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Foss-Freitas MC, Besci Ö, Meral R, Neidert A, Chenevert TL, Oral EA, Rothberg AE. A Very-Low-Calorie Diet Can Cause Remission of Diabetes Mellitus and Hypertriglyceridemia in Familial Partial Lipodystrophy. Obes Facts 2023; 17:103-108. [PMID: 37952526 PMCID: PMC10836931 DOI: 10.1159/000533992] [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: 07/14/2023] [Accepted: 08/28/2023] [Indexed: 11/14/2023] Open
Abstract
There is no strong evidence that any specific diet is the preferred treatment for lipodystrophy syndromes. Here we remark on the benefits of a very-low-calorie diet (VLCD) in a patient with familial partial lipodystrophy type 2 (FPLD2). A 38-year-old female diagnosed with FPLD2, with a history of multiple comorbidities, underwent 16 weeks of VLCD with a short-term goal of improving her metabolic state rapidly to achieve pregnancy by in vitro fertilization (IVF). We observed a reduction of 12.3 kg in body weight and 1.4% in hemoglobin A1c. The decrease in the area under the curves of insulin (-33.2%), triglycerides (-40.7%), and free fatty acids (-34%) were very remarkable. Total body fat was reduced by 16%, and liver fat by 80%. Her egg retrieval rate and quality during IVF were far superior to past hyperstimulation. Our data encourage the use of this medical approach for other patients with similar metabolic and reproductive abnormalities due to adipose tissue insufficiency.
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Affiliation(s)
- Maria C Foss-Freitas
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA,
| | - Özge Besci
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pediatric Endocrinology, Dokuz Eylul University, Izmir, Turkey
| | - Rasimcan Meral
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam Neidert
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elif A Oral
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy E Rothberg
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
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Akgul SU, Cinar CK, Caliskan Y, Demir E, Cebeci E, Meral R, Temurhan S, Ozluk Y, Aydin F, Oguz FS. COSMC expression as a predictor of remission in IgA nephropathy. Int Urol Nephrol 2023; 55:1033-1044. [PMID: 36306048 DOI: 10.1007/s11255-022-03376-1] [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] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The impact of core 1,3-galactosyltransferase-specific molecular chaperon (COSMC) gene expression and methylation profile on clinical progression of IgA nephropathy (IgAN) is unclear. The aim of this study was to determine the clinical significance and the relation of the COSMC gene expression and methylation pattern with the progression of IgAN. METHODS Thirty-nine biopsy-confirmed IgAN patients, 11 healthy relatives and 20 healthy controls were recruited. The COSMC mRNA levels and methylation profile of COSMC gene promoter were measured using the quantitative real-time PCR. The galactose-deficient IgA1 (Gd-IgA1) levels were measured using ELISA in serum and cell culture supernatant. The effect of IL-4 and AZA on COSMC expression and methylation and the correlation of COSMC gene expression and methylation levels with baseline kidney function tests, histology and long-term outcomes were examined. RESULTS The mean COSMC mRNA level was significantly lower, and serum Gd-IgA1 level was higher in IgAN patients compared with the control groups (p < 0.001, and p = < 0.001, respectively). The COSMC mRNA levels were correlated with intensity of hematuria (r = - 0.41, p = 0.009), serum creatinine level (r = - 0.37, p = 0.002) and eGFR (r = 0.36, p = 0.002). The COSMC methylation levels were correlated with age (r = 0.25, p = 0.04) and baseline eGFR (r = - 0.326, p = 0.006). Twenty IgAN patients (51.3%) reached to complete (5, 12.8%) or partial remission (15, 38.5%) after a median of 34.5 months (IQR, 13.75-71). In multivariable Cox regression analysis, COSMC mRNA expression (adjusted HR (aHR) 1.871, 95% CI 1.287-2.722, p = 0.001) and Oxford T score (aHR 0.355, 95% CI 0.146-0.859, p = 0.022) predicted the remission. CONCLUSION COSMC mRNA level is a novel biomarker candidate to predict the remission in IgAN patients.
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Affiliation(s)
- Sebahat Usta Akgul
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
- Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey.
| | - Cigdem Kekik Cinar
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa/Fatih, Istanbul, Turkey
- Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Erol Demir
- Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Egemen Cebeci
- Department of Nephrology, Health Sciences University, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Rasimcan Meral
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sonay Temurhan
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Filiz Aydin
- Department of Medical Biology and Genetics, Demiroglu Science University, Istanbul, Turkey
| | - Fatma Savran Oguz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Meral R, Kutlu N, Alav A, Kılınççeker O. The possibilities of using quinoa flour in the production of chicken meat patties. J HELL VET MED SOC 2023. [DOI: 10.12681/jhvms.29784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In this study, the mixtures obtained by mixing quinoa flour with wheat flour in different proportions were added to chicken meat patties and their effects on some quality characteristics were investigated. The yields of the meatballs prepared with the mixes containing 50% and 100% quinoa flour were higher than those of other meatballs (69.59% and 69.71%, respectively). The moisture retention of the fried meatballs prepared with mixtures containing 50%, 70% and 100% quinoa flour was found to be 45.80%, 45.97% and 51.09%, respectively. The results indicated that the moisture retention of these meatballs was higher than those of meatballs containing 30 and 0% quinoa flour. In contrast, oil absorption rates in the fried samples were in the range of 4.46-5.65% for all quinoa-containing samples and were lower compared to the control sample. Firmness decreased in meat patties prepared with mixtures containing high quinoa rates. It was observed that quinoa flour did not have a negative effect on quality factors. It was concluded that especially the mixtures containing 30% and 50% quinoa flour can be recommended.
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Meral R, Malandrino N, Walter M, Neidert AH, Muniyappa R, Oral EA, Brown RJ. Endogenous Leptin Concentrations Poorly Predict Metreleptin Response in Patients With Partial Lipodystrophy. J Clin Endocrinol Metab 2022; 107:e1739-e1751. [PMID: 34677608 PMCID: PMC8947785 DOI: 10.1210/clinem/dgab760] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/21/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Leptin replacement with metreleptin improves glycemia and hypertriglyceridemia in severely hypoleptinemic patients with generalized lipodystrophy (GLD), but its effects are variable in partially leptin-deficient patients with partial lipodystrophy (PLD). OBJECTIVE Compare 3 leptin assays (Study I); identify diagnostic performance of leptin assays to detect responders to metreleptin for each assay (Study II). DESIGN Study I: cross-sectional analysis of average bias between leptin assays. Study II: retrospective analysis of diagnostic accuracy of potential leptin cut points to detect clinical responders to metreleptin. SETTING National Institutes of Health; University of Michigan. PARTICIPANTS AND INTERVENTIONS Study I: Metreleptin-naïve patients with lipodystrophy (GLD, n = 33, PLD, n = 67) and healthy volunteers (n = 239). Study II: GLD (n = 66) and PLD (n = 84) patients treated with metreleptin for 12 months. OUTCOME MEASURES Leptin concentrations by Millipore radioimmunoassay (RIA), Millipore enzyme-linked immunosorbent assay (MELISA), and R&D Systems enzyme-linked immunosorbent assay (RDELISA). Response to metreleptin therapy was defined as either reduction ≥1.0% in A1c or ≥30% in serum triglycerides. RESULTS RDELISA measured 3.0 ± 9.5 ng/mL higher than RIA; MELISA measured 11.0 ± 17.8 and 14.0 ±19.2 less than RIA and RDELISA, respectively. Leptin by RIA, MELISA, and RDELISA modestly predicted metreleptin response in GLD + PLD [receiver operating characteristic (ROC) area under the curve (AUC) 0.74, 0.69, and 0.71, respectively; P < 0.01 for all] with lower predictive power in PLD (ROC AUC 0.63, 0.61 and 0.65, respectively; P > 0.05 for all). The only reproducible cut point identified on sensitivity analyses was RIA leptin 7.2 ng/mL (sensitivity 56%; specificity 78%). CONCLUSIONS Three common leptin assays are not interchangeable, and a reliable cut point to select responders to metreleptin was not identified.
