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Fellinger P, Beiglböck H, Semmler G, Pfleger L, Smajis S, Baumgartner C, Gajdosik M, Marculescu R, Vila G, Winhofer Y, Scherer T, Trauner M, Kautzky-Willer A, Krssak M, Krebs M, Wolf P. Increased GH/IGF-I Axis Activity Relates to Lower Hepatic Lipids and Phosphor Metabolism. J Clin Endocrinol Metab 2023; 108:e989-e997. [PMID: 37104943 PMCID: PMC10505545 DOI: 10.1210/clinem/dgad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/25/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
CONTEXT Non-alcoholic fatty liver disease (NAFLD) is a leading causes of liver-related morbidity and mortality. While data on acromegaly, a state of chronic growth hormone (GH)/insulin-like growth factor I (IGF-I) excess, suggest an inverse relationship with intrahepatic lipid (IHL) content, less is known about the impact of the GH/IGF-I axis on IHL, lipid composition, and phosphor metabolites in individuals without disorders of GH secretion. OBJECTIVE The aim was to investigate the relation between activity of the GH/IGF-I axis and IHL content and phosphor metabolism. METHODS We performed a cross-sectional study in 59 otherwise metabolically healthy individuals (30 females), of which 16 met the criteria of NAFLD with IHL of ≥5.6%. The GH/IGF-I axis was evaluated in a fasting state and during an oral glucose tolerance test (OGTT). Insulin sensitivity was estimated by validated indices. IHL, lipid composition (unsaturation index), and phosphate metabolites were analyzed by using 1H/31P magnetic resonance spectroscopy. RESULTS In the overall cohort (40.6 ± 15 years; body mass index: 24.5 ± 3 kg/m2; IGF-I: 68.0 ± 17% upper limit of normal), fasting GH (R = -0.31; P = .02), GH during oral glucose tolerance test (R = -0.51; P < .01), and IGF-I (R = -0.28; P = .03) inversely correlated with IHL. GH levels during OGTT were significantly lower in NAFLD than in controls (47.7 [22; 143] ng/mL/min vs 16.8 [7; 32] ng/mL/min; P = .003). GH/IGF-I axis activity correlated with lipid composition and with phosphor metabolites. In multiple regression analysis, the GH/IGF-I axis activity was a strong predictor for IHL and lipid composition independent from insulin sensitivity. CONCLUSION GH/IGF-I axis activity impacts hepatic lipid and phosphate metabolism in individuals without disorders in GH secretion. Lower GH axis activity is associated with higher IHL and an unfavorable lipid composition, probably mediated by changes in hepatic energy metabolism.
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Affiliation(s)
- Paul Fellinger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Hannes Beiglböck
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Lorenz Pfleger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
- Centre of Excellence-High Field MR, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabina Smajis
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Clemens Baumgartner
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Martin Gajdosik
- Centre of Excellence-High Field MR, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Greisa Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Yvonne Winhofer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Scherer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Alexandra Kautzky-Willer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Martin Krssak
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
- Centre of Excellence-High Field MR, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Wolf
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
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Smajis S, Gajdošík M, Pfleger L, Traussnigg S, Kienbacher C, Halilbasic E, Ranzenberger-Haider T, Stangl A, Beiglböck H, Wolf P, Lamp T, Hofer A, Gastaldelli A, Barbieri C, Luger A, Trattnig S, Kautzky-Willer A, Krššák M, Trauner M, Krebs M. Metabolic effects of a prolonged, very-high-dose dietary fructose challenge in healthy subjects. Am J Clin Nutr 2020; 111:369-377. [PMID: 31796953 DOI: 10.1093/ajcn/nqz271] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/08/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Increased fructose intake has been associated with metabolic consequences such as impaired hepatic lipid metabolism and development of nonalcoholic fatty liver disease (NAFLD). OBJECTIVES The aim of this study was to investigate the role of fructose in glucose and lipid metabolism in the liver, heart, skeletal muscle, and adipose tissue. METHODS Ten healthy subjects (age: 28 ± 19 y; BMI: 22.2 ± 0.7 kg/m2) underwent comprehensive metabolic phenotyping prior to and 8 wk following a high-fructose diet (150 g daily). Eleven patients with NAFLD (age: 39.4 ± 3.95 y; BMI: 28.4 ± 1.25) were characterized as "positive controls." Insulin sensitivity was analyzed by a 2-step hyperinsulinemic