1
|
Aloufi MF, Hazem SH, Abdelaziz RR, Suddek GM. Roflumilast counteracts high-dose dexamethasone-induced steatohepatitis, metabolic abnormalities and aortic injury via inhibiting TNF-α/NF-κB, NLRP3/IL-1β and ER stress sensors. Life Sci 2025; 372:123634. [PMID: 40233857 DOI: 10.1016/j.lfs.2025.123634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 03/28/2025] [Accepted: 04/12/2025] [Indexed: 04/17/2025]
Abstract
INTRODUCTION High-dose dexamethasone (DEX) is used for management of severe conditions. However, the multisystem adverse effects induced by glucocorticoids represent a hindering stone toward the effective clinical use of such agents. Various initiatives have been taken to ameliorate these complications with limited success. AIM The present study aims to explore the beneficial effects of roflumilast (ROF), a phosphodiesterase-4 (PDE-4) inhibitor, to combat DEX-induced steatohepatitis, metabolic abnormalities and aortic degeneration. RESULTS The application of ROF (2.5 and 5 mg/kg) has reverted the hepatic and aortic histopathological abnormalities as well as the rise in serum liver enzymes induced by DEX. Such palliative effect is probably attributed to PDE-4 inhibition (↑cAMP) that subsequently regulates multiple effectors. The chemotaxis of inflammatory cells (MCP-1) was inhibited by ROF treatments which was linked to inhibition of extracellular ROS production (MDA and NO) as well as restoration of cellular antioxidant defense (GSH). DEX challenge was associated with activation of the inflammatory pathways including TNF-α/NF-κB and NLRP3/IL-1β that were significantly dampened in the ROF groups. The oxidative stress as well as activation of inflammatory pathways exerted by DEX has contributed to the activation of endoplasmic reticulum stress (CHOP and PERK) posing more threats to the insulted cells, however, fortunately, ROF treatments showed inhibited activation of ER stress sensors and thereby abstaining the cells from inevitable damage. The metabolic abnormalities induced by DEX including elevated fasting insulin and heightened AUC of blood glucose level upon application of oral glucose tolerance test were significantly improved by ROF treatment. CONCLUSION The findings of our study depicted the hepatoprotective and metabolic regulating potentials of ROF in a rat model of DEX- induced steatohepatitis. Thereby, enhancing the overall efficacy and safety of DEX use in management of various disorders.
Collapse
Affiliation(s)
- Mohammed Fulayyih Aloufi
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Sara H Hazem
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.
| | - Rania R Abdelaziz
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Ghada M Suddek
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.
| |
Collapse
|
2
|
Flatley S, Dixon S, Pilsworth E, Dube A, Hoeroldt B, Harrison L, Gleeson D. Diabetes Mellitus in Patients With Autoimmune Hepatitis: Frequency, Risk Factors and Effect on Outcome. Aliment Pharmacol Ther 2025. [PMID: 40342076 DOI: 10.1111/apt.70188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 09/02/2024] [Accepted: 04/30/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Treatment for autoimmune hepatitis (AIH) includes corticosteroids, which are associated with the development of diabetes mellitus (DM). Reported new-onset DM rates in patients with AIH have varied, and predisposing factors and prognostic implications are inadequately characterised. AIM To identify the frequency and predisposing factors for DM in AIH and its association with disease progression and mortality. METHODS Retrospective/prospective single-centre study of 494 patients with AIH presenting 1987-2023, 466 receiving corticosteroids (454 prednisolone, 12 budesonide) and followed for (median (range) 9 (0-36) years). RESULTS Forty-seven patients (10%) already had DM at AIH diagnosis. New-onset DM subsequently developed in another 59 (13%). In those receiving prednisolone, new-onset DM incidence was 8% ± 1% after 1 year and 14% ± 2% after 10 years (14- and 3-fold higher than expected population rate), and was independently associated with older age, non-Caucasian ethnicity, higher initial prednisolone dose, higher BMI at diagnosis and more weight gain after 2 years of follow-up. New-onset DM usually persisted despite stopping prednisolone. New-onset DM and DM at any time were independently associated with all-cause death/transplantation rate, along with previously established risk factors (older age, cirrhosis, lower ALT at diagnosis and failure of early ALT normalisation). New-onset DM and DM at any time were also independently associated with cirrhosis development. Similar associations of new-onset DM and DM at any time with liver-related death/transplantation were significant on univariate but not multivariate analysis. CONCLUSION New-onset DM occurred in 13% of patients with AIH, was related to older age, non-Caucasian ethnicity, higher prednisolone dose, higher BMI at diagnosis and weight gain; and was an independent predictor of all-cause death/transplantation and of cirrhosis development, underlining the need to minimise steroid burden in AIH.
Collapse
Affiliation(s)
- Sarah Flatley
- Liver Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, University of Sheffield Medical School, Sheffield, UK
| | - Selena Dixon
- Liver Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Eleanor Pilsworth
- Liver Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Asha Dube
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Barbara Hoeroldt
- Liver Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Laura Harrison
- Liver Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dermot Gleeson
- Liver Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, University of Sheffield Medical School, Sheffield, UK
| |
Collapse
|
3
|
Burke SJ, Batdorf HM, Ducote MP, Martin TM, Karlstad MD, Noland RC, Ghosh S, Morrison CD, Collier JJ. High-Protein Diet Prevents Glucocorticoid-Induced Fat Mass Accumulation and Hyperglycemia. Int J Mol Sci 2025; 26:4212. [PMID: 40362449 PMCID: PMC12071877 DOI: 10.3390/ijms26094212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2025] [Revised: 04/21/2025] [Accepted: 04/27/2025] [Indexed: 05/15/2025] Open
Abstract
Glucocorticoid-induced diabetes is the most common form of drug-induced hyperglycemia. In addition, chronic exposure to glucocorticoids promotes lean mass loss and fat mass accumulation. In this study, we hypothesized that a high-protein diet (60% kcal; HPD) would help to offset sarcopenia during oral administration of corticosterone to C57BL/6J mice. Carbohydrates were reduced in the HPD to ensure it was isocaloric with the normal-protein diet (20% kcal; NPD). We found that the HPD prevented fat mass accumulation but did not protect against reductions in lean mass in both male and female mice. Mice consuming a HPD did not develop hyperglycemia, while mice given the NPD developed hyperglycemia within two weeks. The HPD diet did not improve insulin sensitivity in response to glucocorticoids but did alter gene expression patterns in adipose tissue and liver measured by RNA sequencing. We conclude that a HPD diet may be beneficial to limit rises in blood glucose and adipose tissue accrual during glucocorticoid therapy.
Collapse
Affiliation(s)
- Susan J. Burke
- Laboratory of Immunogenetics, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Heidi M. Batdorf
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
- Laboratory of Islet Biology and Inflammation, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA;
| | - Maggie P. Ducote
- Laboratory of Immunogenetics, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Thomas M. Martin
- Laboratory of Islet Biology and Inflammation, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA;
| | - Michael D. Karlstad
- Department of Surgery, Graduate School of Medicine, University of Tennessee Health Science Center, Knoxville, TN 37920, USA
| | - Robert C. Noland
- Skeletal Muscle Metabolism Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Sujoy Ghosh
- Laboratory of Computational Biology, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Christopher D. Morrison
- Laboratory of Neurosignaling, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - J. Jason Collier
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
- Laboratory of Islet Biology and Inflammation, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA;
| |
Collapse
|
4
|
Shao T, Lu J, Kang H, Zhang Y, Lan T, Wang J. Diabetes mellitus in patients with myasthenia gravis: a systematic review and meta-analysis. Endocrine 2025; 88:24-35. [PMID: 39729181 DOI: 10.1007/s12020-024-04143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 12/15/2024] [Indexed: 12/28/2024]
Abstract
OBJECTIVES With the prolongation of life expectancy in patients with myasthenia gravis, the number of comorbidities is increasing. Diabetes mellitus is one of the main comorbidities faced by patients with myasthenia gravis. However, there is not enough epidemiological information on diabetes mellitus. Given these limitations, the purpose of this study was to review the prevalence of diabetes mellitus in patients with myasthenia gravis and whether the myasthenia gravis is associated with an increased risk of gestational diabetes mellitus. METHODS PubMed, Embase, and Web of Science were searched for articles published prior to February 2024. Endnote 21 software was used to manage all relevant records. Review Manager version 5.4 and Stata version 18.0 software were used for the statistical analysis. Funnel plots and Egger's test were used to assess publication bias. RESULTS Twenty-four articles met the inclusion criteria and were included in the study. Among 23,516 myasthenia gravis patients, the prevalence of diabetes mellitus was 17% (95% CI 12~22%). In addition, the meta-analysis of the two studies showed that myasthenia gravis was significantly associated with an increased risk of gestational diabetes mellitus (OR = 1.56, 95% CI 1.26~1.93, p < 0.01). CONCLUSIONS Among the comorbidities of myasthenia gravis patients, diabetes mellitus is common, and the risk of gestational diabetes mellitus is increased in myasthenia gravis patients. These findings remind us that diabetes mellitus seems to be an important issue in the clinical management of myasthenia gravis patients and requires more attention.
Collapse
Affiliation(s)
- Tianrui Shao
- Changchun University of Chinese Medicine, Jilin, China
| | - Jing Lu
- Research Center of Traditional Chinese Medicine, The Affiliated Hospital of Changchun University of Chinese Medicine, Jilin, China
| | - Hailan Kang
- Changchun University of Chinese Medicine, Jilin, China
| | - Yibin Zhang
- Department of Encephalopathy, The Affiliated Hospital of Changchun University of Chinese Medicine, Jilin, China
| | - Tianye Lan
- Department of Encephalopathy, The Affiliated Hospital of Changchun University of Chinese Medicine, Jilin, China.
| | - Jian Wang
- Department of Encephalopathy, The Affiliated Hospital of Changchun University of Chinese Medicine, Jilin, China.
| |
Collapse
|
5
|
Wu Y, Yu J, Song H, Lu D, Li Z, Li X, Ding Z, Zhou L, Ma J, Zhang Y, Li Y. Profiling of RNA N6-Methyladenosine methylation reveals the critical role of m6A in betaine alleviating hepatic steatosis. Sci Rep 2025; 15:7298. [PMID: 40025137 PMCID: PMC11873031 DOI: 10.1038/s41598-025-91573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 02/21/2025] [Indexed: 03/04/2025] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major predisposing factor of metabolic dysfunction-associated steatohepatitis, hepatic fibrosis and hepatocellular carcinoma. Abnormal RNA m6A modification leads to the disturbance of lipid metabolism, insulin resistance, and chronic inflammation, all of which are critical for the onset and progression of MASLD. It has been shown that betaine supplementation has an ameliorative effect on symptoms associated with MASLD. The purpose of this study is to explore the role of RNA m6A modification in the alleviation of MASLD by betaine, and to find out the possible targets of betaine. Methylated RNA immunoprecipitation sequencing (MeRIP-seq) and RNA sequencing (RNA-seq) were respectively employed to contrast m6A methylation profiles of livers from high-fat diet mice with betaine supplementation vs. those without betaine supplementation (HB vs. HFD). Functional enrichment analysis showed that up-methylated genes are mainly related to mTOR signaling pathway, Rap1 signaling pathway and MAPK signaling pathway. In addition, differentially expressed mRNAs were enriched in pathways such as promoting lipid catabolism and reducing lipid accumulation. By combining analyses of MeRIP-seq and RNA-seq, we identified 27 genes exhibiting significant differences in m6A abundance and mRNA levels. Notably, a new candidate gene, Trub2, was screened out and identified. Inhibition of Trub2 increased intracellular TG levels in AML12 cells, and this promotion was reduced by betaine, suggesting that betaine reduces intracellular TG levels by increasing Trub2 expression. Our findings in this study provide a new target and a new approach for the treatment of MASLD.
Collapse
Affiliation(s)
- Yuna Wu
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Jingsu Yu
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Haisen Song
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Dehao Lu
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Zhilin Li
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Xiangling Li
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Zhaoxuan Ding
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Lei Zhou
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Jie Ma
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China
| | - Ying Zhang
- School of Life Sciences, Biodiscovery Institute, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Yixing Li
- Guangxi Key Laboratory of Animal Breeding, Disease Control and Prevention, College of Animal Science and Technology, Guangxi University, Nanning, 530004, China.
| |
Collapse
|
6
|
Paydas S, Gergerli MA, Celik A. Hypokalemic periodic paralysis, a rare yet critical condition: A case report. MEDICINE INTERNATIONAL 2025; 5:21. [PMID: 40013235 PMCID: PMC11863296 DOI: 10.3892/mi.2025.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 01/30/2025] [Indexed: 02/28/2025]
Abstract
Hypokalemic periodic paralysis (HPP) is a rare disease. Due to channelopathy caused by mutations in skeletal muscle ion channels, episodes of sudden flaccid muscle weakness and hypokalemia develop as a result of various trigger factors. The present study reports the case of a 25-year-old male patient with HPP admitted with acute onset numbness and paralysis in the extremities accompanying hypokalemia (2.66 mEq/l). The patient became asymptomatic following treatment with a potassium (K) supplement and was diagnosed with HPP. The present study describes this case of HPP in an aim to remind colleagues of the possibility of HPP in hypokalemic patients with muscle weakness and flaccid paralysis.
