Institute of Epidemiology and Health Care, University College London, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, UK
| | - Andrew Kemp
- College of Human and Health Sciences, Swansea University, UK
| | - John E Deanfield
- UCL Institute of Cardiovascular Science, University College London, UK
| | - Eric J Brunner
- Institute of Epidemiology and Health Care, University College London, UK
| | - Julian P Halcox
- Institute of Life Science, Swansea University Medical School, UK
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Lansdown AJ, Warnert EAH, Sverrisdóttir Y, Wise RG, Rees DA. Regional Cerebral Activation Accompanies Sympathoexcitation in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2019; 104:3614-3623. [PMID: 31127833 DOI: 10.1210/jc.2019-00065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is associated with increased sympathetic nervous system activation, but the cerebral pathways involved are unclear. OBJECTIVE To compare cerebral [blood oxygen level-dependent (BOLD) functional MRI], pressor [blood pressure (BP), heart rate (HR], and muscle sympathetic nerve activity (MSNA) responses to isometric forearm contraction (IFC) in women with PCOS and matched control subjects. DESIGN Case-control study. SETTING Referral center. PARTICIPANTS Patients with PCOS (n = 20; mean ± SD data: age, 29.8 ± 4.8 years; body mass index (BMI), 26.1 ± 4.9 kg/ m2) and 20 age- and BMI-matched control subjects (age, 29.7 ± 5.0 years; BMI, 26.1 ± 4.8 kg/ m2). MAIN OUTCOME MEASURES BP, HR, catecholamine, and MSNA responses to 30% IFC. BOLD signal change was modeled for BP response to 30% IFC. RESULTS Although HR and BP increased to a similar extent in both groups after IFC, MSNA burst frequency increased by 68% in the PCOS group compared with 11.9% in control subjects (n = 7 in both groups; P = 0.002). Brain activation indexed by the BOLD signal in response to IFC was significantly greater in the PCOS group (n = 15) compared with controls (n = 15) in the right orbitofrontal cortex (P < 0.0001). Adjustment for insulin sensitivity, but not hyperandrogenism, abolished these between-group differences. CONCLUSION Our study confirms enhanced sympathoexcitation in women with PCOS and demonstrates increased regional brain activation in response to IFC. The right orbitofrontal cortex BOLD signal change in women with PCOS is associated with insulin sensitivity. Additional studies are warranted to clarify whether this may offer a novel target for cardiovascular risk reduction.
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Affiliation(s)
- Andrew J Lansdown
- Department of Endocrinology, University Hospital of Wales, Cardiff, United Kingdom
| | - Esther A H Warnert
- Department of Radiology, Erasmus Medical Center, CA Rotterdam, Netherlands
| | - Yrsa Sverrisdóttir
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford United Kingdom
| | - Richard G Wise
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
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Wilson N, Steadman R, Muller I, Draman M, Rees DA, Taylor P, Dayan CM, Ludgate M, Zhang L. Role of Hyaluronan in Human Adipogenesis: Evidence from in-Vitro and in-Vivo Studies. Int J Mol Sci 2019; 20:ijms20112675. [PMID: 31151314 PMCID: PMC6600677 DOI: 10.3390/ijms20112675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022] Open
Abstract
Hyaluronan (HA), an extra-cellular matrix glycosaminoglycan, may play a role in mesenchymal stem cell differentiation to fat but results using murine models and cell lines are conflicting. Our previous data, illustrating decreased HA production during human adipogenesis, suggested an inhibitory role. We have investigated the role of HA in adipogenesis and fat accumulation using human primary subcutaneous preadipocyte/fibroblasts (PFs, n = 12) and subjects of varying body mass index (BMI). The impact of HA on peroxisome proliferator-activated receptor gamma (PPARγ) expression was analysed following siRNA knockdown or HA synthase (HAS)1 and HAS2 overexpression. PFs were cultured in complete or adipogenic medium (ADM) with/without 4-methylumbelliferone (4-MU = HA synthesis inhibitor). Adipogenesis was evaluated using oil red O (ORO), counting adipogenic foci, and measurement of a terminal differentiation marker. Modulating HA production by HAS2 knockdown or overexpression increased (16%, p < 0.04) or decreased (30%, p = 0.01) PPARγ transcripts respectively. The inhibition of HA by 4-MU significantly enhanced ADM-induced adipogenesis with 1.52 ± 0.18- (ORO), 4.09 ± 0.63- (foci) and 2.6 ± 0.21-(marker)-fold increases compared with the controls, also increased PPARγ protein expression (40%, (p < 0.04)). In human subjects, circulating HA correlated negatively with BMI and triglycerides (r = −0.396 (p = 0.002), r = −0.269 (p = 0.038), respectively), confirming an inhibitory role of HA in human adipogenesis. Thus, enhancing HA action may provide a therapeutic target in obesity.
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Affiliation(s)
- Nicholas Wilson
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
| | - Robert Steadman
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
| | - Ilaria Muller
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
| | - Mohd Draman
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud, Kuala Terengganu 20400, Malaysia.
| | - D Aled Rees
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
| | - Peter Taylor
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
| | - Colin M Dayan
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
| | - Marian Ludgate
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
| | - Lei Zhang
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
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Wadey RM, Connolly KD, Mathew D, Walters G, Rees DA, James PE. Inflammatory adipocyte-derived extracellular vesicles promote leukocyte attachment to vascular endothelial cells. Atherosclerosis 2019; 283:19-27. [PMID: 30771557 DOI: 10.1016/j.atherosclerosis.2019.01.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/21/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Obesity is associated with an increased risk of cardiovascular disease, but the mechanisms involved are not completely understood. In obesity, the adipocyte microenvironment is characterised by both hypoxia and inflammation. Therefore, we sought to determine whether extracellular vesicles (EVs) derived from adipocytes in this setting might be involved in mediating cardiovascular disease, specifically by promoting leukocyte attachment to vascular endothelial cells. METHODS Mature 3T3-L1 adipocytes were incubated for 24 h under control, TNF-α (30 ng/mL), hypoxia (1% O2), or TNF-α+hypoxia (30 ng/mL, 1% O2) conditions. EVs were isolated by differential ultracentrifugation and analysed by nanoparticle tracking analysis. Primary human umbilical vein endothelial cells (HUVECs) were treated with EVs for 6 h before being lysed for Western blotting to investigate changes in adhesion molecule production, or for use in leukocyte attachment assays. RESULTS EVs from adipocytes treated with TNF-α and TNF-α+hypoxia increased vascular cell adhesion molecule (VCAM-1) production in HUVECs compared to basal level (4.2 ± 0.6 and 3.8 ± 0.3-fold increase, respectively (p < 0.05)), an effect that was inhibited by an anti-TNF-α neutralising antibody. Production of other adhesion molecules (E-selectin, P-selectin, platelet endothelial cell adhesion molecule and VE-Cadherin) was unchanged. Pre-incubating HUVECs with TNF-α+hypoxia EVs significantly increased leukocyte attachment compared to basal level (3.0 ± 0.4-fold increase (p < 0.05)). CONCLUSIONS Inflammatory adipocyte EVs induce VCAM-1 production in vascular endothelial cells, accompanied by enhanced leukocyte attachment. Preventing adipocyte derived EV-induced VCAM-1 upregulation may offer a novel therapeutic target in the prevention of obesity-driven cardiovascular disease.
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Affiliation(s)
- Rebecca M Wadey
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, 200 Western Avenue, Cardiff, CF5 2YB, UK
| | - Katherine D Connolly
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, 200 Western Avenue, Cardiff, CF5 2YB, UK
| | - Donna Mathew
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, 200 Western Avenue, Cardiff, CF5 2YB, UK
| | - Gareth Walters
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, 200 Western Avenue, Cardiff, CF5 2YB, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Philip E James
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, 200 Western Avenue, Cardiff, CF5 2YB, UK.