euglycemic clamp, and postprandial interorgan crosstalk of lipid and glucose metabolism was evaluated, by determining postprandial hepatic and intra-myocellular lipid and glycogen accumulation, employing magnetic resonance spectroscopy (MRS) at 7 T. Myocardial lipid content and myocardial function were assessed by 1H MRS imaging and MRI at 3 T. RESULTS High fructose intake resulted in lower intake of other dietary sugars and did not increase total daily energy intake. Ectopic lipid deposition and postprandial glycogen storage in the liver and skeletal muscle were not altered. Postprandial changes in hepatic lipids were measured [Δhepatocellular lipid (HCL)_healthy_baseline: -15.9 ± 10.7 compared with ± ΔHCL_healthy_follow-up: -6.9 ± 4.6; P = 0.17] and hepatic glycogen (Δglycogen_baseline: 64.4 ± 14.1 compared with Δglycogen_follow-up: 51.1 ± 9.8; P = 0.42). Myocardial function and myocardial mass remained stable. As expected, impaired hepatic glycogen storage and increased ectopic lipid storage in the liver and skeletal muscle were observed in insulin-resistant patients with NAFLD. CONCLUSIONS Ingestion of a high dose of fructose for 8 wk was not associated with relevant metabolic consequences in the presence of a stable energy intake, slightly lower body weight, and potentially incomplete absorption of the orally administered fructose load. This indicated that young, metabolically healthy subjects can at least temporarily compensate for increased fructose intake. This trial was registered at www.clinicaltrials.gov as NCT02075164.
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Affiliation(s)
- Sabina Smajis
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Martin Gajdošík
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Department for Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lorenz Pfleger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Department for Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Traussnigg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Kienbacher
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Emina Halilbasic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Anna Stangl
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Hannes Beiglböck
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Peter Wolf
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Tanja Lamp
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Astrid Hofer
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | | | - Chiara Barbieri
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Anton Luger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- High Field MR Center, Department for Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Martin Krššák
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Department for Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
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Wolf P, Fellinger P, Pfleger L, Smajis S, Beiglböck H, Gajdošík M, Anderwald CH, Trattnig S, Luger A, Winhofer Y, Krššák M, Krebs M. Reduced hepatocellular lipid accumulation and energy metabolism in patients with long standing type 1 diabetes mellitus. Sci Rep 2019; 9:2576. [PMID: 30796305 PMCID: PMC6385341 DOI: 10.1038/s41598-019-39362-4] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/22/2019] [Indexed: 02/08/2023] Open
Abstract
The prevalence of obesity and metabolic syndrome increases in patients with type 1 diabetes mellitus (T1DM). In the general population this is linked with ectopic lipid accumulation in liver (HCL) and skeletal muscle (IMCL), representing hallmarks in the development of insulin resistance. Moreover, hepatic mitochondrial activity is lower in newly diagnosed patients with T1DM. If this precedes later development of diabetes related fatty liver disease is currently not known. This study aims to investigate energy metabolism in liver (kATP) and skeletal muscle (kCK) and its impact on HCL, IMCL, cardiac fat depots and heart function in 10 patients with long standing T1DM compared to 11 well-matched controls by 31P/1H magnetic resonance spectroscopy. HCL was almost 70% lower in T1DM compared to controls (6.9 ± 5% vs 2.1 ± 1.3%; p = 0.030). Also kATP was significantly reduced (0.33 ± 0.1 s-1 vs 0.17 ± 0.1 s-1; p = 0.018). In T1DM, dose of basal insulin strongly correlated with BMI (r = 0.676, p = 0.032) and HCL (r = 0.643, p = 0.045), but not with kATP. In the whole cohort, HCL was significantly associated with BMI (r = 0.615, p = 0.005). In skeletal muscle kCK was lower in patients with T1DM (0.25 ± 0.05 s-1 vs 0.31 ± 0-04 s-1; p = 0.039). No significant differences were found in IMCL. Cardiac fat depots as well as heart function were not different. Our results in patients with long standing T1DM show that HCL is lower compared to matched controls, despite reduced energy metabolism in liver and skeletal muscle.