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Affiliation(s)
- Rasimcan Meral
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Noemi Malandrino
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
| | - Mary Walter
- Clinical Core Laboratory, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Adam H Neidert
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ranganath Muniyappa
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
| | - Elif Arioglu Oral
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rebecca J Brown
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
- Correspondence: Rebecca J. Brown, MD, MHSc, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10-CRC, Room 6-5942, 10 Center Dr, Bethesda, MD 20892, USA.
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Akinci B, Subauste A, Ajluni N, Esfandiari NH, Meral R, Neidert AH, Eraslan A, Hench R, Rus D, Mckenna B, Hussain HK, Chenevert TL, Tayeh MK, Rupani AR, Innis JW, Mantzoros CS, Conjeevaram HS, Burant CL, Oral EA. Metreleptin therapy for nonalcoholic steatohepatitis: Open-label therapy interventions in two different clinical settings. Med 2021; 2:814-835. [DOI: 10.1016/j.medj.2021.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Eldin AJ, Akinci B, da Rocha AM, Meral R, Simsir IY, Adiyaman SC, Ozpelit E, Bhave N, Gen R, Yurekli B, Kutbay NO, Siklar Z, Neidert AH, Hench R, Tayeh MK, Innis JW, Jalife J, Oral H, Oral EA. Cardiac phenotype in familial partial lipodystrophy. Clin Endocrinol (Oxf) 2021; 94:1043-1053. [PMID: 33502018 PMCID: PMC9003538 DOI: 10.1111/cen.14426] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES LMNA variants have been previously associated with cardiac abnormalities independent of lipodystrophy. We aimed to assess cardiac impact of familial partial lipodystrophy (FPLD) to understand the role of laminopathy in cardiac manifestations. STUDY DESIGN Retrospective cohort study. METHODS Clinical data from 122 patients (age range: 13-77, 101 females) with FPLD were analysed. Mature human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) from a patient with an LMNA variant were studied as proof-of-concept for future studies. RESULTS Subjects with LMNA variants had a higher prevalence of overall cardiac events than others. The likelihood of having an arrhythmia was significantly higher in patients with LMNA variants (OR: 3.77, 95% CI: 1.45-9.83). These patients were at higher risk for atrial fibrillation or flutter (OR: 5.78, 95% CI: 1.04-32.16). The time to the first arrhythmia was significantly shorter in the LMNA group, with a higher HR of 3.52 (95% CI: 1.34-9.27). Non-codon 482 LMNA variants were more likely to be associated with cardiac events (vs. 482 LMNA: OR: 4.74, 95% CI: 1.41-15.98 for arrhythmia; OR: 17.67, 95% CI: 2.45-127.68 for atrial fibrillation or flutter; OR: 5.71, 95% CI: 1.37-23.76 for conduction disease). LMNA mutant hiPSC-CMs showed a higher frequency of spontaneous activity and shorter action potential duration. Functional syncytia of hiPSC-CMs displayed several rhythm alterations such as early afterdepolarizations, spontaneous quiescence and spontaneous tachyarrhythmia, and significantly slower recovery in chronotropic changes induced by isoproterenol exposure. CONCLUSIONS Our results highlight the need for vigilant cardiac monitoring in FPLD, especially in patients with LMNA variants who have an increased risk of developing cardiac arrhythmias. In addition, hiPSC-CMs can be studied to understand the basic mechanisms for the arrhythmias in patients with lipodystrophy to understand the impact of specific mutations.
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Affiliation(s)
- Abdelwahab Jalal Eldin
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Baris Akinci
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Endocrinology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Andre Monteiro da Rocha
- Center for Arrhythmia Research, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rasimcan Meral
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ilgin Yildirim Simsir
- Division of Endocrinology, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Suleyman Cem Adiyaman
- Division of Endocrinology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ebru Ozpelit
- Division of Cardiology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Nicole Bhave
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ramazan Gen
- Division of Endocrinology, Department of Internal Medicine, Mersin University, Mersin, Turkey
| | - Banu Yurekli
- Division of Endocrinology, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Nilufer Ozdemir Kutbay
- Division of Endocrinology, Department of Internal Medicine, Celal Bayar University, Manisa, Turkey
| | - Zeynep Siklar
- Division of Endocrinology, Department of Pediatrics, Ankara University, Ankara, Turkey
| | - Adam H. Neidert
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rita Hench
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marwan K. Tayeh
- Departments of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey W. Innis
- Departments of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Jose Jalife
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Cardiac Arrhythmia Section, Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, Madrid, Spain
| | - Hakan Oral
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elif A. Oral
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Koo E, Foss-Freitas MC, Meral R, Ozer M, Eldin AJ, Akinci B, Miller N, Rothberg AE, Oral EA. The Metabolic Equivalent BMI in Patients with Familial Partial Lipodystrophy (FPLD) Compared with Those with Severe Obesity. Obesity (Silver Spring) 2021; 29:274-278. [PMID: 33491315 DOI: 10.1002/oby.23049] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/19/2020] [Accepted: 09/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to investigate the shortcoming of BMI as a measurement of adiposity in patients with familial partial lipodystrophy (FPLD). METHODS Two different matching procedures were used to compare 55 FPLD versus control patients with severe obesity (N = 548 patients) to study the relationship between body weight, fat distribution, and metabolic diseases, such as diabetes mellitus, hypertriglyceridemia, and nonalcoholic steatohepatitis. In MATCH1, the patients with FPLD were matched to controls with obesity (OCs) by truncal mass, and in MATCH2, the patients with FPLD were matched to OCs with respect to glucose control. RESULTS With MATCH1, the FPLD group had worse glycemic control (hemoglobin A1c 8.2% ± 1.6% vs. 5.9% ± 0.9%), higher triglycerides (884 ± 1,190 mg/dL vs. 139 ± 79 mg/dL), and lower leptin (20.5 ± 15.8 ng/mL vs. 41.9 ± 29.4 ng/mL, P < 0.001 for all comparisons). In MATCH2, metabolic comorbidity-matched FPLD patients had significantly lower BMI compared with OCs (29.5 ± 5.7 kg/m2 vs. 38.6 ± 5.2 kg/m2 , P < 0.001). CONCLUSIONS Patients with FPLD with similar truncal mass have worse metabolic profiles than non-FPLD OCs. The differential BMI between the FPLD and OCs, when matched for their metabolic comorbidities, approximates 8.6 BMI units.
