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Fowler KJ, Venkatesh SK, Obuchowski N, Middleton MS, Chen J, Pepin K, Magnuson J, Brown KJ, Batakis D, Henderson WC, Shankar SS, Kamphaus TN, Pasek A, Calle RA, Sanyal AJ, Loomba R, Ehman R, Samir AE, Sirlin CB, Sherlock SP. Repeatability of MRI Biomarkers in Nonalcoholic Fatty Liver Disease: The NIMBLE Consortium. Radiology 2023; 309:e231092. [PMID: 37815451 PMCID: PMC10625902 DOI: 10.1148/radiol.231092] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/30/2023] [Accepted: 08/29/2023] [Indexed: 10/11/2023]
Abstract
Background There is a need for reliable noninvasive methods for diagnosing and monitoring nonalcoholic fatty liver disease (NAFLD). Thus, the multidisciplinary Non-invasive Biomarkers of Metabolic Liver disease (NIMBLE) consortium was formed to identify and advance the regulatory qualification of NAFLD imaging biomarkers. Purpose To determine the different-day same-scanner repeatability coefficient of liver MRI biomarkers in patients with NAFLD at risk for steatohepatitis. Materials and Methods NIMBLE 1.2 is a prospective, observational, single-center short-term cross-sectional study (October 2021 to June 2022) in adults with NAFLD across a spectrum of low, intermediate, and high likelihood of advanced fibrosis as determined according to the fibrosis based on four factors (FIB-4) index. Participants underwent up to seven MRI examinations across two visits less than or equal to 7 days apart. Standardized imaging protocols were implemented with six MRI scanners from three vendors at both 1.5 T and 3 T, with central analysis of the data performed by an independent reading center (University of California, San Diego). Trained analysts, who were blinded to clinical data, measured the MRI proton density fat fraction (PDFF), liver stiffness at MR elastography (MRE), and visceral adipose tissue (VAT) for each participant. Point estimates and CIs were calculated using χ2 distribution and statistical modeling for pooled repeatability measures. Results A total of 17 participants (mean age, 58 years ± 8.5 [SD]; 10 female) were included, of which seven (41.2%), six (35.3%), and four (23.5%) participants had a low, intermediate, or high likelihood of advanced fibrosis, respectively. The different-day same-scanner mean measurements were 13%-14% for PDFF, 6.6 L for VAT, and 3.15 kPa for two-dimensional MRE stiffness. The different-day same-scanner repeatability coefficients were 0.22 L (95% CI: 0.17, 0.29) for VAT, 0.75 kPa (95% CI: 0.6, 0.99) for MRE stiffness, 1.19% (95% CI: 0.96, 1.61) for MRI PDFF using magnitude reconstruction, 1.56% (95% CI: 1.26, 2.07) for MRI PDFF using complex reconstruction, and 19.7% (95% CI: 15.8, 26.2) for three-dimensional MRE shear modulus. Conclusion This preliminary study suggests that thresholds of 1.2%-1.6%, 0.22 L, and 0.75 kPa for MRI PDFF, VAT, and MRE, respectively, should be used to discern measurement error from real change in patients with NAFLD. ClinicalTrials.gov registration no. NCT05081427 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Kozaka and Matsui in this issue.
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Affiliation(s)
| | | | - Nancy Obuchowski
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Michael S. Middleton
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Jun Chen
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Kay Pepin
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Jessica Magnuson
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Kathy J. Brown
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Danielle Batakis
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Walter C. Henderson
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Sudha S. Shankar
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Tania N. Kamphaus
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Alex Pasek
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Roberto A. Calle
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Arun J. Sanyal
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Rohit Loomba
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Richard Ehman
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Anthony E. Samir
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
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2
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Sanyal AJ, Shankar SS, Yates KP, Bolognese J, Daly E, Dehn CA, Neuschwander-Tetri B, Kowdley K, Vuppalanchi R, Behling C, Tonascia J, Samir A, Sirlin C, Sherlock SP, Fowler K, Heymann H, Kamphaus TN, Loomba R, Calle RA. Diagnostic performance of circulating biomarkers for non-alcoholic steatohepatitis. Nat Med 2023; 29:2656-2664. [PMID: 37679433 PMCID: PMC10579051 DOI: 10.1038/s41591-023-02539-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
There are no approved diagnostic biomarkers for at-risk non-alcoholic steatohepatitis (NASH), defined by the presence of NASH, high histological activity and fibrosis stage ≥2, which is associated with higher incidence of liver-related events and mortality. FNIH-NIMBLE is a multi-stakeholder project to support regulatory approval of NASH-related biomarkers. The diagnostic performance of five blood-based panels was evaluated in an observational (NASH CRN DB2) cohort (n = 1,073) with full spectrum of non-alcoholic fatty liver disease (NAFLD). The panels were intended to diagnose at-risk NASH (NIS4), presence of NASH (OWLiver) or fibrosis stages >2, >3 or 4 (enhanced liver fibrosis (ELF) test, PROC3 and FibroMeter VCTE). The prespecified performance metric was an area under the receiver operating characteristic curve (AUROC) ≥0.7 and superiority over alanine aminotransferase for disease activity and the FIB-4 test for fibrosis severity. Multiple biomarkers met these metrics. NIS4 had an AUROC of 0.81 (95% confidence interval: 0.78-0.84) for at-risk NASH. The AUROCs of the ELF test, PROC3 and FibroMeterVCTE for clinically significant fibrosis (≥stage 2), advanced fibrosis (≥stage 3) or cirrhosis (stage 4), respectively, were all ≥0.8. ELF and FibroMeter VCTE outperformed FIB-4 for all fibrosis endpoints. These data represent a milestone toward qualification of several biomarker panels for at-risk NASH and also fibrosis severity in individuals with NAFLD.
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Affiliation(s)
- Arun J Sanyal
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | | | - Katherine P Yates
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | - Raj Vuppalanchi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cynthia Behling
- Department of Pathology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - James Tonascia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anthony Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital,Harvard Medical School, Boston, MA, USA
| | - Claude Sirlin
- Deptartment of Radiology, University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Kathryn Fowler
- Deptartment of Radiology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Helen Heymann
- US Food and Drug Administration, Silver Springs, MD, USA
| | | | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Partridge T, Astolfo A, Shankar SS, Vittoria FA, Endrizzi M, Arridge S, Riley-Smith T, Haig IG, Bate D, Olivo A. Enhanced detection of threat materials by dark-field x-ray imaging combined with deep neural networks. Nat Commun 2022; 13:4651. [PMID: 36085141 PMCID: PMC9463187 DOI: 10.1038/s41467-022-32402-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/29/2022] [Indexed: 11/09/2022] Open
Abstract
X-ray imaging has been boosted by the introduction of phase-based methods. Detail visibility is enhanced in phase contrast images, and dark-field images are sensitive to inhomogeneities on a length scale below the system's spatial resolution. Here we show that dark-field creates a texture which is characteristic of the imaged material, and that its combination with conventional attenuation leads to an improved discrimination of threat materials. We show that remaining ambiguities can be resolved by exploiting the different energy dependence of the dark-field and attenuation signals. Furthermore, we demonstrate that the dark-field texture is well-suited for identification through machine learning approaches through two proof-of-concept studies. In both cases, application of the same approaches to datasets from which the dark-field images were removed led to a clear degradation in performance. While the small scale of these studies means further research is required, results indicate potential for a combined use of dark-field and deep neural networks in security applications and beyond.
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Affiliation(s)
- T Partridge
- Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - A Astolfo
- Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 6BT, UK.,Nikon X-Tek Systems Ltd, Tring, Herts, HP23 4JX, UK
| | - S S Shankar
- Nylers Ltd, Marshall House, Middleton Road, Morden, Surrey, SM4 6RW, UK
| | - F A Vittoria
- Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 6BT, UK.,ENEA-Radiation Protection Institute, 4 Via Martiri di Monte Sole, 40129, Bologna, Italy
| | - M Endrizzi
- Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - S Arridge
- Department of Computer Science, UCL, London, WC1E 6BT, UK
| | - T Riley-Smith
- XPCI Technology Ltd, The Elms Courtyard, Bromesberrow, Ledbury, HR8 1RZ, UK
| | - I G Haig
- Nikon X-Tek Systems Ltd, Tring, Herts, HP23 4JX, UK
| | - D Bate
- Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 6BT, UK.,Nikon X-Tek Systems Ltd, Tring, Herts, HP23 4JX, UK
| | - A Olivo
- Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 6BT, UK.