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Affiliation(s)
- Peter Wolf
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Paul Fellinger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lorenz Pfleger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence - High Field MR, Vienna, Austria
| | - Sabina Smajis
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hannes Beiglböck
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Gajdošík
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence - High Field MR, Vienna, Austria
| | - Christian-Heinz Anderwald
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Siegfried Trattnig
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence - High Field MR, Vienna, Austria
| | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Yvonne Winhofer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Krššák
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence - High Field MR, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Pfleger L, Gajdošík M, Wolf P, Smajis S, Fellinger P, Kuehne A, Krumpolec P, Trattnig S, Winhofer Y, Krebs M, Krššák M, Chmelík M. Absolute Quantification of Phosphor-Containing Metabolites in the Liver Using 31 P MRSI and Hepatic Lipid Volume Correction at 7T Suggests No Dependence on Body Mass Index or Age. J Magn Reson Imaging 2018; 49:597-607. [PMID: 30291654 PMCID: PMC6586048 DOI: 10.1002/jmri.26225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 01/07/2023] Open
Abstract
Background Hepatic disorders are often associated with changes in the concentration of phosphorus‐31 (31P) metabolites. Absolute quantification offers a way to assess those metabolites directly but introduces obstacles, especially at higher field strengths (B0 ≥ 7T). Purpose To introduce a feasible method for in vivo absolute quantification of hepatic 31P metabolites and assess its clinical value by probing differences related to volunteers' age and body mass index (BMI). Study Type Prospective cohort. Subjects/Phantoms Four healthy volunteers included in the reproducibility study and 19 healthy subjects arranged into three subgroups according to BMI and age. Phantoms containing 31P solution for correction and validation. Field Strength/Sequence Phase‐encoded 3D pulse‐acquire chemical shift imaging for 31P and single‐volume 1H spectroscopy to assess the hepatocellular lipid content at 7T. Assessment A phantom replacement method was used. Spectra located in the liver with sufficient signal‐to‐noise ratio and no contamination from muscle tissue, were used to calculate following metabolite concentrations: adenosine triphosphates (γ‐ and α‐ATP); glycerophosphocholine (GPC); glycerophosphoethanolamine (GPE); inorganic phosphate (Pi); phosphocholine (PC); phosphoethanolamine (PE); uridine diphosphate‐glucose (UDPG); nicotinamide adenine dinucleotide‐phosphate (NADH); and phosphatidylcholine (PtdC). Correction for hepatic lipid volume fraction (HLVF) was performed. Statistical Tests Differences assessed by analysis of variance with Bonferroni correction for multiple comparison and with a Student's t‐test when appropriate. Results The concentrations for the young lean group corrected for HLVF were 2.56 ± 0.10 mM for γ‐ATP (mean ± standard deviation), α‐ATP: 2.42 ± 0.15 mM, GPC: 3.31 ± 0.27 mM, GPE: 3.38 ± 0.87 mM, Pi: 1.42 ± 0.20 mM, PC: 1.47 ± 0.24 mM, PE: 1.61 ± 0.20 mM, UDPG: 0.74 ± 0.17 mM, NADH: 1.21 ± 0.38 mM, and PtdC: 0.43 ± 0.10 mM. Differences found in ATP levels between lean and overweight volunteers vanished after HLVF correction. Data Conclusion Exploiting the excellent spectral resolution at 7T and using the phantom replacement method, we were able to quantify up to 10 31P‐containing hepatic metabolites. The combination of 31P magnetic resonance spectroscopy imaging data acquisition and HLVF correction was not able to show a possible dependence of 31P metabolite concentrations on BMI or age, in the small healthy population used in this study. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:597–607.