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Affiliation(s)
- Eden Koo
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
- University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Maria C Foss-Freitas
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Rasimcan Meral
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Muhammet Ozer
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Abdelwahab J Eldin
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Baris Akinci
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
- 3 Dokuz Eylul University, Turkey
| | - Nicole Miller
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy E Rothberg
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Elif A Oral
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
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Eldin AJ, Akinci B, da Rocha AM, Meral R, Simsir IY, Adiyaman SC, Ozpelit E, Bhave N, Gen R, Yurekli BS, Kutbay NO, Siklar Z, Neidert A, Swaidan M, Rus D, Hench R, Jalife J, Oral H, Oral EA. SUN-556 Cardiac Phenotype in Familial Partial Lipodystrophy. J Endocr Soc 2020. [PMCID: PMC7207313 DOI: 10.1210/jendso/bvaa046.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Pathogenic variants in Lamin A/C (LMNA) gene are the most common monogenic etiology in Familial Partial Lipodystrophy (FPLD) causing FPLD2. LMNA pathogenic variants have been previously associated with cardiomyopathy, familial arrhythmias or conduction system abnormalities independent of lipodystrophy. We aimed to assess cardiac impacts of FPLD, and to explore the extent of overlap between cardiolaminopathies and FPLD. Methods We conducted a retrospective review of an established cohort of 122 patients (age range: 13-77, M/F 21/101) with FPLD from Michigan (n = 83) and Turkey (n = 39) with an accessible cardiac evaluation. Also, functional syncytia of mature human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) from a FLPD2 patient was studied for assessment of autonomous rhythm and action potential duration with optical mapping using a voltage sensitive dye. Results In the whole study cohort, 95 (78%) patients had cardiac alterations (25% ischemic heart disease, 36% arrhythmia, 16% conduction abnormality, 20% prolonged QT interval, 11% cardiomyopathy, and 15% congestive heart failure). The likelihood of having an arrhythmia (OR; 3.95, 95% CI: 1.49-10.49) and conduction disease (OR: 3.324, 95% CI: 1.33-8.31) was significantly higher in patients with LMNA pathogenic variants. Patients with LMNA pathogenic variants were at high risk for atrial fibrillation/flutter (OR: 6.77, 95% CI: 1.27- 39.18). The time to first arrhythmia was significantly shorter in the LMNA group with a higher hazard rate of 3.04 (95% CI: 1.29-7.17, p = 0.032). Non-482 LMNA pathogenic variants were more likely to be associated with cardiac events (vs. 482 LMNA: OR: 4.74, 95% CI: 1.41- 15.98 for arrhythmia; OR: 17.67, 95% CI: 2.44- 127.68 for atrial fibrillation/flutter; OR: 5.71, 95% CI: 1.37- 23.76 for conduction disease. hiPSC-CMs from a FPLD2 patient had higher frequency of autonomous activity, and shorter Fridericia corrected action potential duration at 80% repolarization compared to control cardiomyocytes. Furthermore, FPLD2 functional syncytia of mature hiPSC-CMs presented several rhythm alterations such as early after-depolarizations, spontaneous quiescence and spontaneous tachyarrhythmia; none of those were observed in the control cell lines. Finally, FPLD2 hiPSC-CMs presented significantly slower recovery in chronotropic changes induced by isoproterenol exposure; which indicates disrupted beta-adrenergic response. Conclusion Our results suggest the need for vigilant cardiac monitoring in FPLD, especially in patients with FPLD2 who have an increased risk to develop cardiac arrhythmias and conduction system diseases. In addition, study of human induced pluripotent stem cell-derived cardiomyocytes may prove useful to understand the mechanism of cardiac disease and arrhythmias and to create precision therapy opportunities in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Diana Rus
- UNIVERSITY OF MICHIGAN, Ann Arbor, MI, USA
| | - Rita Hench
- UNIVERSITY OF MICHIGAN, Ann Arbor, MI, USA
| | | | - Hakan Oral
- UNIVERSITY OF MICHIGAN, Ann Arbor, MI, USA
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Eldin AJ, Akinci B, Luo Y, de Freitas MCF, Swaidan M, Meral R, Rus D, Hench R, Neidert A, Stratton A, Spino C, Clauw D, Oral EA. MON-121 Pain Is a Major Driver of Quality of Life and Psychoemotional Health in Lipodystrophy Syndromes. J Endocr Soc 2020. [PMCID: PMC7208033 DOI: 10.1210/jendso/bvaa046.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background Lipodystrophy is a group of heterogeneous syndromes characterized by selective loss of adipose tissue and metabolic abnormalities. The severity of pain and its possible relation to measures of quality of life (OoL) and psychoemotional and metabolic health have never been studied in-depth previously. Methods LD-Lync study is an international multi-center study collecting data on the natural history of different lipodystrophy syndromes. We have completed phase 1 of the study where only a single site (University of Michigan) entered data (n = 79 patients, M/F: 16/63, mean age: 46.13 ± 14.60, 56 with familial partial lipodystrophy). In this study, we sought to investigate the relationship of pain perception on QoL, psychoemotional and metabolic aspects of the disease. Brief Pain Inventory (BPI) was used to calculate pain severity (BPI-SS) and pain interference scores (BPI-IS). Results From the 77 who completed the questionnaires, 56 (72.73%) patients reported pain at different levels. Out of the 56, 29 (51.79%) patients had moderate/severe pain (BPI-SS ≥ 4). Patients with moderate/severe pain had “more impaired” QoL scores: physical functioning: 20 (15-50) vs. 80 (45-95), p = 0.002; limitation to physical health: 0 (0-25) vs. 75 (0-100), p = 0.002; energy/fatigue 15 (10-30) vs. 45 (20-60), p = 0.032; emotional well-being: 48 (32-60) vs. 72 (48-84), p = 0.029; social functioning: 33 (20-38) vs. 58 (35-70), p = 0.002; general health: 15 (10-25) vs. 35 (20-55), p = 0.005). Severe depression (PHQ-9 > 14) was more frequently detected among patients with moderate/severe pain (63.2% vs. 36.9%, p = 0.008). PHQ-9 score measuring depression was positively correlated with BPI-SS (r = 0.53, p < 0.001), and BPI-IS (r = 0.63, p < 0.001). Emotional burden score was also higher in patients reporting moderate/severe pain (4.0 (2.6-5.0) vs. 2.7 (1.6-3.3), p = 0.015). BPI-SS/BPI-IS scores correlated positively with disease distress (r = 0.33, p < 0.001, and r = 0.31, p = 0.010) and GAD7 scores measuring anxiety (r = 0.52, p < 0.001, and r = 0.50, p < 0.001). Anxiety (GAD7 > 10) was more prevalent among patients with moderate/severe pain (58.6% vs. 23.4%, p = 0.002). The presence of diabetes was associated with higher BPI-SS scores: 3.50 (1.50-5.00) vs. 0 (0-3.25), p = 0.030). Also, patients with HbA1c > 6.5% exhibited higher BPI-SS scores than those with an HbA1c less than 6.5%: 3.38 (1.38-5.00) vs. 1.25 (0-3.50), p = 0.030). Conclusion Our study reveals a high frequency of pain perception among patients with different types of lipodystrophy. Pain severity contributes to worsening in QoL, affects physical and emotional function, and relates to psychoemotional state in patients with lipodystrophy. In addition, the presence of diabetes and higher HbA1c may potentially modulate pain in patients with lipodystrophy. Further work is needed to elucidate the pathways that regulate pain in these patients and to address it effectively.