Collapse
Affiliation(s)
| | - Mehmet Ali Gergerli
- Mehmet Akif Inan Training and Research Hospital, Republic of Turkey Ministry of Health, Şanlıurfa 63040, Turkey
| | - Ahmet Celik
- Mehmet Akif Inan Training and Research Hospital, Republic of Turkey Ministry of Health, Şanlıurfa 63040, Turkey
| |
Collapse
|
7
|
Iwasaki R, Kitaguchi Y, Morimoto T, Nishida K. Postoperative outcomes of biopsy versus debulking surgery for immunoglobulin G4-related ophthalmic disease: a retrospective comparative study. Jpn J Ophthalmol 2025; 69:203-213. [PMID: 39832019 PMCID: PMC12003488 DOI: 10.1007/s10384-024-01157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 11/29/2024] [Indexed: 01/22/2025]
Abstract
PURPOSE To compare the postoperative outcomes of corticosteroid therapy following biopsy with those following debulking surgery in patients with immunoglobulin G4 (IgG4)-related ophthalmic disease (IgG4-ROD). STUDY DESIGN Retrospective comparative study. METHODS Fifteen patients diagnosed with IgG4-ROD (5 unilateral, 10 bilateral) were retrospectively analyzed. IgG4-ROD was diagnosed based on imaging, histopathology, and blood test results. The biopsy group included patients who underwent resection of minimal tissue for diagnosis, whereas the debulking group included patients who underwent resection of a substantial portion of the mass to decrease the tumor size. Postoperative outcomes after steroid administration, recurrence rates, and changes in lacrimal gland function were compared between the groups. RESULTS The biopsy and debulking groups included seven and eight patients, respectively. All patients in the biopsy group and 25% of patients in the debulking group required steroid treatment postoperatively (p = 0.0070). Relapse occurred in 71.4% and 12.5% (p = 0.041) and maintenance therapy was required in 57.1% and 12.5% (p = 0.12) patients in the biopsy and debulking groups, respectively. Twelve patients had extraorbital lesions, with one patient receiving corticosteroid treatment for sphenoid bone lesion. Schirmer I test values did not differ preoperatively and postoperatively in either group (biopsy: p = 0.47; debulking: p = 0.72). One patient from the biopsy group developed severe dry eyes, necessitating lacrimal canalicular excision. CONCLUSIONS Debulking surgery effectively reduced the requirement for postoperative steroid administration for recurrent lacrimal gland lesion in patients with IgG4-ROD, indicating its potential as an effective alternative to current standard treatment.
Collapse
Affiliation(s)
- Rikako Iwasaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Yoshiyuki Kitaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan.
| | - Takeshi Morimoto
- Division of Health Science, Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan
- Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Osaka, Japan
| |
Collapse
|
8
|
Li JH, Zuo YG. The "entanglement" between bullous pemphigoid and diabetes mellitus: a comprehensive review and expert recommendations. Expert Rev Clin Immunol 2025; 21:333-346. [PMID: 39521622 DOI: 10.1080/1744666x.2024.2428621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 11/08/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Bullous pemphigoid (BP) is an autoimmune bullous disease characterized by subepidermal tense blisters, accompanied by urticarial or eczema-like lesions. Circulating autoantibodies in BP patients target BP180 and BP230 at the dermal-epidermal junction. There has been a growing interest in unraveling the intricate relationship between BP and diabetes mellitus (DM), but a comprehensive review is lacking. AREAS COVERED A thorough search of PubMed was conducted to identify studies concerning the association between BP and DM (1978-2023). Our findings comprehensively summarize the intricate association between BP and DM, focusing on the characteristics, potential pathomechanisms, and the influence of various antidiabetic medications on BP development. EXPERT OPINION DM emerges as a prevalent comorbidity and potential risk factor for BP. New-onset DM can manifest during BP treatment, primarily due to corticosteroid therapy. Among all antidiabetic medications, dipeptidyl peptidase-IV inhibitors (DPP-4i) have the most solid association with BP onset. Other antidiabetic medications have also been reportedly associated with BP, including meglitinides, glucagon-like peptide 1 (GLP-1)-receptor agonists, and sodium-dependent glucose transporters 2 inhibitors (SGLT-2i). We suggest prescribing DPP-4i in caution for elderly DM patients with a history of autoimmune diseases.
Collapse
Affiliation(s)
- Jing-Hui Li
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- School of Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Ya-Gang Zuo
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| |
Collapse
|
9
|
Mueller KT, Saavedra AA, O'Keeffe LA, Sparks JA. Patient-Centric Approach for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease in Older People. Drugs Aging 2025; 42:81-94. [PMID: 39800810 DOI: 10.1007/s40266-024-01175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2024] [Indexed: 02/06/2025]
Abstract
PURPOSE OF REVIEW The purpose of this review is to outline considerations for treating older adults with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) as it relates to infection, comorbidities, cancer, and quality of life. RECENT FINDINGS The recent 2023 American College of Rheumatology/American College of Chest Physicians guideline conditionally recommended specific disease-modifying antirheumatic drugs (DMARDs), antifibrotics, and short-term glucocorticoids to treat RA-ILD. Since RA-ILD often affects older adults, we contextualize these pharmacologic options related to infection, gastrointestinal (GI) effects, cancer, cardiovascular disease, and quality of life. Nearly all DMARDs and glucocorticoids are immunosuppressive and increase infection risk. Rituximab, mycophenolate, cyclophosphamide, and glucocorticoids may have particularly high infection risk. Many therapies recommended for treating RA-ILD have potential GI side effects. Antifibrotics have a high rate of nausea and diarrhea. Janus kinase inhibitors may increase risk of cancer and cardiovascular disease in older people. In older individuals, decisions must weigh the risks and benefits of drug options while considering clinical and social factors such as polypharmacy, adherence, cost, convenience, and social support. Management of RA-ILD in older individuals is complex and should consider risks and benefits, while optimizing quality and quantity of life through a shared decision-making process.
Collapse
Affiliation(s)
- Kevin T Mueller
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, no. 6016U, Boston, MA, 02115, USA
| | - Alene A Saavedra
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, no. 6016U, Boston, MA, 02115, USA
| | - Lauren A O'Keeffe
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, no. 6016U, Boston, MA, 02115, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, no. 6016U, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
10
|
Wanas AM, Giacuzzo C, Ghazi-Nouri S, Tan LT. Intravenous methylprednisolone-induced hypokalaemic periodic paralysis in a thyrotoxic patient: a case report and literature review. Orbit 2025; 44:77-81. [PMID: 38186318 DOI: 10.1080/01676830.2023.2296553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Abstract
Hypokalaemic periodic paralysis (HPP) is an uncommon complication of corticosteroid therapy, which may also be seen in thyrotoxicosis. It was mostly described in the Asian population, and it is rare in other ethnic groups. We present the case of a poorly controlled thyrotoxic Caucasian male with thyroid eye disease (TED) who suffered an acute quadriplegic episode caused by severe hypokalaemia and was admitted to the intensive care unit (ITU) within 24 hours of initiating intravenous methylprednisolone (IVMP) infusion. Once his potassium blood levels were repleted, he completely recovered from the episode. Although HPP is rare in the Caucasian population, it can be precipitated in thyrotoxic patients by systemic steroids. Caution should be exercised when administering IVMP in poorly controlled thyrotoxic patients, and we suggest monitoring the potassium levels at regular intervals with ECG monitoring for at least 24 hours in at-risk individuals.
Collapse
Affiliation(s)
- Ahmed Magid Wanas
- Department of Ophthalmology, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Clarice Giacuzzo
- Department of Ophthalmology, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Seyed Ghazi-Nouri
- Department of Ophthalmology, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Lee Teak Tan
- Department of Ophthalmology, Mid and South Essex NHS Foundation Trust, Essex, UK
| |
Collapse
|
11
|
Choi YJ, Jeon SM, Yu S, Jo HS, Kim DS, Yu YD. Accuracy and feasibility of continuous glucose monitoring system in pancreatectomy patients. Langenbecks Arch Surg 2025; 410:32. [PMID: 39792174 DOI: 10.1007/s00423-024-03601-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 12/29/2024] [Indexed: 01/12/2025]
Abstract
PURPOSE Pancreatectomy patients often experience challenging fluctuations in blood glucose levels; therefore, they require a reliable monitoring system. This study aimed to determine the accuracy and acceptability of a continuous glucose monitoring (CGM) system compared with the intermittent capillary glucose test in patients who have undergone pancreatectomy. METHODS Thirty non-diabetic pancreatectomy patients participated. We used the FreeStyle Libre Flash Glucose Monitoring System (Abbott Diabetes Care) for continuous interstitial glucose monitoring. Capillary reference glucose levels were checked four times daily. Accuracy was checked using the Clarke Error Grid. RESULTS The mean age of the participants was 56.8 ± 12.0 years, of whom 61.3% underwent pancreaticoduodenectomy and 38.7% underwent distal pancreatectomy. Three patients developed pancreatogenic diabetes after pancreatectomy. The clinical accuracy of continuous glucose monitoring compared with capillary glucose was 43.9% in Zone A (clinically accurate zone) and 99.8% in Zone A + B (low risk of error) of the Clarke Error Grid. No device-related adverse events were reported. Patients rated favorable user acceptability on the questionnaire. CONCLUSION This pilot study demonstrated that the CGM device is accurate and safe for patients who underwent pancreatectomy, with favorable user acceptability. Despite these challenges, the study proposes that the CGM device is beneficial for monitoring glucose levels after discharge in patients with impaired glucose levels following pancreatectomy.
Collapse
Affiliation(s)
- Yoo Jin Choi
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, Seoul, Korea
| | - Su Min Jeon
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, Seoul, Korea
| | - Sehyeon Yu
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, Seoul, Korea
| | - Hye-Sung Jo
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, Seoul, Korea
| | - Dong-Sik Kim
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, Seoul, Korea
| | - Young-Dong Yu
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, Seoul, Korea.
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea.
| |
Collapse
|
12
|
Cho MH, Jung J, Koo HY, Jung W, Han K, Cho IY, Shin DW. Effects of smoking behavior change on diabetes incidence after cancer development: A nationwide cohort study. DIABETES & METABOLISM 2025; 51:101604. [PMID: 39709168 DOI: 10.1016/j.diabet.2024.101604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 12/11/2024] [Accepted: 12/13/2024] [Indexed: 12/23/2024]
Abstract
AIM Cigarette smoking and diabetes mellitus (DM) increase risks of cardiovascular diseases and all-cause mortality in cancer survivors. An increased risk of DM incidence in cancer survivors has been observed and smoking is an important modifiable risk factor for DM development in the general population. Thus, we investigated the association between smoking behavior change after cancer diagnosis and DM incidence in cancer survivors. METHODS This retrospective cohort study using the Korean National Health Insurance System database included patients with newly diagnosed cancers between 2010 and 2016. Smoking behavior changes after cancer diagnosis were categorized as never smoker, ex-smoker, quitter, smoking starter, and persistent smoker. The associations between smoking behavior changes and DM incidence in overall and specific cancers were investigated using Cox regression analyses. RESULTS Of the 263,940 cancer survivors, 67.6 % were never smokers, 16.0 % were ex-smokers, 9.3 % were quitters, 1.0 % were smoking starters, and 6.2 % were persistent smokers. During a mean follow-up of 4.0 years, 12,175 patients were diagnosed with DM after cancer development. Compared to the never smokers, the adjusted hazard ratios (95 % confidential interval) of DM incidence were 1.06 (1.00-1.13) for ex-smokers, 1.45 (1.35-1.54) for quitters, 1.46 (1.25-1.71) for starters, and 1.57 (1.45-1.69) for persistent smokers. CONCLUSION Compared with never smokers, cancer survivors who engaged smoking at any point before or after cancer diagnosis showed an increased risk of DM incidence after cancer diagnosis. Cancer survivors should be advised to quit smoking promptly and to maintain abstinence throughout cancer survivorship.
Collapse
Affiliation(s)
- Mi Hee Cho
- Samsung C&T Medical Clinic, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinhyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Hye Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wonyoung Jung
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - In Young Cho
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea; Center for Trend sensing-Risk modeling, Institution of Quality of Life in Cancer, Samsung Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
13
|
Campo AO, Valderrama P, Bravo M, Baca A. The 100 most influential articles in mouth breathing. A bibliometric and altmetric analysis: 2002-2021. Med Oral Patol Oral Cir Bucal 2025; 30:e97-e106. [PMID: 39582406 PMCID: PMC11801686 DOI: 10.4317/medoral.26845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 10/08/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND This study aimed to identify and analyze the most influential Mouth Breathing (MB) articles in children and adolescents with the highest relative citation rates (RCRs), through bibliometric and altmetric analysis, from 2002 to 2021. MATERIAL AND METHODS On March 27, 2023 a PubMed search was conducted to detect papers published about MB. From a total of 826 documents, the article data were downloaded from iCite database. The 100 articles with the highest RCRs were selected for analysis in terms of RCR, citations, altmetric attention score, year, journal, first author (name, institution, country), subfield and design of study. The key words were analyzed using Vosviewer. RESULTS Among the 100 articles, there were no differences between the two periods analyzed for RCR and AAS values, yet 2002-11 was more cited than 2012-2021. There was no correlation between RCR and AAS; but there was with citations. Brazil was the most cited country (n=30). The articles were published in 48 journals pertaining to 8 categories, 44 corresponding to Dentistry. The most frequent study design was the cross-sectional (n=48). Although all subfields were well represented, the most frequent ones were "treatment", "sleep disorders" and "clinical characteristics/cephalometry". The most prominent keywords were "malocclusion" and "cephalometry". CONCLUSIONS Using RCR, a time- and field-normalized metric, one can identify influential articles in MB, a multidisciplinary research field of great importance for orthodontics. Because this bibliometric approach reduces the time from publication to the detection of an article´s importance for readers, it could be a valid alternative to using citation counts.
Collapse
Affiliation(s)
- A-O Campo
- Department of Information and Communication Faculty of Communication and Documentation Colegio Máximo. Campus de Cartuja s/n University of Granada, 18071 Granada, Spain
| | | | | | | |
Collapse
|
14
|
Libório H, Borges T, Pereira M, Ross W, Fernandes JC, Fernandes GV, Leitão-Almeida B. The use of methylprednisolone after third molar surgery. A systematic review and meta-analysis of randomized controlled trials. Med Oral Patol Oral Cir Bucal 2025; 30:e86-e96. [PMID: 39724528 PMCID: PMC11801684 DOI: 10.4317/medoral.26842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 12/02/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Extraction of impacted third molars is a standard procedure in dentistry. However, the postoperative inflammation and pain are undesired and uncomfortable. Methylprednisolone has emerged as a possible solution to improve outcomes. This systematic review aimed to evaluate methylprednisolone in the postoperative period of impacted third molars in relation to its efficacy in postoperative pain and edema, dosage regimens, administration forms, and adverse effects. MATERIAL AND METHODS Following the PRISMA guidelines, the focus question was: "In patients who underwent impacted third molar extraction, what was the effect of methylprednisolone used postoperatively compared to non-use or the use of other medications within the same pharmacotherapeutic group to reduce inflammation and pain?" PubMed/MEDLINE and Scopus were consulted, and an additional manual was performed. The search included articles published in the last 10 years, with the language restriction to English. The articles were analyzed using the PRISMA principles, with pre-defined eligibility criteria. The data were extracted based on the general necessary information. The risk of bias for the RCTs included was performed using a revised Cochrane risk-of-bias tool for randomized trials, and a meta-analysis was performed. RESULTS Nine articles were included, and five were quantitatively analyzed. Evaluating the test and control groups (methylprednisolone versus controls), there was no significant heterogeneity for pain at 24 hours (p=0.15, I²=47%) and 7 days (p=0.15, I²=47%), with non-significant effects (p=0.85). In the inter-incisal reduction, there was homogeneity at 48 hours (p=0.96, I²=0%) and 7 days (p=0.37, I²=0%), with a greater reduction in the methylprednisolone group (p<0.01 and p<0.05, respectively). CONCLUSIONS Methylprednisolone is efficient in safely treating patients after third molar extraction, reducing pain, edema, and trismus. It achieved better results for the inter-incisal level than dexamethasone; otherwise, dexamethasone is preferable in minimizing postoperative trismus, presenting superior potential in this specific clinical context.