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Affiliation(s)
- Lorenz Pfleger
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
| | - Martin Gajdošík
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
- Medical University of Vienna, Department of Biomedical Imaging and Image‐guided Therapy, High Field MR CenterViennaAustria
| | - Peter Wolf
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
| | - Sabina Smajis
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
| | - Paul Fellinger
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
| | - Andre Kuehne
- MRI.TOOLS GmbHBerlinGermany
- Medical University of Vienna, Center for Medical Physics and Biomedical EngineeringViennaAustria
| | - Patrik Krumpolec
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
- Slovak Academy of Sciences, Biomedical Research Center, Institute of Experimental EndocrinologyBratislavaSlovakia
| | - Siegfried Trattnig
- Medical University of Vienna, Department of Biomedical Imaging and Image‐guided Therapy, High Field MR CenterViennaAustria
- Medical University of Vienna, Christian Doppler Laboratory for Clinical Molecular Imaging, MOLIMAViennaAustria
| | - Yvonne Winhofer
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
| | - Michael Krebs
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
| | - Martin Krššák
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and MetabolismViennaAustria
- Medical University of Vienna, Department of Biomedical Imaging and Image‐guided Therapy, High Field MR CenterViennaAustria
- Medical University of Vienna, Christian Doppler Laboratory for Clinical Molecular Imaging, MOLIMAViennaAustria
| | - Marek Chmelík
- Medical University of Vienna, Department of Biomedical Imaging and Image‐guided Therapy, High Field MR CenterViennaAustria
- Medical University of Vienna, Christian Doppler Laboratory for Clinical Molecular Imaging, MOLIMAViennaAustria
- Karl Landsteiner Institute for Clinical Molecular MRViennaAustria
- University of PrešovFaculty of HealthcarePrešovSlovakia
- General Hospital of Levoča, Radiology DepartmentLevočaSlovakia
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Scherer T, Wolf P, Smajis S, Gaggini M, Hackl M, Gastaldelli A, Klimek P, Einwallner E, Marculescu R, Luger A, Fürnsinn C, Trattnig S, Buettner C, Krššák M, Krebs M. Chronic Intranasal Insulin Does Not Affect Hepatic Lipids but Lowers Circulating BCAAs in Healthy Male Subjects. J Clin Endocrinol Metab 2017; 102:1325-1332. [PMID: 28323986 PMCID: PMC6283450 DOI: 10.1210/jc.2016-3623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/11/2017] [Indexed: 02/08/2023]
Abstract
CONTEXT Nonalcoholic fatty liver disease and elevated circulating branched-chain amino acids (BCAAs) are common characteristics of obesity and type 2 diabetes. In rodents, brain insulin signaling controls both hepatic triglyceride secretion and BCAA catabolism. Whether brain insulin signaling controls similar metabolic pathways in humans is unknown. OBJECTIVE Here we assessed if intranasal insulin, a method to preferentially deliver insulin to the central nervous system, is able to modulate hepatic lipid content and plasma BCAAs in humans. DESIGN/SETTING We conducted a randomized, double-blind, placebo-controlled trial at the Medical University of Vienna. PARTICIPANTS/INTERVENTION We assessed if a chronic 4-week intranasal insulin treatment (40 IU, 4 times daily) reduces hepatic triglyceride content and circulating BCAAs in 20 healthy male volunteers. MAIN OUTCOME MEASURES Hepatic lipid content was assessed noninvasively by 1H-magnetic resonance spectroscopy, and BCAAs were measured by gas chromatography mass spectrometry at defined time points during the study. RESULTS Chronic intranasal insulin treatment did not alter body weight, body mass index, and hepatic lipid content but reduced circulating BCAA levels. CONCLUSIONS These findings support the notion that brain insulin controls BCAA metabolism in humans. Thus, brain insulin resistance could account at least in part for the elevated BCAA levels observed in the insulin-resistant state.