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Affiliation(s)
| | | | | | | | | | | | - Diana Rus
- UNIVERSITY OF MICHIGAN, Ann Arbor, MI, USA
| | - Rita Hench
- UNIVERSITY OF MICHIGAN, Ann Arbor, MI, USA
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10
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Akinci B, Meral R, Rus D, Hench R, Neidert AH, DiPaola F, Westerhoff M, Taylor SI, Oral EA. The complicated clinical course in a case of atypical lipodystrophy after development of neutralizing antibody to metreleptin: treatment with setmelanotide. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190139. [PMID: 32213649 PMCID: PMC7159256 DOI: 10.1530/edm-19-0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
SUMMARY A patient with atypical partial lipodystrophy who had a transient initial response to metreleptin experienced acute worsening of her metabolic state when neutralizing antibodies against metreleptin appeared. Because her metabolic status continued to deteriorate, a therapeutic trial with melanocortin-4 receptor agonist setmelanotide, that is believed to function downstream from leptin receptor in the leptin signaling system, was undertaken in an effort to improve her metabolic status for the first time in a patient with lipodystrophy. To achieve this, a compassionate use (investigational new drug application; IND) was initiated (NCT03262610). Glucose control, body fat by dual-energy X-ray absorptiometry and MRI, and liver fat by proton density fat fraction were monitored. Daily hunger scores were assessed by patient filled questionnaires. Although there was a slight decrease in hunger scales and visceral fat, stimulating melanocortin-4 receptor by setmelanotide did not result in any other metabolic benefit such as improvement of hypertriglyceridemia or diabetes control as desired. Targeting melanocortin-4 receptor to regulate energy metabolism in this setting was not sufficient to obtain a significant metabolic benefit. However, complex features of our case make it difficult to generalize these observations to all cases of lipodystrophy. It is still possible that melanocortin-4 receptor agonistic action may offer some therapeutic benefits in leptin-deficient patients. LEARNING POINTS A patient with atypical lipodystrophy with an initial benefit with metreleptin therapy developed neutralizing antibodies to metreleptin (Nab-leptin), which led to substantial worsening in metabolic control. The neutralizing activity in her serum persisted for longer than 3 years. Whether the worsening in her metabolic state was truly caused by the development of Nab-leptin cannot be fully ascertained, but there was a temporal relationship. The experience noted in our patient at least raises the possibility for concern for substantial metabolic worsening upon emergence and persistence of Nab-leptin. Further studies of cases where Nab-leptin is detected and better assay systems to detect and characterize Nab-leptin are needed. The use of setmelanotide, a selective MC4R agonist targeting specific neurons downstream from the leptin receptor activation, was not effective in restoring metabolic control in this complex patient with presumed diminished leptin action due to Nab-leptin. Although stimulating the MC4R pathway was not sufficient to obtain a significant metabolic benefit in lowering triglycerides and helping with her insulin resistance as was noted with metreleptin earlier, there was a mild reduction in reported food intake and appetite. Complex features of our case make it difficult to generalize our observation to all leptin-deficient patients. It is possible that some leptin-deficient patients (especially those who need primarily control of food intake) may still theoretically benefit from MC4R agonistic action, and further studies in carefully selected patients may help to tease out the differential pathways of metabolic regulation by the complex network of leptin signaling system.
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Affiliation(s)
- Baris Akinci
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
- Division of Endocrinology and Metabolism, Dokuz Eylul University, Izmir, Turkey
| | - Rasimcan Meral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Diana Rus
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Rita Hench
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam H Neidert
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank DiPaola
- Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Simeon I Taylor
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elif A Oral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
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11
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Lager CJ, Esfandiari NH, Luo Y, Subauste AR, Kraftson AT, Brown MB, Varban OA, Meral R, Cassidy RB, Nay CK, Lockwood AL, Bellers D, Buda CM, Oral EA. Metabolic Parameters, Weight Loss, and Comorbidities 4 Years After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2019; 28:3415-3423. [PMID: 29909517 DOI: 10.1007/s11695-018-3346-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sleeve gastrectomy (LSG) is now the predominant bariatric surgery performed, yet there is limited long-term data comparing important outcomes between LSG and Roux-en-Y gastric bypass (RYGB). This study compares weight loss and impact on comorbidities of the two procedures. METHODS We retrospectively evaluated weight, blood pressure, hemoglobin A1c, cholesterol, and medication use for hypertension, diabetes, and hyperlipidemia at 1-4 years post-operatively in 380 patients who underwent RYGB and 334 patients who underwent LSG at the University of Michigan from January 2008 to November 2013. Follow-up rates from 714 patients initially were 657 (92%), 556 (78%), 507 (71%), and 498 (70%) at 1-4 years post-operatively. RESULTS Baseline characteristics were similar except for higher weight and BMI in LSG. There was greater weight loss with RYGB vs. LSG at all points. Hemoglobin A1c and total cholesterol improved more in RYGB vs. LSG at 4 years. There was greater remission of hypertension and discontinuation of all medications for hypertension and diabetes with RYGB at 4 years. CONCLUSIONS Weight loss, reduction in medications for hypertension and diabetes, improvements in markers of diabetes and hyperlipidemia, and remission rates of hypertension were superior with RYGB vs. LSG 4 years post-operatively. Choice of bariatric procedures should be tailored to surgical risk, comorbidities, and weight loss goals.
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Affiliation(s)
- Corey J Lager
- Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino's Farm, Lobby C, Ann Arbor, MI, 48106, USA
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino's Farm, Lobby C, Ann Arbor, MI, 48106, USA
| | - Yingying Luo
- Department of Endocrinology, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Angela R Subauste
- Division of Endocrinology, University of Mississippi, 2500 N State St, Jackson, MS, 39216, USA
| | - Andrew T Kraftson
- Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino's Farm, Lobby C, Ann Arbor, MI, 48106, USA
| | - Morton B Brown
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Oliver A Varban
- Division of Minimally Invasive Surgery, Department of General Surgery, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Rasimcan Meral
- Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino's Farm, Lobby C, Ann Arbor, MI, 48106, USA
| | - Ruth B Cassidy
- Division of Minimally Invasive Surgery, Department of General Surgery, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Catherine K Nay
- Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino's Farm, Lobby C, Ann Arbor, MI, 48106, USA
| | - Amy L Lockwood
- Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino's Farm, Lobby C, Ann Arbor, MI, 48106, USA
| | - Darlene Bellers
- Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino's Farm, Lobby C, Ann Arbor, MI, 48106, USA
| | - Colleen M Buda
- Division of Minimally Invasive Surgery, Department of General Surgery, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Elif A Oral
- Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino's Farm, Lobby C, Ann Arbor, MI, 48106, USA.