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Connolly KD, Wadey RM, Mathew D, Johnson E, Rees DA, James PE. Evidence for Adipocyte-Derived Extracellular Vesicles in the Human Circulation. Endocrinology 2018; 159:3259-3267. [PMID: 30016424 PMCID: PMC6109300 DOI: 10.1210/en.2018-00266] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/10/2018] [Indexed: 12/17/2022]
Abstract
Adipocyte-derived extracellular vesicles (EVs) may serve as novel endocrine mediators of adipose tissue and impact upon vascular health. However, it is unclear whether adipocyte-derived EVs are present in the human circulation. Therefore, the purpose of this study was to seek evidence for the presence of adipocyte-derived EVs in circulating plasma. Size-exclusion chromatography of platelet-free plasma identified fractions 5 to 10 as containing EVs by a peak in particle concentration, which corresponded with the presence of EV and adipocyte proteins. Pooling fractions 5 to 10 and subjecting to ultracentrifugation yielded a plasma EV sample, as verified by transmission electron microscopy (TEM) showing EV structures and Western blotting for EV (e.g., CD9 and Alix) and adipocyte markers. Magnetic beads and a solid-phase assay were used to deplete the EV sample of the four major families of circulating EVs: platelet-derived, leukocyte-derived, endothelial-derived, and erythrocyte-derived EVs. Postdepletion samples from both techniques contained EV structures as visualized by TEM, as well as CD9, Alix, and classic adipocyte proteins. Postdepletion samples also contained a range of other adipocyte proteins from an adipokine array. Adipocyte proteins and adipokines are expressed in optimally processed plasma EV samples, suggesting that adipocyte-derived EVs are secreted into the human circulation.
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Affiliation(s)
- Katherine D Connolly
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rebecca M Wadey
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Donna Mathew
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Errin Johnson
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Philip E James
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Correspondence: Philip E. James, PhD, School of Sport and Health Sciences, Cardiff Metropolitan University, Western Avenue, Cardiff CF5 2YB, United Kingdom. E-mail:
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30
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Berni TR, Morgan CL, Berni ER, Rees DA. Polycystic Ovary Syndrome Is Associated With Adverse Mental Health and Neurodevelopmental Outcomes. J Clin Endocrinol Metab 2018; 103:2116-2125. [PMID: 29648599 DOI: 10.1210/jc.2017-02667] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/09/2018] [Indexed: 02/04/2023]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and subfertility, but the effects on mental health and child neurodevelopment are unclear. OBJECTIVES To determine if (1) there is an association between PCOS and psychiatric outcomes and (2) whether rates of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are higher in children of mothers with PCOS. DESIGN Data were extracted from the Clinical Practice Research Datalink. Patients with PCOS were matched to two control sets (1:1) by age, body mass index, and primary care practice. Control set 2 was additionally matched on prior mental health status. Primary outcomes were the incidence of depression, anxiety, and bipolar disorder. Secondary outcomes were the prevalence of ADHD or ASD in the children. RESULTS Eligible patients (16,986) were identified; 16,938 and 16,355 were matched to control sets 1 and 2, respectively. Compared with control set 1, baseline prevalence was 23.1% vs 19.3% for depression, 11.5% vs 9.3% for anxiety, and 3.2% vs 1.5% for bipolar disorder (P < 0.001). The hazard ratio for time to each endpoint was 1.26 (95% confidence interval 1.19 to 1.32), 1.20 (1.11 to 1.29), and 1.21 (1.03 to 1.42) for set 1 and 1.38 (1.30 to 1.45), 1.39 (1.29 to 1.51), and 1.44 (1.21 to 1.71) for set 2. The odds ratios for ASD and ADHD in children were 1.54 (1.12 to 2.11) and 1.64 (1.16 to 2.33) for set 1 and 1.76 (1.27 to 2.46) and 1.34 (0.96 to 1.89) for set 2. CONCLUSIONS PCOS is associated with psychiatric morbidity and increased risk of ADHD and ASD in their children. Screening for mental health disorders should be considered during assessment.
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Affiliation(s)
- Thomas R Berni
- Pharmatelligence, Cardiff Medicentre, Cardiff, United Kingdom
| | - Christopher L Morgan
- Pharmatelligence, Cardiff Medicentre, Cardiff, United Kingdom
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ellen R Berni
- Pharmatelligence, Cardiff Medicentre, Cardiff, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
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31
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Hales C, Taylor PN, Channon S, Paradice R, McEwan K, Zhang L, Gyedu M, Bakhsh A, Okosieme O, Muller I, Draman MS, Gregory JW, Dayan C, Lazarus JH, Rees DA, Ludgate M. Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Cognition. J Clin Endocrinol Metab 2018; 103:1583-1591. [PMID: 29346569 DOI: 10.1210/jc.2017-02378] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023]
Abstract
CONTEXT AND OBJECTIVE The Controlled Antenatal Thyroid Screening (CATS) study investigated treatment of suboptimal gestational thyroid function (SGTF) on childhood cognition and found no difference in intelligence quotient (IQ) at 3 years between children of treated and untreated SGTF mothers. We have measured IQ in the same children at age 9.5 years and included children from normal gestational thyroid function (normal-GTF) mothers. DESIGN, SETTING, AND PARTICIPANTS One examiner, blinded to participant group, assessed children's IQ (Wechsler Intelligence Scale for Children, Fourth Edition UK), long-term memory, and motor function (Developmental Neuropsychological Assessment II) from children of 119 treated and 98 untreated SGTF mothers plus children of 232 mothers with normal-GTF. Logistic regression explored the odds and percentages of an IQ < 85 in the groups. RESULTS There was no difference in IQ < 85 between children of mothers with normal-GTF and combined SGTF, i.e., treated and untreated (fully adjusted odds ratio [OR] = 1.15 [95% confidence interval (CI) 0.52, 2.51]; P = 0.731). Furthermore, there was no significant effect of treatment [untreated OR = 1.33 (95% CI 0.53, 3.34); treated OR = 0.75 (95% CI 0.27, 2.06) P = 0.576]. IQ < 85 was 6.03% in normal-GTF, 7.56% in treated, and 11.22% in untreated groups. Analyses accounting for treated-SGTF women with free thyroxine > 97.5th percentile of the entire CATS-I cohort revealed no significant effect on a child's IQ < 85 in CATS-II. IQ at age 3 predicted IQ at age 9.5 (P < 0.0001) and accounted for 45% of the variation. CONCLUSIONS Maternal thyroxine during pregnancy did not improve child cognition at age 9.5 years. Our findings confirmed CATS-I and suggest that the lack of treatment effect may be a result of the similar proportion of IQ < 85 in children of women with normal-GTF and SGTF.