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Affiliation(s)
- Thomas Scherer
- Department of Medicine III, Division of Endocrinology and Metabolism
| | - Peter Wolf
- Department of Medicine III, Division of Endocrinology and Metabolism
| | - Sabina Smajis
- Department of Medicine III, Division of Endocrinology and Metabolism
| | - Melania Gaggini
- National Research Council Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Martina Hackl
- Department of Medicine III, Division of Endocrinology and Metabolism
| | - Amalia Gastaldelli
- National Research Council Institute of Clinical Physiology, 56124 Pisa, Italy
| | | | | | | | - Anton Luger
- Department of Medicine III, Division of Endocrinology and Metabolism
| | - Clemens Fürnsinn
- Department of Medicine III, Division of Endocrinology and Metabolism
| | - Siegfried Trattnig
- High Field MR Centre, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Buettner
- Department of Medicine and Department of Neuroscience, Diabetes, Obesity and Metabolism Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Martin Krššák
- Department of Medicine III, Division of Endocrinology and Metabolism
- High Field MR Centre, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Krebs
- Department of Medicine III, Division of Endocrinology and Metabolism
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Wolf P, Winhofer Y, Krssak M, Smajis S, Harreiter J, Kosi-Trebotic L, Fürnsinn C, Anderwald CH, Baumgartner-Parzer S, Trattnig S, Luger A, Krebs M. Suppression of plasma free fatty acids reduces myocardial lipid content and systolic function in type 2 diabetes. Nutr Metab Cardiovasc Dis 2016; 26:387-392. [PMID: 27118107 DOI: 10.1016/j.numecd.2016.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 02/25/2016] [Accepted: 03/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Type 2 diabetes (T2DM) is closely associated with the development of heart failure, which might be related with impaired substrate metabolism and accumulation of myocardial lipids (MYCL). The aim of this study was to investigate the impact of an acute pharmacological inhibition of adipose tissue lipolysis leading to reduced availability of circulating FFA on MYCL and heart function in T2DM. METHODS AND RESULTS 8 patients with T2DM (Age: 56 ± 11; BMI: 28 ± 3.5 kg/m(2); HbA1c: 7.29 ± 0.88%) were investigated on two study days in random order. Following administration of Acipimox or Placebo MYCL and heart function were measured by (1)H-magnetic-resonance-spectroscopy and tomography at baseline, at 2 and at 6 h. Acipimox reduced circulating FFA by -69% (p < 0.001), MYCL by -39 ± 41% (p < 0.001) as well as systolic heart function (Ejection Fraction (EF): -13 ± 8%, p = 0.025; Cardiac Index: -16 ± 15%, p = 0.063 compared to baseline). Changes in plasma FFA concentrations strongly correlated with changes in MYCL (r = 0.707; p = 0.002) and EF (r = 0.651; p = 0.006). Diastolic heart function remained unchanged. CONCLUSIONS Our results indicate, that inhibition of adipose tissue lipolysis is associated with a rapid depletion of MYCL-stores and reduced systolic heart function in T2DM. These changes were comparable to those previously found in insulin sensitive controls. MYCL thus likely serve as a readily available energy source to cope with short-time changes in FFA availability.
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Affiliation(s)
- P Wolf
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - Y Winhofer
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria.
