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Hope DCD, Ansari S, Choudhury S, Alexiadou K, Tabbakh Y, Ilesanmi I, Lazarus K, Davies I, Jimenez-Pacheco L, Yang W, Ball LJ, Malviya R, Reglinska B, Khoo B, Minnion J, Bloom SR, Tan TMM. Adaptive infusion of a glucagon-like peptide-1/glucagon receptor co-agonist G3215, in adults with overweight or obesity: Results from a phase 1 randomized clinical trial. Diabetes Obes Metab 2024; 26:1479-1491. [PMID: 38229453 DOI: 10.1111/dom.15448] [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: 11/17/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/18/2024]
Abstract
AIMS To determine whether a continuous infusion of a glucagon-like peptide receptor (GLP-1R)/glucagon receptor (GCGR) co-agonist, G3215 is safe and well tolerated in adults with overweight or obesity. METHODS A phase 1 randomized, double blind, placebo-controlled trial of G3215 in overweight or obese participants, with or without type 2 diabetes. RESULTS Twenty-six participants were recruited and randomized with 23 completing a 14-day subcutaneous infusion of G3215 or placebo. The most common adverse events were nausea or vomiting, which were mild in most cases and mitigated by real-time adjustment of drug infusion. There were no cardiovascular concerns with G3215 infusion. The pharmacokinetic characteristics were in keeping with a continuous infusion over 14 days. A least-squares mean body weight loss of 2.39 kg was achieved with a 14-day infusion of G3215, compared with 0.84 kg with placebo infusion (p < .05). A reduction in food consumption was also observed in participants receiving G3215 and there was no deterioration in glycaemia. An improved lipid profile was seen in G3215-treated participants and consistent with GCGR activation, a broad reduction in circulating amino acids was seen during the infusion period. CONCLUSION An adaptive continuous infusion of the GLP-1/GCGR co-agonist, G3215, is safe and well tolerated offering a unique strategy to control drug exposure. By allowing rapid, response-directed titration, this strategy may allow for mitigation of adverse effects and afford significant weight loss within shorter time horizons than is presently possible with weekly GLP-1R and multi-agonists. These results support ongoing development of G3215 for the treatment of obesity and metabolic disease.
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Affiliation(s)
- David C D Hope
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Saleem Ansari
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Sirazum Choudhury
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Kleopatra Alexiadou
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Yasmin Tabbakh
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ibiyemi Ilesanmi
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Katharine Lazarus
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Iona Davies
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Lara Jimenez-Pacheco
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Wei Yang
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Laura-Jayne Ball
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Reshma Malviya
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Beata Reglinska
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Bernard Khoo
- Endocrinology, Division of Medicine, University College London, London, UK
| | - James Minnion
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Stephen R Bloom
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Tricia M-M Tan
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Alexiadou K, Hartley A, Tan TMM, Khamis R. The cardiovascular effects of GLP-1 receptor agonists beyond obesity and type 2 diabetes: An anti-atherosclerotic action. Trends Cardiovasc Med 2024:S1050-1738(24)00019-7. [PMID: 38555029 DOI: 10.1016/j.tcm.2024.03.003] [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: 11/29/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
Obesity and overweight affect almost one third of the European population. Obesity and its associated conditions, including type 2 diabetes, significantly impact healthcare systems, life expectancy and quality of life. The emergence of glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of obesity, with or without diabetes, has provided an effective alternative to metabolic surgery and dietary interventions. We are now beginning to understand their pleiotropic effects beyond weight loss, such as their favourable impact on cardiovascular profiles. The aim of this review is to summarize available preclinical and clinical data on the beneficial effects of GLP-1 receptor agonists on atherosclerosis and cardiovascular disease which has the potential to substantially broaden the scope of their clinical applications.
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Affiliation(s)
- Kleopatra Alexiadou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Adam Hartley
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College London
| | - Tricia M-M Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ramzi Khamis
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College London.
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Alexiadou K, Ansari S, Jones B, Yu C, Dornhorst A, Oliver N, Tsironis C, Purkayastha S, Ahmed A, Agha-Jaffar R, Khoo B, Tan TMM. Increased glycemic variability in pregnant women with Roux-en-Y gastric bypass compared with sleeve gastrectomy. BMJ Open Diabetes Res Care 2024; 12:e003642. [PMID: 38233077 PMCID: PMC10806855 DOI: 10.1136/bmjdrc-2023-003642] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Bariatric surgery is associated with adverse pregnancy outcomes such as reduced birth weight and premature birth. One possible mechanism for this is increased glycemic variability (GV) which occurs after bariatric surgery. The objective of this study was to compare the effect of Roux-en-Y gastric bypass (RYGB) versus vertical sleeve gastrectomy (SG) on GV during pregnancy and to investigate the relationships of GV, type of bariatric surgery and maternal and neonatal outcomes. RESEARCH DESIGN AND METHODS Fourteen pregnant women after RYGB and 14 after SG were investigated with continuous glucose monitoring in their second or third trimester in this observational study carried out as part of routine clinical care. RESULTS Pregnant women with RYGB had similar mean interstitial glucose values but significantly increased indices of GV and a lower %time in range 3.9-7.8 mmol/L (70-140 mg/dL), compared with SG. CONCLUSIONS Pregnant women who have undergone RYGB have greater GV during pregnancy compared with those who have undergone SG. Further research is needed to establish the relationship between GV and pregnancy outcomes to determine the preferred bariatric operation in women of reproductive age, and whether interventions to reduce GV might improve outcomes.