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12
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Kaval G, Altun M, Ibis K, Ozkaya K, Meral R, Karadeniz A, Sarı M, Ekenel M, Basaran M, Bavbek S. Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Jalal Eldin AW, Tombayoglu D, Butz L, Affinati A, Meral R, Ontan MS, Walkovich K, Westerhoff M, Innis JW, Parikh ND, Oral EA. Natural history of ROHHAD syndrome: development of severe insulin resistance and fatty liver disease over time. Clin Diabetes Endocrinol 2019; 5:9. [PMID: 31333877 PMCID: PMC6617654 DOI: 10.1186/s40842-019-0082-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/04/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare syndrome with unknown etiology. Metabolic abnormalities are not known to be part of the syndrome. We present one of the oldest cases reported in the literature, who developed severe metabolic abnormalities and hepatic disease suggesting that these features may be part of the syndrome. Case presentation A 27-year-old woman, diagnosed with ROHHAD syndrome at age 15, who previously developed diabetes insipidus, growth hormone deficiency, hyperprolactinemia, and hypothyroidism in her first decade of life. This was followed by insulin resistance, NAFLD, liver fibrosis, and splenomegaly before age 14 years. Her regimen included a short course of growth hormone, and cyclic estrogen and progesterone. Her metabolic deterioration continued despite treatment with metformin. Interestingly, she had a favorable response to liraglutide therapy despite having a centrally mediated cause for her obesity. At age 26, a 1.6 cm lesion was found incidentally in her liver. Liver biopsy showed hepatocellular carcinoma which was successfully treated with radiofrequency ablation. Conclusion Metabolic abnormalities, Insulin resistance and fatty liver disease are potentially part of the ROHHAD syndrome that may develop over time. GLP1 agonists were reasonably effective to treat insulin resistance and hyperphagia. Patients with ROHHAD may benefit from close follow up in regards to liver disease. Electronic supplementary material The online version of this article (10.1186/s40842-019-0082-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdel Wahab Jalal Eldin
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Dilara Tombayoglu
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA.,2Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Laura Butz
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Alison Affinati
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Rasimcan Meral
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Mehmet Selman Ontan
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Kelly Walkovich
- 3Division of Pediatric Hematology/Oncology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Maria Westerhoff
- 4Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Jeffrey W Innis
- Division of Genetics, Metabolism and Genomic Medicine, Department of Pediatrics,and Departments of Human Genetics and Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Neehar D Parikh
- 6Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Elif A Oral
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
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14
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Koo E, Meral R, Ozer M, Jalal Eldin A, Miller N, Rothberg A, Oral E. MON-104 Defining the Contribution of Weight to the Extent of Metabolic Disease in FPLD: Insights from a Retrospective "Matched" Case-Control Study. J Endocr Soc 2019. [PMCID: PMC6551147 DOI: 10.1210/js.2019-mon-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/26/2022] Open
Abstract
Familial partial lipodystrophy (FPLD) presents with an absence of adipose tissue in the extremities, with accumulation in the upper body. Metabolic abnormalities associated with FPLD include diabetes mellitus and/or severe insulin resistance, hypertriglyceridemia, and non-alcoholic steatohepatitis. FPLD patients have a disproportionately lower BMI compared to individuals with common obesity and similar metabolic derangements. However, the extent and degree of metabolic disease at comparable truncal mass, or the “equivalent” BMI between the groups with similar metabolic disease are not known. To determine a BMI reference or “equivalence”, we performed a retrospective case control study comparing “cases” of FPLD against “controls” with severe obesity while matching for co-morbidities or total trunk mass. Baseline data were gathered to perform two k:1 nearest neighbor case-control matches using matchControls function of R’s e1071 package. MATCH1 included matching of age, sex, and total trunk mass with the hypothesis that FPLD with similar trunk mass had worse metabolic parameters. MATCH2 was performed using age, sex, and presence of comorbidities (hypertension, hypertriglyceridemia (>300mg/dL), diabetes, fatty liver, heart disease, arthritis, depression and anxiety, smoking history) with the hypothesis that there would be a significant difference in weight or BMI between the two populations. Our populations consisted of 55 FPLD cases (46F/9M, Age = 47±12 years, Total trunk mass=45.3±11.6 Kg) and a pool of 549 non-FPLD controls (338F/211M, Age = 48±10 years). MATCH1 allowed for a 2:1 nearest neighbor match with 110 obese controls (92F/18M, p=1.00, Age=48±11 years, p=0.72; Total Trunk Mass= 46.8±10.9 Kg, p=0.36). FPLD had worse glycemic control (HbA1c= 8.2±1.6%, 5.9±0.9%, respectively, p=<0.001), higher triglycerides (884±1190 mg/dL, 139±79 mg/dL, respectively, p<0.001), and lower leptin compared to obese controls (20.5±15.8 ng/mL, 41.9±29.4 ng/mL, p<0.001). MATCH2 allowed for a 1:1 nearest neighbor match with 55 controls (38F/17M, Age=53±9 years). The two groups had similar glycemic control (HbA1c = 8.2±1.6%, 7.8±1.6%, respectively, p=0.15), but the FPLD group had markedly higher triglycerides (884±1190 mg/dL, 224±123 mg/dL, respectively, p<0.001). Average BMI was 9.1 kg/m2 lower in the FPLD group compared to controls (BMI = 29.5±5.7 kg/m2, 38.6±5.2 kg/m2, respectively, p<0.001). In conclusion, FPLD patients with a similar truncal mass will have a worse metabolic profile than that of a non-FPLD obese patients despite having a lower BMI. This supports the understanding that lack of healthy fat depots drives metabolic disease in FPLD. The metabolic disease burden of the FPLD patients is equivalent to non-FPLD obesity that is at on average 9.1kg/m2 heavier than the observed BMI. This can be taken into account while defining weight goals for these patients.
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Affiliation(s)
- Eden Koo
- University of Hawaii, Honolulu, HI, United States
| | - Rasimcan Meral
- Brehm Center for Diabetes Research, University of Michigan, Ann Arbor, MI, United States
| | - Muhammet Ozer
- University of Michigan, Ann Arbor, MI, United States
| | | | - Nicole Miller
- University of Michigan, Ann Arbor, MI, United States
| | - Amy Rothberg
- MEND, University of Michigan, Ann Arbor, MI, United States
| | - Elif Oral
- University of Michigan, Ann Arbor, MI, United States
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15
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Jalal Eldin A, Akinci B, Meral R, Rus D, Swaidan M, Hench R, Neidert A, Stratton A, Spino C, Oral E. MON-101 The LD Lync Study: Natural History Study of Lipodystrophy Syndromes: Early Lessons from the Pilot Data. J Endocr Soc 2019. [PMCID: PMC6551070 DOI: 10.1210/js.2019-mon-101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/24/2022] Open
Abstract
Lipodystrophy syndromes are a heterogeneous cluster of rare diseases characterized by a paucity or abnormal distribution of fat which are also associated with insulin resistance and ectopic lipid deposition. Owing to the rarity of the syndromes, the natural history and exact evolution of clinical, and psychosocial aspects are largely unknown. In March, 2018 we launched a prospective data registry- the LD Lync. The registry will be expanded to multiple centers across the US to ensure maximum number of participants. Anticipated sample size is 500. The goal is to collect data on various aspects of lipodystrophy syndromes (LD) including demographic, morphometric, clinical, genetic, socioeconomic characteristics and novel patient related end points such as quality of life, hunger and pain scales, mood and anxiety, and eating habits. During the past 8 months, we initiated the pilot data collection at our center. As of this month, we collected data on 61 affected individuals (49F/12 M, mean±SD Age: 44±15, with 4 acquired generalized LD (AGL), 3 acquired partial LD (APL), 48 familial partial LD (FPLD), 1 congenital generalized LD (CGL), 5 atypical LD). The median (IQR) difference between symptoms onset and time of diagnosis was 14y (24). The prevalence (95%CI) of diabetes, hypertriglyceridemia, nonalcoholic fatty liver disease were 83% (71-92), 81% (69-90), and 78% (67-89) respectively. In terms of significant organ manifestations, 10% (95%CI:2-18) had myocardial infarction, 3% (0-8) had heart failure, 23% (14-35) had pancreatitis, and 8% (1-16) had malignancy. The (Median: IQR) age of diagnosis of these diseases was heterogeneous: diabetes 31y (26), hypercholesterolemia 27y (20), hypertriglyceridemia 25y (17), fatty liver disease 33y (31), and myocardial infarction 50y (16) . Out of 60 patients, 70% (58-82) are on lipid lowering drugs, 77% (66-87) on glucose lowering drugs, 37% (24-49) on hormones, and 68% (57-80) on anti-hypertensives. Out of the 61 who completed the GAD-7, IPAQ-2002, Modified 13 item binge eating scale, SF-36 scale, PHQ-9, and the perceived financial burden scale, 33% (95% CI, 21-45) had minimal anxiety, 28.3% (17-40) had mild anxiety, 20% (10-30) had moderate anxiety, and 18% (8-28) had severe anxiety. On quality of life, with 100% being the perfect score, our patients had low scores mean(95%CI): 37%(34-40) on emotional wellbeing, 49% (43-55) on social functioning, 55% (48-62) on pain level, and 32% (27-37) on general health. On the financial impact of lipodystrophy: 46% (33-58) reported moderate or higher levels of burden. We conclude that the lipodystrophy syndromes present with a large burden not only in terms of known medical complications but also in socioeconomic and psychosocial aspects of life. Expansion of this registry to include multiple sites in the US and across the globe will improve our understanding of all aspects of these diseases.