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Affiliation(s)
- Charlotte Hales
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Peter N Taylor
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ruth Paradice
- St David's Hospital, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom
| | - Kirsten McEwan
- Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Lei Zhang
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Michael Gyedu
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ameen Bakhsh
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | | | - Ilaria Muller
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Mohd S Draman
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - John W Gregory
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Colin Dayan
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - John H Lazarus
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, Wales, United Kingdom
| | - Marian Ludgate
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
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Affiliation(s)
- C Feeney
- Specialist Registrar in Endocrinology and Diabetes, Department of Medicine, The Diabetes Centre, Watford General Hospital, Watford WD18 0HB and Honorary Clinical Research Fellow, Faculty of Medicine, Imperial College London, London
| | - K G Buell
- Academic Foundation Year 2 Doctor, Department of Primary Care and Public Health, Imperial College London, London
| | - P Avari
- Specialist Registrar in Endocrinology and Diabetes and Clinical Research Fellow, Faculty of Medicine, Imperial College London, London
| | - A Buckley
- Specialist Registrar in Intensive Care Medicine, Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London
| | - K Meeran
- Professor of Endocrinology, Faculty of Medicine, Imperial College London, London
| | - D A Rees
- Reader in Neuroendocrinology, School of Medicine, Cardiff University, Cardiff
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Burnley-Hall N, Abdul F, Androshchuk V, Morris K, Ossei-Gerning N, Anderson R, Rees DA, James PE. Dietary Nitrate Supplementation Reduces Circulating Platelet-Derived Extracellular Vesicles in Coronary Artery Disease Patients on Clopidogrel Therapy: A Randomised, Double-Blind, Placebo-Controlled Study. Thromb Haemost 2018; 118:112-122. [PMID: 29304531 DOI: 10.1160/th17-06-0394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Extracellular vesicles (EVs) are implicated in the pathogenesis of cardiovascular disease (CVD). Specifically, platelet-derived EVs are highly pro-coagulant, promoting thrombin generation and fibrin clot formation. Nitrate supplementation exerts beneficial effects in CVD, via an increase in nitric oxide (NO) bioavailability. Clopidogrel is capable of producing NO-donating compounds, such as S-nitrosothiols (RSNO) in the presence of nitrite and low pH. The aim of this study was to assess the effect of nitrate supplementation with versus without clopidogrel therapy on circulating EVs in coronary artery disease (CAD) patients. In this randomized, double-blind, placebo-controlled study, CAD patients with (n = 10) or without (n = 10) clopidogrel therapy received a dietary nitrate supplement (SiS nitrate gel) or identical placebo. NO metabolites and platelet activation were measured using ozone-based chemiluminescence and multiple electrode aggregometry. EV concentration and origin were determined using nanoparticle tracking analysis and time-resolved fluorescence. Following nitrate supplementation, plasma RSNO was elevated (4.7 ± 0.8 vs 0.2 ± 0.5 nM) and thrombin-receptor mediated platelet aggregation was reduced (-19.9 ± 6.0 vs 4.0 ± 6.4 U) only in the clopidogrel group compared with placebo. Circulating EVs were significantly reduced in this group (-1.183e11 ± 3.15e10 vs -9.93e9 ± 1.84e10 EVs/mL), specifically the proportion of CD41+ EVs (-2,120 ± 728 vs 235 ± 436 RFU [relative fluorescence unit]) compared with placebo. In vitro experiments demonstrated clopidogrel-SNO can reduce platelet-EV directly (6.209e10 ± 4.074e9 vs 3.94e11 ± 1.91e10 EVs/mL). In conclusion, nitrate supplementation reduces platelet-derived EVs in CAD patients on clopidogrel therapy, increasing patient responsiveness to clopidogrel. Nitrate supplementation may represent a novel approach to moderating the risk of thrombus formation in CAD patients.
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Affiliation(s)
- Nicholas Burnley-Hall
- Department of Biomedical Science, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Fairoz Abdul
- Department of Biomedical Science, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Vitaliy Androshchuk
- Department of Biomedical Science, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Keith Morris
- Department of Biomedical Science, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Nick Ossei-Gerning
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - D Aled Rees
- Neurosciences and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Philip E James
- Department of Biomedical Science, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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Abstract
PURPOSE Central diabetes insipidus is characterised by arginine vasopressin deficiency. Oxytocin is structurally related to vasopressin and is synthesised in the same hypothalamic nuclei, thus we hypothesised that patients with acquired central diabetes insipidus and anterior hypopituitarism would display an oxytocin deficiency. Moreover, psychological research has demonstrated that oxytocin influences social and emotional behaviours, particularly empathic behaviour. We therefore further hypothesised that central diabetes insipidus patients would perform worse on empathy-related tasks, compared to age-matched and gender-matched clinical control (clinical control-isolated anterior hypopituitarism) and healthy control groups. METHOD Fifty-six participants (age 46.54 ± 16.30 yrs; central diabetes insipidus: n = 20, 8 males; clinical control: n = 15, 6 males; healthy control: n = 20, 7 males) provided two saliva samples which were analysed for oxytocin and completed two empathy tasks. RESULTS Hypopituitary patients (both central diabetes insipidus and clinical control groups) had significantly lower oxytocin concentrations compared to healthy control participants. Hypopituitary patients also performed significantly worse on both the reading the mind in the eyes task and the facial expression recognition task compared to healthy control participants. Regression analyses further revealed that central diabetes insipidus patients' oxytocin concentrations significantly predicted their performance on easy items of the reading the mind in the eyes task. CONCLUSIONS Hypopituitarism may therefore be associated with reduced oxytocin concentrations and impaired empathic ability. While further studies are needed to replicate these findings, our data suggest that oxytocin replacement may offer a therapeutic approach to improve psychological well-being in patients with hypopituitarism.
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Affiliation(s)
- Katie Daughters
- School of Psychology, Cardiff University, Cardiff, CF10 3AT, UK.
| | | | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK
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35
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Arlt W, Lang K, Sitch AJ, Dietz AS, Rhayem Y, Bancos I, Feuchtinger A, Chortis V, Gilligan LC, Ludwig P, Riester A, Asbach E, Hughes BA, O'Neil DM, Bidlingmaier M, Tomlinson JW, Hassan-Smith ZK, Rees DA, Adolf C, Hahner S, Quinkler M, Dekkers T, Deinum J, Biehl M, Keevil BG, Shackleton CH, Deeks JJ, Walch AK, Beuschlein F, Reincke M. Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary aldosteronism. JCI Insight 2017; 2:93136. [PMID: 28422753 PMCID: PMC5396526 DOI: 10.1172/jci.insight.93136] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/14/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Adrenal aldosterone excess is the most common cause of secondary hypertension and is associated with increased cardiovascular morbidity. However, adverse metabolic risk in primary aldosteronism extends beyond hypertension, with increased rates of insulin resistance, type 2 diabetes, and osteoporosis, which cannot be easily explained by aldosterone excess. METHODS We performed mass spectrometry-based analysis of a 24-hour urine steroid metabolome in 174 newly diagnosed patients with primary aldosteronism (103 unilateral adenomas, 71 bilateral adrenal hyperplasias) in comparison to 162 healthy controls, 56 patients with endocrine inactive adrenal adenoma, 104 patients with mild subclinical, and 47 with clinically overt adrenal cortisol excess. We also analyzed the expression of cortisol-producing CYP11B1 and aldosterone-producing CYP11B2 enzymes in adenoma tissue from 57 patients with aldosterone-producing adenoma, employing immunohistochemistry with digital image analysis. RESULTS Primary aldosteronism patients had significantly increased cortisol and total glucocorticoid metabolite excretion (all P < 0.001), only exceeded by glucocorticoid output in patients with clinically overt adrenal Cushing syndrome. Several surrogate parameters of metabolic risk correlated significantly with glucocorticoid but not mineralocorticoid output. Intratumoral CYP11B1 expression was significantly associated with the corresponding in vivo glucocorticoid excretion. Unilateral adrenalectomy resolved both mineralocorticoid and glucocorticoid excess. Postoperative evidence of adrenal insufficiency was found in 13 (29%) of 45 consecutively tested patients. CONCLUSION Our data indicate that glucocorticoid cosecretion is frequently found in primary aldosteronism and contributes to associated metabolic risk. Mineralocorticoid receptor antagonist therapy alone may not be sufficient to counteract adverse metabolic risk in medically treated patients with primary aldosteronism. FUNDING Medical Research Council UK, Wellcome Trust, European Commission.