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Affiliation(s)
- Kleopatra Alexiadou
- Department of Metabolism Digestion and Reproduction, Imperial College London, London, UK
| | - Saleem Ansari
- Department of Metabolism Digestion and Reproduction, Imperial College London, London, UK
| | - Bryony Jones
- Queen Charlotte's and Chelsea Hospital, London, UK
| | - Christina Yu
- Queen Charlotte's and Chelsea Hospital, London, UK
| | - Anne Dornhorst
- Department of Metabolism Digestion and Reproduction, Imperial College London, London, UK
| | - Nick Oliver
- Department of Metabolism Digestion and Reproduction, Imperial College London, London, UK
| | - Christos Tsironis
- Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ahmed Ahmed
- Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Rochan Agha-Jaffar
- Department of Metabolism Digestion and Reproduction, Imperial College London, London, UK
| | - Bernard Khoo
- Division of Medicine, University College London, London, UK
| | - Tricia M-M Tan
- Department of Metabolism Digestion and Reproduction, Imperial College London, London, UK
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Kjeldsen SA, Gluud LL, Werge MP, Pedersen JS, Bendtsen F, Alexiadou K, Tan T, Torekov SS, Iepsen EW, Jensen NJ, Richter MM, Goetze JP, Rungby J, Hartmann B, Holst JJ, Holst B, Holt J, Gustafsson F, Madsbad S, Svane MS, Bojsen-Møller KN, Wewer Albrechtsen NJ. Neprilysin activity is increased in metabolic dysfunction-associated steatotic liver disease and normalizes after bariatric surgery or GLP-1 therapy. iScience 2023; 26:108190. [PMID: 37953952 PMCID: PMC10638073 DOI: 10.1016/j.isci.2023.108190] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Inhibitors of neprilysin improve glycemia in patients with heart failure and type 2 diabetes (T2D). The effect of weight loss by diet, surgery, or pharmacotherapy on neprilysin activity (NEPa) is unknown. We investigated circulating NEPa and neprilysin protein concentrations in obesity, T2D, metabolic dysfunction-associated steatotic liver disease (MASLD), and following bariatric surgery, or GLP-1-receptor-agonist therapy. NEPa, but not neprilysin protein, was enhanced in obesity, T2D, and MASLD. Notably, MASLD associated with NEPa independently of BMI and HbA1c. NEPa decreased after bariatric surgery with a concurrent increase in OGTT-stimulated GLP-1. Diet-induced weight loss did not affect NEPa, but individuals randomized to 52-week weight maintenance with liraglutide (1.2 mg/day) decreased NEPa, consistent with another study following 6-week liraglutide (3 mg/day). A 90-min GLP-1 infusion did not alter NEPa. Thus, MASLD may drive exaggerated NEPa, and lowered NEPa following bariatric surgery or liraglutide therapy may contribute to the reported improved cardiometabolic effects.
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Affiliation(s)
- Sasha A.S. Kjeldsen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Lise L. Gluud
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mikkel P. Werge
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Julie S. Pedersen
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kleopatra Alexiadou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK
| | - Tricia Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK
| | - Signe S. Torekov
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Eva W. Iepsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Nicole J. Jensen
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Michael M. Richter
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Jens P. Goetze
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jørgen Rungby
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jens J. Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Birgitte Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Joachim Holt
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Sten Madsbad
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Hvidovre, 2650 Hvidovre, Denmark
| | - Maria S. Svane
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Hvidovre, 2650 Hvidovre, Denmark
| | - Kirstine N. Bojsen-Møller
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Hvidovre, 2650 Hvidovre, Denmark
| | - Nicolai J. Wewer Albrechtsen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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5
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Kowalka AM, Alexiadou K, Cuenco J, Clarke RE, Minnion J, Williams EL, Bech P, Purkayastha S, Ahmed AR, Takats Z, Whitwell HJ, Romero MG, Bloom SR, Camuzeaux S, Lewis MR, Khoo B, Tan TM. The postprandial secretion of peptide YY 1-36 and 3-36 in obesity is differentially increased after gastric bypass versus sleeve gastrectomy. Clin Endocrinol (Oxf) 2023; 99:272-284. [PMID: 36345253 PMCID: PMC10952770 DOI: 10.1111/cen.14846] [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: 05/16/2022] [Revised: 10/13/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Peptide tyrosine tyrosine (PYY) exists as two species, PYY1-36 and PYY3-36 , with distinct effects on insulin secretion and appetite regulation. The detailed effects of bariatric surgery on PYY1-36 and PYY3-36 secretion are not known as previous studies have used nonspecific immunoassays to measure total PYY. Our objective was to characterize the effect of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on fasting and postprandial PYY1-36 and PYY3-36 secretion using a newly developed liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. DESIGN AND SUBJECTS Observational study in 10 healthy nonobese volunteers and 30 participants with obesity who underwent RYGB (n = 24) or SG (n = 6) at the Imperial Weight Centre [NCT01945840]. Participants were studied using a standardized mixed meal test (MMT) before and 1 year after surgery. The outcome measures were PYY1-36 and PYY3-36 concentrations. RESULTS Presurgery, the fasting and postprandial levels of PYY1-36 and PYY3-36 were low, with minimal responses to the MMT, and these did not differ from healthy nonobese volunteers. The postprandial secretion of both PYY1-36 and PYY3-36 at 1 year was amplified after RYGB, but not SG, with the response being significantly higher in RYGB compared with SG. CONCLUSIONS There appears to be no difference in PYY secretion between nonobese and obese volunteers at baseline. At 1 year after surgery, RYGB, but not SG, is associated with increased postprandial secretion of PYY1-36 and PYY3-36 , which may account for long-term differences in efficacy and adverse effects between the two types of surgery.
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Affiliation(s)
- Anna M. Kowalka
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Kleopatra Alexiadou
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Joyceline Cuenco
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | | | - James Minnion
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Emma L. Williams
- Department of Clinical Biochemistry, North West London PathologyCharing Cross HospitalLondonUK
| | - Paul Bech
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Sanjay Purkayastha
- Department of Surgery and CancerImperial College Healthcare NHS TrustLondonUK
| | - Ahmed R. Ahmed
- Department of Surgery and CancerImperial College Healthcare NHS TrustLondonUK
| | - Zoltan Takats
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Harry J. Whitwell
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Maria Gomez Romero
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Stephen R. Bloom
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Stephane Camuzeaux
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Matthew R. Lewis
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Bernard Khoo
- Endocrinology, Division of MedicineUniversity College LondonLondonUK
| | - Tricia M.‐M. Tan
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
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6
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Kowalka AM, Alexiadou K, Cuenco J, Clarke RE, Camuzeaux S, Minnion J, Williams EL, Bech P, Purkayastha S, Ahmed AR, Takats Z, Khoo B, Whitwell HJ, Romero MG, Bloom SR, Lewis MR, Tan TM. Commentary on "The road to reliable peptide assays is paved with good guidelines". Clin Endocrinol (Oxf) 2023; 98:763-765. [PMID: 36915993 PMCID: PMC10952462 DOI: 10.1111/cen.14894] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Anna M. Kowalka
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Kleopatra Alexiadou