| | - M Krssak
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria; Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence - High Field MR, Vienna, Austria
| | - S Smajis
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - J Harreiter
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - L Kosi-Trebotic
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - C Fürnsinn
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - C-H Anderwald
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria; Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy; Medical Direction, Specialized Hospital Complex Agathenhof, A-9322 Micheldorf, Austria
| | - S Baumgartner-Parzer
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - S Trattnig
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence - High Field MR, Vienna, Austria
| | - A Luger
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - M Krebs
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
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Wolf P, Winhofer Y, Smajis S, Jankovic D, Anderwald CH, Trattnig S, Luger A, Krebs M, Krššák M. Pericardial- Rather than Intramyocardial Fat Is Independently Associated with Left Ventricular Systolic Heart Function in Metabolically Healthy Humans. PLoS One 2016; 11:e0151301. [PMID: 26967641 PMCID: PMC4788448 DOI: 10.1371/journal.pone.0151301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background Obesity is a major risk factor to develop heart failure, in part due to possible lipotoxic effects of increased intramyocardial (MYCL) and/or local or paracrine effects of pericardial (PERI) lipid accumulation. Recent evidence suggests that MYCL is highly dynamic and might rather be a surrogate marker for disturbed energy metabolism than the underlying cause of cardiac dysfunction. On the other hand, PERI might contribute directly by mechanic and paracrine effects. Therefore, we hypothesized that PERI rather than MYCL is associated with myocardial function. Methods To avoid potential confounding of metabolic disease 31 metabolically healthy subjects (age: 29±10yrs; BMI: 23±3kg/m2) were investigated using 1H-magnetic resonance spectroscopy and imaging. MYCL and PERI, as well as systolic and diastolic left ventricular heart function were assessed. Additionally, anthropometric data and parameters of glucose and lipid metabolism were analyzed. Correlation analysis was performed using Pearson’s correlation coefficient. Linear regression model was used to show individual effects of PERI and MYCL on myocardial functional parameters. Results Correlation analysis with parameters of systolic heart function revealed significant associations for PERI (Stroke Volume (SV): R = -0.513 p = 0.001; CardiacIndex (CI): R = -0.442 p = 0.014), but not for MYCL (SV: R = -0.233; p = 0.207; CI: R = -0.130; p = 0.484). No significant correlations were found for E/A ratio as a parameter of diastolic heart function. In multiple regression analysis CI was negatively predicted by PERI, whereas no impact of MYCL was observed in direct comparison. Conclusions Cardiac fat depots impact left ventricular heart function in a metabolically healthy population. Direct comparison of different lipid stores revealed that PERI is a more important predictor than MYCL for altered myocardial function.
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Affiliation(s)
- Peter Wolf
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - Yvonne Winhofer
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - Sabina Smajis
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - Draženka Jankovic
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
- Wilhelminenspital, Department of Internal Medicine I, Division of Oncology, Hematology and Palliative Care, Vienna, Austria
| | - Christian-Heinz Anderwald
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy
- Medical Direction, Specialized Hospital Complex Agathenhof, A-9322 Micheldorf, Carinthia, Austria
| | - Siegfried Trattnig
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence—High Field MR, Vienna, Austria
| | - Anton Luger
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - Michael Krebs
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
- * E-mail:
| | - Martin Krššák
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence—High Field MR, Vienna, Austria
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Wolf P, Winhofer Y, Smajis S, Anderwald CH, Scheuba C, Niederle B, Gessl A, Luger A, Krebs M, Koperek O. Clinical presentation in insulinoma predicts histopathological tumour characteristics. Clin Endocrinol (Oxf) 2015; 83:67-71. [PMID: 25817061 DOI: 10.1111/cen.12777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/13/2015] [Accepted: 03/23/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Insulinomas are rare neuroendocrine tumours (NETs) of the pancreas, characterized clinically by neuroglycopenic symptoms during periods of substrate deficiency. The gold standard test for diagnosing an insulinoma is a 72-h fast. However, the prognostic value of parameters in the standardized 72-h fast on histopathological tumour criteria and clinical presentation has not been examined. METHODS In thirty-three patients diagnosed with an insulinoma records, and data were investigated retrospectively. Histopathological tumour characteristics, including staging, grading and size, were reviewed. Grading was performed using Ki-67 index. Cut-off values for classical grading (G(clas)) were set at G1(clas) ≤ 2%, G2(clas) 3-20% & G3(clas) >20% and for modified grading (G(mod)) at G1(mod) <5%, G2(mod) 5-20% & G3(mod) >20%. RESULTS When G(mod) criteria were applied, the initial blood glucose was lower in GII/III(mod) patients compared to GI(mod) (2.8 ± 0.8 vs 3.8 ± 1.3 mmol/l; P = 0.046). Basal and end of fast levels of insulin (basal insulin 71 ± 61 vs 20 ± 16 mU/l; P < 0.001; end of fast insulin 77 ± 51 vs 21 ± 20 mU/l; P < 0.001) and c-peptide (basal c-peptide 5.4 ± 2.4 vs 2.7 ± 1.6 μg/l; P = 0.004; end of fast c-peptide 5.3 ± 2.4 vs 2.5 ± 1.4 μg/l; P = 0.001) were significantly higher in GII/III(mod) than in GI(mod). No differences between the groups were observed when G(clas) criteria were applied. Additionally, close correlations were observed between insulin concentration, Ki-67 index and tumour size. CONCLUSION This study shows an impact of histopathological tumour characteristics in patients suffering from an insulinoma on clinical presentation during a standardized 72-h fast. Lower initial blood glucose levels and higher concentrations of insulin and c-peptide are associated with worse tumour grading and larger tumour size.