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Affiliation(s)
- Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Katharina Lang
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Alice J Sitch
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anna S Dietz
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Yara Rhayem
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Irina Bancos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Helmholtz Zentrum Munich, Oberschleißheim, Germany
| | - Vasileios Chortis
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Philippe Ludwig
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anna Riester
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Evelyn Asbach
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Beverly A Hughes
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Donna M O'Neil
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
| | - Zaki K Hassan-Smith
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - D Aled Rees
- Neurosciences and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefanie Hahner
- Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany
| | | | - Tanja Dekkers
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Michael Biehl
- Johann Bernoulli Institute for Mathematics and Computer Science, University of Groningen, Groningen, Netherlands
| | - Brian G Keevil
- Department of Clinical Biochemistry, University Hospital South Manchester, Manchester, United Kingdom
| | - Cedric Hl Shackleton
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,University of California at San Francisco Benioff Children's Hospital, Oakland, California, USA
| | - Jonathan J Deeks
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Axel K Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum Munich, Oberschleißheim, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
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Abstract
Cortisol is a steroid hormone produced in response to stress. It is essential for maintaining health and wellbeing and leads to significant morbidity when deficient or present in excess. It is lipophilic and is transported bound to cortisol-binding globulin (CBG) and albumin; a small fraction (∼10%) of total serum cortisol is unbound and biologically active. Serum cortisol assays measure total cortisol and their results can be misleading in patients with altered serum protein concentrations. Automated immunoassays are used to measure cortisol but lack specificity and show significant inter-assay differences. Liquid chromatography - tandem mass spectrometry (LC-MS/MS) offers improved specificity and sensitivity; however, cortisol cut-offs used in the short Synacthen and Dexamethasone suppression tests are yet to be validated for these assays. Urine free cortisol is used to screen for Cushing's syndrome. Unbound cortisol is excreted unchanged in the urine and 24-h urine free cortisol correlates well with mean serum-free cortisol in conditions of cortisol excess. Urine free cortisol is measured predominantly by immunoassay or LC-MS/MS. Salivary cortisol also reflects changes in unbound serum cortisol and offers a reliable alternative to measuring free cortisol in serum. LC-MS/MS is the method of choice for measuring salivary cortisol; however, its use is limited by the lack of a single, validated reference range and poorly standardized assays. This review examines the methods available for measuring cortisol in serum, urine and saliva, explores cortisol in disease and considers the difficulties of measuring cortisol in acutely unwell patients and in neonates.
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Affiliation(s)
- Nadia El-Farhan
- 1 Biochemistry Department, Royal Gwent Hospital, Newport, UK
| | - D Aled Rees
- 2 Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Carol Evans
- 3 Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
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Burnley-Hall N, Willis G, Davis J, Rees DA, James PE. Nitrite-derived nitric oxide reduces hypoxia-inducible factor 1α-mediated extracellular vesicle production by endothelial cells. Nitric Oxide 2016; 63:1-12. [PMID: 28017872 DOI: 10.1016/j.niox.2016.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/07/2016] [Accepted: 12/15/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Extracellular vesicles (EVs) are small, spherical particles enclosed by a phospholipid bilayer (∼30-1000 nm) released from multiple cell types, and have been shown to have pathophysiological roles in a plethora of disease states. The transcription factor hypoxia-inducible factor-1 (HIF-1) allows for adaptation of cellular physiology in hypoxia and may permit the enhanced release of EVs under such conditions. Nitric oxide (NO) plays a pivotal role in vascular homeostasis, and can modulate the cellular response to hypoxia by preventing HIF-1 accumulation. We aimed to selectively target HIF-1 via sodium nitrite (NaNO2) addition, and examine the effect on endothelial EV, size, concentration and function, and delineate the role of HIF-1 in EV biogenesis. METHODS Endothelial (HECV) cells were exposed to hypoxic conditions (1% O2, 24 h) and compared to endothelial cells exposed to normoxia (21% O2) with and without the presence of sodium nitrite (NaNO2) (30 μM). Allopurinol (100 μM), an inhibitor of xanthine oxidoreductase, was added both alone and in combination with NaNO2 to cells exposed to hypoxia. EV and cell preparations were quantified by nanoparticle tracking analysis and confirmed by electron microscopy. Western blotting and siRNA were used to confirm the role of HIF-1α and HIF-2α in EV biogenesis. Flow cytometry and time-resolved fluorescence were used to assess the surface and intravesicular protein content. RESULTS Endothelial (HECV) cells exposed to hypoxia (1% O2) produced higher levels of EVs compared to cells exposed to normoxia. This increase was confirmed using the hypoxia-mimetic agent desferrioxamine. Treatment of cells with sodium nitrite (NaNO2) reduced the hypoxic enhancement of EV production. Treatment of cells with the xanthine oxidoreductase inhibitor allopurinol, in addition to NaNO2 attenuated the NaNO2-attributed suppression of hypoxia-mediated EV release. Transfection of cells with HIF-1α siRNA, but not HIF-2α siRNA, prior to hypoxic exposure prevented the enhancement of EV release. CONCLUSION These data provide evidence that hypoxia enhances the release of EVs in endothelial cells, and that this is mediated by HIF-1α, but not HIF-2α. Furthermore, the reduction of NO2- to NO via xanthine oxidoreductase during hypoxia appears to inhibit HIF-1α-mediated EV production.
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Affiliation(s)
| | - Gareth Willis
- Division Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, 02115, MA, USA
| | - Jessica Davis
- Institute of Cancer & Genetics, Cardiff University, Cardiff, CF14 4XN, UK
| | - D Aled Rees
- Neurosciences and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Philip E James
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2SG, UK.
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Drake WM, Stiles CE, Bevan JS, Karavitaki N, Trainer PJ, Rees DA, Richardson TI, Baldeweg SE, Stojanovic N, Murray RD, Toogood AA, Martin NM, Vaidya B, Han TS, Steeds RP, Baldeweg FC, Sheikh UE, Kyriakakis N, Parasuraman SK, Taylor L, Butt N, Anyiam S. A Follow-Up Study of the Prevalence of Valvular Heart Abnormalities in Hyperprolactinemic Patients Treated With Cabergoline. J Clin Endocrinol Metab 2016; 101:4189-4194. [PMID: 27571182 DOI: 10.1210/jc.2016-2224] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Uncertainty exists whether the long-term use of ergot-derived dopamine agonist (DA) drugs for the treatment of hyperprolactinemia may be associated with clinically significant valvular heart disease and whether current regulatory authority guidelines for echocardiographic screening are clinically appropriate. OBJECTIVE Our objective was to provide follow-up echocardiographic data on a previously described cohort of patients treated with DA for lactotrope pituitary tumors and to explore possible associations between structural and functional valve abnormalities with the cumulative dose of drug used. DESIGN Follow-up echocardiographic data were collected from a proportion of our previously reported cohort of patients; all had received continuous DA therapy for at least 2 years in the intervening period. Studies were performed according to British Society of Echocardiography minimum standards for adult transthoracic echocardiography. Generalized estimating equations with backward selection were used to determine odds ratios of valvular heart abnormalities according to tertiles of cumulative cabergoline dose, using the lowest tertile as the reference group. SETTING Thirteen centers of secondary/tertiary endocrine care across the United Kingdom were included. RESULTS There were 192 patients (81 males; median age, 51 years; interquartile range [IQR], 42-62). Median (IQR) cumulative cabergoline doses at the first and second echocardiograms were 97 mg (20-377) and 232 mg (91-551), respectively. Median (IQR) duration of uninterrupted cabergoline therapy between echocardiograms was 34 months (24-42). No associations were observed between cumulative doses of dopamine agonist used and the age-corrected prevalence of any valvular abnormality. CONCLUSION This large UK follow-up study does not support a clinically significant association between the use of DA for the treatment of hyperprolactinemia and cardiac valvulopathy.
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Affiliation(s)
- William M Drake
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Craig E Stiles
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - John S Bevan
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Niki Karavitaki
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Peter J Trainer
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - D Aled Rees
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Tristan I Richardson
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Stephanie E Baldeweg
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Nemanja Stojanovic
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Robert D Murray
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Andrew A Toogood
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Niamh M Martin
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Bijay Vaidya
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Than S Han
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Rick P Steeds
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | -
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - F C Baldeweg
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - U E Sheikh
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - N Kyriakakis
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - S K Parasuraman
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - L Taylor
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - N Butt
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - S Anyiam
- Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
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Rao Bondugulapati LN, Rees DA. Inhaled corticosteroids and HPA axis suppression: how important is it and how should it be managed? Clin Endocrinol (Oxf) 2016; 85:165-9. [PMID: 27038017 DOI: 10.1111/cen.13073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/19/2016] [Accepted: 03/29/2016] [Indexed: 12/12/2022]
Abstract
Inhaled corticosteroids (ICS) are established as a cornerstone of management for patients with bronchoconstrictive lung disease. However, systemic absorption may lead to suppression of the hypothalamic-pituitary-adrenal (HPA) axis in a significant minority of patients. This is more likely in 'higher risk' patients exposed to high cumulative ICS doses, and in those treated with frequent oral corticosteroids or drugs which inhibit cytochrome p450 3A4. Hypothalamic-pituitary-adrenal axis suppression is frequently unrecognized, such that some patients, notably children, only come to light when an adrenal crisis is precipitated by physical stress. To minimize this risk, 'higher risk' patients and those with previously identified suppressed cortisol responses to Synacthen testing should undergo an education programme to inform them about sick day rules. A review of ICS therapy should also be undertaken to ensure that the dose administered is the minimum required to control symptoms.