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Joyceline Cuenco
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | | | - Stephane Camuzeaux
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - James Minnion
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Emma L. Williams
- Department of Clinical Biochemistry, North West London PathologyCharing Cross HospitalLondonUK
| | - Paul Bech
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Sanjay Purkayastha
- Department of Surgery and CancerImperial College Healthcare NHS TrustLondonUK
| | - Ahmed R. Ahmed
- Department of Surgery and CancerImperial College Healthcare NHS TrustLondonUK
| | - Zoltan Takats
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Bernard Khoo
- Endocrinology, Division of MedicineUniversity College LondonLondonUK
| | - Harry J. Whitwell
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Maria G. Romero
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Stephen R. Bloom
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Matthew R. Lewis
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Tricia M.‐M. Tan
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
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7
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Behary P, Alessimii H, Miras AD, Tharakan G, Alexiadou K, Aldhwayan MM, Purkayastha S, Moorthy K, Ahmed AR, Bloom SR, Tan TM. Tripeptide gut hormone infusion does not alter food preferences or sweet taste function in volunteers with obesity and prediabetes/diabetes but promotes restraint eating: A secondary analysis of a randomized single-blind placebo-controlled study. Diabetes Obes Metab 2023; 25:1731-1739. [PMID: 36811311 DOI: 10.1111/dom.15028] [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: 01/09/2023] [Revised: 02/12/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
AIMS To investigate whether the elevation in postprandial concentrations of the gut hormones glucagon-like peptide-1 (GLP-1), oxyntomodulin (OXM) and peptide YY (PYY) accounts for the beneficial changes in food preferences, sweet taste function and eating behaviour after Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS This was a secondary analysis of a randomized single-blind study in which we infused GLP-1, OXM, PYY (GOP) or 0.9% saline subcutaneously for 4 weeks in 24 subjects with obesity and prediabetes/diabetes, to replicate their peak postprandial concentrations, as measured at 1 month in a matched RYGB cohort (ClinicalTrials.gov NCT01945840). A 4-day food diary and validated eating behaviour questionnaires were completed. Sweet taste detection was measured using the method of constant stimuli. Correct sucrose identification (corrected hit rates) was recorded, and sweet taste detection thresholds (EC50s: half maximum effective concencration values) were derived from concentration curves. The intensity and consummatory reward value of sweet taste were assessed using the generalized Labelled Magnitude Scale. RESULTS Mean daily energy intake was reduced by 27% with GOP but no significant changes in food preferences were observed, whereas a reduction in fat and increase in protein intake were seen post-RYGB. There was no change in corrected hit rates or detection thresholds for sucrose detection following GOP infusion. Additionally, GOP did not alter the intensity or consummatory reward value of sweet taste. A significant reduction in restraint eating, comparable to the RYGB group was observed with GOP. CONCLUSION The elevation in plasma GOP concentrations after RYGB is unlikely to mediate changes in food preferences and sweet taste function after surgery but may promote restraint eating.
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Affiliation(s)
- Preeshila Behary
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Haya Alessimii
- Clinical Nutrition Department, College of Applied Medical Sciences, Umm Al Qura University, Mecca, Saudi Arabia
| | - Alexander D Miras
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- School of Medicine, Ulster University, Londonderry, UK
| | - George Tharakan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Kleopatra Alexiadou
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Madhawi M Aldhwayan
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, UK
| | - Krishna Moorthy
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, UK
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, UK
| | - Stephen R Bloom
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Tricia M Tan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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8
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Jones B, Sands C, Alexiadou K, Minnion J, Tharakan G, Behary P, Ahmed AR, Purkayastha S, Lewis MR, Bloom S, Li JV, Tan TM. The Metabolomic Effects of Tripeptide Gut Hormone Infusion Compared to Roux-en-Y Gastric Bypass and Caloric Restriction. J Clin Endocrinol Metab 2022; 107:e767-e782. [PMID: 34460933 PMCID: PMC8764224 DOI: 10.1210/clinem/dgab608] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/23/2021] [Indexed: 12/23/2022]
Abstract
CONTEXT The gut-derived peptide hormones glucagon-like peptide-1 (GLP-1), oxyntomodulin (OXM), and peptide YY (PYY) are regulators of energy intake and glucose homeostasis and are thought to contribute to the glucose-lowering effects of bariatric surgery. OBJECTIVE To establish the metabolomic effects of a combined infusion of GLP-1, OXM, and PYY (tripeptide GOP) in comparison to a placebo infusion, Roux-en-Y gastric bypass (RYGB) surgery, and a very low-calorie diet (VLCD). DESIGN AND SETTING Subanalysis of a single-blind, randomized, placebo-controlled study of GOP infusion (ClinicalTrials.gov NCT01945840), including VLCD and RYGB comparator groups. PATIENTS AND INTERVENTIONS Twenty-five obese patients with type 2 diabetes or prediabetes were randomly allocated to receive a 4-week subcutaneous infusion of GOP (n = 14) or 0.9% saline control (n = 11). An additional 22 patients followed a VLCD, and 21 underwent RYGB surgery. MAIN OUTCOME MEASURES Plasma and urine samples collected at baseline and 4 weeks into each intervention were subjected to cross-platform metabolomic analysis, followed by unsupervised and supervised modeling approaches to identify similarities and differences between the effects of each intervention. RESULTS Aside from glucose, very few metabolites were affected by GOP, contrasting with major metabolomic changes seen with VLCD and RYGB. CONCLUSIONS Treatment with GOP provides a powerful glucose-lowering effect but does not replicate the broader metabolomic changes seen with VLCD and RYGB. The contribution of these metabolomic changes to the clinical benefits of RYGB remains to be elucidated.
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MESH Headings
- Adult
- Aged
- Blood Glucose/analysis
- Caloric Restriction/methods
- Caloric Restriction/statistics & numerical data
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/therapy
- Diabetes Mellitus, Type 2/urine
- Drug Therapy, Combination/methods
- Female
- Gastric Bypass/methods
- Gastric Bypass/statistics & numerical data
- Gastrointestinal Hormones/administration & dosage
- Glucagon-Like Peptide 1/administration & dosage
- Humans
- Infusions, Subcutaneous
- Male
- Metabolomics/statistics & numerical data
- Middle Aged
- Obesity, Morbid/blood
- Obesity, Morbid/metabolism
- Obesity, Morbid/therapy
- Obesity, Morbid/urine
- Oxyntomodulin/administration & dosage
- Peptide YY/administration & dosage
- Single-Blind Method
- Treatment Outcome
- Weight Loss
- Young Adult
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Affiliation(s)
- Ben Jones
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Caroline Sands
- National Phenome Centre, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Kleopatra Alexiadou
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - James Minnion
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - George Tharakan
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Preeshila Behary
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Matthew R Lewis
- National Phenome Centre, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen Bloom
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Jia V Li
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Tricia M Tan
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Correspondence: Tricia M. Tan, MB, ChB, BSc, PhD, FRCP, FRCPath, 6th Floor, Commonwealth Building, Hammersmith Campus, Imperial College London, London W12 0HS, UK.