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4
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Sanyal AJ, Shankar SS, Calle RA, Samir AE, Sirlin CB, Sherlock SP, Loomba R, Fowler KJ, Dehn CA, Heymann H, Kamphaus TN. Non-Invasive Biomarkers of Nonalcoholic Steatohepatitis: the FNIH NIMBLE project. Nat Med 2022; 28:430-432. [PMID: 35145308 PMCID: PMC9588405 DOI: 10.1038/s41591-021-01652-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Arun J. Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | | | - Anthony E. Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, , University of California, San Diego, San Diego, CA, USA
| | | | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Kathryn J. Fowler
- Liver Imaging Group, Department of Radiology, , University of California, San Diego, San Diego, CA, USA
| | | | - Helen Heymann
- Foundation for the National Institutes of Health, North Bethesda, MD, USA
| | - Tania N. Kamphaus
- Foundation for the National Institutes of Health, North Bethesda, MD, USA
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5
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Barb D, Repetto EM, Stokes ME, Shankar SS, Cusi K. Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease. Obesity (Silver Spring) 2021; 29:1950-1960. [PMID: 34553836 PMCID: PMC9290591 DOI: 10.1002/oby.23263] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study assessed the impact of diabetes mellitus (DM) on nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) with advanced fibrosis prevalence in adults with overweight or obesity in the United States. METHODS Participants (National Health and Nutrition Examination Survey [NHANES] 2015-2016 database) included 834 middle-aged patients with DM (21.7%) and 3,007 without DM (78.3%). NAFLD was defined by Fatty Liver Index (FLI) ≥ 60 or United States FLI (USFLI) ≥ 30. Moderate-to-high and high risk of advanced fibrosis was defined by fibrosis-4 index (FIB-4) ≥ 1.67 and ≥ 2.67, respectively, and NAFLD fibrosis scores > 0.676 also indicated a high risk. RESULTS NAFLD prevalence increased with BMI. Steatosis was higher in individuals with overweight with DM versus without DM (USFLI ≥ 30: 48.3% vs. 17.4%; p < 0.01) and in individuals with obesity with DM versus without DM (USFLI ≥ 30: 79.9% vs. 57.6%; p < 0.01). DM significantly increased the proportion of individuals at moderate-to-high risk of fibrosis (FIB-4 ≥ 1.67: 31.8% vs. 20.1%; p < 0.05). In the high risk of advanced fibrosis group (FIB-4 ≥ 2.67), the risk almost doubled (3.8% vs. 7.1%). Among individuals with obesity, DM increased the proportion of adults with moderate and high risk of fibrosis by 1.8- and 2.5-fold, respectively (p < 0.01 and p = 0.39, respectively, vs. without DM). CONCLUSIONS In this US cohort, DM modestly impacted steatosis, which was primarily obesity-driven. DM added a significant risk of fibrosis to individuals with overweight or obesity, suggesting that screening is imperative in adults with DM.
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Affiliation(s)
- Diana Barb
- Division of Endocrinology, Diabetes and MetabolismUniversity of FloridaGainesvilleFloridaUSA
| | | | | | - Sudha S. Shankar
- Early Clinical DevelopmentAstraZeneca plcGaithersburgMarylandUSA
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and MetabolismUniversity of FloridaGainesvilleFloridaUSA
- Division of Endocrinology, Diabetes and MetabolismMalcom Randall Veterans Affairs Medical CenterGainesvilleFloridaUSA
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6
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Mucinski JM, Vena JE, Ramos-Roman MA, Lassman ME, Szuszkiewicz-Garcia M, McLaren DG, Previs SF, Shankar SS, Parks EJ. High-throughput LC-MS method to investigate postprandial lipemia: considerations for future precision nutrition research. Am J Physiol Endocrinol Metab 2021; 320:E702-E715. [PMID: 33522396 DOI: 10.1152/ajpendo.00526.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Elevated postprandial lipemia is an independent risk factor for cardiovascular disease, yet methods to quantitate postmeal handling of dietary lipids in humans are limited. This study tested a new method to track dietary lipid appearance using a stable isotope tracer (2H11-oleate) in liquid meals containing three levels of fat [low fat (LF), 15 g; moderate fat (MF), 30 g; high fat (HF), 60 g]. Meals were fed to 12 healthy men [means ± SD, age 31.3 ± 9.2 yr, body mass index (BMI) 24.5 ± 1.9 kg/m2] during four randomized study visits; the HF meal was administered twice for reproducibility. Blood was collected over 8 h postprandially, triglyceride (TG)-rich lipoproteins (TRL), and particles with a Svedberg flotation rate >400 (Sf > 400, n = 8) were isolated by ultracentrifugation, and labeling of two TG species (54:3 and 52:2) was quantified by LC-MS. Total plasma TRL-TG concentrations were threefold greater than Sf > 400-TG. Both Sf > 400- and TRL-TG 54:3 were present at higher concentrations than 52:2, and singly labeled TG concentrations were higher than doubly labeled. Furthermore, TG 54:3 and the singly labeled molecules demonstrated higher plasma absolute entry rates differing significantly across fat levels within a single TG species (P < 0.01). Calculation of fractional entry showed no significant differences in label handling supporting the utility of either TG species for appearance rate calculations. These data demonstrate the utility of labeling research meals with stable isotopes to investigate human postprandial lipemia while simultaneously highlighting the importance of examining individual responses. Meal type and timing, control of prestudy activities, and effects of sex on outcomes should match the research goals. The method, optimized here, will be beneficial to conduct basic science research in precision nutrition and clinical drug development.NEW & NOTEWORTHY A novel method to test human intestinal lipid handling using stable isotope labeling is presented and, for the first time, plasma appearance and lipid turnover were quantified in 12 healthy men following meals with varying amounts of fat. The method can be applied to studies in precision nutrition characterizing individual response to support basic science research or drug development. This report discusses key questions for consideration in precision nutrition that were highlighted by the data.
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Affiliation(s)
- Justine M Mucinski
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Jennifer E Vena
- Alberta's Tomorrow Project, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Maria A Ramos-Roman
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | | | - Elizabeth J Parks
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
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7
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Leslie RD, Pozzilli P, Peters AL, Buzzetti R, Shankar SS, Milicevic Z, Pavo I, Lebrec J, Martin S, Schloot NC. Response to the comment on: "Dulaglutide treatment results in effective glycaemic control in latent autoimmune diabetes in adults (LADA): A post-hoc analysis of the AWARD-2, -4 and -5 trials". Diabetes Obes Metab 2018; 20:2319-2320. [PMID: 29781106 DOI: 10.1111/dom.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Paolo Pozzilli
- Blizard Institute, London, UK
- Department of Endocrinology & Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Anne L Peters
- Keck School of Medicine of USC, Los Angeles, California
| | - Raffaella Buzzetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | | | - Imre Pavo
- Eli Lilly and Company, Vienna, Austria
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Ruetten H, Gebauer M, Raymond RH, Calle RA, Cobelli C, Ghosh A, Robertson RP, Shankar SS, Staten MA, Stefanovski D, Vella A, Wright K, Fryburg DA. Mixed Meal and Intravenous L-Arginine Tests Both Stimulate Incretin Release Across Glucose Tolerance in Man: Lack of Correlation with β Cell Function. Metab Syndr Relat Disord 2018; 16:406-415. [PMID: 30117761 DOI: 10.1089/met.2018.0022] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The aims of this study were to 1. define the responses of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), glucagon, and peptide YY (PYY) to an oral meal and to intravenous L-arginine; and 2. examine correlation of enteroendocrine hormones with insulin secretion. We hypothesized a relationship between circulating incretin concentrations and insulin secretion. METHODS Subjects with normal glucose tolerance (NGT, n = 23), prediabetes (PDM, n = 17), or with type 2 diabetes (T2DM, n = 22) were studied twice, following a mixed test meal (470 kCal) (mixed meal tolerance test [MMTT]) or intravenous L-arginine (arginine maximal stimulation test [AST], 5 g). GLP-1 (total and active), PYY, GIP, glucagon, and β cell function were measured before and following each stimulus. RESULTS Baseline enteroendocrine hormones differed across the glucose tolerance (GT) spectrum, T2DM generally >NGT and PDM. In response to MMTT, total and active GLP-1, GIP, glucagon, and PYY increased in all populations. The incremental area-under-the-curve (0-120 min) of analytes like total GLP-1 were often higher in T2DM compared with NGT and PDM (35-51%; P < 0.05). At baseline glucose, L-arginine increased total and active GLP-1 and glucagon concentrations in all GT populations (all P < 0.05). As expected, the MMTT and AST provoked differential glucose, insulin, and C-peptide responses across GT populations. Baseline or stimulated enteroendocrine hormone concentrations did not consistently correlate with either measure of β cell function. CONCLUSIONS/INTERPRETATION Both MMTT and AST resulted in insulin and enteroendocrine hormone responses across GT populations without consistent correlation between release of incretins and insulin, which is in line with other published research. If a defect is in the enteroendocrine/β cell axis, it is probably reduced response to rather than diminished secretion of enteroendocrine hormones.