Collapse
Affiliation(s)
- H Libório
- 1500 Park Ave., St. Louis 63104, MO, U.S.A. ;
| | | | | | | | | | | | | |
Collapse
|
15
|
Hamed AM, Elbahy DA, Ahmed ARH, Thabet SA, Refaei RA, Ragab I, Elmahdy SM, Osman AS, Abouelella AMA. Comparison of the efficacy of curcumin and its nano formulation on dexamethasone-induced hepatic steatosis, dyslipidemia, and hyperglycemia in Wistar rats. Heliyon 2024; 10:e41043. [PMID: 39759349 PMCID: PMC11696662 DOI: 10.1016/j.heliyon.2024.e41043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 12/04/2024] [Accepted: 12/05/2024] [Indexed: 01/07/2025] Open
Abstract
Background and objective Insulin resistance is a primary feature of type 2 diabetes. This study compared the effects of curcumin and its nanoformulation on insulin resistance, fasting blood sugar, liver function, GLUT4, lipid profile, and oxidative stress in the liver and pancreas in a diabetic model. Methods Thirty male Wistar rats were divided into five groups: a control group, a diabetic group, a diabetic group treated with metformin (40 mg/kg), a diabetic group treated with curcumin (100 mg/kg), and a diabetic group treated with curcumin NPs (100 mg/kg). Diabetes was induced by injecting dexamethasone daily for 14 days. Treatment with curcumin and curcumin NPs was administered by gavage for 14 days. Body weight and fasting blood sugar levels were measured on days 1, 14, and 28. Results The metformin, curcumin, and curcumin NPs groups showed significantly greater body weight gain than the untreated diabetic group (P < 0.001). In diabetic rats treated with curcumin and curcumin NPs, insulin resistance decreased by approximately 40 %, while fasting blood sugar levels dropped by 35-40 % (P < 0.001). The levels of liver enzymes (AST, ALT), cholesterol, triglycerides, LDL, and the oxidative stress marker MDA in liver and pancreatic tissues were reduced by 30-50 %. Additionally, beneficial markers such as albumin, HDL, antioxidants (GSH, SOD), and GLUT4 levels were increased by 25-45 % (P < 0.001). Nano-curcumin consistently showed greater improvements than curcumin, especially in reducing oxidative stress and supporting liver and pancreatic health. Conclusion This study demonstrates that curcumin NPs has a superior effect on reducing oxidative stress and improving metabolic parameters in diabetes compared to curcumin. by enhancing the bioavailability and stability of curcumin, the nanoformulation showed stronger therapeutic potential for managing high blood sugar, cholesterol issues, and liver health, positioning curcumin NPs as a promising alternative to conventional treatments for diabetes and its complications.
Collapse
Affiliation(s)
- Amany M. Hamed
- Chemistry Department, Faculty of Science, Sohag University, Sohag, Egypt
| | - Dalia A. Elbahy
- Department of Clinical Pharmacology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed RH. Ahmed
- Department of Pathology, faculty of medicine, Sohag University, Sohag, Egypt
| | - Shymaa A. Thabet
- Central Research Center, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Islam Ragab
- Department of Chemistry, College of Science, Qassim University, Buraidah, 51452, Saudi Arabia
| | | | - Ahmed S. Osman
- Department of Biochemistry, Faculty of Veterinary Medicine, Sohag University, Sohag, Egypt
| | - Azza MA. Abouelella
- Department of Clinical Pharmacology, Faculty of Medicine, Sohag University, Sohag, Egypt
| |
Collapse
|
16
|
Gao F, Shen Y, Wu H, Laue HE, Lau FK, Gillet V, Lai Y, Shrubsole MJ, Prada D, Zhang W, Liu Z, Bellenger JP, Takser L, Baccarelli AA. Associations of Stool Metal Exposures with Childhood Gut Microbiome Multiomics Profiles in a Prospective Birth Cohort Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:22053-22063. [PMID: 39630952 DOI: 10.1021/acs.est.4c09642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
Metal exposures are closely related to childhood developmental health. However, their effects on the childhood gut microbiome, which also impacts health, are largely unexplored using microbiome multiomics including the metagenome and metatranscriptome. This study examined the associations of fecal profiles of metal/element exposures with gut microbiome species and active functional pathways in 8- to 12-year-old children (N = 116) participating in the GESTation and Environment (GESTE) cohort study. We analyzed 19 stool metal and element concentrations (B, Na, Mg, Al, K, Ca, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Mo, Cd, Ba, and Pb). Covariate-adjusted linear regression models identified several significant microbiome associations with continuous stool metal/element concentrations. For instance, Zn was positively associated with Turicibacter sanguinis (coef = 1.354, q-value = 0.039) and negatively associated with Eubacterium eligens (coef = -0.794, q-value = 0.044). Higher concentrations of Cd were associated with lower Eubacterium eligens (coef = -0.774, q-value = 0.045). Additionally, a total of 490 significant functional pathways such as biosynthesis and degradation/utilization/assimilation were identified, corresponding to different functions, including amino acid synthesis and carbohydrate degradation. Our results suggest links among metal exposures, pediatric gut microbiome multiomics, and potential health implications. Future work will further explore their relation to childhood health.
Collapse
Affiliation(s)
- Feng Gao
- Department of Environmental Health Sciences, Fielding School of Public Health, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California 90095, United States
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032, United States
| | - Yike Shen
- Department of Earth and Environmental Sciences, University of Texas at Arlington, Arlington, Texas 76019, United States
| | - Haotian Wu
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032, United States
| | - Hannah E Laue
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts 01003, United States
| | - Fion K Lau
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Virginie Gillet
- Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Yunjia Lai
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032, United States
| | - Martha J Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Diddier Prada
- Institute for Health Equity Research - IHER, Department of Population Health Science and Policy and the Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Zhonghua Liu
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York 10032, United States
| | | | - Larissa Takser
- Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Andrea A Baccarelli
- Office of the Dean, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| |
Collapse
|
17
|
Gianchandani R, Wei M, Demidowich A. Management of Hyperglycemia in Hospitalized Patients. Ann Intern Med 2024; 177:ITC177-ITC192. [PMID: 39652876 DOI: 10.7326/annals-24-02754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2024] Open
Abstract
People with diabetes account for 25% of hospitalizations, or 8 million admissions annually. Poor glycemic control in the hospital is associated with increased morbidity, mortality, length of stay, and readmissions. Key considerations of inpatient diabetes management include initiation of appropriate insulin or medication regimens and frequent dose adjustments based on patient-specific factors. Inpatient diabetes management teams and new technologies are increasingly prevalent and can assist in achieving glycemic targets in the hospital. At discharge, standardized checklists should be used to ensure successful transitions of care.
Collapse
Affiliation(s)
- Roma Gianchandani
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California (R.G., M.W.)
| | - Margaret Wei
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California (R.G., M.W.)
| | - Andrew Demidowich
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (A.D.)
| |
Collapse
|
18
|
Kato A, Fuwa M, Asano M, Mori I, Iida S, Okada H, Uno Y, Fujioka K, Morita H. Development and validation of a predictive scoring system for hypoglycaemic agents for optimal control of blood glucose during glucocorticoid therapy. Intern Med J 2024. [PMID: 39440721 DOI: 10.1111/imj.16547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 09/24/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Glucocorticoid (GC) treatments are often used. There is limited information on the prediction of hyperglycaemia after GC administration. AIMS This study aimed to identify the risk factors for hyperglycaemia after glucocorticoid (GC) administration and the need for hypoglycaemic agents to correct it and to develop and validate a novel scoring system for predicting GC-induced hyperglycaemia. METHODS In a development set, 508 adults receiving prednisolone (PSL) for the first time were divided into two groups based on treatment with or without hypoglycaemic agents. Clinical and laboratory parameters were compared, and risk factors were identified using logistic regression analysis after performing univariate analyses between the two groups. A point-addition scoring system with several categories and coefficients for each risk factor was constructed to predict the need for hypoglycaemic agents. The scoring system was then applied and validated on two validation sets: A and B. RESULTS Older age, higher glycated haemoglobin percentage, body mass index and initial PSL dosage were identified as risk factors. The sensitivity, specificity and accuracy of the scoring system were 70.6%, 81.9% and 77.1% in the development set; 75.8%, 78.4% and 77.4% in validation set A; and 79.4%, 73.9% and 75.3% in validation set B respectively. By fitting the total score in the development set and the probability of hyperglycaemia to a logistic curve, a figure was created to show the probability of GC-induced hyperglycaemia in patients scheduled to receive GC. CONCLUSION This scoring system is a novel, valid and reliable tool for predicting GC-induced hyperglycaemia and the need for hypoglycaemic agents to correct it.
Collapse
Affiliation(s)
- Ayaka Kato
- Department of General Medicine and General Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masayuki Fuwa
- Department of General Medicine and General Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Motochika Asano
- Department of General Medicine and General Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ichiro Mori
- Department of General Medicine and General Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Saori Iida
- Department of General Internal Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Hideyuki Okada
- Department of General Internal Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yoshihiro Uno
- Department of General Internal Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kei Fujioka
- Center of General Internal Medicine and Rheumatology, Gifu Municipal Hospital, Gifu, Japan
| | - Hiroyuki Morita
- Department of General Medicine and General Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|
19
|
Sparling K, Butler DC. Oral Corticosteroids for Skin Disease in the Older Population: Minimizing Potential Adverse Effects. Drugs Aging 2024; 41:795-808. [PMID: 39285122 DOI: 10.1007/s40266-024-01143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 10/16/2024]
Abstract
Corticosteroids play a crucial role as anti-inflammatory and immunomodulatory agents in dermatology and other medical specialties; however, their therapeutic benefits are accompanied by significant risks, especially in older adults. This review examines the broad spectrum of adverse effects (AEs) associated with oral corticosteroid therapy and offers strategies to prevent, monitor, and manage these issues effectively in older adults. AEs associated with systemic corticosteroids include immune suppression, gastrointestinal problems, hyperglycemia, insulin resistance, weight gain, cardiovascular complications, ocular issues, osteoporosis, osteonecrosis, muscle weakness, collagen impairment, psychiatric symptoms, and adrenal suppression. To minimize these AEs, tailored dosing and duration, frequent monitoring, and additional preventative measures can be employed to optimize corticosteroid treatment. By customizing management plans to the specific needs and risk factors associated with each patient, clinicians can promote the safe and effective use of oral corticosteroids, ultimately improving outcomes and quality of life in patients with inflammatory dermatologic disorders.
Collapse
Affiliation(s)
- Kennedy Sparling
- University of Arizona, College of Medicine - Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA.
| | - Daniel C Butler
- University of Arizona, College of Medicine - Tucson, Tucson, AZ, USA
| |
Collapse
|
20
|
Vainer N, Rotbain Curovic V, Niemann CU, Slager SL, Rotbain EC. Understanding the interplay between chronic lymphocytic leukemia and type 2 diabetes. Expert Rev Hematol 2024; 17:617-629. [PMID: 39041465 DOI: 10.1080/17474086.2024.2383417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Comorbidities play an important role in the management of chronic lymphocytic leukemia (CLL) and may influence survival and treatment outcomes. Considering the aging general population and increasing incidence of type 2 diabetes (T2D), a comprehensive understanding of the interplay between CLL and T2D is essential for optimizing care and outcomes. AREAS COVERED We present current knowledge on co-existing CLL and T2D including prevalence, shared etiology and risk factors and how the conditions and treatment hereof may influence the outcome of one another. A literature search was performed using PubMed with the cutoff date on 1 February 2024. EXPERT OPINION The increased mortality observed in persons with CLL who have co-existing T2D is partially ascribed to infections, prompting physicians managing individuals with both conditions to consider closer monitoring during instances of infection and individualized prophylaxis. People with CLL and T2D should be managed for CLL in accordance with the international working group on CLL criteria, and we recommend that physicians exercise particular care not to delay treatment for these individuals. Multidisciplinary approaches with involvement of several specialties may be required for optimal supportive care of co-occurring T2D and CLL.
Collapse
Affiliation(s)
- Noomi Vainer
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Hematology Group, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susan L Slager
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emelie Curovic Rotbain
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Hematology Group, Danish Cancer Institute, Copenhagen, Denmark
| |
Collapse
|
21
|
Agarwal K, Kirti R, Shyama S, Kumar P, Biswas R, Ojha VS. Long-term outcome of patients with diabetic-range hyperglycemia first detected during admission for COVID-19: A single-center observational study. J Family Med Prim Care 2024; 13:3374-3380. [PMID: 39228533 PMCID: PMC11368375 DOI: 10.4103/jfmpc.jfmpc_140_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 09/05/2024] Open
Abstract
Background and Objective Diabetic-range hyperglycemia has been reported for the first time in many patients during their hospitalization with coronavirus disease 2019 (COVID-19). This study was undertaken to determine the proportion of such patients who actually have new-onset diabetes mellitus rather than transient hyperglycemia during acute illness. Methods This descriptive study included patients with diabetic-range hyperglycemia first detected at or during admission for COVID-19 but no prior history of diabetes. The study protocol involved patient identification, data recording from the case-notes, and telephonic follow-ups. Blood sugar levels done at least two weeks after discharge or the last dose of steroids, whichever was later, were recorded, and patients were categorized as diabetic, pre-diabetic, or non-diabetic accordingly. Results Out of 86 patients, ten (11.6%) were found to have developed diabetes, and 13 (15.1%) had pre-diabetes on follow-up. About 63 (73.3%) patients had become normoglycemic. Eight (80%) out of the ten patients with new-onset diabetes were on treatment, with five (50%) achieving the target glycemic levels. The associations of new-onset diabetes with age, gender, comorbidities, intensive care stay, and steroid administration were not found to be statistically significant (p-values 0.809, 0.435, 0.324, 0.402, and 0.289, respectively). Interpretation and Conclusions While a majority of post-COVID patients with diabetic-range hyperglycemia returned to a normoglycemic state after the acute illness had settled down, one in ten developed new-onset diabetes, and an additional one in seven had impaired glucose tolerance. Thus, regular glucose screening is crucial for such patients and lifestyle modifications should be encouraged to reduce the risk of diabetes. Loss to follow-up and reliance on a single set of blood sugar readings for classification were some of the limitations of this study.