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9
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Salem V, Demetriou L, Behary P, Alexiadou K, Scholtz S, Tharakan G, Miras AD, Purkayastha S, Ahmed AR, Bloom SR, Wall MB, Dhillo WS, Tan TMM. Weight Loss by Low-Calorie Diet Versus Gastric Bypass Surgery in People With Diabetes Results in Divergent Brain Activation Patterns: A Functional MRI Study. Diabetes Care 2021; 44:1842-1851. [PMID: 34158363 PMCID: PMC8385466 DOI: 10.2337/dc20-2641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Weight loss achieved with very-low-calorie diets (VLCDs) can produce remission of type 2 diabetes (T2D), but weight regain very often occurs with reintroduction of higher calorie intakes. In contrast, bariatric surgery produces clinically significant and durable weight loss, with diabetes remission that translates into reductions in mortality. We hypothesized that in patients living with obesity and prediabetes/T2D, longitudinal changes in brain activity in response to food cues as measured using functional MRI would explain this difference. RESEARCH DESIGN AND METHODS Sixteen participants underwent gastric bypass surgery, and 19 matched participants undertook a VLCD (meal replacement) for 4 weeks. Brain responses to food cues and resting-state functional connectivity were assessed with functional MRI pre- and postintervention and compared across groups. RESULTS We show that Roux-en-Y gastric bypass surgery (RYGB) results in three divergent brain responses compared with VLCD-induced weight loss: 1) VLCD resulted in increased brain reward center food cue responsiveness, whereas in RYGB, this was reduced; 2) VLCD resulted in higher neural activation of cognitive control regions in response to food cues associated with exercising increased cognitive restraint over eating, whereas RYGB did not; and 3) a homeostatic appetitive system (centered on the hypothalamus) is better engaged following RYGB-induced weight loss than VLCD. CONCLUSIONS Taken together, these findings point to divergent brain responses to different methods of weight loss in patients with diabetes, which may explain weight regain after a short-term VLCD in contrast to enduring weight loss after RYGB.
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Affiliation(s)
- Victoria Salem
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K
| | | | - Preeshila Behary
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K
| | - Kleopatra Alexiadou
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K
| | - Samantha Scholtz
- West London Mental Health National Health Service Trust, London, U.K
| | - George Tharakan
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K
| | - Alexander D Miras
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - Stephen R Bloom
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K
| | - Matthew B Wall
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K.,Invicro London, Hammersmith Hospital, London, U.K
| | - Waljit S Dhillo
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K
| | - Tricia M-M Tan
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, U.K.
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10
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Kokkinos A, Liaskos C, Alexiadou K, Papassotiriou I, Margeli A, Argyrakopoulou G, Perrea D, Alexandrou A, Katsilambros N, Diamantis T, Tentolouris N. Plasma levels of soluble urokinase plasminogen activator receptor (suPAR) and high-sensitivity C-reactive protein after Roux-en-Y gastric bypass or sleeve gastrectomy: a 1-year prospective observational study. J Endocrinol Invest 2021; 44:599-608. [PMID: 32681464 DOI: 10.1007/s40618-020-01358-7] [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: 03/25/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Low-grade inflammation in obesity contributes to the development of cardiovascular disease, diabetes mellitus and cancer, and is associated with increased mortality. The purpose of this 1-year prospective observational study was to examine the weight loss effect of bariatric surgery on plasma concentrations of two inflammatory markers, namely high-sensitivity C-reactive protein (hsCRP) and soluble urokinase-type plasminogen activator receptor (suPAR), in patients with obesity. METHODS Sixteen subjects without obesity and 32 patients with obesity class III, who had already settled upon Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were included in the study. Subjects without obesity were examined once, at baseline; patients with obesity were examined preoperatively (baseline) and 3, 6 and 12 months postoperatively. RESULTS Plasma suPAR and hsCRP concentrations at baseline were higher in patients with obesity than in lean participants (2.68 ± 0.86 vs 1.86 ± 0.34 ng/mL, p < 0.001 and 9.83 ± 9.55 vs 1.36 ± 1.95 mg/dL, p < 0.001). Levels of suPAR following bariatric surgery increased significantly 3 months after either RYGB or SG (3.58 ± 1.58 vs 3.26 ± 0.7 ng/mL, respectively) and declined at 6 (3.19 ± 1.75 vs 2.8 ± 0.84 ng/mL, respectively) and 12 months (2.6 ± 1.5 vs 2.22 ± 0.49 ng/mL, respectively; p < 0.05 for the effect of time on suPAR levels during the study), whereas those of hsCRP declined consistently after bariatric surgery (3 months: 5.44 ± 3.99 vs 9.47 ± 11.98 mg/dL, respectively; 6 months; 5.39 ± 5.6 vs 10.25 ± 17.22 mg/dL, respectively; and 12 months: 2.23 ± 2.5 vs 3.07 ± 3.63 mg/dL, respectively; p < 0.001 for the effect of time on hsCRP levels during the study). 1-year change in BMI was negatively associated with suPAR levels at 12 months. CONCLUSION Our findings support an association between obesity and low-grade inflammation. Weight loss following bariatric surgery is associated with a consistent decline in plasma hsCRP, while plasma suPAR levels increase at 3 months and decline by 12 months.
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Affiliation(s)
- A Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - C Liaskos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - K Alexiadou
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - I Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou Street, 11527, Athens, Greece
| | - A Margeli
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou Street, 11527, Athens, Greece
| | - G Argyrakopoulou
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - D Perrea
- Laboratory of Experimental Surgery and Surgical Research "NS Christeas", Medical School, National and Kapodistrian University of Athens, 15Β Agiou Thoma Street, 11527, Athens, Greece
| | - A Alexandrou
- First Department of Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - N Katsilambros
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - T Diamantis
- First Department of Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - N Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece.
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11
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Ilesanmi I, Tharakan G, Alexiadou K, Behary P, Alessimii H, Bovill-Taylor C, Kenkre J, Choudhury S, Doyle C, Purkayastha S, Miras A, Tsironis C, Chahal H, Bloom SR, Oliver NS, Ahmed AR, Khoo B, Tan TMM. Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study. Diabetes Care 2021; 44:614-617. [PMID: 33334806 DOI: 10.2337/dc20-1609] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Roux-en-Y gastric bypass (RYGB) is an established treatment for type 2 diabetes and obesity. The study objective was to establish RYGB's effects on glycemic variability (GV) and hypoglycemia. RESEARCH DESIGN AND METHODS This was a prospective observational study of 10 participants with obesity and prediabetes or type 2 diabetes who underwent RYGB. Patients were studied before RYGB (Pre) and 1 month, 1 year, and 2 years postsurgery with continuous glucose measurement (CGM). A mixed-meal test (MMT) was conducted at Pre, 1 month, and 1 year. RESULTS After RYGB, mean CGM decreased (at 1 month, 1 year, and 2 years), and GV increased (at 1 year and 2 years). Five of the 10 participants had a percent time in range (%TIR) <3.0 mmol/L (54 mg/dL) greater than the international consensus target of 1% at 1 or 2 years. Peak glucagon-like peptide-1 (GLP-1) and glucagon area under the curve during MMT were positively and negatively associated, respectively, with contemporaneous %TIR <3.0 mmol/L. CONCLUSIONS Patients undergoing RYGB are at risk for development of postbariatric hypoglycemia due to a combination of reduced mean glucose, increased GV, and increased GLP-1 response.