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Affiliation(s)
| | | | | | | | - Claudio Cobelli
- 4 Department of Information Engineering, University of Padova , Padova, Italy
| | - Atalanta Ghosh
- 5 Janssen Research and Development , Raritan, New Jersey
| | - R Paul Robertson
- 6 Pacific Northwest Diabetes Institute, University of Washington , Seattle, Washington
| | - Sudha S Shankar
- 7 Lilly Research Laboratories, Lilly Corporate Center , Indianapolis, Indiana
| | | | - Darko Stefanovski
- 9 School of Veterinary Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Adrian Vella
- 10 Division of Endocrinology, Mayo Clinic and Foundation , Rochester, Minnesota
| | - Kathryn Wright
- 11 Wright Biomarker Consulting , Gales Ferry, Connecticut
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Shankar SS, Lee DS, Raymond RH, Calle RA, Cobelli C, Ghosh A, Robertson RP, Ruetten H, Staten MA, Stefanovski D, Vella A, Whitaker S, Fryburg DA. Outpatient versus inpatient mixed meal tolerance and arginine stimulation testing yields comparable measures of variability for assessment of beta cell function. Contemp Clin Trials Commun 2018; 10:94-99. [PMID: 30023442 PMCID: PMC6047312 DOI: 10.1016/j.conctc.2018.03.009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 11/24/2022] Open
Abstract
Standard practice to minimize variability in beta cell function (BCF) measurement is to test in inpatient (IP) settings. IP testing strains trial subjects, investigators, and budgets. Outpatient (OP) testing may be a solution although there are few reports on OP BCF testing variability. We compared variability metrics between OP and IP from a standardized mixed meal tolerance test (MMTT) and arginine stimulation test (AST) in two separate type 2 diabetes (T2DM) cohorts (OP, n = 20; IP n = 22) in test-retest design. MMTT variables included: insulin sensitivity (Si); beta cell responsivity (Φtot); and disposition index (DItot = Si* Φtot) following 470 kCal meal. AST variables included: acute insulin response to arginine (AIRarg) and during hyperglycemia (AIRargMAX). Results Baseline characteristics were well-matched. Between and within subject variance for each parameter across cohorts, and intraclass correlation coefficients (ICC-a measure of reproducibility) across parameters were generally comparable for OP to IP. Table summarizes the ICC results for each key parameter and cohort.Test/Parameter | Outpatient (95% CI) | Inpatient (95% CI) |
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MMTT: Si | 0.49(0,0.69) | 0.28(0,0.60) | MMTT: Φtot | 0.65(0.16,0.89) | 0.81(0.44,0.93) | MMTT: DI | 0.67(0,0.83) | 0.36(0,0.69) |
| AST: AIR Arg | 0.96(0.88,0.98) | 0.84(0.59,0.94) | AST: AIR Arg Max | 0.97(0.90,0.99) | 0.95(0.86,0.97) | AST: ISR | 0.93(0.77,0.97) | 0.93(0.82,0.96) |
In conclusion, the variability (reproducibility) of BCF measures from standardized MMTT and AST is comparable between OP and IP settings. These observations have significant implications for complexity and cost of metabolic studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - David A. Fryburg
- ROI BioPharma Consulting, United States
- Corresponding author. 14 Alexander Drive, East Lyme, CT 06333, United States.
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10
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Pozzilli P, Leslie RD, Peters AL, Buzzetti R, Shankar SS, Milicevic Z, Pavo I, Lebrec J, Martin S, Schloot NC. Dulaglutide treatment results in effective glycaemic control in latent autoimmune diabetes in adults (LADA): A post-hoc analysis of the AWARD-2, -4 and -5 Trials. Diabetes Obes Metab 2018; 20:1490-1498. [PMID: 29377522 DOI: 10.1111/dom.13237] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 12/07/2017] [Revised: 01/14/2018] [Accepted: 01/23/2018] [Indexed: 02/03/2023]
Abstract
AIMS Patients with a type-2-diabetes (T2D) phenotype positive for glutamic acid decarboxylase antibodies (GADA) represent the majority of cases of latent autoimmune diabetes of the adult (LADA). The GLP-1 receptor agonist dulaglutide, recently introduced for treatment of T2D, has yet to be evaluated in LADA patients. Our primary objective was to evaluate the effect of dulaglutide on glycaemic control (HbA1c) in GADA-positive LADA vs GADA-negative T2D patients. METHODS A post-hoc analysis was performed using data from 3 randomized phase 3 trials (AWARD-2,-4,-5; patients with GADA assessment) which were part of the dulaglutide clinical development programme in T2D. LADA patients were identified by GADA ≥5 IU/mL (ELISA). Changes in HbA1c during 12 months of treatment with dulaglutide or comparator were analysed using mixed-effect model repeated measures. RESULTS Of 2466 adults tested for GADA (dulaglutide, 1710; glargine, 298; sitagliptin, 294; placebo, 164), 2278 (92.4%) were GADA-negative and 188 (7.6%) were GADA-positive, including 58 GADA-high patients (> 200 IU/mL) and 130 GADA-low patients (≤200 and ≥5 IU/mL). Overall, baseline parameters were comparable between the groups. Dulaglutide resulted in comparable HbA1c reductions in GADA-negative (LS mean change [95%CI], -1.09% [-1.15, -1.03]) and GADA-positive patients (-0.94% [-1.15, -0.72]) at 12 months. HbA1c reductions were numerically, but not statistically, significantly larger in GADA-low patients (-1.02% [-1.26, -0.78]) vs GADA-high patients (-0.72% [-1.21,-0.24]) at 12 months. Similar outcomes were observed at 3 and 6 months. CONCLUSIONS These data are the first to indicate that dulaglutide was effective in reducing HbA1c in LADA patients.
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Affiliation(s)
- Paolo Pozzilli
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
- Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK
| | - Richard D Leslie
- Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK
| | - Anne L Peters
- USC Westside Center for Diabetes, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Raffaella Buzzetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | | | | | - Imre Pavo
- Eli Lilly and Company, Vienna, Austria
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Shankar SS, Shankar RR, Mixson LA, Miller DL, Pramanik B, O'Dowd AK, Williams DM, Frederick CB, Beals CR, Stoch SA, Steinberg HO, Kelley DE. Native Oxyntomodulin Has Significant Glucoregulatory Effects Independent of Weight Loss in Obese Humans With and Without Type 2 Diabetes. Diabetes 2018; 67:1105-1112. [PMID: 29545266 DOI: 10.2337/db17-1331] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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] [Received: 11/02/2017] [Accepted: 03/06/2018] [Indexed: 12/20/2022]
Abstract
Oxyntomodulin (OXM), an enteroendocrine hormone, causes appetite suppression, increased energy expenditure, and weight loss in obese humans via activation of GLP-1 and glucagon receptors. However, the effects of OXM on glucose homeostasis remain ill defined. To address this gap, we evaluated the effects of an i.v. infusion of native OXM on insulin secretion rates (ISRs) and glycemic excursion in a graded glucose infusion (GGI) procedure in two separate randomized, placebo (PBO)-controlled, single-dose crossover trials in 12 overweight and obese subjects without diabetes and in 12 obese subjects with type 2 diabetes mellitus (T2DM), using the GLP-1 analog liraglutide (LIRA) as a comparator in T2DM. In both groups, in the GGI, 3.0 pmol/kg/min of OXM significantly increased ISR and blunted glycemic excursion relative to PBO. In T2DM, the effects of OXM were comparable to those of LIRA, including restoration of β-cell glucose responsiveness to that of nonobese subjects without diabetes. Our findings indicate that native OXM significantly augments glucose-dependent insulin secretion acutely in obese subjects with and without diabetes, with effects comparable to pharmacologic GLP-1 receptor activation and independent of weight loss. Native OXM has potential to improve hyperglycemia via complementary and independent induction of insulin secretion and weight loss.