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Affiliation(s)
| | - D A Rees
- Neurosciences and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
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Rees DA, Jenkins-Jones S, Morgan CL. Contemporary Reproductive Outcomes for Patients With Polycystic Ovary Syndrome: A Retrospective Observational Study. J Clin Endocrinol Metab 2016; 101:1664-72. [PMID: 26859102 PMCID: PMC4880155 DOI: 10.1210/jc.2015-2682] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility and may be associated with adverse pregnancy and neonatal outcomes. However, it is difficult to establish how much of this risk is due to PCOS and how much to obesity. OBJECTIVE This study aimed to determine the effect of PCOS upon fertility, pregnancy, and neonatal outcomes. DESIGN AND SETTING Data were extracted from the Clinical Practice Research Datalink (CPRD), a longitudinal anonymized primary care research database in the United Kingdom. Patients with a diagnosis of PCOS were matched to controls (1:2) by age (±1 y), body mass index (± 3 U), and CPRD practice. Standardized fertility ratios before and after diagnosis (index date) were calculated. Rates of miscarriage, pre-eclampsia, gestational diabetes, premature delivery, delivery method, and neonatal outcomes were compared. RESULTS Nine thousand sixty-eight women with PCOS matched study criteria. Prior to index date the standardized fertility ratio for patients with PCOS was 0.80 (95% confidence interval, 0.77–0.83); following index date it was 1.16 (1.12–1.20). The adjusted odds ratios (95% CI) for miscarriage (1.70; 1.56–1.84), pre-eclampsia (1.32; 1.16–1.49), gestational diabetes (1.41; 1.2–1.66), and premature delivery (1.25; 1.1–1.43) were all increased compared with controls. Of PCOS births, 27.7% were by Caesarean section compared with 23.7% of controls (1.13; 1.05–1.21). Infants born to mothers with PCOS had an increased risk of neonatal jaundice (1.20; 1.03–1.39) and respiratory complications (1.20; 1.06–1.37). CONCLUSIONS PCOS is associated with subfertility but fertility rates are restored to those of the background population following diagnosis. Pregnancy complications and adverse neonatal outcomes are more prevalent for women with PCOS independently of obesity.
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Affiliation(s)
- D Aled Rees
- Pharmatelligence (S.J.-J.), Cardiff Medicentre, Heath Park, Cardiff CF14 4UJ, United Kingdom; and Institute of Primary Care and Public Health (C.L.M.) and Neurosciences and Mental Health Research Institute (D.A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Sara Jenkins-Jones
- Pharmatelligence (S.J.-J.), Cardiff Medicentre, Heath Park, Cardiff CF14 4UJ, United Kingdom; and Institute of Primary Care and Public Health (C.L.M.) and Neurosciences and Mental Health Research Institute (D.A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Christopher L Morgan
- Pharmatelligence (S.J.-J.), Cardiff Medicentre, Heath Park, Cardiff CF14 4UJ, United Kingdom; and Institute of Primary Care and Public Health (C.L.M.) and Neurosciences and Mental Health Research Institute (D.A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom
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Roy Chowdhury S, Thomas RL, Dunseath GJ, Peter R, Rees DA, North RV, Luzio SD, Owens DR. Diabetic Retinopathy in Newly Diagnosed Subjects With Type 2 Diabetes Mellitus: Contribution of β-Cell Function. J Clin Endocrinol Metab 2016; 101:572-80. [PMID: 26652932 DOI: 10.1210/jc.2015-2203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE The association of hyperglycemia and diabetic retinopathy (DR) in established type 2 diabetes mellitus (T2DM) subjects is well accepted. However, the association between β-cell responsiveness and insulin sensitivity leading to fasting and postprandial hyperglycemia with DR in newly diagnosed treatment-naïve T2DM subjects remain unreported. METHODS A total of 544 newly diagnosed treatment-naïve T2DM subjects were screened for DR (digital photography) and underwent a standardized meal tolerance test. Serial plasma glucose and insulin levels were measured, and fasting (M0) and postprandial β-cell responsiveness calculated Calculating Pancreatic Response Program along with homeostasis model assessment-β cell function (HOMA-B) and HOMA-Insulin Sensitivity. A subgroup of 201 subjects also underwent a frequently sampled IV glucose tolerance test and the acute insulin response to glucose, insulin sensitivity, and glucose effectiveness (SG) estimated (MINMOD model). RESULTS A total of 16.5% (90) subjects had DR at diagnosis. Subjects with DR had significantly reduced M0, HOMA-B and SG leading to higher fasting and postprandial (2 hour) glucose and significantly lower fasting and postprandial (2 hour) insulin. Factors independently associated with DR in multivariate logistic regression analysis were M0, HOMA-B, and SG with fasting and postprandial (2 hour) glucose and insulin. There was no statistical difference in glycated hemoglobin, systolic blood pressure, acute insulin response to glucose, and insulin sensitivity between those with or without DR. PRINCIPAL CONCLUSIONS In this cohort of newly diagnosed T2DM subjects, DR is associated with reduced β-cell responsiveness, resulting from β-cell failure rather than insulin resistance, leading to fasting and postprandial hyperglycemia and hypoinsulinemia.