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Affiliation(s)
- Ibiyemi Ilesanmi
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - George Tharakan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Kleopatra Alexiadou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Preeshila Behary
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Haya Alessimii
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Candace Bovill-Taylor
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Julia Kenkre
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Sirazum Choudhury
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Chedie Doyle
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - Alex Miras
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - Christos Tsironis
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - Harvinder Chahal
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Stephen R Bloom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Nick S Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - Bernard Khoo
- Endocrinology, Division of Medicine, Royal Free Campus, University College London, London, U.K
| | - Tricia M-M Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K.
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12
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Abstract
PURPOSE OF REVIEW Obesity affects over than 600 million adults worldwide resulting in multi-organ complications and major socioeconomic impact. The purpose of this review is to summarise the physiological effects as well as the therapeutic implications of the gut hormones glucagon-like peptide-1 (GLP-1), oxyntomodulin, peptide YY (PYY), and glucose-dependent insulinotropic peptide (GIP) in the treatment of obesity and type 2 diabetes. RECENT FINDINGS Clinical trials have proven that the widely used GLP-1 analogues have pleotropic effects beyond those on weight and glucose metabolism and appear to confer favourable cardiovascular and renal outcomes. However, GLP-1 analogues alone do not deliver sufficient efficacy for the treatment of obesity, being limited by their dose-dependent gastrointestinal side effects. Novel dual agonists for GLP-1/glucagon and GLP-1/GIP are being developed by the pharmaceutical industry and have demonstrated some promising results for weight loss and improvement in glycaemia over and above GLP-1 analogues. Triagonists (for example GLP-1/GIP/glucagon) are currently in pre-clinical or early clinical development. Gastrointestinal hormones possess complementary effects on appetite, energy expenditure, and glucose metabolism. We highlight the idea that combinations of these hormones may represent the way forward in obesity and diabetes therapeutics.
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Affiliation(s)
- Kleopatra Alexiadou
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK
| | - Tricia M-M Tan
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK.
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13
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Alexiadou K, Cuenco J, Howard J, Wewer Albrechtsen NJ, Ilesanmi I, Kamocka A, Tharakan G, Behary P, Bech PR, Ahmed AR, Purkayastha S, Wheller R, Fleuret M, Holst JJ, Bloom SR, Khoo B, Tan TMM. Proglucagon peptide secretion profiles in type 2 diabetes before and after bariatric surgery: 1-year prospective study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001076. [PMID: 32209584 PMCID: PMC7103850 DOI: 10.1136/bmjdrc-2019-001076] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/20/2020] [Accepted: 02/07/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hyperglucagonemia is a key pathophysiological driver of type 2 diabetes. Although Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for diabetes, it is presently unclear how surgery alters glucagon physiology. The aim of this study was to characterize the behavior of proglucagon-derived peptide (glucagon, glucagon-like peptide-1 (GLP-1), oxyntomodulin, glicentin) secretion after RYGB surgery. RESEARCH DESIGN AND METHODS Prospective study of 19 patients with obesity and pre-diabetes/diabetes undergoing RYGB. We assessed the glucose, insulin, GLP-1, glucose-dependent insulinotropic peptide (GIP), oxyntomodulin, glicentin and glucagon responses to a mixed-meal test (MMT) before and 1, 3 and 12 months after surgery. Glucagon was measured using a Mercodia glucagon ELISA using the 'Alternative' improved specificity protocol, which was validated against a reference liquid chromatography combined with mass spectrometry method. RESULTS After RYGB, there were early improvements in fasting glucose and glucose tolerance and the insulin response to MMT was accelerated and amplified, in parallel to significant increases in postprandial GLP-1, oxyntomodulin and glicentin secretion. There was a significant decrease in fasting glucagon levels at the later time points of 3 and 12 months after surgery. Glucagon was secreted in response to the MMT preoperatively and postoperatively in all patients and there was no significant change in this postprandial secretion. There was no significant change in GIP secretion. CONCLUSIONS There is a clear difference in the dynamics of secretion of proglucagon peptides after RYGB. The reduction in fasting glucagon secretion may be one of the mechanisms driving later improvements in glycemia after RYGB. TRIAL REGISTRATION NUMBER NCT01945840.
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Affiliation(s)
- Kleopatra Alexiadou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Joyceline Cuenco
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James Howard
- Drug Development Solutions, LGC Bioscience, Fordham, Cambridgeshire, UK
| | - Nicolai Jacob Wewer Albrechtsen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- NNF Center for Protein Research, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Ibiyemi Ilesanmi
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Anna Kamocka
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - George Tharakan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Preeshila Behary
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Paul R Bech
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Robert Wheller
- Drug Development Solutions, LGC Bioscience, Fordham, Cambridgeshire, UK
| | - Matthieu Fleuret
- Drug Development Solutions, LGC Bioscience, Fordham, Cambridgeshire, UK
| | - Jens Juul Holst
- Department of Biomedical Sciences and the NNF Center for Basic Metabolic Research, University of Copenhagen Panum Institute, Copenhagen, Denmark
| | - Stephen R Bloom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Bernard Khoo
- Division of Medicine, University College London, London, UK
| | - Tricia M-M Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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14
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Behary P, Tharakan G, Alexiadou K, Johnson N, Wewer Albrechtsen NJ, Kenkre J, Cuenco J, Hope D, Anyiam O, Choudhury S, Alessimii H, Poddar A, Minnion J, Doyle C, Frost G, Le Roux C, Purkayastha S, Moorthy K, Dhillo W, Holst JJ, Ahmed AR, Prevost AT, Bloom SR, Tan TM. Combined GLP-1, Oxyntomodulin, and Peptide YY Improves Body Weight and Glycemia in Obesity and Prediabetes/Type 2 Diabetes: A Randomized, Single-Blinded, Placebo-Controlled Study. Diabetes Care 2019; 42:1446-1453. [PMID: 31177183 DOI: 10.2337/dc19-0449] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/25/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Roux-en-Y gastric bypass (RYGB) augments postprandial secretion of glucagon-like peptide 1 (GLP-1), oxyntomodulin (OXM), and peptide YY (PYY). Subcutaneous infusion of these hormones ("GOP"), mimicking postprandial levels, reduces energy intake. Our objective was to study the effects of GOP on glycemia and body weight when given for 4 weeks to patients with diabetes and obesity. RESEARCH DESIGN AND METHODS In this single-blinded mechanistic study, obese patients with prediabetes/diabetes were randomized to GOP (n = 15) or saline (n = 11) infusion for 4 weeks. We also studied 21 patients who had undergone RYGB and 22 patients who followed a very low-calorie diet (VLCD) as unblinded comparators. Outcomes measured were 1) body weight, 2) fructosamine levels, 3) glucose and insulin during a mixed meal test (MMT), 4) energy expenditure (EE), 5) energy intake (EI), and 6) mean glucose and measures of glucose variability during continuous glucose monitoring. RESULTS GOP infusion was well tolerated over the 4-week period. There was a greater weight loss (P = 0.025) with GOP (mean change -4.4 [95% CI -5.3, -3.5] kg) versus saline (-2.5 [-4.1, -0.9] kg). GOP led to a greater improvement (P = 0.0026) in fructosamine (-44.1 [-62.7, -25.5] µmol/L) versus saline (-11.7 [-18.9, -4.5] µmol/L). Despite a smaller weight loss compared with RYGB and VLCD, GOP led to superior glucose tolerance after a mixed-meal stimulus and reduced glycemic variability compared with RYGB and VLCD. CONCLUSIONS GOP infusion improves glycemia and reduces body weight. It achieves superior glucose tolerance and reduced glucose variability compared with RYGB and VLCD. GOP is a viable alternative for the treatment of diabetes with favorable effects on body weight.