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Pozzilli P, Leslie RD, Peters AL, Buzzetti R, Shankar SS, Milicevic Z, Pavo I, Lebrec J, Martin S, Nanette CS. Reduction of HbA1c with dulaglutide in type 2 diabetes (T2D) patients negative, low positive or high positive for GAD antibodies (GADA): a post hoc analysis of AWARD -2, -4 and -5. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- P Pozzilli
- University Campus Bio-Medico, Department of Endocrinology & Diabetes, Rome, Italy
- Queen Mary University Hospital, Blizard Institute, London, United Kingdom
| | - RD Leslie
- Queen Mary University Hospital, Blizard Institute, London, United Kingdom
| | - AL Peters
- Keck School of Medicine of USC, Los Angeles, United States
| | - R Buzzetti
- “Sapienza” University of Rome, Department of Experimental Medicine, Rome, Italy
| | - SS Shankar
- Eli Lilly and Company, Indianapolis, United States
| | | | - I Pavo
- Eli Lilly and Company, Vienna, Austria
| | - J Lebrec
- Lilly Deutschland GmbH, Bad Homburg, Germany
| | - S Martin
- Eli Lilly and Company, Indianapolis, United States
| | - CS Nanette
- Lilly Deutschland GmbH, Bad Homburg, Germany
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13
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Shankar SS, Shankar RR, Mixson LA, Miller DL, Steinberg HO, Beals CR, Kelley DE. Insulin secretory effect of sitagliptin: assessment with a hyperglycemic clamp combined with a meal challenge. Am J Physiol Endocrinol Metab 2018; 314:E406-E412. [PMID: 29138226 DOI: 10.1152/ajpendo.00238.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 12/17/2022]
Abstract
Sitagliptin, a dipeptidyl peptidase-IV inhibitor (DPP-4), sustains activity of the incretin hormones GLP-1 and GIP and improves hyperglycemia in Type 2 diabetes mellitus (T2DM). It has however proven challenging to quantify the effect of sitagliptin on rates of insulin secretion (ISR) during a prandial challenge. The tight feedback governance of ISR by plasma glucose means that in the face of treatment-related lowering of postprandial glycemia, corresponding stimulation of ISR is lessened. We postulated that sustaining a stable level of moderate hyperglycemia before and during a meal challenge (MC) would be a platform that enables greater clarity to assess the effect of sitagliptin on ISR and an approach that could be valuable to evaluate novel targets that increase insulin secretion directly and by augmenting incretins. A hyperglycemic clamp (HGC) at 160 mg/dl was conducted in 12 healthy volunteers (without diabetes) for 6 h; 3 h into the HGC, MC was administered while maintaining stable hyperglycemia of the HGC for an additional 3 h. Modeling of C-peptide response was used to calculate ISR. In crossover design of three periods (sitagliptin twice and placebo once), the effect of sitagliptin vs. placebo on ISR and the reproducibility of the response to sitagliptin were assessed. Sitagliptin increased ISR compared with placebo by 50% and 20% during the HGC alone and the HGC-MC phases, respectively ( P < 0.001 for both). There was an associated significant treatment-based increase in circulating insulin, as well as active levels of GLP-1. Robust reproducibility of the sitagliptin-mediated ISR response was observed; the intraclass correlation value was 0.94. The findings delineate the effect of sitagliptin to stimulate insulin secretion, and these benchmark data also demonstrate that an HGC-MC can be a useful platform for interrogating therapeutic targets that could potentially modulate ISR via direct action on beta-cells as well as by augmenting release or action of incretins.
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Affiliation(s)
| | | | - Lori A Mixson
- Merck & Company, Incorporated, Kenilworth, New Jersey
| | | | | | - Chan R Beals
- Merck & Company, Incorporated, Kenilworth, New Jersey
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14
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Guzman CB, Duvvuru S, Akkari A, Bhatnagar P, Battioui C, Foster W, Zhang XM, Shankar SS, Deeg MA, Chalasani N, Hardy TA, Kazda CM, Pillai SG. Coding variants in PNPLA3 and TM6SF2 are risk factors for hepatic steatosis and elevated serum alanine aminotransferases caused by a glucagon receptor antagonist. Hepatol Commun 2018; 2:561-570. [PMID: 29761171 PMCID: PMC5944587 DOI: 10.1002/hep4.1171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/16/2017] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 01/04/2023] Open
Abstract
LY2409021 is a glucagon receptor antagonist that was associated with hepatic steatosis and elevated aminotransferases in phase 2 diabetes studies. We investigated the relationship between selected genetic variants and hepatic steatosis and elevated alanine aminotransferases (ALTs) associated with LY2409021. Patients participated in a 6‐week placebo‐controlled trial (I1R‐MC‐GLDI [GLDI], n = 246) and a 52‐week placebo‐ and active comparator‐controlled trial (I1R‐MC‐GLDJ [GLDJ], n = 158). GLDJ had endpoints at 6 months, including measures of hepatic fat fraction (HFF) by magnetic resonance imaging. The five genes tested were patatin‐like phospholipase domain containing 3 (PNPLA3) (rs738409 and rs738491), transmembrane 6 superfamily member 2 (TM6SF2) (rs58542926), peroxisome proliferative activated receptor gamma coactivator 1 alpha (PPARGC1A) (rs4361373, rs3774921, rs2970849), adenylate cyclase 3 (ADCY3) (rs713586), and insulin‐like growth factor 1 (IGF‐1) (rs1520220). In GLDI, PNPLA3 I148M (P = 0.001) and TM6SF2 E167K (P = 0.001) were significantly associated with an increase in ALT at 6 weeks for LY2409021 but not for placebo. In GLDJ, PNPLA3 I148M showed the same effect (P = 0.007) on ALT at 6 months but the placebo or sitagliptin did not. In GLDJ, both PNPLA3 and TM6SF2 risk‐allele carriers showed increases in HFF that were numerically greater but not statistically significant. The carriers of PNPLA3 and/or TM6SF2 risk alleles showed significantly increased ALT (GLDI, +13.28 U/L in carriers versus +4.84 U/L in noncarriers, P = 4 × 10–5; GLDJ, +14.6 U/L in carriers versus +1.7 in noncarriers, P = 0.0018) and HFF (GLDJ, +5.35% in carriers versus 2.38% in noncarriers, P = 0.048). Elevation of transaminase and HFF were also noted in the noncarriers but at a significantly lower degree. Conclusion: The carriers of PNPLA3 and/or TM6SF2 variant alleles are at risk for hepatic steatosis and elevated ALT levels caused by LY2409021, a glucagon receptor antagonist. More studies are needed to investigate if our observations are generalizable to hepatic steatosis caused by other medications. (Hepatology Communications 2018;2:561‐570)
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Affiliation(s)
- Cristina B Guzman
- Eli Lilly and Company Indianapolis IN.,Present address: Enanta Pharmaceuticals Inc Watertown MA
| | - Suman Duvvuru
- Eli Lilly and Company Indianapolis IN.,Present address: Amazon Seattle WA
| | | | | | | | | | | | - Sudha S Shankar
- Eli Lilly and Company Indianapolis IN.,Present address: NGM Biopharmaceuticals San Francisco CA
| | - Mark A Deeg
- Eli Lilly and Company Indianapolis IN.,Present address: Regulus Pharmaceuticals San Diego CA
| | - Naga Chalasani
- Indiana University Department of Medicine Indianapolis IN
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Singh P, Emami H, Subramanian S, Maurovich-Horvat P, Marincheva-Savcheva G, Medina HM, Abdelbaky A, Alon A, Shankar SS, Rudd JHF, Fayad ZA, Hoffmann U, Tawakol A. Coronary Plaque Morphology and the Anti-Inflammatory Impact of Atorvastatin: A Multicenter 18F-Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Study. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004195. [PMID: 27956407 PMCID: PMC5175997 DOI: 10.1161/circimaging.115.004195] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 10/23/2015] [Accepted: 09/29/2016] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Nonobstructive coronary plaques manifesting high-risk morphology (HRM) associate with an increased risk of adverse clinical cardiovascular events. We sought to test the hypothesis that statins have a greater anti-inflammatory effect within coronary plaques containing HRM. Methods and Results— In this prospective multicenter study, 55 subjects with or at high risk for atherosclerosis underwent 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic imaging at baseline and after 12 weeks of treatment with atorvastatin. Coronary arterial inflammation (18F-fluorodeoxyglucose uptake, expressed as target-to-background ratio) was assessed in the left main coronary artery (LMCA). While blinded to the PET findings, contrast-enhanced computed tomographic angiography was performed to characterize the presence of HRM (defined as noncalcified or partially calcified plaques) in the LMCA. Arterial inflammation (target-to-background ratio) was higher in LMCA segments with HRM than those without HRM (mean±SEM: 1.95±0.43 versus 1.67±0.32 for LMCA with versus without HRM, respectively; P=0.04). Moreover, atorvastatin treatment for 12 weeks reduced target-to-background ratio more in LMCA segments with HRM than those without HRM (12 week-baseline Δtarget-to-background ratio [95% confidence interval]: −0.18 [−0.35 to −0.004] versus 0.09 [−0.06 to 0.26]; P=0.02). Furthermore, this relationship between coronary plaque morphology and change in LMCA inflammatory activity remained significant after adjusting for baseline low-density lipoprotein and statin dose (β=−0.27; P=0.038). Conclusions— In this first study to evaluate the impact of statins on coronary inflammation, we observed that the anti-inflammatory impact of statins is substantially greater within coronary plaques that contain HRM features. These findings suggest an additional mechanism by which statins disproportionately benefit individuals with more advanced atherosclerotic disease. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00703261.