Collapse
Affiliation(s)
- Ketan Agarwal
- Department of General Medicine, All India Institute of Medical Sciences Patna, Phulwari Sharif, Patna, Bihar, India
| | - Ravi Kirti
- Department of General Medicine, All India Institute of Medical Sciences Patna, Phulwari Sharif, Patna, Bihar, India
| | - Shyama Shyama
- Department of General Medicine, All India Institute of Medical Sciences Patna, Phulwari Sharif, Patna, Bihar, India
| | - Pragya Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences Patna, Phulwari Sharif, Patna, Bihar, India
| | - Ratnadeep Biswas
- Department of General Medicine, All India Institute of Medical Sciences Patna, Phulwari Sharif, Patna, Bihar, India
| | - Vishnu S. Ojha
- Department of General Medicine, All India Institute of Medical Sciences Patna, Phulwari Sharif, Patna, Bihar, India
| |
Collapse
|
22
|
Oliveras L, Coloma A, Lloberas N, Lino L, Favà A, Manonelles A, Codina S, Couceiro C, Melilli E, Sharif A, Hecking M, Guthoff M, Cruzado JM, Pascual J, Montero N. Immunosuppressive drug combinations after kidney transplantation and post-transplant diabetes: A systematic review and meta-analysis. Transplant Rev (Orlando) 2024; 38:100856. [PMID: 38723582 DOI: 10.1016/j.trre.2024.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/16/2024]
Abstract
Post-transplant diabetes mellitus (PTDM) is a frequent complication after kidney transplantation (KT). This systematic review investigated the effect of different immunosuppressive regimens on the risk of PTDM. We performed a systematic literature search in MEDLINE and CENTRAL for randomized controlled trials (RCTs) that included KT recipients with any immunosuppression and reported PTDM outcomes up to 1 October 2023. The analysis included 125 RCTs. We found no differences in PTDM risk within induction therapies. In de novo KT, there was an increased risk of developing PTDM with tacrolimus versus cyclosporin (RR 1.71, 95%CI [1.38-2.11]). No differences were observed between tacrolimus+mammalian target of rapamycin inhibitor (mTORi) and tacrolimus+MMF/MPA, but there was a tendency towards a higher risk of PTDM in the cyclosporin+mTORi group (RR 1.42, 95%CI [0.99-2.04]). Conversion from cyclosporin to an mTORi increased PTDM risk (RR 1.89, 95%CI [1.18-3.03]). De novo belatacept compared with a calcineurin inhibitor resulted in 50% lower risk of PTDM (RR 0.50, 95%CI [0.32-0.79]). Steroid avoidance resulted in 31% lower PTDM risk (RR 0.69, 95%CI [0.57-0.83]), whereas steroid withdrawal resulted in no differences. Immunosuppression should be decided on an individual basis, carefully weighing the risk of future PTDM and rejection.
Collapse
Affiliation(s)
- Laia Oliveras
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain; Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Ana Coloma
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain
| | - Nuria Lloberas
- Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Luis Lino
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain
| | - Alexandre Favà
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain
| | - Anna Manonelles
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain; Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Sergi Codina
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain; Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Carlos Couceiro
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain; Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Edoardo Melilli
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain; Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Adnan Sharif
- Department of Nephrology and Transplantation, University Hospitals Birmingham, Birmingham, United Kingdom; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Manfred Hecking
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Josep M Cruzado
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain; Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Julio Pascual
- Hospital 12 de Octubre, Nephrology Department, Madrid, Spain.
| | - Nuria Montero
- Hospital Universitari de Bellvitge, Nephrology Department. L'Hospitalet de Llobregat, Spain; Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain.
| |
Collapse
|
23
|
Zheng D, Hong X, He X, Lin J, Fan S, Wu J, Liang Z, Chen S, Yan L, Ren M, Wang W. Intermittent Fasting-Improved Glucose Homeostasis Is Not Entirely Dependent on Caloric Restriction in db/db Male Mice. Diabetes 2024; 73:864-878. [PMID: 38502858 PMCID: PMC11109801 DOI: 10.2337/db23-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
Intermittent fasting (IF), which involves prolonged fasting intervals accompanied by caloric restriction (CR), is an effective dietary treatment for obesity and diabetes. Although IF offers many benefits, it is difficult to determine whether these benefits are the consequences of CR. Every-other-day feeding (EODF) is a commonly used IF research model. This study was designed to identify factors, in addition to CR, responsible for the effects of EODF and the possible underlying mechanisms. Diabetic db/db mice were divided into three groups: ad libitum (AL), meal feeding (MF), and EODF. The MF model was used to attain a level of CR comparable to that of EODF, with food distribution evenly divided between 10:00 a.m. and 6:00 p.m., thereby minimizing the fasting interval. EODF yielded greater improvements in glucose homeostasis than MF in db/db mice by reducing fasting glucose levels and enhancing glucose tolerance. However, these effects on glucose metabolism were less pronounced in lean mice. Furthermore, ubiquitination of the liver-specific glucocorticoid (GC) receptor (GR) facilitated its degradation and downregulation of Kruppel-like factor 9 (KLF9), which ultimately suppressed liver gluconeogenesis in diabetic EODF mice. Although GR and KLF9 might mediate the metabolic benefits of EODF, the potential benefits of EODF might be limited by elevated serum GC levels in diabetic EODF mice. Overall, this study suggests that the metabolic benefits of EODF in improving glucose homeostasis are independent of CR, possibly because of the downstream effects of liver-specific GR degradation. ARTICLE HIGHLIGHTS
Collapse
Affiliation(s)
- Dinghao Zheng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Xiaosi Hong
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Xiaodan He
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Jianghong Lin
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Shujin Fan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Jinli Wu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Zhuoxian Liang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Sifan Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-sen Memorial Hospital, Foshan, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Meng Ren
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
| | - Wei Wang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Metabolic Diseases, Guangzhou, China
- Department of Endocrinology, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
24
|
Jensen ASH, Ytting H, Werge MP, Rashu EB, Hetland LE, Thing M, Nabilou P, Burisch J, Bojsen-Møller KN, Junker AE, Hobolth L, Mortensen C, Tofteng F, Bendtsen F, Møller S, Vyberg M, Serizawa RR, Gluud LL, Wewer Albrechtsen NJ. Patients with autoimmune liver disease have glucose disturbances that mechanistically differ from steatotic liver disease. Am J Physiol Gastrointest Liver Physiol 2024; 326:G736-G746. [PMID: 38625142 DOI: 10.1152/ajpgi.00047.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
Autoimmune liver diseases are associated with an increased risk of diabetes, yet the underlying mechanisms remain unknown. In this cross-sectional study, we investigated the glucose-regulatory disturbances in patients with autoimmune hepatitis (AIH, n = 19), primary biliary cholangitis (PBC, n = 15), and primary sclerosing cholangitis (PSC, n = 6). Healthy individuals (n = 24) and patients with metabolic dysfunction-associated steatotic liver disease (MASLD, n = 18) were included as controls. Blood samples were collected during a 120-min oral glucose tolerance test. We measured the concentrations of glucose, C-peptide, insulin, glucagon, and the two incretin hormones, glucose insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1). We calculated the homeostasis model assessment of insulin resistance (HOMA-IR), whole body insulin resistance (Matsuda index), insulin clearance, and insulinogenic index. All patient groups had increased fasting plasma glucose and impaired glucose responses compared with healthy controls. Beta-cell secretion was increased in AIH, PBC, and MASLD but not in PSC. Patients with AIH and MASLD had hyperglucagonemia and hepatic, as well as peripheral, insulin resistance and decreased insulin clearance, resulting in hyperinsulinemia. Patients with autoimmune liver disease had an increased GIP response, and those with AIH or PBC had an increased GLP-1 response. Our data demonstrate that the mechanism underlying glucose disturbances in patients with autoimmune liver disease differs from that underlying MASLD, including compensatory incretin responses in patients with autoimmune liver disease. Our results suggest that glucose disturbances are present at an early stage of the disease.NEW & NOTEWORTHY Patients with autoimmune liver disease but without overt diabetes display glucose disturbances early on in their disease course. We identified pathophysiological traits specific to these patients including altered incretin responses.
Collapse
Affiliation(s)
- Anne-Sofie H Jensen
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital-Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Ytting
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel P Werge
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Elias B Rashu
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Liv E Hetland
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Mira Thing
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Puria Nabilou
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Johan Burisch
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine N Bojsen-Møller
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Anders E Junker
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Lise Hobolth
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Christian Mortensen
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Flemming Tofteng
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Møller
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Mogens Vyberg
- Department of Pathology, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Center for RNA Medicine, Aalborg University, Copenhagen, Denmark
| | - Reza R Serizawa
- Department of Pathology, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Lise L Gluud
- Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Clinical Biochemistry, Copenhagen University Hospital-Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
25
|
Liu W, Tian G, Chen C, Zhang M, Chen Z, Chen T, Lin Z, Wu W, Wu Y, Wu K, Liu Q. Application of biological agents in the treatment of anti-neutrophil cytoplasmic antibody-associated vasculitis. Front Pharmacol 2024; 15:1378384. [PMID: 38831887 PMCID: PMC11144864 DOI: 10.3389/fphar.2024.1378384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/19/2024] [Indexed: 06/05/2024] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has been traditionally treated using glucocorticoids and immunosuppressants. However, these treatment modes are associated with high recurrence AAV rates and adverse reactions. Therefore, treatment strategies for AAV need to be urgently optimized. The efficacy and safety of biological agents in the treatment of vasculitis have been clinically validated. This review comprehensively summarizes the evidence-based support for the clinical use of existing biological agents in AAV. The findings reveal that multiple biological agents not only effectively reduce the adverse reactions associated with glucocorticoids and immunosuppressants but also demonstrate significant therapeutic efficacy. Notably, rituximab, an anti-CD20 antibody, has emerged as a first-line treatment option for AAV. Mepolizumab has shown promising results in relapsed and refractory eosinophilic granulomatosis with polyangiitis. Other biological agents targeting cytokines, complement, and other pathways have also demonstrated clinical benefits in recent studies. The widespread application of biological agents provides new insights into the treatment of AAV and is expected to drive further clinical research. These advancements not only improve patient outcomes but also offer more possibilities and hope in the field of AAV treatment.
Collapse
Affiliation(s)
- Weijun Liu
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Guanyuan Tian
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Chao Chen
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Mingying Zhang
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Zhanmao Chen
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Tietao Chen
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Zhibin Lin
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Wuzhong Wu
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Yiqaing Wu
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Kefei Wu
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
| | - Qinghua Liu
- Department of Nephrology, Jieyang People’s Hospital, Jieyang, China
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| |
Collapse
|
26
|
van der Pol JA, Allaart CF, Lems W, van der Kooij SM, Huizinga TWJ, Bergstra SA. Prednisone use, disease activity and the occurrence of hyperglycaemia and diabetes in patients with early rheumatoid arthritis: a 10-year subanalysis of the BeSt study. RMD Open 2024; 10:e004246. [PMID: 38688692 PMCID: PMC11086516 DOI: 10.1136/rmdopen-2024-004246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To assess whether prednisone use and/or disease activity score (DAS) are associated with the development of hyperglycaemia and diabetes in rheumatoid arthritis (RA). METHODS We included 504 non-diabetic early RA patients from the BeSt study (Dutch acronym for treatment strategies). Patients were randomised to four DAS-steered treatment arms and followed for 10 years. The associations between DAS and prednisone use with glucose levels and the occurrence of hyperglycaemia over time were assessed with linear and logistic mixed effects regression models. Development of diabetes was analysed with Cox regression. Sensitivity analyses were performed in patients who had a first episode of hyperglycaemia. RESULTS 31 of 504 patients (6.2%) with a mean age of 54 years developed diabetes during follow-up; 11 of these (35%) had received prior treatment with prednisone. Prednisone use was not associated with development of hyperglycaemia or diabetes after correction for multiple testing in main or sensitivity analyses. In the main analyses, DAS was significantly associated with development of diabetes (HR 1.802 per 1 point DAS increase, 95% CI 1.284 to 2.529) but not with glucose levels nor hyperglycaemia. In patients with previous hyperglycaemia, DAS was associated with glucose levels, recurrence of hyperglycaemia and diabetes. CONCLUSIONS In non-diabetic early RA patients, the use of prednisone was not associated with developing hyperglycaemia or diabetes. However, high DAS increased the risk of diabetes. Potential risks associated with prednisone use may have been mitigated by its effect on DAS.