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Affiliation(s)
- Preeshila Behary
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - George Tharakan
- Section of Investigative Medicine, Imperial College London, London, U.K
| | | | - Nicholas Johnson
- Imperial Clinical Trials Unit, Imperial College London, London, U.K
| | - Nicolai J Wewer Albrechtsen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julia Kenkre
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Joyceline Cuenco
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - David Hope
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Oluwaseun Anyiam
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Sirazum Choudhury
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Haya Alessimii
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Ankur Poddar
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - James Minnion
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Chedie Doyle
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Gary Frost
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Carel Le Roux
- Section of Investigative Medicine, Imperial College London, London, U.K.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - Krishna Moorthy
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - Waljit Dhillo
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Jens J Holst
- Panum Institute, Department of Biomedical Sciences and the Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K
| | - A Toby Prevost
- Imperial Clinical Trials Unit, Imperial College London, London, U.K
| | - Stephen R Bloom
- Section of Investigative Medicine, Imperial College London, London, U.K
| | - Tricia M Tan
- Section of Investigative Medicine, Imperial College London, London, U.K.
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Alexiadou K, Anyiam O, Tan T. Cracking the combination: Gut hormones for the treatment of obesity and diabetes. J Neuroendocrinol 2019; 31:e12664. [PMID: 30466162 PMCID: PMC6563152 DOI: 10.1111/jne.12664] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/11/2018] [Accepted: 11/17/2018] [Indexed: 12/21/2022]
Abstract
Obesity and type 2 diabetes are a veritable global pandemic. There is an imperative to develop new therapies for these conditions that can be delivered at scale to patients, which deliver effective and titratable weight loss, amelioration of diabetes, prevention of diabetic complications and improvements in cardiovascular health. Although agents based on glucagon-like peptide-1 (GLP-1) are now in routine use for diabetes and obesity, the limited efficacy of such drugs means that newer agents are required. By combining the effects of GLP-1 with other gut and metabolic hormones such as glucagon (GCG), oxyntomodulin, glucose-dependent insulinotropic peptide (GIP) and peptide YY (PYY), we may obtain improved weight loss, increased energy expenditure and improved metabolic profiles. Drugs based on dual agonism of GLP1R/GCGR and GLP1R/GIPR are being actively developed in clinical trials. Triple agonism, for example with GLPR1/GCGR/GIPR unimolecular agonists or using GLP-1/oxyntomodulin/PYY, is also being explored. Multi-agonist drugs seem set to deliver the next generation of therapies for diabetes and obesity soon.
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Affiliation(s)
| | - Oluwaseun Anyiam
- Section of Investigative MedicineImperial College LondonLondonUK
| | - Tricia Tan
- Section of Investigative MedicineImperial College LondonLondonUK
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Cheong J, Alexiadou K, Devendra S. Absent monofilament sensation in a type 2 diabetic feet. London J Prim Care (Abingdon) 2017; 9:73-76. [PMID: 29081839 PMCID: PMC5649318 DOI: 10.1080/17571472.2017.1370813] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuropathy is a common complication which can affect up to 90% of patients with diabetes mellitus. Asymptomatic neuropathy is a common presentation. We present a case that emphasises the importance of foot screening in people with diabetes. It also highlights that patient education is key to prevent development of foot ulceration which can lead to amputations. In addition, pharmacological therapy (as per NICE guidance) can be offered for pain relief. Patients with diabetic neuropathy are at high risk of falling and sustaining fractures.
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Affiliation(s)
- Julia Cheong
- Faculty of Health Sciences, Bristol University, Bristol, UK
| | - K Alexiadou
- Department of Diabetes, North West Thames Deanery, Watford General Hospital, Watford, UK
| | - Senan Devendra
- Department of Acute Medicine & Endocrinology, Watford General Hospital, Watford, UK
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Tentolouris N, Alexiadou K, Makrilakis K, Liatis S, Jude E, Boulton AJ. Standard and emerging treatment options for diabetic neuropathy. Curr Pharm Des 2015; 20:3689-704. [PMID: 24040869 DOI: 10.2174/13816128113196660682] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/10/2013] [Indexed: 11/22/2022]
Abstract
Diabetic neuropathy is a common complication of diabetes mellitus affecting 30-50% of patients and is a major cause for increased costs, morbidity and mortality. Strict diabetes control prevents this complication and may restore neurologic deficits in the early stages. Several efforts have been undertaken to alter the natural history of this complication, including the use of aldose reductase and protein kinase-C inhibitors, as well as antioxidants. Available data so far do not support the use of aldose reductase inhibitors due to safety issues and efficacy. Protein kinase-C inhibitors have provided encouraging initial results but their development has been halted. Antioxidants, like a-lipoic acid, improve some neurological deficits and painful symptoms. There are effective and safe medications such as anticonvulsants, antidepressants and opioids for the management of patients with painful symptoms. In this revew we present standard and emerging treatment modalities for the etiologic and symptomatic treatment of diabetic neuropathy.
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Affiliation(s)
| | | | | | | | | | - Andrew J Boulton
- 1st Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece.