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Affiliation(s)
- Sharmistha Roy Chowdhury
- Diabetes Research Unit (S.R.C.), Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK CF14 4XN; Diabetes Research Group (R.L.T., G.J.D., S.D.L., D.R.O.), Swansea University, Singleton Park, Swansea, UK SA2 8PP; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK CF14-4XN; School of Optometry & Vision Sciences (R.V.N.), Cardiff University, Cardiff, UK CF24 4HQ
| | - Rebecca L Thomas
- Diabetes Research Unit (S.R.C.), Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK CF14 4XN; Diabetes Research Group (R.L.T., G.J.D., S.D.L., D.R.O.), Swansea University, Singleton Park, Swansea, UK SA2 8PP; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK CF14-4XN; School of Optometry & Vision Sciences (R.V.N.), Cardiff University, Cardiff, UK CF24 4HQ
| | - Gareth J Dunseath
- Diabetes Research Unit (S.R.C.), Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK CF14 4XN; Diabetes Research Group (R.L.T., G.J.D., S.D.L., D.R.O.), Swansea University, Singleton Park, Swansea, UK SA2 8PP; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK CF14-4XN; School of Optometry & Vision Sciences (R.V.N.), Cardiff University, Cardiff, UK CF24 4HQ
| | - Rajesh Peter
- Diabetes Research Unit (S.R.C.), Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK CF14 4XN; Diabetes Research Group (R.L.T., G.J.D., S.D.L., D.R.O.), Swansea University, Singleton Park, Swansea, UK SA2 8PP; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK CF14-4XN; School of Optometry & Vision Sciences (R.V.N.), Cardiff University, Cardiff, UK CF24 4HQ
| | - D Aled Rees
- Diabetes Research Unit (S.R.C.), Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK CF14 4XN; Diabetes Research Group (R.L.T., G.J.D., S.D.L., D.R.O.), Swansea University, Singleton Park, Swansea, UK SA2 8PP; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK CF14-4XN; School of Optometry & Vision Sciences (R.V.N.), Cardiff University, Cardiff, UK CF24 4HQ
| | - Rachel V North
- Diabetes Research Unit (S.R.C.), Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK CF14 4XN; Diabetes Research Group (R.L.T., G.J.D., S.D.L., D.R.O.), Swansea University, Singleton Park, Swansea, UK SA2 8PP; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK CF14-4XN; School of Optometry & Vision Sciences (R.V.N.), Cardiff University, Cardiff, UK CF24 4HQ
| | - Stephen D Luzio
- Diabetes Research Unit (S.R.C.), Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK CF14 4XN; Diabetes Research Group (R.L.T., G.J.D., S.D.L., D.R.O.), Swansea University, Singleton Park, Swansea, UK SA2 8PP; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK CF14-4XN; School of Optometry & Vision Sciences (R.V.N.), Cardiff University, Cardiff, UK CF24 4HQ
| | - David R Owens
- Diabetes Research Unit (S.R.C.), Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK CF14 4XN; Diabetes Research Group (R.L.T., G.J.D., S.D.L., D.R.O.), Swansea University, Singleton Park, Swansea, UK SA2 8PP; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK CF14-4XN; School of Optometry & Vision Sciences (R.V.N.), Cardiff University, Cardiff, UK CF24 4HQ
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Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is a disorder characterized by insulin resistance and hyperandrogenism, which leads to an increased risk of type 2 diabetes in later life. Androgens and insulin signaling affect brain function but little is known about brain structure and function in younger adults with PCOS. OBJECTIVE To establish whether young women with PCOS display altered white matter microstructure and cognitive function. PATIENTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Eighteen individuals with PCOS (age, 31 ± 6 y; body mass index [BMI] 30 ± 6 kg/m(2)) and 18 control subjects (age, 31 ± 7 y; BMI, 29 ± 6 kg/m(2)), matched for age, IQ, and BMI, underwent anthropometric and metabolic evaluation, diffusion tensor MRI, a technique especially sensitive to brain white matter structure, and cognitive assessment. Cognitive scores and white matter diffusion metrics were compared between groups. White matter microstructure was evaluated across the whole white matter skeleton using tract-based spatial statistics. Associations with metabolic indices were also evaluated. RESULTS PCOS was associated with a widespread reduction in axial diffusivity (diffusion along the main axis of white matter fibers) and increased tissue volume fraction (the proportion of volume filled by white or grey matter rather than cerebrospinal fluid) in the corpus callosum. Cognitive performance was reduced compared with controls (first principal component, t = 2.9, P = .007), reflecting subtle decrements across a broad range of cognitive tests, despite similar education and premorbid intelligence. In PCOS, there was a reversal of the relationship seen in controls between brain microstructure and both androgens and insulin resistance. CONCLUSIONS White matter microstructure is altered, and cognitive performance is compromised, in young adults with PCOS. These alterations in brain structure and function are independent of age, education and BMI. If reversible, these changes represent a potential target for treatment.
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Affiliation(s)
- D Aled Rees
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Maneesh Udiawar
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Rok Berlot
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Derek K Jones
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Michael J O'Sullivan
- Institute of Molecular and Experimental Medicine (D.A.R., M.U.), School of Medicine and Cardiff University Brain Research Imaging Centre (M.U., D.K.J., M.J.O.), School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Department of Basic and Clinical Neuroscience (R.B., M.J.O.), Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 9RX, United Kingdom; and Department of Neurology (R.B.), University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
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Connolly KD, Guschina IA, Yeung V, Clayton A, Draman MS, Von Ruhland C, Ludgate M, James PE, Rees DA. Characterisation of adipocyte-derived extracellular vesicles released pre- and post-adipogenesis. J Extracell Vesicles 2015; 4:29159. [PMID: 26609807 PMCID: PMC4661001 DOI: 10.3402/jev.v4.29159] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/07/2015] [Accepted: 10/28/2015] [Indexed: 01/01/2023] Open
Abstract
Extracellular vesicles (EVs) are submicron vesicles released from many cell types, including adipocytes. EVs are implicated in the pathogenesis of obesity-driven cardiovascular disease, although the characteristics of adipocyte-derived EVs are not well described. We sought to define the characteristics of adipocyte-derived EVs before and after adipogenesis, hypothesising that adipogenesis would affect EV structure, molecular composition and function. Using 3T3-L1 cells, EVs were harvested at day 0 and day 15 of differentiation. EV and cell preparations were visualised by electron microscopy and EVs quantified by nanoparticle tracking analysis (NTA). EVs were then assessed for annexin V positivity using flow cytometry; lipid and phospholipid composition using 2D thin layer chromatography and gas chromatography; and vesicular protein content by an immuno-phenotyping assay. Pre-adipogenic cells are connected via a network of protrusions and EVs at both time points display classic EV morphology. EV concentration is elevated prior to adipogenesis, particularly in exosomes and small microvesicles. Parent cells contain higher proportions of phosphatidylserine (PS) and show higher annexin V binding. Both cells and EVs contain an increased proportion of arachidonic acid at day 0. PREF-1 was increased at day 0 whilst adiponectin was higher at day 15 indicating EV protein content reflects the stage of adipogenesis of the cell. Our data suggest that EV production is higher in cells before adipogenesis, particularly in vesicles <300 nm. Cells at this time point possess a greater proportion of PS (required for EV generation) whilst corresponding EVs are enriched in signalling fatty acids, such as arachidonic acid, and markers of adipogenesis, such as PREF-1 and PPARγ.
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Affiliation(s)
- Katherine D Connolly
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Irina A Guschina
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Vincent Yeung
- Institute of Cancer Genetics, School of Medicine, Velindre Cancer Centre, Cardiff University, Cardiff, United Kingdom
| | - Aled Clayton
- Institute of Cancer Genetics, School of Medicine, Velindre Cancer Centre, Cardiff University, Cardiff, United Kingdom
| | - Mohd Shazli Draman
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Christopher Von Ruhland
- Central Biotechnology Services, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Marian Ludgate
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Philip E James
- School of Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - D Aled Rees
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom;
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Bondugulapati LNR, Campbell C, Chowdhury SR, Goetz P, Davies JS, Rees DA, Hayhurst C. Use of day 1 early morning cortisol to predict the need for glucocorticoid replacement after pituitary surgery. Br J Neurosurg 2015; 30:76-9. [PMID: 26313503 DOI: 10.3109/02688697.2015.1071325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Assessment of adrenal reserve in patients who have undergone pituitary surgery is crucial. However, there is no clear consensus with regards to the type and timing of the test that should be used in the immediate post-operative period. Recently, there has been increased interest in measuring post-operative cortisol levels. We present our data utilising day 1 post-operative early morning cortisol as a tool to assess adrenal reserve in steroid-naive patients. METHODS A retrospective analysis of endoscopic pituitary surgery undertaken over a 2-year period. 82 patients underwent 84 surgeries in total. Patients who were already on glucocorticoids pre-operatively and patients with Cushing's disease, pituitary apoplexy and those without follow-up data were excluded, leaving a study group of 44 patients with 45 operations. A 9am day 1 post-operative cortisol value of > 400 nmol/L was taken as an indicator of adequate adrenal reserve. All the patients were reassessed at 6 weeks with a standard short synacthen test (SST) using 250 micrograms of intravenous synacthen. RESULTS 22 out of 45 patients had a cortisol value of > 400 nmol/L on day 1 post-operatively and were discharged without glucocorticoid supplementation. Of these, only 2 patients subsequently failed the SST when reassessed at 6-8 weeks. The remaining 23 patients had a cortisol value of < 400 nmol/L on day 1 post-operatively and were discharged on hydrocortisone 10 mg twice daily. At 6-8 weeks, nine continued to show suboptimal stimulated cortisol levels whereas the remaining fourteen patients showed adequate adrenal reserve. The 9 am cortisol value had high specificity (81.8%) and positive predictive value (90.9%) for integrity of the HPA axis. Sensitivity was 58.8% and negative predictive value was 39.1%. CONCLUSION A day 1 post-operative early morning cortisol is a useful tool to predict adrenal reserve post-pituitary surgery, enabling clinicians to avoid unnecessary blanket glucocorticoid replacement.