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Affiliation(s)
- Parmanand Singh
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Hamed Emami
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Sharath Subramanian
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Pal Maurovich-Horvat
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Gergana Marincheva-Savcheva
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Hector M Medina
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Amr Abdelbaky
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Achilles Alon
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Sudha S Shankar
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - James H F Rudd
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Zahi A Fayad
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Udo Hoffmann
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Ahmed Tawakol
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.).
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16
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Shankar SS, Mixson LA, Chakravarthy M, Chisholm R, Acton AJ, Jones R, Mattar SG, Miller DL, Petry L, Beals CR, Stoch SA, Kelley DE, Considine RV. Metabolic improvements following Roux-en-Y surgery assessed by solid meal test in subjects with short duration type 2 diabetes. BMC Obes 2017; 4:10. [PMID: 28265415 PMCID: PMC5331732 DOI: 10.1186/s40608-017-0149-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/14/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glucose homeostasis improves within days following Roux-en-Y gastric bypass (RYGB) surgery. The dynamic metabolic response to caloric intake following RYGB has been assessed using liquid mixed meal tolerance tests (MMTT). Few studies have evaluated the glycemic and hormonal response to a solid mixed meal in subjects with diabetes prior to, and within the first month following RYGB. METHODS Seventeen women with type 2 diabetes of less than 5 years duration participated. Fasting measures of glucose homeostasis, lipids and gut hormones were obtained pre- and post-surgery. MMTT utilizing a solid 4 oz chocolate pudding performed pre-, 2 and 4 weeks post-surgery. Metabolic response to 4 and 2 oz MMTT assessed in five diabetic subjects not undergoing surgery. RESULTS Significant reductions in fasting glucose and insulin at 3 days, and in fasting betatrophin, triglycerides and total cholesterol at 2 weeks post-surgery. Hepatic insulin clearance was greater at 3 days post-surgery. Subjects exhibited less hunger and greater feelings of fullness and satisfaction during the MMTT while consuming 52.9 ± 6.5% and 51.0 ± 6.5% of the meal at 2 and 4 weeks post-surgery respectively. At 2 weeks post-surgery, glucose and insulin response to MMTT were improved, with greater GLP-1 and PYY secretion. Improved response to solid MMTT not replicated by consumption of smaller pudding volume in diabetic non-surgical subjects. CONCLUSIONS With a test meal of size and composition representative of the routine diet of post-RYGB subjects, improved glycemic and gut hormone responses occur which cannot be replicated by reducing the size of the MMTT in diabetic subjects not undergoing surgery. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT00957957 August 11, 2009.
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Affiliation(s)
| | - Lori A Mixson
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | | | - Robin Chisholm
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
| | - Anthony J Acton
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
| | | | - Samer G Mattar
- Department of Surgery, Oregon Health & Science University, Portland, OR USA
| | | | - Lea Petry
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | - Chan R Beals
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | - S Aubrey Stoch
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | - David E Kelley
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | - Robert V Considine
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
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Shankar SS, Vella A, Raymond RH, Staten MA, Calle RA, Bergman RN, Cao C, Chen D, Cobelli C, Dalla Man C, Deeg M, Dong JQ, Lee DS, Polidori D, Robertson RP, Ruetten H, Stefanovski D, Vassileva MT, Weir GC, Fryburg DA. Standardized Mixed-Meal Tolerance and Arginine Stimulation Tests Provide Reproducible and Complementary Measures of β-Cell Function: Results From the Foundation for the National Institutes of Health Biomarkers Consortium Investigative Series. Diabetes Care 2016; 39:1602-13. [PMID: 27407117 PMCID: PMC5001146 DOI: 10.2337/dc15-0931] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 05/05/2016] [Accepted: 06/15/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Standardized, reproducible, and feasible quantification of β-cell function (BCF) is necessary for the evaluation of interventions to improve insulin secretion and important for comparison across studies. We therefore characterized the responses to, and reproducibility of, standardized methods of in vivo BCF across different glucose tolerance states. RESEARCH DESIGN AND METHODS Participants classified as having normal glucose tolerance (NGT; n = 23), prediabetes (PDM; n = 17), and type 2 diabetes mellitus (T2DM; n = 22) underwent two standardized mixed-meal tolerance tests (MMTT) and two standardized arginine stimulation tests (AST) in a test-retest paradigm and one frequently sampled intravenous glucose tolerance test (FSIGT). RESULTS From the MMTT, insulin secretion in T2DM was >86% lower compared with NGT or PDM (P < 0.001). Insulin sensitivity (Si) decreased from NGT to PDM (∼50%) to T2DM (93% lower [P < 0.001]). In the AST, insulin secretory response to arginine at basal glucose and during hyperglycemia was lower in T2DM compared with NGT and PDM (>58%; all P < 0.001). FSIGT showed decreases in both insulin secretion and Si across populations (P < 0.001), although Si did not differ significantly between PDM and T2DM populations. Reproducibility was generally good for the MMTT, with intraclass correlation coefficients (ICCs) ranging from ∼0.3 to ∼0.8 depending on population and variable. Reproducibility for the AST was very good, with ICC values >0.8 across all variables and populations. CONCLUSIONS Standardized MMTT and AST provide reproducible and complementary measures of BCF with characteristics favorable for longitudinal interventional trials use.
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Affiliation(s)
- Sudha S Shankar
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN
| | - Adrian Vella
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Myrlene A Staten
- Kelly Government Solutions for National Institute of Diabetes and Digestive and Kidney Diseases, Rockville, MD
| | | | - Richard N Bergman
- Cedars-Sinai Diabetes and Obesity Research Institute, Los Angeles, CA
| | - Charlie Cao
- Takeda Development Center Americas, Deerfield, IL
| | | | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Mark Deeg
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN
| | | | | | | | - R Paul Robertson
- Pacific Northwest Diabetes Research Institute, Seattle, WA Division of Endocrinology, Departments of Medicine and Pharmacology, University of Washington, Seattle, WA
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18
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Shankar SS, Shankar RR, Mixson LA, Miller DL, Chung C, Cilissen C, Beals CR, Stoch SA, Steinberg HO, Kelley DE. Linearity of β-cell response across the metabolic spectrum and to pharmacology: insights from a graded glucose infusion-based investigation series. Am J Physiol Endocrinol Metab 2016; 310:E865-73. [PMID: 27072496 DOI: 10.1152/ajpendo.00527.2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/05/2016] [Indexed: 11/22/2022]
Abstract
The graded glucose infusion (GGI) examines insulin secretory response patterns to continuously escalating glycemia. The current study series sought to more fully appraise its performance characteristics. Key questions addressed were comparison of the GGI to the hyperglycemic clamp (HGC), comparison of insulin secretory response patterns across three volunteer populations known to differ in β-cell function (healthy nonobese, obese nondiabetic, and type 2 diabetic), and characterization of effects of known insulin secretagogues in the context of a GGI. Insulin secretory response was measured as changes in insulin, C-peptide, insulin secretion rates (ISR), and ratio of ISR to prevailing glucose (ISR/G). The GGI correlated well with the HGC (r = 0.72 for ISR/G, P < 0.01). The insulin secretory response in type 2 diabetes (T2DM) was significantly blunted (P < 0.001), whereas it was significantly increased in obese nondiabetics compared with healthy nonobese (P < 0.001). Finally, robust (P < 0.001 over placebo) pharmacological effects were observed in T2DM and healthy nonobese volunteers. Collectively, the findings of this investigational series bolster confidence that the GGI has solid attributes for assessing insulin secretory response to glucose across populations and pharmacology. Notably, the coupling of insulin secretory response to glycemic changes was distinctly and uniformly linear across populations and in the context of insulin secretagogues. (Clinical Trial Registration Nos. NCT00782418, NCT01055340, NCT01373450).