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Affiliation(s)
| | - Baris Akinci
- Dept of Endocrinology, Dokuz Eylul Univ, Izmir, , Turkey
| | - Rasimcan Meral
- Brehm Center for Diabetes Research, University of Michigan, Ann Arbor, MI, United States
| | - Diana Rus
- University of Michigan, Ann Arbor, MI, United States
| | - Mario Swaidan
- University of Michigan, Ann Arbor, MI, United States
| | - Rita Hench
- University of Michigan, Ann Arbor, MI, United States
| | - Adam Neidert
- University of Michigan, Ann Arbor, MI, United States
| | | | - Cathie Spino
- University of Michigan, Ann Arbor, MI, United States
| | - Elif Oral
- University of Michigan, Ann Arbor, MI, United States
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Meral R, Köse YE. The effect of bread-making process on the antioxidant activity and phenolic profile of enriched breads. Quality Assurance and Safety of Crops & Foods 2019. [DOI: 10.3920/qas2018.1350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- R. Meral
- Van Yüzüncü Yıl University, Faculty of Engineering, Department of Food Engineering, 65080 Van, Turkey
| | - Y. Erim Köse
- Van Yüzüncü Yıl University, Faculty of Engineering, Department of Food Engineering, 65080 Van, Turkey
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Esfandiari NH, Rubenfire M, Neidert AH, Hench R, Eldin AJ, Meral R, Oral EA. Diagnosis of acquired generalized lipodystrophy in a single patient with T-cell lymphoma and no exposure to Metreleptin. Clin Diabetes Endocrinol 2019; 5:4. [PMID: 30923630 PMCID: PMC6419468 DOI: 10.1186/s40842-019-0076-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Metreleptin, a recombinant methionyl -human -leptin, was approved to treat patients with generalized lipodystrophy (GL) in February 2014. However, leptin therapy has been associated with the development of lymphoma. We present a unique case of a patient with prior history of T cell lymphoma in remission, who was diagnosed with Acquired Generalized Lipodystrophy (AGL) during the following year after a clinical remission of her lymphoma without receiving leptin therapy. Case presentation A 33-year-old woman with a diagnosis of stage IV subcutaneous panniculitis like T-cell lymphoma in 2011, underwent chemotherapy. Shortly after completion therapy, she had a relapse and required more chemotherapy with complete response, followed by allogenic stem cell transplant on June 28, 2012. Since that time, she has been on observation with no evidence of disease recurrence. Subsequent to the treatment, she was found to have high triglycerides, loss of fat tissue from her entire body and diagnosis of diabetes. Constellation of these findings led to the diagnosis of AGL in 2013. Her leptin level was low at 3.4 ng/mL (182 pmol/mL). She is currently not receiving any treatment with Metreleptin for her AGL. Conclusions Causal association between exogenous leptin therapy and T-cell lymphoma still remains unclear. We hereby present a case of a young woman who was diagnosed with AGL after going into remission from T-cell lymphoma and who has never been treated with Metreleptin. Steroid therapy and chemotherapy might have masked the diagnosis of AGL in this patient. We believe that patients can develop these 2 conditions independent of each other.
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Affiliation(s)
- Nazanene H Esfandiari
- 1Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Melvyn Rubenfire
- 2Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Adam H Neidert
- 1Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Rita Hench
- 1Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Abdelwahab Jalal Eldin
- 1Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Rasimcan Meral
- 1Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Elif A Oral
- 1Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
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Abstract
PURPOSE OF REVIEW This article focuses on recent progress in understanding the genetics of lipodystrophy syndromes, the pathophysiology of severe metabolic abnormalities caused by these syndromes, and causes of severe morbidity and a possible signal of increased mortality associated with lipodystrophy. An updated classification scheme is also presented. RECENT FINDINGS Lipodystrophy encompasses a group of heterogeneous rare diseases characterized by generalized or partial lack of adipose tissue and associated metabolic abnormalities including altered lipid metabolism and insulin resistance. Recent advances in the field have led to the discovery of new genes associated with lipodystrophy and have also improved our understanding of adipose biology, including differentiation, lipid droplet assembly, and metabolism. Several registries have documented the natural history of the disease and the serious comorbidities that patients with lipodystrophy face. There is also evolving evidence for increased mortality rates associated with lipodystrophy. Lipodystrophy syndromes represent a challenging cluster of diseases that lead to severe insulin resistance, a myriad of metabolic abnormalities, and serious morbidity. The understanding of these syndromes is evolving in parallel with the identification of novel disease-causing mechanisms.
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Affiliation(s)
- Baris Akinci
- Brehm Center for Diabetes Research, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
- Division of Endocrinology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Rasimcan Meral
- Brehm Center for Diabetes Research, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Elif Arioglu Oral
- Brehm Center for Diabetes Research, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the therapeutic approach for lipodystrophy syndromes with conventional treatment options and metreleptin therapy in detail and to point out the current investigational treatments in development. RECENT FINDINGS The observation of leptin deficiency in patients with lipodystrophy and the potential of leptin replacement to rescue metabolic abnormalities in animal models of lipodystrophy were followed by the first clinical study of leptin therapy in patients with severe lipodystrophy. This and several other long-term studies demonstrated important benefits of recombinant human leptin (metreleptin) to treat metabolic abnormalities of lipodystrophy. These studies ultimately led to the recent FDA approval of metreleptin for the treatment of generalized lipodystrophy and EMA approval for both generalized and partial lipodystrophy. Additional research efforts in progress focus on novel treatment options, predominantly for patients with partial lipodystrophy. Current treatment of generalized lipodystrophy includes metreleptin replacement as an adjunct to diet and standard treatment approach for metabolic consequences of lipodystrophy. Beyond metreleptin, a number of different compounds and treatment modalities are being studied for the treatment of partial lipodystrophy.
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Affiliation(s)
- Baris Akinci
- Brehm Center for Diabetes Research, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
- Division of Endocrinology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Rasimcan Meral
- Brehm Center for Diabetes Research, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Elif Arioglu Oral
- Brehm Center for Diabetes Research, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA.
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Meral R, Ryan BJ, Malandrino N, Jalal A, Neidert AH, Muniyappa R, Akıncı B, Horowitz JF, Brown RJ, Oral EA. "Fat Shadows" From DXA for the Qualitative Assessment of Lipodystrophy: When a Picture Is Worth a Thousand Numbers. Diabetes Care 2018; 41:2255-2258. [PMID: 30237235 PMCID: PMC6150431 DOI: 10.2337/dc18-0978] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 05/03/2018] [Accepted: 07/09/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Lipodystrophy syndromes are a heterogeneous group of disorders associated with selective absence of fat. Currently, the diagnosis is established only clinically. RESEARCH DESIGN AND METHODS We developed a new method from DXA scans called a "fat shadow," which is a color-coded representation highlighting only the fat tissue. We conducted a blinded retrospective validation study to assess its usefulness for the diagnosis of lipodystrophy syndromes. RESULTS We evaluated the fat shadows from 16 patients (11 female and 5 male) with generalized lipodystrophy (GL), 57 (50 female and 7 male) with familial partial lipodystrophy (FPLD), 2 (1 female and 1 male) with acquired partial lipodystrophy, and 126 (90 female and 36 male) control subjects. FPLD was differentiated from control subjects with 85% sensitivity and 96% specificity (95% CIs 72-93 and 91-99, respectively). GL was differentiated from nonobese control subjects with 100% sensitivity and specificity (95% CIs 79-100 and 92-100, respectively). CONCLUSIONS Fat shadows provided sufficient qualitative information to infer clinical phenotype and differentiate these patients from appropriate control subjects. We propose that this method could be used to support the diagnosis.