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Affiliation(s)
| | - Christopher Campbell
- b Institute of Molecular and Experimental Medicine, Cardiff University , Cardiff , UK
| | | | - Pablo Goetz
- c Department of Neurosurgery , University Hospital of Wales , Cardiff , UK
| | - J Stephen Davies
- a Department of Endocrinology , University Hospital of Wales , Cardiff , UK
| | - D Aled Rees
- a Department of Endocrinology , University Hospital of Wales , Cardiff , UK.,b Institute of Molecular and Experimental Medicine, Cardiff University , Cardiff , UK
| | - Caroline Hayhurst
- c Department of Neurosurgery , University Hospital of Wales , Cardiff , UK
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Ellins EA, New KJ, Datta DBN, Watkins S, Haralambos K, Rees A, Aled Rees D, Halcox JPJ. Validation of a new method for non-invasive assessment of vasomotor function. Eur J Prev Cardiol 2015. [DOI: 10.1177/2047487315597210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elizabeth A Ellins
- Institute of Molecular and Experimental Medicine, Cardiff University, UK
- Institute of Life Sciences, Swansea University, UK
| | - Karl J New
- Neurovascular Research Laboratory, University of South Wales, Pontypridd, UK
| | - Dev BN Datta
- Lipid Unit, University Hospital Llandough, Cardiff, UK
| | | | - Kate Haralambos
- Institute of Molecular and Experimental Medicine, Cardiff University, UK
| | - Alan Rees
- University Hospital of Wales, Cardiff, UK
| | - D Aled Rees
- Institute of Molecular and Experimental Medicine, Cardiff University, UK
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Gagliardi L, Schreiber AW, Hahn CN, Feng J, Cranston T, Boon H, Hotu C, Oftedal BE, Cutfield R, Adelson DL, Braund WJ, Gordon RD, Rees DA, Grossman AB, Torpy DJ, Scott HS. ARMC5 mutations are common in familial bilateral macronodular adrenal hyperplasia. J Clin Endocrinol Metab 2014; 99:E1784-92. [PMID: 24905064 DOI: 10.1210/jc.2014-1265] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Bilateral macronodular adrenal hyperplasia (BMAH) is a rare form of adrenal Cushing's syndrome. Familial cases have been reported, but at the time we conducted this study, the genetic basis of BMAH was unknown. Recently, germline variants of armadillo repeat containing 5 (ARMC5) in patients with isolated BMAH and somatic, second-hit mutations in tumor nodules, were identified. OBJECTIVE Our objective was to identify the genetic basis of familial BMAH. DESIGN We performed whole exome capture and sequencing of 2 affected individuals from each of 4 BMAH families (BMAH-01, BMAH-02, BMAH-03, and BMAH-05). Based on clinical evaluation, there were 7, 3, 3, and 4 affected individuals in these families, respectively. Sanger sequencing of ARMC5 was performed in 1 other BMAH kindred, BMAH-06. RESULTS Exome sequencing identified novel variants Chr16:g.31477540, c.2139delT, p.(Thr715Leufs*1) (BMAH-02) and Chr16:g.31473811, c.943C→T, p.(Arg315Trp) (BMAH-03) in ARMC5 (GRch37/hg19), validated by Sanger sequencing. BMAH-01 had a recently reported mutation Chr16:g.31476121, c.1777C→T, p.(Arg593Trp). Sanger sequencing of ARMC5 in BMAH-06 identified a previously reported mutation, Chr16:g. 31473688; c.799C→T, p.(Arg267*). The genetic basis of BMAH in BMAH-05 was not identified. CONCLUSIONS Our studies have detected ARMC5 mutations in 4 of 5 BMAH families tested, confirming that these mutations are a frequent cause of BMAH. Two of the 4 families had novel mutations, indicating allelic heterogeneity. Preclinical evaluation did not predict mutation status. The ARMC5-negative family had unusual prominent hyperaldosteronism. Further studies are needed to determine the penetrance of BMAH in ARMC5 mutation-positive relatives of affected patients, the practical utility of genetic screening and genotype-phenotype correlations.
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Affiliation(s)
- Lucia Gagliardi
- Endocrine and Metabolic Unit (L.G., D.J.T.), Royal Adelaide Hospital; Department of Genetics and Molecular Pathology (L.G., C.N.H., B.E.O., H.S.S.) and ACRF Cancer Genomics Facility (A.W.S., J.F., H.S.S.), Centre for Cancer Biology, SA Pathology; and School of Pharmacy and Medical Sciences (H.S.S.), Division of Health Sciences, University of South Australia, Adelaide SA 5000, Australia; Schools of Medicine (L.G., C.N.H., D.J.T., H.S.S.) and Molecular and Biomedical Science (A.W.S., J.F., D.L.A., H.S.S.), University of Adelaide SA 5005, Australia; Oxford Medical Genetics Laboratories (T.C., H.B.), Oxford University Hospitals National Health Service Trust, and Oxford Centre for Diabetes, Endocrinology and Metabolism (A.B.G.), Churchill Hospital, University of Oxford, Oxford OX3 7LE, United Kingdom; Department of Endocrinology (C.H.), Greenlane Clinical Centre, Auckland District Health Board, Auckland 1051, New Zealand; Department of Clinical Science (B.E.O.), University of Bergen, 5021 Bergen, Norway; Department of Endocrinology (R.C.), North Shore Hospital, Waitemata District Health Board, Auckland 0622, New Zealand; Department of Endocrinology (W.J.B.), Flinders Medical Centre, Bedford Park, SA 5042 Australia; School of Medicine (R.D.G.), University of Queensland, Brisbane QLD 4072, Australia; Endocrine Hypertension Research Centre (R.D.G.), Greenslopes and Princess Alexandra Hospitals, Brisbane QLD 4120, Australia; and Centre for Endocrine and Diabetes Sciences (D.A.R.), School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
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Connolly KD, Willis GR, Datta DBN, Ellins EA, Ladell K, Price DA, Guschina IA, Rees DA, James PE. Lipoprotein-apheresis reduces circulating microparticles in individuals with familial hypercholesterolemia. J Lipid Res 2014; 55:2064-72. [PMID: 25121984 PMCID: PMC4173999 DOI: 10.1194/jlr.m049726] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lipoprotein-apheresis (apheresis) removes LDL-cholesterol in patients with severe dyslipidemia. However, reduction is transient, indicating that the long-term cardiovascular benefits of apheresis may not solely be due to LDL removal. Microparticles (MPs) are submicron vesicles released from the plasma membrane of cells. MPs, particularly platelet-derived MPs, are increasingly being linked to the pathogenesis of many diseases. We aimed to characterize the effect of apheresis on MP size, concentration, cellular origin, and fatty acid concentration in individuals with familial hypercholesterolemia (FH). Plasma and MP samples were collected from 12 individuals with FH undergoing routine apheresis. Tunable resistive pulse sensing (np200) and nanoparticle tracking analysis measured a fall in MP concentration (33 and 15%, respectively; P < 0.05) pre- to post-apheresis. Flow cytometry showed MPs were predominantly annexin V positive and of platelet (CD41) origin both pre- (88.9%) and post-apheresis (88.4%). Fatty acid composition of MPs differed from that of plasma, though apheresis affected a similar profile of fatty acids in both compartments, as measured by GC-flame ionization detection. MP concentration was also shown to positively correlate with thrombin generation potential. In conclusion, we show apheresis nonselectively removes annexin V-positive platelet-derived MPs in individuals with FH. These MPs are potent inducers of coagulation and are elevated in CVD; this reduction in pathological MPs could relate to the long-term benefits of apheresis.