Collapse
Affiliation(s)
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Willem Lems
- Rheumatology, VU Medical Center, Amsterdam, Netherlands
| | | | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
27
|
Orešković D, Madero Pohlen A, Cvitković I, Alen JF, Raguž M, Álvarez-Sala de la Cuadra A, Bazarra Castro GJ, Bušić Z, Konstantinović I, Ledenko V, Martínez Macho C, Müller D, Žarak M, Jovanov-Milosevic N, Chudy D, Marinović T. Chronic hyperglycemia and intracranial meningiomas. BMC Cancer 2024; 24:488. [PMID: 38632533 PMCID: PMC11022447 DOI: 10.1186/s12885-024-12243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Meningiomas are among the most common primary tumors of the central nervous system. Previous research into the meningioma histological appearance, genetic markers, transcriptome and epigenetic landscape has revealed that benign meningiomas significantly differ in their glucose metabolism compared to aggressive lesions. However, a correlation between the systemic glucose metabolism and the metabolism of the tumor hasn't yet been found. We hypothesized that chronic levels of glycaemia (approximated with glycated hemoglobin (HbA1c)) are different in patients with aggressive and benign meningiomas. The study encompassed 71 patients with de novo intracranial meningiomas, operated on in three European hospitals, two in Croatia and one in Spain. Our results show that patients with WHO grade 2 meningiomas had significantly higher HbA1c values compared to patients with grade 1 lesions (P = 0.0290). We also found a significant number of patients (19/71; 26.7%) being hyperglycemic, harboring all the risks that such a condition entails. Finally, we found a significant correlation between our patients' age and their preoperative HbA1c levels (P = 0.0008, ρ(rho) = 0.388), suggesting that older meningioma patients are at a higher risk of having their glycaemia severely dysregulated. These findings are especially important considering the current routine and wide-spread use of corticosteroids as anti-edematous treatment. Further research in this area could lead to better understanding of meningiomas and have immediate clinical impact.
Collapse
Affiliation(s)
- D Orešković
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia.
| | - A Madero Pohlen
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - I Cvitković
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - J F Alen
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - M Raguž
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - G J Bazarra Castro
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - Z Bušić
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - I Konstantinović
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - V Ledenko
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - C Martínez Macho
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - D Müller
- Department of Pathology, Clinical Hospital Dubrava, Zagreb, Croatia
| | - M Žarak
- Clinical Department of Laboratory Diagnostics, Clinical Hospital Dubrava, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - N Jovanov-Milosevic
- Department of Biology, School of Medicine, University of Zagreb, Zagreb, Croatia
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, School of Medicine, Croatian Institute for Brain Research, University of Zagreb, Zagreb, Croatia
| | - D Chudy
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, School of Medicine, Croatian Institute for Brain Research, University of Zagreb, Zagreb, Croatia
| | - T Marinović
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
- Department of Neurology and Neurosurgery, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| |
Collapse
|
28
|
Langworthy M, Lascarides P, Ngai W, Steele K, Huang Y. Three once-weekly intra-articular injections of Hylan G-F 20 significantly improve pain relief compared with placebo in patients with chronic idiopathic knee osteoarthritis: a single-centre, evaluator-blinded and patient-blinded, randomized controlled trial. Drugs Context 2024; 13:2023-11-3. [PMID: 38601838 PMCID: PMC11006243 DOI: 10.7573/dic.2023-11-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Background Clinical trials on the use of viscosupplementation with hyaluronic acid (HA) in patients with knee osteoarthritis (KOA) are inconsistent, making it challenging to determine its value in clinical practice. One issue is the availability of various HA products on the market; differences in their chemical features can impact patient outcomes. Herein, we assess the efficacy and safety of three once-weekly intra-articular (IA) injections of Hylan G-F 20, a high-molecular-weight and highly crosslinked HA product, in patients with KOA. We hypothesized that Hylan G-F 20 would provide significant pain relief with no increased safety risk compared with IA saline (placebo). Methods This was a 26-week, patient-blinded and evaluator-blinded, single-centre, randomized placebo- controlled trial. Men or women ≥18 years of age with Larsen grade II or III KOA were included. Patients received IA injections of either Hylan G-F 20 or placebo once a week for 3 weeks. The primary endpoints were the week 12 and 26 visits. Primary efficacy outcomes included visual analogue scale (VAS) pain scores, patient activity level and an overall assessment of clinical condition. Secondary outcomes included adverse events (AEs) that emerged during treatment. The primary analysis included the intention-to-treat population. An alpha level of 0.05 was used in the statistical analysis. Results Thirty patients were included in the intention-to-treat population (15 per group). All efficacy outcomes were statistically significant in favour of Hylan G-F 20, except night pain and inactivity stiffness, for both patient- assessed (all p=0.0001 at week 12) and evaluator-assessed (all p=0.0001 at week 12 and p=0.0004-0.0180 at week 26) measurements. There was also a greater proportion of symptom-free patients and those with a >50% improvement in their VAS scores, except night pain, in the Hylan G-F 20 group (p=0.001-0.003 in patient-assessed scores and p<0.0001 to 0.002 in evaluator-assessed scores at week 12). Two patients, one in each group, experienced an AE; no sequelae occurred, and no special treatment was required for either AE. No patients withdrew from the study prematurely due to an AE. Conclusion In patients with chronic idiopathic KOA, Hylan G-F 20 provides significant improvements in pain relief compared with placebo with no added safety concerns.
Collapse
Affiliation(s)
| | - Peter Lascarides
- Northwell Health, Northern Westchester Hospital, Mt Kisco, NY, USA
| | | | | | - Yili Huang
- Zucker School of Medicine at Hofstra/Northwell, Northwell Phelps Hospital, Sleepy Hollow, NY, USA
| |
Collapse
|
29
|
Seaton WB, Burke SJ, Fisch AR, Schilletter WA, Beck MGA, Cassagne GA, Harvey I, Fontenot MS, Collier JJ, Campagna SR. Channel Expansion in the Ligand-Binding Domain of the Glucocorticoid Receptor Contributes to the Activity of Highly Potent Glucocorticoid Analogues. Molecules 2024; 29:1546. [PMID: 38611825 PMCID: PMC11013598 DOI: 10.3390/molecules29071546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Glucocorticoids (GCs) act through the glucocorticoid receptor (GR) and are commonly used as anti-inflammatory and immunosuppressant medications. Chronic GC use has been linked with unwanted complications such as steroid-induced diabetes mellitus (SIDM), although the mechanisms for these effects are not completely understood. Modification of six GC parent molecules with 2-mercaptobenzothiazole resulted in consistently less promoter activity in transcriptional activation assays using a 3xGRE reporter construct while constantly reducing inflammatory pathway activity. The most selective candidate, DX1, demonstrated a significant reduction (87%) in transactivation compared to commercially available dexamethasone. DX1 also maintained 90% of the anti-inflammatory potential of dexamethasone while simultaneously displaying a reduced toxicity profile. Additionally, two novel and highly potent compounds, DX4 and PN4, were developed and shown to elicit similar mRNA expression at attomolar concentrations that dexamethasone exhibits at nanomolar dosages. To further explain these results, Molecular Dynamic (MD) simulations were performed to examine structural changes in the ligand-binding domain of the glucocorticoid receptor in response to docking with the top ligands. Differing interactions with the transcriptional activation function 2 (AF-2) region of the GR may be responsible for lower transactivation capacity in DX1. DX4 and PN4 lose contact with Arg611 due to a key interaction changing from a stronger hydrophilic to a weaker hydrophobic one, which leads to the formation of an unoccupied channel at the location of the deacylcortivazol (DAC)-expanded binding pocket. These findings provide insights into the structure-function relationships important for regulating anti-inflammatory activity, which has implications for clinical utility.
Collapse
Affiliation(s)
- Wesley B. Seaton
- Department of Chemistry, University of Tennessee, Knoxville, TN 37996, USA; (W.B.S.)
| | - Susan J. Burke
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA (J.J.C.)
| | - Alexander R. Fisch
- Department of Chemistry, University of Tennessee, Knoxville, TN 37996, USA; (W.B.S.)
| | | | - Mary Grace A. Beck
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA (J.J.C.)
| | | | - Innocence Harvey
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA (J.J.C.)
| | - Molly S. Fontenot
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA (J.J.C.)
| | - J. Jason Collier
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA (J.J.C.)
| | - Shawn R. Campagna
- Department of Chemistry, University of Tennessee, Knoxville, TN 37996, USA; (W.B.S.)
| |
Collapse
|
30
|
Tsutsumi T, Nakagomi D, Kobayashi K, Hanai S, Kobayashi Y, Ito R, Ishii T, Okuma H, Uchinuma H, Ichijo M, Tsuchiya K. Moon-like Facies by Glucocorticoid Is Associated With the Development of Diabetes and Body Image Disturbance. J Endocr Soc 2024; 8:bvae036. [PMID: 38481602 PMCID: PMC10928504 DOI: 10.1210/jendso/bvae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 04/07/2024] Open
Abstract
Context Moon-like facies (MLF) are a typical side effect of glucocorticoid (GC) therapy; however, its predisposing factors, relationship with GC-induced complications, and effects on body image are not well understood. Objective This study aimed to determine the predisposing factors for MLF during GC therapy; its association with GC-induced diabetes, hypertension, and dyslipidemia; and its effects on body image. Methods This prospective observational study spanned 24 weeks and targeted patients who received GC therapy at the University of Yamanashi Hospital from June 2020 to August 2022. The MLF was defined based on the following 3 factors: (1) an increase in facial measurement lengths, (2) subjective facial changes by patients' self-assessment using a visual analog scale; (3) objective and qualitative facial changes assessed by physicians. We examined the predisposing factors for MLF and the association of MLF with GC-induced diabetes, hypertension, dyslipidemia, and body image. Results The cumulative incidence rate of MLF at 24 weeks was 37.6%. Predisposing factors for MLF were an initial oral prednisolone dosage of ≥ 30 mg/day [odds ratio (OR) 63.91, 95% confidence interval (CI) 5.82-701.81] and female (OR 6.66, 95% CI 1.35-32.79). MLF showed a significant association with the onset of GC-induced diabetes (OR 6.58, 95% CI 1.25-34.74). MLF was also an independent factor contributing to body image disturbance (β = -18.94, P = .01). Conclusion MLF contributes to body image disturbance and is associated with the development of GC-induced diabetes; therefore, it is clinically important as a physical manifestation of GC therapy.
Collapse
Affiliation(s)
- Takahiro Tsutsumi
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Daiki Nakagomi
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Kei Kobayashi
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Shunichiro Hanai
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Yoshiaki Kobayashi
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Ryosuke Ito
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Toshihisa Ishii
- Department of Nephrology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hideyuki Okuma
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hiroyuki Uchinuma
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Masashi Ichijo
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Kyoichiro Tsuchiya
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| |
Collapse
|
31
|
Veisi A, Aletaha M, Abolhosseini M, Ownagh V, Fekri S, Feizi M, Amoushahi Khouzani S, Najafi M. Ophthalmic presentation and outcomes of rhino-orbito-cerebral mucormycosis during the COVID-19 pandemic: An 18-month follow-up report. J Fr Ophtalmol 2024; 47:104139. [PMID: 38696866 DOI: 10.1016/j.jfo.2024.104139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE To investigate the long-term outcomes of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM) patients. METHODS Retrospective, observational study including all COVID-19 patients who developed ROCM and were referred to our oculoplastic clinic. RESULTS Twenty-one patients with COVID-19-associated ROCM were included in this study. Twelve (57.1%) individuals were female with a mean age of 50.7±7.6 years (range 33-59), and nine (38.1%) were male with a mean age of 58.7±14.4 years (range 37-82). Corticosteroids were used in 85.7% of patients, and three patients received no systemic corticosteroids; 76.2% were diabetic and two of these developed new-onset diabetes mellitus (DM) after receiving corticosteroids during their treatment course. The average interval between COVID-19 and the development of ROCM in our subjects was 18.6 days (range 8-46 days). In our series of patients, decreasing vision, proptosis, and periorbital edema constituted the most prevalent presentation, seen in 52.4% of subjects. Endoscopic paranasal sinus debridement was performed a mean of 3.4 times in 95.2%, abscess drainage in one, and orbital exenteration in three (14.2%) patients. Orbital apex and bilateral paranasal sinus involvement were significantly associated with higher mortality, and the overall 18-month survival rate was 52.3%. CONCLUSION Based upon common factors among the COVID-19-associated ROCM patients, we presume that DM and drug-induced immunosuppression are two main factors, which may lead to a higher rate of ROCM infection in areas where fungal spores are more likely to be present, such as hospitals.
Collapse
Affiliation(s)
- A Veisi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Aletaha
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Abolhosseini
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - V Ownagh
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - S Fekri
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Feizi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Amoushahi Khouzani
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Najafi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
32
|
Kaneguchi A, Yamaoka K, Ozawa J. The Effects of Corticosteroid Administration and Treadmill Exercise on Marrow Adipose Tissue and Trabecular Bone after Anterior Cruciate Ligament Reconstruction in Rats. Acta Histochem Cytochem 2024; 57:47-55. [PMID: 38463208 PMCID: PMC10918434 DOI: 10.1267/ahc.23-00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/22/2024] [Indexed: 03/12/2024] Open
Abstract
We aimed to investigate the effects of short-term corticosteroid administration after anterior cruciate ligament (ACL) reconstruction on marrow adipose tissue (MAT) and trabecular bone mass, as well as to examine whether treadmill exercise can mitigate MAT increase and trabecular bone deterioration caused by corticosteroid. ACL-reconstructed rats were divided into groups: no intervention, daily treadmill exercise (60 min/day), administration of the steroidal drug dexamethasone (250 μg/kg on days 0-5, 7, and 9 post-operatively), or dexamethasone administration combined with treadmill exercise. Untreated rats were served as controls. At day 10 or 30 post-operatively, histological assessments were performed in the proximal tibial epiphysis. MAT accumulation and trabecular bone loss were observed after ACL reconstruction. Dexamethasone promoted MAT accumulation at day 10 post-operatively but did not affect the trabecular bone loss. The MAT accumulation caused by dexamethasone reversed within 21 days after discontinuation. Treadmill exercise did not influence the changes in the MAT and trabecular bone areas. Short-term corticosteroid administration after ACL reconstruction promoted MAT accumulation while not affecting trabecular bone area. The MAT accumulation resulting from corticosteroid administration was reversible after discontinuation. Treadmill exercise could not mitigate the accumulation of MAT caused by corticosteroid administration and did not affect trabecular bone area.