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Affiliation(s)
- Rasimcan Meral
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Benjamin J Ryan
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, MI
| | - Noemi Malandrino
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Abdelwahab Jalal
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Adam H Neidert
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Ranganath Muniyappa
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.,Inter-Institute Endocrinology Training Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Barış Akıncı
- Division of Endocrinology, Dokuz Eylül University, Izmir, Turkey
| | - Jeffrey F Horowitz
- Substrate Metabolism Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, MI
| | - Rebecca J Brown
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Elif A Oral
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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Sahinoz M, Khairi S, Cuttitta A, Brady GF, Rupani A, Meral R, Tayeh MK, Thomas P, Riebschleger M, Camelo-Piragua S, Innis JW, Bishr Omary M, Michele DE, Oral EA. Potential association of LMNA-associated generalized lipodystrophy with juvenile dermatomyositis. Clin Diabetes Endocrinol 2018; 4:6. [PMID: 29610677 PMCID: PMC5870259 DOI: 10.1186/s40842-018-0058-3] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background Juvenile dermatomyositis (JDM) is an auto-immune muscle disease which presents with skin manifestations and muscle weakness. At least 10% of the patients with JDM present with acquired lipodystrophy. Laminopathies are caused by mutations in the lamin genes and cover a wide spectrum of diseases including muscular dystrophies and lipodystrophy. The p.T10I LMNA variant is associated with a phenotype of generalized lipodystrophy that has also been called atypical progeroid syndrome. Case presentation A previously healthy female presented with bilateral proximal lower extremity muscle weakness at age 4. She was diagnosed with JDM based on her clinical presentation, laboratory tests and magnetic resonance imaging (MRI). She had subcutaneous fat loss which started in her extremities and progressed to her whole body. At age 7, she had diabetes, hypertriglyceridemia, low leptin levels and low body fat on dual energy X-ray absorptiometry (DEXA) scan, and was diagnosed with acquired generalized lipodystrophy (AGL). Whole exome sequencing (WES) revealed a heterozygous c.29C > T; p.T10I missense pathogenic variant in LMNA, which encodes lamins A and C. Muscle biopsy confirmed JDM rather than muscular dystrophy, showing perifascicular atrophy and perivascular mononuclear cell infiltration. Immunofluroscence of skin fibroblasts confirmed nuclear atypia and fragmentation. Conclusions This is a unique case with p.T10I LMNA variant displaying concurrent JDM and AGL. This co-occurrence raises the intriguing possibility that LMNA, and possibly p.T10I, may have a pathogenic role in not only the occurrence of generalized lipodystrophy, but also juvenile dermatomyositis. Careful phenotypic characterization of additional patients with laminopathies as well as individuals with JDM is warranted.
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Affiliation(s)
- Melis Sahinoz
- 1Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Shafaq Khairi
- 2Metabolism Endocrinology and Diabetes Division, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI MI48105 USA
| | - Ashley Cuttitta
- 3Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI USA
| | - Graham F Brady
- 4Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Amit Rupani
- 5Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Rasimcan Meral
- 2Metabolism Endocrinology and Diabetes Division, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI MI48105 USA
| | - Marwan K Tayeh
- 5Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Peedikayil Thomas
- 5Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Meredith Riebschleger
- 6Division of Pediatric Rheumatology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | | | - Jeffrey W Innis
- 5Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA.,8Department of Human Genetics, University of Michigan, Ann Arbor, MI USA
| | - M Bishr Omary
- 3Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI USA
| | - Daniel E Michele
- 3Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI USA
| | - Elif A Oral
- 2Metabolism Endocrinology and Diabetes Division, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI MI48105 USA
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22
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Ajluni N, Meral R, Neidert AH, Brady GF, Buras E, McKenna B, DiPaola F, Chenevert TL, Horowitz JF, Buggs-Saxton C, Rupani AR, Thomas PE, Tayeh MK, Innis JW, Omary MB, Conjeevaram H, Oral EA. Spectrum of disease associated with partial lipodystrophy: lessons from a trial cohort. Clin Endocrinol (Oxf) 2017; 86:698-707. [PMID: 28199729 PMCID: PMC5395301 DOI: 10.1111/cen.13311] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 11/03/2016] [Revised: 01/18/2017] [Accepted: 02/10/2017] [Indexed: 12/29/2022]
Abstract
CONTEXT Partial lipodystrophy (PL) is associated with metabolic co-morbidities but may go undiagnosed as the disease spectrum is not fully described. OBJECTIVE The objective of the study was to define disease spectrum in PL using genetic, clinical (historical, morphometric) and laboratory characteristics. DESIGN Cross-sectional evaluation. PARTICIPANTS Twenty-three patients (22 with familial, one acquired, 78·3% female, aged 12-64 years) with PL and non-alcoholic fatty liver disease (NAFLD). MEASUREMENTS Genetic, clinical and laboratory characteristics, body composition indices, liver fat content by magnetic resonance imaging (MRI), histopathological and immunofluorescence examinations of liver biopsies. RESULTS Seven patients displayed heterozygous pathogenic variants in LMNA. Two related patients had a heterozygous, likely pathogenic novel variant of POLD1 (NM002691·3: c.3199 G>A; p.E1067K). Most patients had high ratios (>1·5) of percentage fat trunk to percentage fat legs (FMR) when compared to reference normals. Liver fat quantified using MR Dixon method was high (11·3 ± 6·3%) and correlated positively with haemoglobin A1c and triglycerides while leg fat by dual-energy X-ray absorptiometry (DEXA) correlated negatively with triglycerides. In addition to known metabolic comorbidities; chronic pain (78·3%), hypertension (56·5%) and mood disorders (52·2%) were highly prevalent. Mean NAFLD Activity Score (NAS) was 5 ± 1 and 78·3% had fibrosis. LMNA-immunofluorescence staining from select patients (including one with the novel POLD1 variant) showed a high degree of nuclear atypia and disorganization. CONCLUSIONS Partial lipodystrophy is a complex multi-system disorder. Metabolic parameters correlate negatively with extremity fat and positively with liver fat. DEXA-based FMR may prove useful as a diagnostic tool. Nuclear disorganization and atypia may be a common biomarker even in the absence of pathogenic variants in LMNA.