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Affiliation(s)
| | | | | | | | | | | | - Chan R Beals
- Merck & Company, Inc., Kenilworth, New Jersey; and
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19
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Shankar SS, Shankar RR, Railkar RA, Beals CR, Steinberg HO, Kelley DE. Early Clinical Detection of Pharmacologic Response in Insulin Action in a Nondiabetic Insulin-Resistant Population. Curr Ther Res Clin Exp 2015; 77:83-9. [PMID: 26543510 PMCID: PMC4589823 DOI: 10.1016/j.curtheres.2015.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Accepted: 08/07/2015] [Indexed: 11/16/2022] Open
Abstract
Background Insulin resistance heightens the risk for type 2 diabetes mellitus and cardiovascular disease. Amelioration of insulin resistance may reduce this risk. The thiazolidinedone class of insulin sensitizers improves insulin action in individuals with insulin-resistant diabetes and nondiabetic individuals. However, there are few reports on the time of onset of such effects independent of reversal of glucotoxicity. Objective The goal of our study was to test whether the thiazolidinedione pioglitazone has prominent early metabolic effects that can be detected in an obese, nondiabetic, insulin-resistant population. Methods We conducted a randomized, double-blind, placebo-controlled, parallel-group trial in men with nondiabetic insulin resistance using a hyperinsulinemic euglycemic clamp technique (at low and high doses of insulin at 10 and 40 mU/m2/min, respectively). The patients were given 30 mg daily oral pioglitazone or placebo for 28 days. Patients underwent a baseline clamp before initiation of treatment, and again at 14 and 28 days of treatment. Results Compared with placebo, under high-dose hyperinsulinemia, pioglitazone led to significant increases in glucose disposal rates (GDR) of 1.29 mg/kg/min (90% CI, 0.43–2.15; 39%; P=0.008) that were detectable at 2 weeks of treatment and persisted at 4 weeks of treatment. Under low-dose hyperinsulinemia, significant increases in GDR of 0.40 mg/kg/min (90% CI, 0.17–0.62; 95%; P=0.003) were observed at 4 weeks of treatment. These responses were accompanied by robust suppression of free fatty acids under hyperinsulinemic conditions, and by significant increases in circulating basal total adiponectin at 2 and 4 weeks of treatment. Conclusions Significant changes in insulin action across multiple insulin-sensitive tissues can be detected within 2 weeks of initiation of insulin-sensitizing therapy with pioglitazone in obese patients with nondiabetic insulin resistance. ClinicalTrials.gov identifier: NCT01115712.
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Affiliation(s)
- Sudha S Shankar
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - R Ravi Shankar
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Radha A Railkar
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Chan R Beals
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | | | - David E Kelley
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
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Robertson RP, Raymond RH, Lee DS, Calle RA, Ghosh A, Savage PJ, Shankar SS, Vassileva MT, Weir GC, Fryburg DA. Arginine is preferred to glucagon for stimulation testing of β-cell function. Am J Physiol Endocrinol Metab 2014; 307:E720-7. [PMID: 25159323 PMCID: PMC4200308 DOI: 10.1152/ajpendo.00149.2014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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] [Indexed: 11/22/2022]
Abstract
A key aspect of research into the prevention and treatment of type 2 diabetes is the availability of reproducible clinical research methodology to assess β-cell function. One commonly used method employs nonglycemic secretagogues like arginine (arg) or glucagon (glgn). This study was designed to quantify the insulin response to arg and glgn and determine test repeatability and tolerability. Obese overnight-fasted subjects with normal glucose tolerance were studied on 4 separate days: twice using arg (5 g iv) and twice with glgn (1 mg iv). Pre- and postinfusion samples for plasma glucose, insulin, and C-peptide were acquired. Arg and glgn challenges were repeated in the last 10 min of a 60-min glucose (900 mg/min) infusion. Insulin and C-peptide secretory responses were estimated under baseline fasting glucose conditions (AIRarg and AIRglgn) and hyperglycemic (AIRargMAX AIRglgnMAX) states. Relative repeatability was estimated by intraclass correlation coefficient (ICC). Twenty-three (12 men and 11 women) subjects were studied (age: 42.4 ± 8.3 yr; BMI: 31.4 ± 2.8 kg/m²). Geometric means (95% CI) for baseline-adjusted values AIRarg and AIRglgn were 84 (75-95) and 102 (90-115) μU/ml, respectively. After the glucose infusion, AIRargMAX and AIRglgnMAX were 395 (335-466) and 483 (355-658) μU/ml, respectively. ICC values were >0.90 for AIRarg andAIRargMAX. Glucagon ICCs were 0.83, 0.34, and 0.36, respectively, although the exclusion of one outlier increased the latter two values (to 0.84 and 0.86). Both glgn and arg induced mild adverse events that were transient. Glucagon, but not arginine, induced moderate adverse events due to nausea. Taken together, arginine is preferred to glucagon for assessment of β-cell function.
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Affiliation(s)
- R Paul Robertson
- Pacific Northwest Diabetes Research Institute, Seattle, Washington
| | | | | | | | | | - Peter J Savage
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | - Maria T Vassileva
- Foundation for the National Institutes of Health, Bethesda, Maryland
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Subramanian S, Emami H, Vucic E, Singh P, Vijayakumar J, Fifer KM, Alon A, Shankar SS, Farkouh M, Rudd JHF, Fayad ZA, Van Dyke TE, Tawakol A. High-dose atorvastatin reduces periodontal inflammation: a novel pleiotropic effect of statins. J Am Coll Cardiol 2013; 62:2382-2391. [PMID: 24070911 DOI: 10.1016/j.jacc.2013.08.1627] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [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: 05/04/2013] [Revised: 07/25/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to test whether high-dose statin treatment would result in a reduction in periodontal inflammation as assessed by (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT). BACKGROUND Periodontal disease (PD) is an independent risk factor for atherosclerosis. METHODS Eighty-three adults with risk factors or with established atherosclerosis and who were not taking high-dose statins were randomized to atorvastatin 80 mg vs. 10 mg in a multicenter, double-blind trial to evaluate the impact of atorvastatin on arterial inflammation. Subjects were evaluated using FDG-PET/CT at baseline and at 4 and 12 weeks. Arterial and periodontal tracer activity was assessed while blinded to treatment allocation, clinical characteristics, and temporal sequence. Periodontal bone loss (an index of PD severity) was evaluated using contrast-enhanced CT images while blinded to clinical and imaging data. RESULTS Seventy-one subjects completed the study, and 59 provided periodontal images for analysis. At baseline, areas of severe PD had higher target-to-background ratio (TBR) compared with areas without severe PD (mean TBR: 3.83 [95% confidence interval (CI): 3.36 to 4.30] vs. 3.18 [95% CI: 2.91 to 3.44], p = 0.004). After 12 weeks, there was a significant reduction in periodontal inflammation in patients randomized to atorvastatin 80 mg vs. 10 mg (ΔTBR 80 mg vs. 10 mg group: mean -0.43 [95% CI: -0.83 to -0.02], p = 0.04). Between-group differences were greater in patients with higher periodontal inflammation at baseline (mean -0.74 [95% CI: -1.29 to -0.19], p = 0.01) and in patients with severe bone loss at baseline (-0.61 [95% CI: -1.16 to -0.054], p = 0.03). Furthermore, the changes in periodontal inflammation correlated with changes in carotid inflammation (R = 0.61, p < 0.001). CONCLUSIONS High-dose atorvastatin reduces periodontal inflammation, suggesting a newly recognized effect of statins. Given the concomitant changes observed in periodontal and arterial inflammation, these data raise the possibility that a portion of that beneficial impact of statins on atherosclerosis relate to reductions in extra-arterial inflammation, for example, periodontitis. (Evaluate the Utility of 18FDG-PET as a Tool to Quantify Atherosclerotic Plaque; NCT00703261).