Collapse
Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555–36, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555–36, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555–36, Higashi-Hiroshima, Hiroshima, Japan
| |
Collapse
|
33
|
Singh K, Panda UK, Pattnaik JI, Padhan P, Ravan JR. Case-based Insights into Managing Co-existing Rheumatoid Arthritis and Schizophrenia. Indian J Psychol Med 2024:02537176241226928. [PMID: 39564344 PMCID: PMC11572646 DOI: 10.1177/02537176241226928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2024] Open
Affiliation(s)
- KaranBir Singh
- Kalinga Institute of Medical sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Udit Kumar Panda
- Dept. of Psychiatry and Behavioural Sciences, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Jigyansa Ipsita Pattnaik
- Dept. of Psychiatry and Behavioural Sciences, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Prasanta Padhan
- Dept. of Rhematology and Immunology, Kalinga institute of Medical sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Jayaprakash Russell Ravan
- Dept. of Psychiatry and Behavioural Sciences, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| |
Collapse
|
34
|
Kiconco R, Lumumba SA, Bagenda CN, Atwine R, Ndarubweine J, Rugera SP. Insulin therapy among diabetic patients in rural communities of Sub-Saharan Africa: a perspective review. Ther Adv Endocrinol Metab 2024; 15:20420188241232280. [PMID: 38379780 PMCID: PMC10878220 DOI: 10.1177/20420188241232280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Abstract
In this perspective review, we describe a brief background on the status quo of diabetes mellitus-related therapies and glycemic control among patients in rural communities in sub-Saharan Africa. The article discusses insulin therapy as well as the difficulties in obtaining insulin and oral hypoglycemic medications for diabetic patients living in sub-Saharan Africa. We wrap up our discussion with suggestions on solutions and opportunities for future research to tackle this health challenge in these impoverished communities. We conducted a literature search from PubMed and Google Scholar up until August 2023. Key words were used to generate search terms used to retrieve the required information. All types of literature with pertinent information on the current topic were included in the study. Diabetes mellitus is on the rise in sub-Saharan Africa. Several studies have reported poor glycemic control, low screening rates for diabetes mellitus, cigarette smoking, high alcohol consumption, prescription of antidiabetic therapy, and associated costs as contributors to the uptake of antidiabetic treatment. Although there is paucity of data on the extent of insulin therapy uptake and its possible modifiable contributors among the diabetic patients in the region, the anticipated increase in the number of people with diabetes on the continent makes it critical for global leaders to address the research gaps in insulin therapy among rural communities of sub-Saharan Africa, thus reducing the burden of diabetes in these populations.
Collapse
Affiliation(s)
- Ritah Kiconco
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Mbarara-Kabale Road, Mbarara 1410, Uganda
- Department of Biochemistry, Sororti University, Soroti, Uganda
| | - Sylvia Achieng Lumumba
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Laboratory Science, Technical University of Mombasa, Mombasa, Kenya
| | - Charles Nkubi Bagenda
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raymond Atwine
- Department of Pathology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ndarubweine
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Simon Peter Rugera
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
35
|
Rosager EV, Heltø ALK, Fox Maule CU, Friis-Hansen L, Petersen J, Nielsen FE, Haugaard SB, Gregersen R. Incidence and Characteristics of the Hyperosmolar Hyperglycemic State: A Danish Cohort Study. Diabetes Care 2024; 47:272-279. [PMID: 38085699 DOI: 10.2337/dc23-0988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/13/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE The hyperosmolar hyperglycemic state (HHS) is a rare and life-threatening complication of diabetes. We aimed to estimate the incidence of HHS and describe the clinical and biomarker profiles of patients with HHS, including subgroups with acidosis and acute kidney injury. RESEARCH DESIGN AND METHODS This nationwide, descriptive cohort study used Danish registry data during years 2016-2018 to identify acutely admitted patients fulfilling the hyperglycemia and hyperosmolarity criteria of HHS (glucose ≥33 mmol/L and osmolarity [2 × sodium + glucose] ≥320 mmol/L). RESULTS We identified 634 patients (median age, 69 years (first quartile; third quartile: 58; 79) who met the criteria of HHS among 4.80 million inhabitants aged ≥18 years. The incidence rates were 16.5 and 3.9 per 10,000 person-years among people with known type 1 (n = 24,196) and type 2 (n = 251,357) diabetes, respectively. Thirty-two percent of patients with HHS were not previously diagnosed with diabetes. Patients were categorized as pure HHS (n = 394) and combined HHS and diabetic ketoacidosis (HHS-DKA; n = 240). The in-hospital mortality rate for pure HHS was 17% and 9% for HHS-DKA. CONCLUSIONS The incidence of HHS was higher among patients with type 1 diabetes compared with type 2 diabetes. HHS is a spectrum of hyperglycemic crises and can be divided in pure HHS and HHS-DKA. In one-third of patients, HHS was the debut of their diabetes diagnosis.
Collapse
Affiliation(s)
- Emilie V Rosager
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Amalia Lærke K Heltø
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Cathrine U Fox Maule
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lennart Friis-Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janne Petersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn E Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Steen B Haugaard
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Gregersen
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
36
|
Mengual-Moreno E, Nava M, Manzano A, Ariza D, D’Marco L, Castro A, Marquina MA, Hernández M, Corredor-Pereira C, Checa-Ros A, Bermúdez V. Pancreatic and Hepatic Injury in COVID-19: A Worse Prognosis in NAFLD Patients? Biomedicines 2024; 12:283. [PMID: 38397885 PMCID: PMC10887136 DOI: 10.3390/biomedicines12020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 02/25/2024] Open
Abstract
The novel disease produced by SARS-CoV-2 mainly harms the respiratory tract, but it has shown the capacity to affect multiple organs. Epidemiologic evidence supports the relationship between Coronavirus Disease 2019 (COVID-19) and pancreatic and hepatic injury development, identified by alterations in these organ function markers. In this regard, it is important to ascertain how the current prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) might affect COVID-19 evolution and complications. Although it is not clear how SARS-CoV-2 affects both the pancreas and the liver, a multiplicity of potential pathophysiological mechanisms seem to be implicated; among them, a direct viral-induced injury to the organ involving liver and pancreas ACE2 expression. Additionally, immune system dysregulation, coagulopathies, and drugs used to treat the disease could be key for developing complications associated with the patient's clinical decline. This review aims to provide an overview of the available epidemiologic evidence regarding developing liver and pancreatic alterations in patients with COVID-19, as well as the possible role that NAFLD/NASH might play in the pathophysiological mechanisms underlying some of the complications associated with COVID-19. This review employed a comprehensive search on PubMed using relevant keywords and filters. From the initial 126 articles, those aligning with the research target were selected and evaluated for their methodologies, findings, and conclusions. It sheds light on the potential pathophysiological mechanisms underlying this relationship. As a result, it emphasises the importance of monitoring pancreatic and hepatic function in individuals affected by COVID-19.
Collapse
Affiliation(s)
- Edgardo Mengual-Moreno
- Biological Research Institute “Doctors Orlando Castejon and Haydee V Castejon”, Universidad del Zulia, Maracaibo 4002, Venezuela;
| | - Manuel Nava
- Endocrine and Metabolic Diseases Research Center, School of Medicine, Universidad del Zulia, Maracaibo 4002, Venezuela; (M.N.); (A.M.); (D.A.); (A.C.); (M.A.M.); (M.H.)
| | - Alexander Manzano
- Endocrine and Metabolic Diseases Research Center, School of Medicine, Universidad del Zulia, Maracaibo 4002, Venezuela; (M.N.); (A.M.); (D.A.); (A.C.); (M.A.M.); (M.H.)
| | - Daniela Ariza
- Endocrine and Metabolic Diseases Research Center, School of Medicine, Universidad del Zulia, Maracaibo 4002, Venezuela; (M.N.); (A.M.); (D.A.); (A.C.); (M.A.M.); (M.H.)
| | - Luis D’Marco
- Grupo de Investigación en Enfermedades Cardiorenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Santiago Ramón y Cajal s/n, 46115 Alfara del Patriarca, Valencia, Spain; (L.D.); (A.C.-R.)
| | - Ana Castro
- Endocrine and Metabolic Diseases Research Center, School of Medicine, Universidad del Zulia, Maracaibo 4002, Venezuela; (M.N.); (A.M.); (D.A.); (A.C.); (M.A.M.); (M.H.)
| | - María A. Marquina
- Endocrine and Metabolic Diseases Research Center, School of Medicine, Universidad del Zulia, Maracaibo 4002, Venezuela; (M.N.); (A.M.); (D.A.); (A.C.); (M.A.M.); (M.H.)
| | - Marlon Hernández
- Endocrine and Metabolic Diseases Research Center, School of Medicine, Universidad del Zulia, Maracaibo 4002, Venezuela; (M.N.); (A.M.); (D.A.); (A.C.); (M.A.M.); (M.H.)
| | | | - Ana Checa-Ros
- Grupo de Investigación en Enfermedades Cardiorenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Santiago Ramón y Cajal s/n, 46115 Alfara del Patriarca, Valencia, Spain; (L.D.); (A.C.-R.)
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080001, Colombia;
| |
Collapse
|
37
|
Takahashi K, Uenishi N, Sanui M, Uchino S, Yonezawa N, Takei T, Nishioka N, Kobayashi H, Otaka S, Yamamoto K, Yasuda H, Kosaka S, Tokunaga H, Fujiwara N, Kondo T, Ishida T, Komatsu T, Endo K, Moriyama T, Oyasu T, Hayakawa M, Hoshino A, Matsuyama T, Miyamoto Y, Yanagisawa A, Wakabayashi T, Ueda T, Komuro T, Sugimoto T, Lefor AK. Clinical profile of patients with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome in Japan: a multicenter retrospective cohort study. Acta Diabetol 2024; 61:117-126. [PMID: 37728831 DOI: 10.1007/s00592-023-02181-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. Their clinical profiles have not been fully investigated. METHODS A multicenter retrospective cohort study was conducted in 21 acute care hospitals in Japan. Patients included were adults aged 18 or older who had been hospitalized from January 1, 2012, to December 31, 2016 due to DKA or HHS. The data were extracted from patient medical records. A four-group comparison (mild DKA, moderate DKA, severe DKA, and HHS) was performed to evaluate outcomes. RESULTS A total of 771 patients including 545 patients with DKA and 226 patients with HHS were identified during the study period. The major precipitating factors of disease episodes were poor medication compliance, infectious diseases, and excessive drinking of sugar-sweetened beverages. The median hospital stay was 16 days [IQR 10-26 days]. The intensive care unit (ICU) admission rate was 44.4% (mean) and the rate at each hospital ranged from 0 to 100%. The in-hospital mortality rate was 2.8% in patients with DKA and 7.1% in the HHS group. No significant difference in mortality was seen among the three DKA groups. CONCLUSIONS The mortality rate of patients with DKA in Japan is similar to other studies, while that of HHS was lower. The ICU admission rate varied among institutions. There was no significant association between the severity of DKA and mortality in the study population. TRIAL REGISTRATION This study is registered in the UMIN clinical Trial Registration System (UMIN000025393, Registered 23th December 2016).
Collapse
Affiliation(s)
- Kyosuke Takahashi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-Ku, Saitama City, Saitama Prefecture, 330-0834, Japan.
| | - Norimichi Uenishi
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-Ku, Saitama City, Saitama Prefecture, 330-0834, Japan
| | - Shigehiko Uchino
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-Ku, Saitama City, Saitama Prefecture, 330-0834, Japan
| | - Naoki Yonezawa
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Tetsuhiro Takei
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan
- Division of Nephrology, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan
| | - Hirotada Kobayashi
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Shunichi Otaka
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
- Department of Emergency Medicine, Kumamoto Red Cross Hospital, Higashi, Kumamoto, Japan
| | - Kotaro Yamamoto
- Department of Emergency Medicine, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Hideto Yasuda
- Department of Emergency Medicine, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
- Department of Emergency Medicine, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan
| | - Shintaro Kosaka
- Department of Medicine, Nerima Hikarigaoka Hospital, Nerima, Tokyo, Japan
| | - Hidehiko Tokunaga
- Department of Medicine, Nerima Hikarigaoka Hospital, Nerima, Tokyo, Japan
| | - Naoki Fujiwara
- Department of Medicine, Nerima Hikarigaoka Hospital, Nerima, Tokyo, Japan
- Department of Medicine, Taito Municipal Taito Hospital, Taito, Tokyo, Japan
| | - Takashiro Kondo
- Department of Emergency and Critical Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Tomoki Ishida
- Nanohana Clinic, Ikuno, Osaka, Japan
- Department of Emergency Medicine, Yodogawa Christian Hospital, Higashi Yodogawa, Osaka, Japan
| | - Takayuki Komatsu
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima, Tokyo, Japan
| | - Koji Endo
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Sakyo, Kyoto, Japan
- Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, Tottori, Japan
| | - Taiki Moriyama
- Department of Emergency Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan
- Department of Emergency Medicine, Saiseikai Senri Hospital, Suita, Osaka, Japan
| | - Takayoshi Oyasu
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Atsumi Hoshino
- Department of Intensive Care Medicine, Tokyo Women's Medical University Hospital, Shinjuku, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Toyooka Public Hospital, Toyooka, Hyogo, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo, Kyoto, Japan
| | - Yuki Miyamoto
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo, Kyoto, Japan
| | - Akihiro Yanagisawa
- Department of Anesthesia, Gyoda General Hospital, Gyoda, Saitama, Japan
- Department of Anesthesiology and Intensive Care, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Tadamasa Wakabayashi
- Department of Medicine, Suwa Central Hospital, Chino, Nagano, Japan
- Department of Cardiology, Suwa Central Hospital, Chino, Nagano, Japan
| | - Takeshi Ueda
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Nakagyo, Kyoto, Japan
| | - Tetsuya Komuro
- Department of Medicine, TMG Muneoka Central Hospital, Shiki, Saitama, Japan
- Department of Critical Care, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Toshiro Sugimoto
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Medicine, National Hospital Organization Higashiohmi General Medical Center, Higashiohmi, Shiga, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| |
Collapse
|
38
|
Kawabata K, Hosono M, Mori Y, Tsukamoto S, Ito S, Ando S, Kanagaki M. Steroids May Be Associated With Extensive Skeletal Muscle Uptake of 18 F-FDG. Clin Nucl Med 2023; 48:1015-1020. [PMID: 37756474 DOI: 10.1097/rlu.0000000000004856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE The possibility of steroid administration inducing the extensive skeletal muscle uptake (ESMU) of FDG in PET scans was investigated. METHODS From 8923 consecutive 18 F-FDG PET/CT scans taken at our hospital, 23 scans (15 patients) met adult age and ESMU-positive inclusion criteria. Among the 15 patients, 13 with both ESMU-positive and -negative scans were examined for association with steroid administration. RESULTS Extensive skeletal muscle uptake was associated with a history of steroid administration ( χ2 test: P = 0.001). Notably, 20 ESMU-positive scans and 11 ESMU-negative scans were significantly different, with 0 to 95 days (median, 18.5 days) and 0 to 708 days (median, 319.0 days) since the last steroid administration, respectively (Mann-Whitney U test, P = 0.003). A significant correlation was observed between mean skeletal muscle SUV max and the number of days since the last steroid administration (Spearman rank correlation coefficient, ρ = -0.501, P = 0.004). Specifically, the degree of ESMU tended to decrease over time, after steroid administration. From multiple regression analysis, the number of days since the last steroid administration was significantly associated with mean SUV max ( P = 0.007), but the blood glucose level was not significant ( P = 0.204), revealing that the number of days since the last steroid administration was an independent risk factor. Multicollinearity was low (the variance inflation factor was 1.007 for both the number of days since the last steroid administration and blood glucose levels). CONCLUSIONS Steroid administration within months before PET may be one cause of ESMU.