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Affiliation(s)
- Nevin Ajluni
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Rasimcan Meral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Adam H. Neidert
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Graham F. Brady
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eric Buras
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Barbara McKenna
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Frank DiPaola
- Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Colleen Buggs-Saxton
- Pediatric Endocrinology, Children’s Hospital of Michigan, Wayne School of Medicine, Detroit, MI, USA
| | - Amit R. Rupani
- Departments of Pediatrics and Communicable Diseases and Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Peedikayil E. Thomas
- Departments of Pediatrics and Communicable Diseases and Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Marwan K. Tayeh
- Departments of Pediatrics and Communicable Diseases and Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey W. Innis
- Departments of Pediatrics and Communicable Diseases and Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - M. Bishr Omary
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Hari Conjeevaram
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elif A. Oral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
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Meral R, Gurdal N, Kemikler G, Okutan M, Sahin D, Ahmedova A, Altun M, Sencer A, Uzum A, Hatipoglu E. Radiation Dose to Hippocampus With Increasing Planning Target Volume in Patients With Pituitary Adenoma Treated With Hypofractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Meral R, Tambas M, Guveli M, Kemikler G, Altun M, Cakır A, Okutan M, Ahmed S, Donmez N, Disci R. Side Effects of Stereotactic Fractionated Radiation Therapy for Malignant and Benign Lesions. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Meral R, Tuna S, Disci R, Karadeniz A, Altun M. Cranial Nerve Deficit Indicates Less Favorable Prognosis Than Advanced Cervical Nodal Disease In Patients With Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Ekenel M, Keskin S, Başsaran M, Bavbek SE, Ozdemir C, Meral R, Altun M. Clinical outcomes in patients with locally advanced nasopharyngeal cancer treated with neoadjuvant docetaxel and cisplatin followed by radiation treatment and concomitant cisplatin. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bilge H, Yondem S, Kucucuk H, Cakir A, Meral R. Effects of immobilization beds on the dose in the entrance and exit dose region for Co-60, 4, 6 and 15 MV photons. J BUON 2008; 13:385-390. [PMID: 18979554] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE The aim of this study was to determine the effects of Styrofoam beds used for immobilization on build-up and exit dose regions for high energy photon beams. MATERIALS AND METHODS Build-up dose and exit dose measurements in central axis of Co-60 and 4, 6 and 15 MV photons at various field sizes and source to phantom distances were made in a water equivalent solid phantom with 2, 5 and 10 cm thick uniform Styrofoam beds at the surface. A Markus type plane-parallel ion chamber with fixed separation between collecting electrodes was used to measure the percent depth doses. RESULTS The surface dose increased almost linearly with field size for Co-60, 4, 6 and 15 MV X-ray beams. The effect of immobilization (Styrofoam beds) on the surface dose increased with the thickness and this effect was lower with higher energies. When a 2 cm thick Styrofoam bed was used for immobilization, the surface dose in a 10x10 cm field was higher (43.9, 36.8, 28.8 and 14.9% for Co-60, 4, 6 and 15 MV, respectively). CONCLUSION As the Styrofoam bed was thicker, the maximum dose point moved closer to the surface of the phantom for all energies. The exit surface dose was also enhanced with the presence of Styrofoam beds and similar to the effects on the surface dose. This enhancement was the maximum 5% for high energy photon beams and 6% for Co-60 beam. The introduction of Styrofoam beds in the radiation beam for the immobilization of the patient increases surface and exit doses to a considerable extent.
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Affiliation(s)
- H Bilge
- Istanbul University, Oncology Institute, Medical Physics Division, Radiation Oncology Department, Istanbul, Turkey
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Meral R. Comment on: Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment (Burnet et al. Clin Oncol 2006;18:93-103). Clin Oncol (R Coll Radiol) 2006; 18:578-9. [PMID: 16969995 DOI: 10.1016/j.clon.2006.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meral R, Duranyildiz D, Tas F, Camlica H, Yasasever V, Kurul S, Dalay N. Prognostic significance of melanoma inhibiting activity levels in malignant melanoma. Melanoma Res 2001; 11:627-32. [PMID: 11725209 DOI: 10.1097/00008390-200112000-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This analytic (phase II) study aimed to investigate the hypothesis that the decline in serum melanoma-inhibiting activity (MIA) levels following initiation of treatment might have prognostic value. The mean serum lactate dehydrogenase (LDH), MIA and S100 levels in patients with malignant melanoma before treatment were higher than in the control group. Patients with visceral dissemination had much higher mean serum MIA levels than patients with nodal spread only. A regression model was constructed to analyse the prognostic factors in patients with advanced stage malignant melanoma. Therapy included surgical excision or lymph node dissection, hypofractionated radiotherapy, and immunotherapy or chemotherapy. Blood samples were collected within 24 h before the initiation of systemic treatment and two or three times more at 20-28 day intervals. Overall survival was investigated by univariate analysis, and correlation with clinical factors was compared using the log-rank test. Gender, primary tumour site, surgery, radiation therapy, serum S100 levels before systemic treatment and choice of chemotherapy were not correlated with the outcome. In addition to the stage of disease, low serum LDH levels before systemic treatment and a decline in serum MIA levels following initiation of systemic treatment predicted a favourable outcome. Metastasis to visceral organs was associated with higher serum MIA levels. Persistence of high serum MIA levels despite systemic treatment predicts an unfavourable prognosis.
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Affiliation(s)
- R Meral
- Department of Clinical Oncology, University of Istanbul, Oncology Institute, Capa 34390, Istanbul, Turkey
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Altun M, Teneckeci N, Kaytan E, Meral R. In response to Dr. Ozyar. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(00)01451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Altun M, Tenekeci N, Kaytan E, Meral R. Locally advanced nasopharyngeal carcinoma: computed tomography findings, clinical evaluation, and treatment outcome. Int J Radiat Oncol Biol Phys 2000; 47:401-4. [PMID: 10802366 DOI: 10.1016/s0360-3016(00)00426-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE We present our experience with computed tomography (CT) for delineating the extent of bone erosion in nasopharyngeal carcinoma (NPC) and propose that a new subdivision of Stage T4 disease be added to the staging criteria for cases of minimal bone disease, defined as erosion of the base of the sphenoid or the pterygoid without cranial nerve (CN) involvement. METHODS AND MATERIALS We retrospectively reviewed the clinical findings, radiological findings, and treatment outcome in 64 patients with Stage T4 NPC, diagnosed according to the American Joint Committee on Cancer 4th edition criteria. The median follow-up was 34 months (range, 3-118 months). Statistical analyses were performed using the chi-square test, the Kaplan-Meier method, and the log-rank test. RESULTS Local control was achieved in 19 (46%) of 41 patients with CN deficits and 18 (78%) of 23 patients without CN deficits (p = 0.01). Overall 5-year survival with and without CN deficits was 25% and 58%, respectively (p = 0.01). When the 16 patients with minimal bone disease were compared to the remaining 48 patients, there were significant differences in local control rates (87% vs. 48%, p = 0. 006) and 5-year survival rates (68% vs. 28%, p = 0.008). CONCLUSION Among patients with Stage T4 NPC, a subgroup of patients with only minimal bone disease may have a more favorable prognosis, which may have a considerable bearing on our approach to this patient group.
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Affiliation(s)
- M Altun
- Department ofRadiation Oncology, University of Istanbul, Istanbul, Turkey.
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Inanç SE, Meral R, Darendeliler E, Yasasever V, Onat H. Prognostic significance of marker half-life during chemotherapy in non-seminomatous germ cell testicular tumors. Acta Oncol 1999; 38:505-9. [PMID: 10418719 DOI: 10.1080/028418699432059] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Decrease in serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) levels is considered as a response during chemotherapy of non-seminomatous germ cell testicular tumors, but data on the prognostic significance of marker half-life remains inconclusive. Serum marker half-life was evaluated in 34 patients with elevated markers, receiving chemotherapy (CT). Marker half-life was calculated from the natural logarithm of the sequential AFP or HCG concentrations. The correlation between event-free (EFS) and overall survival (OS) with unfavorable half-lives of AFP and HCG was evaluated. Median actual half-life (AHL) AFP was 3.9 days (range, 1.4-21.5) and median AHL HCG was 4.4 days (range, 1.4-21.0); 82% of the patients had a satisfactory initial decline in AFP, and 71% had a satisfactory initial decline in HCG. There was a significant difference in EFS and OS between the two groups of patients with an AFP half-life < 7 days and > 7 days. HCG half-life did not adversely affect EFS and OS. The correlation of better EFS and OS with appropriate AFP marker half-life during chemotherapy could provide a dynamic method, which could complement the standard baseline prognostic factors, for the prediction of prognosis.
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Affiliation(s)
- S E Inanç
- Division of Medical Oncology, University of Istanbul, Institute of Gynecology, Turkey.
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