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Affiliation(s)
- Sharath Subramanian
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hamed Emami
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Esad Vucic
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Parmanand Singh
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jayanthi Vijayakumar
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kenneth M Fifer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Achilles Alon
- Merck Sharp & Dohme Corp., Whitehouse Station, New Jersey
| | | | - Michael Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre of Excellence, the University of Toronto, Toronto, Ontario, Canada
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Ahmed Tawakol
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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Tawakol A, Fayad ZA, Mogg R, Alon A, Klimas MT, Dansky H, Subramanian SS, Abdelbaky A, Rudd JH, Farkouh ME, Nunes IO, Beals CR, Shankar SS. Intensification of Statin Therapy Results in a Rapid Reduction in Atherosclerotic Inflammation. J Am Coll Cardiol 2013; 62:909-17. [DOI: 10.1016/j.jacc.2013.04.066] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 03/27/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
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Hardy TA, Meyers AL, Yu J, Shankar SS, Steinberg HO, Porksen NK. Acute insulin response and beta-cell compensation in normal subjects treated with olanzapine or risperidone for 2 weeks. Diabetes Care 2007; 30:157-8. [PMID: 17192353 DOI: 10.2337/dc06-1063] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Thomas A Hardy
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
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Bell LN, Ward JL, Degawa-Yamauchi M, Bovenkerk JE, Jones R, Cacucci BM, Gupta CE, Sheridan C, Sheridan K, Shankar SS, Steinberg HO, March KL, Considine RV. Adipose tissue production of hepatocyte growth factor contributes to elevated serum HGF in obesity. Am J Physiol Endocrinol Metab 2006; 291:E843-8. [PMID: 16757549 DOI: 10.1152/ajpendo.00174.2006] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Serum HGF is elevated in obese individuals. This study examined the contribution of excess adipose tissue to increased circulating HGF levels in obesity. Serum HGF was measured by ELISA before and after weight loss due to bariatric surgery or a 24-h fast. At 6.1 +/- 0.1 mo following surgery, BMI (50.6 +/- 1.6 vs. 35.1 +/- 1.3 kg/m(2); P < 0.0001) and serum HGF were significantly decreased (1,164 +/- 116 vs. 529 +/- 39 pg/ml, P < 0.001). A 24-h fast did not change serum HGF, but serum leptin was significantly reduced (67.7 +/- 7.1 vs. 50.3 +/- 8.3 ng/ml, P = 0.02). HGF secretion in vitro from adipocytes of obese (BMI 40.3 +/- 2.8 kg/m(2)) subjects was significantly greater (80.9 +/- 10.4 vs. 21.5 +/- 4.0 pg/10(5) cells, P = 0.008) than release from adipocytes of lean (BMI 23.3 +/- 1.4 kg/m(2)) subjects. HGF mRNA levels determined by real-time RT-PCR were not different in adipocytes from lean (BMI 24.0 +/- 0.8 kg/m(2)) and obese (45.7 +/- 3.0 kg/m(2)) subjects, but serum HGF was significantly elevated in the obese individuals studied (787 +/- 61 vs. 489 +/- 49 pg/ml, P = 0.001). TNF-alpha (24 h treatment) significantly increased HGF release from subcutaneous adipocytes 23.6 +/- 8.3% over control (P = 0.02). These data suggest that elevated serum HGF in obesity is in part attributable to excess adipose tissue and that this effect can be reversed by reducing adipose tissue mass through weight loss. Increased HGF secretion from adipocytes of obese subjects may be due to posttranscriptional events possibly related to adipocyte size and stimulation by elevated TNF-alpha in the adipose tissue of obese individuals.
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Affiliation(s)
- Lauren N Bell
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 541 North Clinical Drive, Rm. CL455, Indianapolis, IN 46202-5111, USA
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Abstract
It is well established that endothelial dysfunction and insulin resistance go hand in hand. However, it is unclear whether endothelial dysfunction per se is sufficient to impair insulin-mediated glucose uptake. We have previously reported that 4 wk of administration of the human immunodeficiency virus (HIV)-1 protease inhibitor indinavir to HIV-negative subjects induces endothelial dysfunction. Hence, we hypothesized that indinavir-induced endothelial dysfunction was associated with impaired insulin-mediated glucose disposal. We measured insulin-mediated glucose disposal at the level of the whole body, skeletal muscle, and vasculature by performing hyperinsulinemic euglycemic clamp, and vascular function studies, in a separate group of HIV-negative healthy nonobese subjects (n = 13) before and after 4 wk of daily oral indinavir. Four weeks of indinavir resulted in a 113 +/- 29% (P < 0.01) reduction of endothelium-dependent vasodilation, consistent with our earlier findings. In addition, there was a significant impairment of insulin-mediated vasodilation (101 +/- 14% before indinavir vs. 35 +/- 15% after indinavir; P < 0.05). However, there was no significant change in insulin-mediated glucose disposal at the level of the whole body (8.9 +/- 0.5 before indinavir vs. 8.5 +/- 0.6 mgxkg(-1)xmin(-1) after indinavir; P = 0.4), or skeletal muscle. Furthermore, in a separate group of four HIV-negative healthy nonobese subjects, we found that 4 wk of indinavir has no sustained effect on insulin-stimulated glucose uptake in adipose tissue. Thus our findings indicate that 1) endothelial dysfunction alone is insufficient to impair insulin-mediated glucose disposal, and 2) indinavir-induced endothelial dysfunction is likely due to a direct effect of the drug on the endothelium and is not coupled to the induction of insulin resistance.
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Affiliation(s)
- Sudha S Shankar
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, 975 W. Walnut, IB 424 D, Indianapolis, IN 46202, USA
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Degawa-Yamauchi M, Moss KA, Bovenkerk JE, Shankar SS, Morrison CL, Lelliott CJ, Vidal-Puig A, Jones R, Considine RV. Regulation of adiponectin expression in human adipocytes: effects of adiposity, glucocorticoids, and tumor necrosis factor alpha. ACTA ACUST UNITED AC 2005; 13:662-9. [PMID: 15897474 DOI: 10.1038/oby.2005.74] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Adiponectin mRNA expression in isolated subcutaneous and omental adipocytes was examined across a wide range of adiposity to determine whether adiponectin synthesis is impaired in these adipose tissue depots in obese humans. Tumor necrosis factor (TNF)alpha and dexamethasone were tested for inhibitory effects on adiponectin release from human adipocytes in vitro. RESEARCH METHODS AND PROCEDURES Adipocytes were isolated by collagenase digestion of abdominal adipose tissue obtained from subjects undergoing surgical procedures or outpatient needle biopsy. Adiponectin and leptin mRNA were quantitated by real-time reverse transcriptase-polymerase chain reaction. Adiponectin and leptin secretion from isolated adipocytes treated with dexamethasone or TNFalpha were determined by radioimmunoassay. RESULTS There was a significant negative correlation between adiponectin gene expression and BMI in subcutaneous adipocytes from 32 women (r = 0.420; p = 0.02). Adiponectin mRNA was also significantly correlated with serum adiponectin (r = 0.44; p = 0.03; n = 25). There was no correlation between adiponectin mRNA expression and BMI in omental adipocytes from 29 women. Leptin mRNA was significantly and positively correlated (r = 0.484; p = 0.01) with BMI in the same omental adipocyte mRNA preparations. In subcutaneous adipocytes from lean subjects, TNFalpha inhibited adiponectin release by 7.4 +/- 1.2% (n = 9, p < 0.05) but had no effect on adiponectin release from subcutaneous or omental adipocytes from obese subjects. Dexamethasone significantly inhibited adiponectin release with 24 hours of treatment. DISCUSSION The data suggest that reduced adiponectin synthesis in subcutaneous adipocytes contributes to lower serum adiponectin levels in obesity and that glucocorticoids regulate adiponectin gene expression in human adipocytes. TNFalpha does not seem to directly inhibit adiponectin synthesis in human adipocytes.