Collapse
Affiliation(s)
- Kazuna Kawabata
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka
| | - Yukiko Mori
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Suzune Tsukamoto
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Shunsuke Ito
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Saya Ando
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Mitsunori Kanagaki
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| |
Collapse
|
39
|
Berg AK, Svensson J, Thyssen JP, Chawes B, Zachariae C, Egeberg A, Thorsen SU. No associations between type 1 diabetes and atopic dermatitis, allergic rhinitis, or asthma in childhood: a nationwide Danish case-cohort study. Sci Rep 2023; 13:19933. [PMID: 37968327 PMCID: PMC10652009 DOI: 10.1038/s41598-023-47292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023] Open
Abstract
Studies examining the association between type 1 diabetes (T1D) and atopic diseases, i.e., atopic dermatitis, allergic rhinitis and asthma have yielded conflicting results due to different algorithms for classification, sample size issues and risk of referral bias of exposed cohorts with frequent contact to health care professionals. Using Danish national registries and well-established disease algorithms, we examined the bidirectional association between T1D and atopic diseases in childhood and adolescence using Cox Proportional Hazard regression compared to two different unexposed cohorts from a population of 1.5 million Danish children born from 1997 to 2018. We found no associations between T1D and atopic dermatitis, allergic rhinitis, or asthma (defined after age five). However, in multivariable analysis we found an increased risk of persistent wheezing (defined as asthma medication before age five) after T1D with an adjusted hazard ratio (aHR) of 1.70 [1.17-2.45]. We also identified an increased risk of developing T1D after persistent wheezing with aHR of 1.24 [1.13-1.36]. This study highlights similar risks of atopic diseases in children with T1D and of T1D in children with atopic disease after age of five years versus healthy controls. However, more research is needed to understand the possible early immunological effects of the link between persistent wheezing and T1D.
Collapse
Affiliation(s)
- Anna Korsgaard Berg
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev, Denmark.
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Jannet Svensson
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Venerology, Bispebjerg Hospital, København, Denmark
| | - Bo Chawes
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Claus Zachariae
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Alexander Egeberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Venerology, Bispebjerg Hospital, København, Denmark
| | - Steffen Ullitz Thorsen
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
40
|
Sharadha M, Vishal Gupta N, Rahamathulla M, Muqtader Ahmed M, Ayesha Farhana S, Osmani RAM, Veeranna B, Koteshwara KB. Subconjunctival therapy by cubic liquid crystalline nanoparticles to deliver Triamcinolone acetonide for the management of diabetic Retinopathy: In vivo evidences. Int J Pharm 2023; 646:123443. [PMID: 37748633 DOI: 10.1016/j.ijpharm.2023.123443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
The expression of inflammatory markers and vascular endothelial growth factor (VEGF) was found to be upregulated in various posterior ocular disorders, including diabetic retinopathy (DR). Effective delivery of therapeutic agents to the retina poses a significant challenge in ophthalmic drug delivery due to biological ocular barriers. Triamcinolone acetonide (TA) was selected as the model corticosteroid drug targeting cytokines and VEGF in DR. However, despite TA's low molecular weight and hydrophobicity, which enable it to bypass the conjunctival epithelial barrier, it doesn't efficiently exert its effect at the target site. Nanocarriers have emerged as a solution to enhance drug delivery to the retina and improve bioavailability. This study aimed to compare the effects of Triamcinolone-loaded cubic liquid crystalline nanoparticles (TA-cubic LCNPs) and TA-Suspension in an experimental DR model administered via the subconjunctival (SCJ) route. The results demonstrated that TA-cubic LCNPs enhanced TA periocular delivery efficacy by reducing inflammatory and VEGF markers through the advanced glycation end products (AGE)/protein kinase C pathway. They were identified as promising nano-carriers, exhibiting potential for targeted delivery to the retina.
Collapse
Affiliation(s)
- M Sharadha
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSS AHER), Mysuru-570015, Karnataka, India
| | - N Vishal Gupta
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSS AHER), Mysuru-570015, Karnataka, India.
| | - Mohamed Rahamathulla
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, P O Box 62223, Al Faraa, Abha 61421, Saudi Arabia
| | - Mohammed Muqtader Ahmed
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, P.O. Box 173, Al Kharj 11942, Saudi Arabia
| | - Syeda Ayesha Farhana
- Department of Pharmaceutics, Unaizah College of Pharmacy, Qassim University, Unaizah 52571, Saudi Arabia
| | - Riyaz Ali M Osmani
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSS AHER), Mysuru-570015, Karnataka, India.
| | - Balamuralidhara Veeranna
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSS AHER), Mysuru-570015, Karnataka, India
| | - K B Koteshwara
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal-576104, Karnataka, India
| |
Collapse
|
41
|
Jordt N, Kjærgaard KA, Thomsen RW, Borgquist S, Cronin-Fenton D. Breast cancer and incidence of type 2 diabetes mellitus: a systematic review and meta-analysis. Breast Cancer Res Treat 2023; 202:11-22. [PMID: 37656235 PMCID: PMC10504120 DOI: 10.1007/s10549-023-07043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/06/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Breast cancer and its treatments may increase the risk of type 2 diabetes (T2D). We conducted a systematic review and meta-analysis to investigate the association between breast cancer and the incidence of T2D overall, and according to breast cancer treatments. METHODS We searched PubMed, Embase and references of relevant papers for studies on breast cancer, breast cancer treatment, and subsequent T2D risk. Using random-effects models, we calculated effect estimates and associated 95% confidence intervals of the association between breast cancer, adjuvant breast cancer treatments (i.e., endocrine therapy (tamoxifen, aromatase inhibitors, and combined) and chemotherapy), and subsequent T2D. We used funnel plots to assess publication bias. RESULTS Among 15 eligible studies, 10 reported on T2D risk after breast cancer, chemotherapy, or endocrine therapy; five studies investigated more than one association. Compared with patients without breast cancer, those with breast cancer and those who received any endocrine therapy had elevated risk of incident T2D (EE = 1.23, 95% CI = 1.13-1.33 and EE = 1.23, 95% CI = 1.16-1.32, respectively). Among breast cancer patients only, the risk of T2D was higher for those who received tamoxifen compared with those who did not receive tamoxifen (EE = 1.28, 95% CI = 1.18-1.38). Due to few studies, analyses investigating T2D risk after treatment with aromatase inhibitors or chemotherapy were inconclusive. CONCLUSION Our findings suggest an elevated risk of T2D in breast cancer survivors, particularly after tamoxifen therapy. Further research is needed to determine the impact of aromatase inhibitors, and chemotherapy on the incidence of T2D after breast cancer.
Collapse
Affiliation(s)
- Nanna Jordt
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital & Aarhus University, Aarhus, Denmark
| | - Kasper Aalbæk Kjærgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital & Aarhus University, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital & Aarhus University, Aarhus, Denmark
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital & Aarhus University, Aarhus, Denmark.
| |
Collapse
|
42
|
Jensen ASH, Winther-Sørensen M, Burisch J, Bergquist A, Ytting H, Gluud LL, Wewer Albrechtsen NJ. Autoimmune liver diseases and diabetes: A propensity score matched analysis and a proportional meta-analysis. Liver Int 2023; 43:2479-2491. [PMID: 37752719 DOI: 10.1111/liv.15720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND AIMS Patients with some chronic liver diseases have increased risk of diabetes. Whether this is also the case for patients with autoimmune liver diseases is unknown. The study aimed to calculate risk and worldwide prevalence of diabetes in patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). METHODS We performed a case-control study using data from the United Kingdom Biobank (UKB) and compared frequency of type 1 diabetes (T1D) and type 2 diabetes (T2D) in AIH and PBC with age-, sex-, BMI- and ethnicity-matched controls. Next, we performed a systematic review and proportional meta-analysis searching PubMed, Embase, Cochrane Library and Web of Science (inception to 1 May 2022 [AIH]; 20 August 2022 [PBC]; 11 November 2022 [PSC]). The pooled prevalence of diabetes was calculated using an inverse method random effects model. RESULTS Three hundred twenty-eight AIH patients and 345 PBC patients were identified in UKB and risk of T1D and T2D significantly increased compared with matched controls. Our systematic search identified 6914 records including the UKB study. Of these, 77 studies were eligible for inclusion comprising 36 467, 39 924 and 4877 individuals with AIH, PBC and PSC, respectively. The pooled prevalence of T1D was 3.8% (2.6%-5.7%), 1.7% (0.9%-3.1%), 3.1% (1.9%-4.8%) and of T2D 14.8% (11.1%-19.5%), 18.1% (14.6%-22.2%), 6.3% (2.8%-13.3%) in patients with AIH, PBC and PSC, respectively. CONCLUSIONS Patients with autoimmune liver diseases have increased risk of diabetes. Increased awareness of diabetes risk in patients with autoimmune liver diseases is warranted.
Collapse
Affiliation(s)
- Anne-Sofie H Jensen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marie Winther-Sørensen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Johan Burisch
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Annika Bergquist
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Henriette Ytting
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Lise L Gluud
- Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| |
Collapse
|
43
|
Jung S, Jung G, Kim D, Oh J, Choi K. Epidemiology of Chronic Inflammatory Demyelinating Polyneuropathy in South Korea: A Population-Based Study. J Clin Neurol 2023; 19:558-564. [PMID: 37488959 PMCID: PMC10622719 DOI: 10.3988/jcn.2023.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/08/2023] [Accepted: 04/03/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND PURPOSE We performed a population-based study to determine the prevalence and incidence of chronic inflammatory demyelinating polyneuropathy (CIDP) in South Korea using data from the Korean Health Insurance Review and Assessment Service (HIRA) database. METHODS Data recorded in the HIRA database between January 2016 and December 2020 were analyzed. The inclusion criteria in this study for patients with CIDP were a diagnostic code of G61.8 in the seventh and eighth revision of the Korean Standard Classification of Disease and a >3-month history of oral immunosuppressant use. The age-adjusted incidence rate and prevalence of CIDP in South Korea were also analyzed. RESULTS CIDP was newly diagnosed in 953 patients during the study period. The mean age at diagnosis was 58.36 years, and the male-to-female ratio was 1.74. The age-adjusted incidence rates were 0.22, 0.21, 0.23, 0.30, and 0.25 per 100,000 person-years in 2016, 2017, 2018, 2019, and 2020, respectively. The age-adjusted prevalence was estimated at 1.16 per 100,000 persons in 2020. Age and the Elixhauser Comorbidity Index were associated with the in-hospital mortality of patients with CIDP. Infection and cardiovascular disease (CVD) were also significantly associated with the in-hospital mortality of those patients. Acute-onset CIDP was initially diagnosed in an estimated 101 out of 953 patients with CIDP. CONCLUSIONS The prevalence and incidence rates of CIDP in South Korea were comparable between this nationwide cohort study and previous studies. Common comorbidities such as CVD and diabetes should be appropriately monitored in patients with CIDP to prevent a poor prognosis and socioeconomic burden.
Collapse
Affiliation(s)
- Sohee Jung
- Department of Medical Artificial Intelligence, Deepnoid, Inc., Seoul, Korea
| | - Gucheol Jung
- Department of Medical Artificial Intelligence, Deepnoid, Inc., Seoul, Korea
| | - Dayoung Kim
- Department of Neurology, College of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jeeyoung Oh
- Department of Neurology, College of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Kyomin Choi
- Department of Neurology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
| |
Collapse
|
44
|
Won SY, Kinney SM, Sefton MV. Neutrophil depletion for early allogeneic islet survival in a methacrylic acid (MAA) copolymer-induced, vascularized subcutaneous space. FRONTIERS IN TRANSPLANTATION 2023; 2:1244093. [PMID: 38993844 PMCID: PMC11235352 DOI: 10.3389/frtra.2023.1244093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/03/2023] [Indexed: 07/13/2024]
Abstract
Islet transplantation is a promising treatment for type I diabetes (T1D). Despite the high loss of islets during transplantation, current islet transplant protocols continue to rely on portal vein infusion and intrahepatic engraftment. Because of the risk of portal vein thrombosis and the loss of islets to instant blood mediated inflammatory reaction (IBMIR), other transplantation sites like the subcutaneous space have been pursued for its large transplant volume, accessibility, and amenability for retrieval. To overcome the minimal vasculature of the subcutaneous space, prevascularization approaches or vascularizing biomaterials have been used to subcutaneously deliver islets into diabetic mice to return them to normoglycemia. Previous vascularization methods have relied on a 4 to 6 week prevascularization timeframe. Here we show that a vascularizing MAA-coated silicone tube can generate sufficient vasculature in 2 to 3 weeks to support a therapeutic dose of islets in mice. In order to fully harness the potential of this prevascularized site, we characterize the unique, subcutaneous immune response to allogeneic islets in the first 7 days following transplantation, a critical stage in successful engraftment. We identify neutrophils as a specific cellular target, a previously overlooked cell in the context of subcutaneous allogeneic islet transplantation. By perioperatively depleting neutrophils, we show that neutrophils are a key, innate immune cell target for successful early engraftment of allogeneic islets in a prevascularized subcutaneous site.