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Angelopoulos T, Kokkinos A, Liaskos C, Tentolouris N, Alexiadou K, Miras AD, Mourouzis I, Perrea D, Pantos C, Katsilambros N, Bloom SR, le Roux CW. The effect of slow spaced eating on hunger and satiety in overweight and obese patients with type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2014; 2:e000013. [PMID: 25452861 PMCID: PMC4212566 DOI: 10.1136/bmjdrc-2013-000013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/27/2014] [Accepted: 06/13/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Slow spaced eating is associated with improved satiety and gut hormone responses in normal-weight participants. This crossover study compared the effect of slow and rapid eating patterns on hunger, fullness, glucose, insulin, and the appetite-related gut hormones peptide YY (PYY), glucagon-like peptide-1 (GLP-1), and ghrelin in overweight and obese participants with type 2 diabetes mellitus (T2DM). METHODS 20 overweight and obese participants with T2DM on metformin were recruited. A test meal of 300 mL ice-cream was consumed in random order in two different sessions by each participant; meal duration was 5 or 30 min. Fullness and hunger as assessed by visual analog scales (VAS), and glucose, insulin, PYY, GLP-1, and ghrelin were measured at baseline and at 30 min intervals after meal termination for 3 h. RESULTS Fullness VAS ratings were significantly higher at the 90', 120', 150', and 180' time points and hunger ratings were lower at 90', 150', and 180' for the 30 min meal. The area under the curve (AUC) for fullness was higher after the 30 min meal than after the 5 min meal (11 943.7±541.2 vs 10 901.0±568.8 mm min, p=0.003) whereas the hunger AUC was lower (4442.9±328 vs 4966.7±347.5 mm min, p=0.012). There were no differences in glucose, insulin, PYY, GLP-1, and ghrelin responses. CONCLUSIONS Slow spaced eating increased fullness and decreased hunger ratings in overweight and obese participants with T2DM, without the improvement in gut hormone responses found in normal-weight participants. Slow spaced eating may be a useful prevention strategy, but might also help curb food intake in those already suffering from obesity and diabetes.
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Affiliation(s)
- Theodoros Angelopoulos
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Christos Liaskos
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Kleopatra Alexiadou
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | | | - Iordanis Mourouzis
- Department of Pharmacology, Athens University Medical School, Athens, Greece
| | - Despoina Perrea
- Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, Athens University Medical School, Athens, Greece
| | - Constantinos Pantos
- Department of Pharmacology, Athens University Medical School, Athens, Greece
| | - Nicholas Katsilambros
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Stephen R Bloom
- Department of Metabolic Medicine, Hammersmith Hospital, Imperial College, London, UK
| | - Carel Wynard le Roux
- Department of Metabolic Medicine, Hammersmith Hospital, Imperial College, London, UK
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Tsiakou A, Liatis S, Alexiadou K, Diakoumopoulou E, Makrilakis K, Tentolouris N, Kyriaki D, Katsilambros N. Arterial stiffness is inversely related to plasma adiponectin levels in young normotensive patients with type 1 diabetes. Diabetes Care 2013; 36:734-6. [PMID: 23002087 PMCID: PMC3579361 DOI: 10.2337/dc12-0387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study investigated the association between arterial stiffness and plasma adiponectin in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS Participants were normotensive patients with type 1 diabetes who were up to age 40 years. Subjects on statins with macrovascular disease or overt nephropathy were excluded. Large artery stiffness was assessed by measurement of carotid-femoral pulse wave velocity (PWV), whereas plasma adiponectin was measured by radioimmunoassay. RESULTS Data from 80 patients (age 27.1 ± 6.1 years, BMI 24.2 ± 3.1 kg/m(2), HbA(1c) 7.5 ± 1.6%, 39 men, adiponectin 13.9 ± 6.7 μg/mL, and PWV 5.6 ± 0.9 m/s) were analyzed. Log adiponectin inversely correlated with age-adjusted PWV (r = -0.291, P = 0.009) and waist circumference (r = -0.427, P < 0.001). In a fully adjusted model, age, expiration/inspiration index, and log adiponectin were independently associated with PWV, explaining 39.6% of its variance. CONCLUSIONS Arterial stiffness is inversely related to adiponectin concentration in young patients with type 1 diabetes without major complications.
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Affiliation(s)
- Afroditi Tsiakou
- First Propaedeutic Department of Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece.
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Abstract
Diabetic foot is a serious complication of diabetes which aggravates the patient's condition whilst also having significant socioeconomic impact. The aim of the present review is to summarize the causes and pathogenetic mechanisms leading to diabetic foot, and to focus on the management of this important health issue. Increasing physicians' awareness and hence their ability to identify the "foot at risk," along with proper foot care, may prevent diabetic foot ulceration and thus reduce the risk of amputation.
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Affiliation(s)
- Kleopatra Alexiadou
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - John Doupis
- Department of Internal Medicine and Diabetes Clinic, Salamis Naval Hospital, Salamis Naval Base, 18900 Salamis, Greece
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Alexiadou K, Kokkinos A, Liatis S, Perrea D, Katsilambros N, Tentolouris N. Differences in plasma apelin and visfatin levels between patients with type 1 diabetes mellitus and healthy subjects and response after acute hyperglycemia and insulin administration. Hormones (Athens) 2012; 11:444-50. [PMID: 23422767 DOI: 10.14310/horm.2002.1376] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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: 11/20/2022]
Abstract
OBJECTIVE Previous data suggest that apelin and visfatin play a role in metabolism and glucose homeostasis. The aim of the present study was to determine differences in plasma apelin and visfatin concentrations between healthy subjects and patients with type 1 diabetes mellitus and to study the effect of hyperglycemia and insulin administration on their levels in patients with type 1 diabetes mellitus. DESIGN One hundred patients with T1DM and 52 healthy subjects were examined. Nine patients with type 1 diabetes and 9 controls participated in a further study. In the main study, blood samples were taken after a 12-hour fast. In a further study, an oral glucose tolerance test was performed on two occasions. In session A, at baseline, insulin lispro (7 units) was administered subcutaneously to the type 1 diabetic patients, while a placebo injection was administered to controls. In session B, no insulin or placebo was administered. Apelin, visfatin, insulin and glucose levels were measured at baseline and 10, 20, 30, 60, 90, 120, 150 and 180 min after glucose consumption. RESULTS AND CONCLUSIONS Fasting plasma apelin concentrations were higher (p<0.001), while fasting visfatin levels tended to be lower (p=0.06) in patients with type 1 diabetes in comparison to healthy subjects. In the diabetes group, fasting apelin (but not visfatin) correlated with HDL-C (p=0.001). Apelin and visfatin did not change significantly during the oral glucose tolerance test in either group with or without exogenous insulin administration.
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Affiliation(s)
- Kleopatra Alexiadou
- First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece.
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Abstract
The prevalence of cardiovascular disease as the leading cause of morbidity and mortality is increasing worldwide. This fact is mainly attributed to the modern lifestyle with predominant characteristics the change of dietary habits and the reduced physical activity which lead to metabolic disorders such as obesity and diabetes. Therefore, drastic dietary interventions are considered necessary in order to reduce cardiovascular risk. Nuts, as a nutritional component have drawn particular attention, due to their beneficial cardiovascular properties derived from their nutrient composition. This is a comprehensive review concerning the potential general effects of nuts. It includes data from older large epidemiologic studies as well as recent significant information from clinical trials regarding this topic. All studies conclude that nuts can play an important role as part of a healthy diet in order to minimize cardiovascular risk and obtain multiple health benefits.