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Affiliation(s)
- Peter Wolf
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Yvonne Winhofer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Sabina Smajis
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian-Heinz Anderwald
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy
- Medical Direction, Specialized Hospital Complex Agathenhof, Micheldorf, Austria
| | - Christian Scheuba
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Bruno Niederle
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Alois Gessl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Oskar Koperek
- Department of Pathology, Medical University of Vienna, Vienna, Austria
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Anderwald CH, Tura A, Gessl A, Smajis S, Bieglmayer C, Marculescu R, Luger A, Pacini G, Krebs M. Whole-body insulin sensitivity rather than body-mass-index determines fasting and post-glucose-load growth hormone concentrations. PLoS One 2014; 9:e115184. [PMID: 25517727 PMCID: PMC4269423 DOI: 10.1371/journal.pone.0115184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/19/2014] [Indexed: 11/25/2022] Open
Abstract
Background Obese, non-acromegalic persons show lower growth hormone (GH) concentrations at fasting and reduced GH nadir during an oral glucose tolerance test (OGTT). However, this finding has never been studied with regard to whole-body insulin-sensitivity as a possible regulator. Methods In this retrospective analysis, non-acromegalic (NonACRO, n = 161) and acromegalic (ACRO, n = 35), non-diabetic subjects were subdivided into insulin-sensitive (IS) and –resistant (IR) groups according to the Clamp-like Index (CLIX)-threshold of 5 mg·kg−1·min−1 from the OGTT. Results Non-acromegalic IS (CLIX: 8.8±0.4 mg·kg−1·min−1) persons with similar age and sex distribution, but lower (p<0.001) body-mass-index (BMI = 25±0 kg/m2, 84% females, 56±1 years) had 59% and 70%, respectively, higher (p<0.03) fasting GH and OGTT GH area under the curve concentrations than IR (CLIX: 3.5±0.1 mg·kg−1·min−1, p<0.001) subjects (BMI = 29±1 kg/m2, 73% females, 58±1 years). When comparing on average overweight non-acromegalic IS and IR with similar anthropometry (IS: BMI: 27±0 kg/m2, 82% females, 58±2 years; IR: BMI: 27±0 kg/m2, 71% females, 60±1 years), but different CLIX (IS: 8.7±0.9 vs. IR: 3.8±0.1 mg·kg−1·min−1, p<0.001), the results remained almost the same. In addition, when adjusted for OGTT-mediated glucose rise, GH fall was less pronounced in IR. In contrast, in acromegalic subjects, no difference was found between IS and IR patients with regard to fasting and post-glucose-load GH concentrations. Conclusions Circulating GH concentrations at fasting and during the OGTT are lower in non-acromegalic insulin-resistant subjects. This study seems the first to demonstrate that insulin sensitivity rather than body-mass modulates fasting and post-glucose-load GH concentrations in non-diabetic non–acromegalic subjects.
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Affiliation(s)
- Christian-Heinz Anderwald
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council (ISIB-CNR), Padua, Italy
- Mariahilf Community Pharmacy, Arnoldstein, Austria
- Medical Direction, Specialized Hospital Complex Agathenhof, Micheldorf, Austria
- * E-mail:
| | - Andrea Tura
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council (ISIB-CNR), Padua, Italy
| | - Alois Gessl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Sabina Smajis
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Bieglmayer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Giovanni Pacini
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council (ISIB-CNR), Padua, Italy
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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