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Affiliation(s)
- Mikako Degawa-Yamauchi
- Division of Endocrinology and Metabolism, Department of Medicine, Indiana University School of Medicine, 541 North Clinical Drive, Clinical Building 455, Indianapolis, IN 46202-5111, USA
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Abstract
BACKGROUND Potent antiretroviral treatment has drastically reduced mortality in HIV-infected patients but may accelerate atherosclerotic disease, which could be partially mediated via endothelial dysfunction. METHODS In 8 HIV-negative healthy males, leg blood flow responses to intraartery infusions of methacholine chloride (Mch), sodium nitroprusside, and NG-mono-methyl-L-arginine (L-NMMA) were measured before and after 4 weeks of daily oral indinavir. In the same subjects, we also assessed the effect of indinavir on lipids, insulin sensitivity, markers of inflammation, as well as oxidative stress. RESULTS After 4 weeks of indinavir, the endothelium-dependent response to methacholine chloride was impaired (195% +/- 38% vs 83% +/- 13%, P < .05), the response to NG-mono-methyl-L-arginine (nitric oxide-dependent tone) was nearly abrogated (-30% +/- 4% vs -1% +/- 11%, P < .05), whereas the endothelium-independent response to sodium nitroprusside remained unchanged. Fasting insulin levels increased from 5.8 +/- 1.2 to 7.0 +/- 1.4 microU/mL (P < .05), and HOMA-IR scores increased from 1.3 +/- 0.3 to 1.6 +/- 0.3 U (P < .05). There were no changes in blood pressure, lipids, markers of inflammation, or oxidative stress. CONCLUSIONS Four weeks of the HIV-1 protease inhibitor indinavir, in the absence of HIV-1 infection, causes vascular dysfunction most likely at the level of endothelial nitric oxide production. The vascular dysfunction may be mediated partially by the concomitant induction of insulin resistance but other mechanisms cannot be ruled out.
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Affiliation(s)
- Sudha S Shankar
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Abstract
Obesity is becoming more prevalent in the developed world because of the abundance of food and the decrease of physical activity. Obesity is a risk factor for a host of diseases from arthritis to cardiovascular disease. The precise mechanisms by which obesity promotes cardiovascular disease are not well understood but are likely to include metabolic and inflammatory responses to the increased amount of stored fat. The endothelium plays a pivotal role in maintaining vascular health. Impaired endothelial function is an independent predictor of cardiovascular disease. Most studies of vascular function in obese subjects have demonstrated impaired endothelial function. This impairment of endothelial function becomes obvious early on, long before any vascular abnormalities become clinically relevant and detectable. Better understanding of the mediators of obesity-induced endothelial dysfunction may lead to the identification of new targets for interventions that may prevent or postpone the development of obesity-related cardiovascular disease.
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Affiliation(s)
- Sudha S Shankar
- Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Abstract
We have recently shown that elevated levels of free fatty acid (FFA) seen in insulin-resistant obese subjects are associated with endothelial dysfunction. L-carnitine, which is required for mitochondrial FFA transport/oxidation, has been reported to improve vascular function in subjects with diabetes and heart disease. Here, we tested the hypothesis that L-carnitine attenuates FFA-induced endothelial dysfunction. We studied leg blood flow (LBF) responses and leg vascular resistance (LVR) to graded intrafemoral artery infusions of the endothelium-dependent vasodilator, methacholine chloride (MCh). A group (n = 7) of normal lean subjects was studied under basal conditions (saline), after 2 h of FFA elevation (FFA), and then after 2 h of superimposing L-carnitine on FFA elevation. FFA elevation caused the maximal LBF increment in response to MCh to decrease from 0.388 +/- 0.08 to 0.212 +/- 0.071 L/min (P < 0.05). Similarly, FFA blunted the maximum decrease in LVR in response to MCh from -315 +/- 41 U to -105 +/- 46 U (P < 0.05). The superimposed L-carnitine restored the LBF increment in response to MCh to 0.488 +/- 0.088 L/min (P < 0.05 vs. FFA) and the maximum fall in LVR to -287 +/- 75 U (P < 0.05 vs. FFA), indicating that L-carnitine elevation may attenuate FFA-induced endothelial dysfunction. In conclusion, our data suggest that increasing L-carnitine levels may improve FFA-induced and obesity-associated endothelial dysfunction. This improved endothelial function may delay or prevent the development of excess cardiovascular disease.
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Affiliation(s)
- Sudha S Shankar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-5111, USA
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Abstract
The insulin resistance syndrome, otherwise known as the metabolic syndrome, describes a cluster of cardiovascular and metabolic abnormalities, which are strongly associated with overweight and obesity. The importance of the syndrome is due to its increased rates of cardiovascular morbidity and mortality. Insulin resistance is also characterized by elevated free fatty acid (FFA) levels. In otherwise healthy human subjects, elevation of FFA impairs endothelial function. This appears to be largely the result of blunting of nitric oxide-dependent tone, most likely at the level of the endothelial isoform of nitric oxide synthase (eNOS). Some of the potential mediatory mechanisms include oxidative stress, proinflammatory cytokines, C-reactive protein, or endogenous inhibitors of eNOS. Regardless of the mechanism(s) that mediates the effects of increased FFA on the vasculature, impaired vascular function is likely to account, at least in part, for the increase in cardiovascular mortality in subjects with the insulin resistance syndrome.
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Affiliation(s)
- Sudha S Shankar
- Department of Medicine, Division of Endocrinology and Metabolism, Indiana University Medical Center, 975 W. Walnut, IB 424, Indianapolis, IN 46202-5111, USA
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Shankar SS, Dubé MP. Clinical Aspects of Endothelial Dysfunction Associated With Human Immunodeficiency Virus Infection and Antiretroviral Agents. Cardiovasc Toxicol 2004; 4:261-9. [PMID: 15470273 DOI: 10.1385/ct:4:3:261] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [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: 12/16/2003] [Revised: 02/06/2004] [Accepted: 02/08/2004] [Indexed: 11/11/2022]
Abstract
Endothelial dysfunction is a critical initial step of atherogenesis that subsequently contributes to the progression and clinical manifestations of atherosclerosis. The use of human immunodeficiency virus type 1 (HIV-1) protease inhibitor (PI) agents has been associated with increased cardiovascular events and worsening of multiple coronary heart disease risk factors including dys-lipidemia, insulin resistance, and endothelial dysfunction. Endothelial dysfunction may be caused by HIV infection itself as well as treatment-related effects of the antiretroviral agents used to treat HIV. The available evidence suggests that PIs may induce endothelial dysfunction via their effects on both lipid and glucose metabolism. Studies in healthy subjects confirm a role for reduced endothelial nitric oxide production in the endothelial dysfunction associated with the PI indinavir. Further work is needed to determine the relative tendencies of other antiretroviral agents to induce endothelial dysfunction, the physiologic mechanisms involved, and the contribution of the metabolic and body shape changes associated with HIV treatment-related lipodystrophy, and to establish effective interventions for endothelial dysfunction in HIV-infected patients.
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Affiliation(s)
- Sudha S Shankar
- Department of Medicine and Divisions of Endocrinology, Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
The diuretic response to loop diuretics in various disease states has consistently been found to be subnormal. One of the key determinants of the degree of diuretic response is the functional integrity of the sodium-potassium-chloride transporter in the loop of Henle. Studies in animal models suggest that expression/activity of the transporter may be affected by factors such as altered natural splicing events of NKCC2 (the gene encoding for the renal transporter), renal prostanoids, vasopressin, and other autacoids. We have reviewed the pharmacokinetics and pharmacodynamics of loop diuretics in health and in edematous disorders for which they are used. On the basis of evidence reviewed in this paper, we propose that altered expression or activity of the sodium-potassium-chloride transporter in the loop of Henle, in conjunction with events occurring in other segments of the nephron, possibly accounts for the altered diuretic response to these agents. Thus the modulators of this altered expression/activity could serve as important therapeutic targets for alternative diuretic regimens in these conditions.
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Affiliation(s)
- Sudha S Shankar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-5124, USA
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