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Affiliation(s)
- Katherine D Connolly
- Institute of Molecular and Experimental Medicine School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Gareth R Willis
- Institute of Molecular and Experimental Medicine School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Dev B N Datta
- Lipid Unit, Llandough Hospital, Cardiff CF64 2XX, United Kingdom
| | - Elizabeth A Ellins
- Institute of Molecular and Experimental Medicine School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom Institute of Life Sciences, College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, United Kingdom
| | - Kristin Ladell
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - David A Price
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Irina A Guschina
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, United Kingdom
| | - D Aled Rees
- Institute of Molecular and Experimental Medicine School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Philip E James
- Institute of Molecular and Experimental Medicine School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
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Han TS, Conway GS, Willis DS, Krone N, Rees DA, Stimson RH, Arlt W, Walker BR, Ross RJ. Relationship between final height and health outcomes in adults with congenital adrenal hyperplasia: United Kingdom congenital adrenal hyperplasia adult study executive (CaHASE). J Clin Endocrinol Metab 2014; 99:E1547-55. [PMID: 24878054 DOI: 10.1210/jc.2014-1486] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Treatment of congenital adrenal hyperplasia (CAH) in childhood focuses on growth and development and adult final height (FH) is a measure of effective treatment. We hypothesized that shorter adults will have more severe underlying disease and worse health outcomes. METHODS This was a cross-sectional analysis of 199 adults with CAH. FH and quality of life were expressed as z-scores adjusted for midparental target height or UK population height. RESULTS FH correlated inversely with age (men, r = -0.38; women, r = -0.26, P < .01). Men and women had z-scores adjusted for midparental target height of -2 and -1, respectively, and both groups had UK population height z-scores of -1 below the UK population (P < .01). In women, FH was shorter in non-salt-wasting than salt-wasting classic CAH (P < .05) and in moderately affected genotype group B women than either more severely affected groups null and A (P < .01) or the mildest group C (P < .001). Short stature and a higher prevalence of hypertension were observed in classic CAH patients diagnosed late (after 1 y) compared with those diagnosed early and in women treated with glucocorticoid only compared with those treated with both glucocorticoids and mineralocorticoids (P < .05). FH did not associate with insulin sensitivity, lipid profile, adiposity, or quality of life. CONCLUSIONS Adult CAH patients remain short, although height prognosis has improved over time. The shortest adults are those diagnosed late with moderate severity CAH and are at increased risk of adult hypertension; we hypothesize that these patients are exposed in childhood to high androgens and/or excessive glucocorticoids with potential programming of hypertension. Another possibility is inadequate mineralocorticoid treatment early in life in the late-diagnosed patient group. Prospective studies are now required to examine these hypotheses.
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Affiliation(s)
- T S Han
- Department of Endocrinology (T.S.H.), St Peter's National Health Service Foundation Trust, Surrey KT16 0PZ, United Kingdom; Department of Endocrinology (G.S.C.), University College London Hospitals, London W1T 3AA, United Kingdom; Society for Endocrinology (D.S.W.), Bristol BS32 4JT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K., W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrine and Diabetes Sciences (D.A.R.), Institute for Molecular and Experimental Medicine, Cardiff University, Cardiff CF10 3US, United Kingdom; Endocrinology Unit (R.H.S., B.R.W.), Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom; and Academic Unit of Diabetes, Endocrinology, and Metabolism (R.J.R.), University of Sheffield, Sheffield S10 2HF, United Kingdom
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Willis GR, Udiawar M, Evans WD, Blundell HL, James PE, Rees DA. Detailed characterisation of circulatory nitric oxide and free radical indices--is there evidence for abnormal cardiovascular homeostasis in young women with polycystic ovary syndrome? BJOG 2014; 121:1596-603. [PMID: 24816317 DOI: 10.1111/1471-0528.12834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess circulating biochemical indices of endothelial function and nitro-oxidative stress in women with polycystic ovary syndrome (PCOS). DESIGN Case-control study. POPULATION Seventeen women with PCOS and eighteen age- and body mass index-matched healthy volunteers. METHODS Nitric oxide (NO) metabolite levels were assessed by chemiluminescence. Electron paramagnetic resonance spectroscopy with spin trapping was used to assess oxidative stress ex vivo and in vitro. Antioxidant capacity was measured using oxygen radical absorbance. MAIN OUTCOME MEASURES Biochemical indices of endothelial function, including NO metabolites, lipid-derived radicals and antioxidant capacity. RESULTS Plasma NO metabolites were similar in the two groups (nitrite: 257±116 nmol/l [PCOS], 261±135 nmol/l [controls] P=0.93; nitrate: 27±7 μmol/l [PCOS], 26±6 μmol/l [controls] P=0.89). Alkoxyl free radicals (lipid-derived) were detected as the dominant species, but levels were not different between women with PCOS and controls whether measured directly ex vivo (median 7.2 [range 0.17-16.73]e6 arbitrary units [a.u.] and 7.2 [1.7-11.9]e6 a.u., respectively, P=0.57) or when stimulated in vitro to test radical generation capacity (1.23 [0.3-5.62]e7 a.u. and 1.1 [0.48-15.7]e7 a.u. respectively, P=0.71). In regression analysis, visceral fat area was independently associated with in vitro oxidative potential (β=0.6, P=0.002). Total plasma antioxidant capacity (94±30% [PCOS], 79±24% [controls], P=0.09) and plasma hydroperoxides (7.5±4 μmol/l [PCOS], 6.7±5 μmol/l [controls], P=0.21) were not different between groups. However, lipophilic antioxidant capacity was lower in women with PCOS compared with controls (92±32 and 125±48%, respectively, P=0.02). CONCLUSIONS Young overweight women with PCOS display a reduced lipophilic antioxidant capacity compared with healthy volunteers, but no change in circulating free radicals or nitro-oxidative stress.
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Affiliation(s)
- G R Willis
- Institute of Molecular and Experimental Medicine, Cardiff University, Cardiff, UK
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Dodd AJ, Ducroq DH, Neale SM, Wise MP, Mitchem KL, Armston A, Barth JH, El-Farhan N, Rees DA, Evans C. The effect of serum matrix and gender on cortisol measurement by commonly used immunoassays. Ann Clin Biochem 2013; 51:379-85. [DOI: 10.1177/0004563213514567] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Considerable intermethod bias has been observed between cortisol immunoassays, with some also displaying a gender difference. Cortisol immunoassay performance is affected by serum matrix effects such as changes in steroid binding proteins and presence of interfering steroids which can be altered in various clinical settings. This study investigates cortisol immunoassay bias in pregnancy, renal failure and intensive care patients. Methods Serum remaining after routine analysis from pregnant patients, patients on the intensive care unit and patients with renal failure were obtained prior to disposal and used to create 20 anonymous samples per group. A male and female serum pool was prepared and spiked with cortisol. Samples were aliquoted and distributed to four hospitals for cortisol analysis by immunoassays from four different manufacturers. Cortisol was also measured by an isotope dilution-gas chromatography–mass spectrometry method for comparison of assay bias. Results Differences in cortisol immunoassay bias were observed across the different patient groups. A negative bias compared to pooled serum samples was observed for pregnancy serum, whilst a more positive bias was seen in renal failure and intensive care patients. Variation in bias was greatest in renal failure with the Roche E170 the most affected and the Abbott architect the least (interquartile ranges 44% and 14%, respectively). Conclusions Cortisol immunoassay bias may be affected by gender and differences in serum matrix from patients with various clinical conditions. Users of cortisol assays should be aware of differing matrix effects on their assay and the relevance of these for the interpretation of clinical results.
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Affiliation(s)
- AJ Dodd
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - DH Ducroq
- Quality Laboratory, WEQAS, Cardiff, UK
| | - SM Neale
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - MP Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - KL Mitchem
- Department of Clinical Biochemistry, Prince Charles Hospital, Merthyr Tydfil, UK
| | - A Armston
- Department of Lab Medicine, University Hospital Southampton, Southampton, UK
| | - JH Barth
- Blood Sciences, Old Medical School, Leeds Teaching Hospitals Trust, Leeds, UK
| | - N El-Farhan
- Department of Medicine, Royal Gwent Hospital, Newport, UK
| | - DA Rees
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - C Evans
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
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