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Affiliation(s)
- Kleopatra Alexiadou
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma street, 11527 Athens, Greece.
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23
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Tentolouris N, Alexiadou K, Kokkinos A, Koukou E, Perrea D, Kyriaki D, Katsilambros N. Meal-induced thermogenesis and macronutrient oxidation in lean and obese women after consumption of carbohydrate-rich and fat-rich meals. Nutrition 2011; 27:310-5. [DOI: 10.1016/j.nut.2010.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 02/06/2010] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
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Abstract
Oedema is a common finding in obesity and its cause is not always clear. Possible causes include impairment of cardiac, respiratory and/or renal function, chronic venous insufficiency and lymphatic problems. Lymphoscintigraphy is the best method to detect structural lymphatic abnormalities that can cause lymphoedema. We reviewed 49 female subjects with pitting oedema who had undergone lymphoscintigraphy, divided in three groups. The first group was comprised of severely obese patients in whom cardiorespiratory causes for oedema had been excluded. The second group consisted of non-obese patients with recognized causes for oedema and the third group was non-obese patients with 'idiopathic' oedema. A standard classification was used to interpret lymphoscintigraphy results. The frequency and severity of lymphoscintigraphic abnormalities was greatest in patients with clinical diagnoses of oedema related to 'recognized causes' (any abnormality in 50% of legs with obstruction in 22%). Obese patients and those with 'idiopathic'oedema had fewer (P=0.02 for both) and milder lymphoscintographic abnormalities (any abnormality 32 and 25%, respectively, obstruction 5 and 3%, respectively), and although the clinical oedema was invariably bilateral, the lymphoscintigraphy abnormalities were usually unilateral. In conclusion, structural lymphoscintigraphic abnormalities are uncommon in obesity and do not closely correlate with the clinical pattern of oedema.
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Affiliation(s)
- A-M Vasileiou
- East London Obesity Service, Barts and The London Medical School, Homerton University Hospital and Nuclear Medicine, The Royal London Hospital, London, UK
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Sfikakis PP, Grigoropoulos V, Emfietzoglou I, Theodossiadis G, Tentolouris N, Delicha E, Katsiari C, Alexiadou K, Hatziagelaki E, Theodossiadis PG. Infliximab for diabetic macular edema refractory to laser photocoagulation: a randomized, double-blind, placebo-controlled, crossover, 32-week study. Diabetes Care 2010; 33:1523-8. [PMID: 20413522 PMCID: PMC2890353 DOI: 10.2337/dc09-2372] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Because many patients with diabetic macular edema (DME) do not respond to focal/grid laser photocoagulation, the only currently approved treatment, alternatives are needed. Based on encouraging preliminary findings, we aimed to assess efficacy and safety of the anti-tumor necrosis factor (TNF) monoclonal antibody infliximab in this condition. RESEARCH DESIGN AND METHODS This was a single-center, double-blind, randomized, placebo-controlled, crossover study. Eleven patients with sight-threatening DME persisting after two sessions of laser photocoagulation received infliximab (5 mg/kg) intravenously at weeks 0, 2, 6, and 14, followed by placebo at weeks 16, 18, 22, and 30, or vice versa. Blinding was maintained to week 32, when the final assessments were performed. Best corrected visual acuity evaluated by a mixed-models approach for imbalanced crossover design using the percentage difference as the outcome variable was the primary study end point. Data were analyzed on an intention-to-treat basis. RESULTS Early Treatment of Diabetic Retinopathy Study (ETDRS) scores dropped from 31.6 +/- 5.1 (mean +/- SD) letters read at baseline to 28.8 +/- 11.6 letters read at week 16 in six placebo-treated eyes and improved to 35.4 +/- 11.2 letters read after infliximab. In contrast, visual acuity improved from 23.5 +/- 10.3 at baseline to 30.4 +/- 13.4 letters read at week 16 in eight infliximab-treated eyes and was sustained at completion of placebo treatment (31.4 +/- 12.1 letters read). The excess visual acuity in infliximab-treated eyes was greater by 24.3% compared with that in placebo-treated eyes (95% CI 4.8-43.7; P = 0.017). Infliximab treatment was well tolerated. CONCLUSIONS The positive results of this small phase III study suggest that larger and longer term trials should be conducted to assess the efficacy of systemic or intravitreal anti-TNF agent administration for primary treatment of DME.
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Affiliation(s)
- Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine, Laiko General Hospital, Athens, Greece.
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Kokkinos A, le Roux CW, Alexiadou K, Tentolouris N, Vincent RP, Kyriaki D, Perrea D, Ghatei MA, Bloom SR, Katsilambros N. Eating slowly increases the postprandial response of the anorexigenic gut hormones, peptide YY and glucagon-like peptide-1. J Clin Endocrinol Metab 2010; 95:333-7. [PMID: 19875483 DOI: 10.1210/jc.2009-1018] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [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 The rate at which people eat has been suggested to be positively associated with obesity, although appetite and related gut hormones have not been measured. The objective of the study was to determine whether eating the same meal at varying speeds elicits different postprandial gut peptide responses. DESIGN AND SETTING This was a crossover study at a clinical research facility. STUDY PARTICIPANTS Seventeen healthy adult male volunteers participated in the study. INTERVENTION A test meal consisting of 300 ml ice cream (675 kcal) was consumed in random order on two different sessions by each subject: meal duration took either 5 or 30 min. MAIN OUTCOME MEASURES The postprandial response of the orexigenic hormone ghrelin and the anorexigenic peptides peptide YY and glucagon-like peptide-1 over 210 min was assessed. Visual analog scales for the subjective feelings of hunger and fullness were completed throughout each session. RESULTS Peptide YY area under the curve (AUC) was higher after the 30-min meal than after the 5-min meal (mean +/- sem AUC 5 min meal: 4133 +/- 324, AUC 30 min meal: 5250 +/- 330 pmol/liter . min, P = 0.004), as was glucagon-like peptide-1 AUC (mean +/- sem AUC 5 min meal: 6219 +/- 256, AUC 30 min meal: 8794 +/- 656 pmol/liter . min, P = 0.001). There was a trend for higher visual analog scale fullness ratings immediately after the end of the 30-min meal compared with immediately after the 5-min meal. There were no differences in ghrelin response. CONCLUSIONS Eating at a physiologically moderate pace leads to a more pronounced anorexigenic gut peptide response than eating very fast.
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Affiliation(s)
- Alexander Kokkinos
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 11527 Athens, Greece
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