Collapse
Affiliation(s)
- So-Yoon Won
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Sean M Kinney
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada
| | - Michael V Sefton
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
45
|
Heneberg P. Diabetes in stiff-person syndrome. Trends Endocrinol Metab 2023; 34:640-651. [PMID: 37586963 DOI: 10.1016/j.tem.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
Anti-glutamic acid decarboxylase (GAD) autoantibodies are a hallmark of stiff-person syndrome (SPS) and insulin-dependent diabetes mellitus (IDDM). However, patients with concurrent IDDM and SPS often manifest insulin resistance, and SPS-associated IDDM probably has heterogeneous causes. Some patients manifest IDDM associated only with high titers of anti-GAD65 caused by SPS. By contrast, other patients develop IDDM only after being treated with high-dose corticosteroids or they progress to insulin dependency following their treatment with high-dose corticosteroids. The profile of autoantibodies differs markedly between type 1 diabetes mellitus (T1DM), late-onset diabetes mellitus, and SPS-associated IDDM. Therefore, as with new-onset diabetes after transplantation (NODAT), SPS-associated IDDM should be classified as a specific diabetes entity, the pathophysiology of which requires increased attention.
Collapse
Affiliation(s)
- Petr Heneberg
- Charles University, Third Faculty of Medicine, Prague, Czech Republic.
| |
Collapse
|
46
|
Guo W, Rathi S, Marquez J, Smith H, Kuruvilla A, Tonnesen MG, Salvemini JN. Prevalence of diabetes mellitus in bullous pemphigoid patients in the absence of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis. Arch Dermatol Res 2023; 315:2207-2213. [PMID: 36867222 DOI: 10.1007/s00403-023-02562-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 03/04/2023]
Abstract
Bullous pemphigoid (BP) has been associated with dipeptidyl peptidase-4 inhibitor (DDP-4i) use in patients with diabetes mellitus (DM). The prevalence and association of DM in BP patients independent of DPP-4i use has not been investigated by meta-analysis. To perform a systematic review and meta-analysis on the association between diabetes and bullous pemphigoid. The goal was to determine the prevalence and pooled odds ratio of BP patients with DM in the absence of DDP-4i use compared to the general population prevalence of diabetes mellitus. OVID Medline, EMBASE, Cochrane Central and Web of Science were searched for relevant studies published from inception to April 2020. Case-control, case-series, cohort, and cross-sectional studies that included the association of BP and DM without DDP-4i's, in any language. PRISMA guidelines were followed for data extraction and the Newcastle-Ottawa Scale for risk of bias evaluation. Three reviewers independently performed data extraction. Pooled odds ratio and prevalence were calculated using the random effects model. The odds ratio and prevalence of BP patients with DM. Overall, 8 studies out of 856 identified publications through data base searches were included. The pooled prevalence of diabetes in patients with BP was 20.0% [95% CI 14%-26%; p = 0.00]. Within the comparative non-BP control population, 13% had diabetes. BP patients were more likely to have diabetes compared to a control population without BP [OR 2.10, 95% CI 1.22-3.60; p = 0.01]. This study found that twice the number of BP patients have DM (20%) compared to the general population reported as 10.5%, warranting monitoring of blood glucose levels in BP patients who may have yet undeclared or undiagnosed DM when initiating systemic steroids.
Collapse
Affiliation(s)
- William Guo
- Department of Dermatology, Stony Brook University, 1320 Stony Brook RD, Building F, Suite 200, Stony Brook, NY, 11790, USA.
| | - Sourish Rathi
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Jocellie Marquez
- Department of Plastic Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Holly Smith
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Annet Kuruvilla
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Marcia G Tonnesen
- Department of Dermatology, Stony Brook University, 1320 Stony Brook RD, Building F, Suite 200, Stony Brook, NY, 11790, USA
| | - Joann N Salvemini
- Department of Dermatology, Stony Brook University, 1320 Stony Brook RD, Building F, Suite 200, Stony Brook, NY, 11790, USA
| |
Collapse
|
47
|
Hato H, Sakata KI, Watanabe H, Sugitani A, Sato J, Asaka T, Ohga N, Kitagawa Y. Potential relationship between the dosage of prednisolone and delayed healing at tooth extraction: A retrospective study. J Dent Sci 2023; 18:1765-1770. [PMID: 37799897 PMCID: PMC10547945 DOI: 10.1016/j.jds.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background/purpose Delayed healing of the extraction socket is not uncommon when tooth extraction is performed on patients taking prednisolone. This study aimed to identify specific dosage of prednisolone and factors associated with delayed healing of the extraction socket in patients taking prednisolone. Materials and methods This single-center retrospective study included 80 patients who underwent tooth extraction under local anesthesia and were taking prednisolone orally. Patients were divided into the nondelayed healing group (n = 50) and delayed healing group (n = 30), and their background and dosage of prednisolone were compared. Results The dosage of prednisolone was significantly higher in the delayed healing group than in the nondelayed healing group. A receiver operating characteristics curve analysis resulted in moderate accuracy when the cutoff value was set at 8.0, with 67% sensitivity, 76% specificity, and 0.765 area under the curve. The multivariate logistic regression analysis revealed that prednisolone dosage >8.0 mg/day (odds ratio [OR], 10.8; 95% confidence interval [CI], 2.79-41.6) and osteosclerotic changes beyond the alveolar bone around the tooth to be extracted (OR, 10.3; 95% CI, 2.81-37.8) in X-ray imaging had significant effects on delayed healing. Conclusion The results of this study suggested that delayed healing following tooth extractions in patients taking prednisolone was related to a dosage of 8.0 mg/day or higher and osteosclerotic changes.
Collapse
Affiliation(s)
- Hiroyuki Hato
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Ken-ichiro Sakata
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Haruhisa Watanabe
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Ayumu Sugitani
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Jun Sato
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takuya Asaka
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Noritaka Ohga
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
48
|
Wu T, Shao Y, Li X, Wu T, Yu L, Liang J, Zhang Y, Wang J, Sun T, Zhu Y, Chang X, Wang S, Chen F, Han X. NR3C1/Glucocorticoid receptor activation promotes pancreatic β-cell autophagy overload in response to glucolipotoxicity. Autophagy 2023; 19:2538-2557. [PMID: 37039556 PMCID: PMC10392762 DOI: 10.1080/15548627.2023.2200625] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023] Open
Abstract
Diabetes is a complex and heterogeneous disorder characterized by chronic hyperglycemia. Its core cause is progressively impaired insulin secretion by pancreatic β-cell failures, usually upon a background of preexisting insulin resistance. Recent studies demonstrate that macroautophagy/autophagy is essential to maintain architecture and function of β-cells, whereas excessive autophagy is also involved in β-cell dysfunction and death. It has been poorly understood whether autophagy plays a protective or harmful role in β-cells, while we report here that it is dependent on NR3C1/glucocorticoid receptor activation. We proved that deleterious hyperactive autophagy happened only upon NR3C1 activation in β-cells under glucolipotoxic conditions, which eventually promoted diabetes. The transcriptome and the N6-methyladenosine (m6A) methylome revealed that NR3C1-enhancement upregulated the RNA demethylase FTO (fat mass and obesity associated) protein in β-cells, which caused diminished m6A modifications on mRNAs of four core Atg (autophagy related) genes (Atg12, Atg5, Atg16l2, Atg9a) and, hence, hyperactive autophagy and defective insulin output; by contrast, FTO inhibition, achieved by the specific FTO inhibitor Dac51, prevented NR3C1-instigated excessive autophagy activation. Importantly, Dac51 effectively alleviated impaired insulin secretion and glucose intolerance in hyperglycemic β-cell specific NR3C1 overexpression mice. Our results determine that the NR3C1-FTO-m6A modifications-Atg genes axis acts as a key mediator of balanced autophagic flux in pancreatic β-cells, which offers a novel therapeutic target for the treatment of diabetes.Abbreviations: 3-MA: 3-methyladenine; AAV: adeno-associated virus; Ac: acetylation; Ad: adenovirus; AL: autolysosome; ATG: autophagy related; AUC: area under curve; Baf A1: bafilomycin A1; βNR3C1 mice: pancreatic β-cell-specific NR3C1 overexpression mice; cFBS: charcoal-stripped FBS; Ctrl: control; ER: endoplasmic reticulum; FTO: fat mass and obesity associated; GC: glucocorticoid; GRE: glucocorticoid response element; GSIS: glucose-stimulated insulin secretion assay; HFD: high-fat diet; HG: high glucose; HsND: non-diabetic human; HsT2D: type 2 diabetic human; i.p.: intraperitoneal injected; KSIS: potassium-stimulated insulin secretion assay; m6A: N6-methyladenosine; MeRIP-seq: methylated RNA immunoprecipitation sequencing; NR3C1/GR: nuclear receptor subfamily 3, group C, member 1; NR3C1-Enhc.: NR3C1-enhancement; NC: negative control; Palm.: palmitate; RNA-seq: RNA sequencing; T2D: type 2 diabetes; TEM: transmission electron microscopy; UTR: untranslated region; WT: wild-type.
Collapse
Affiliation(s)
- Tijun Wu
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yixue Shao
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xirui Li
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Wu
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ling Yu
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jin Liang
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yaru Zhang
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiahui Wang
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tong Sun
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yunxia Zhu
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoai Chang
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shusen Wang
- Organ Transplant Center, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Fang Chen
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao Han
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
49
|
Wang L, Huang B, Zeng Y, Yang J, Li Z, Ng JPL, Xu X, Su L, Yun X, Qu L, Chen R, Luo W, Wang Y, Chen C, Yang L, Qu Y, Zhang W, Chan JTW, Wang X, Law BYK, Mok SWF, Chung SK, Wong VKW. N-Acetylcysteine overcomes epalrestat-mediated increase of toxic 4-hydroxy-2-nonenal and potentiates the anti-arthritic effect of epalrestat in AIA model. Int J Biol Sci 2023; 19:4082-4102. [PMID: 37705749 PMCID: PMC10496504 DOI: 10.7150/ijbs.85028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/29/2023] [Indexed: 09/15/2023] Open
Abstract
Epalrestat, an aldose reductase inhibitor (ARI), has been clinically adopted in treating diabetic neuropathy in China and Japan. Apart from the involvement in diabetic complications, AR has been implicated in inflammation. Here, we seek to investigate the feasibility of clinically approved ARI, epalrestat, for the treatment of rheumatoid arthritis (RA). The mRNA level of AR was markedly upregulated in the peripheral blood mononuclear cells (PBMCs) of RA patients when compared to those of healthy donors. Besides, the disease activity of RA patients is positively correlated with AR expression. Epalrestat significantly suppressed lipopolysaccharide (LPS) induced TNF-α, IL-1β, and IL-6 in the human RA fibroblast-like synoviocytes (RAFLSs). Unexpectedly, epalrestat treatment alone markedly exaggerated the disease severity in adjuvant induced arthritic (AIA) rats with elevated Th17 cell proportion and increased inflammatory markers, probably resulting from the increased levels of 4-hydroxy-2-nonenal (4-HNE) and malondialdehyde (MDA). Interestingly, the combined treatment of epalrestat with N-Acetylcysteine (NAC), an anti-oxidant, to AIA rats dramatically suppressed the production of 4-HNE, MDA and inflammatory cytokines, and significantly improved the arthritic condition. Taken together, the anti-arthritic effect of epalrestat was diminished or even overridden by the excessive accumulation of toxic 4-HNE or other reactive aldehydes in AIA rats due to AR inhibition. Co-treatment with NAC significantly reversed epalrestat-induced upregulation of 4-HNE level and potentiated the anti-arthritic effect of epalrestat, suggesting that the combined therapy of epalrestat with NAC may sever as a potential approach in treating RA. Importantly, it could be regarded as a safe intervention for RA patients who need epalrestat for the treatment of diabetic complications.
Collapse
Affiliation(s)
- Linna Wang
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Baixiong Huang
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Yaling Zeng
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Jiujie Yang
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
- Macau Medical Science and Technology Research Association, Macau, China
| | - Zhi Li
- Centro Hospitalar Conde de São Januário, Macau, China
- Macau Medical Science and Technology Research Association, Macau, China
| | - Jerome P. L. Ng
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Xiongfei Xu
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Lu Su
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Xiaoyun Yun
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Liqun Qu
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Ruihong Chen
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Weidan Luo
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Yuping Wang
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Chang Chen
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Lijun Yang
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Yuanqing Qu
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Wei Zhang
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Joyce Tsz Wai Chan
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Xingxia Wang
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Betty Yuen Kwan Law
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Simon Wing Fai Mok
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Sookja Kim Chung
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China
| | - Vincent Kam Wai Wong
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| |
Collapse
|
50
|
Wang W, Yao W, Tan Q, Li S, Duan H, Tian X, Xu C, Zhang D. Identification of key DNA methylation changes on fasting plasma glucose: a genome-wide DNA methylation analysis in Chinese monozygotic twins. Diabetol Metab Syndr 2023; 15:159. [PMID: 37461060 PMCID: PMC10351111 DOI: 10.1186/s13098-023-01136-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Elevated fasting plasma glucose (FPG) levels can increase morbidity and mortality even when it is below the diagnostic threshold of type 2 diabetes mellitus (T2DM). We conducted a genome-wide DNA methylation analysis to detect DNA methylation (DNAm) variants potentially related to FPG in Chinese monozygotic twins. METHODS Genome-wide DNA methylation profiling in whole blood of twins was performed using Reduced Representation Bisulfite Sequencing (RRBS), yielding 551,447 raw CpGs. Association between DNAm of single CpG and FPG was tested using a generalized estimation equation. Differentially methylated regions (DMRs) were identified using comb-P approach. ICE FALCON method was utilized to perform the causal inference. Candidate CpGs were quantified and validated using Sequenom MassARRAY platform in a community population. Weighted gene co-expression network analysis (WGCNA) was conducted using gene expression data from twins. RESULTS The mean age of 52 twin pairs was 52 years (SD: 7). The relationship between DNAm of 142 CpGs and FPG reached the genome-wide significance level. Thirty-two DMRs within 24 genes were identified, including TLCD1, MRPS31P5, CASZ1, and CXADRP3. The causal relationship of top CpGs mapped to TLCD1, MZF1, PTPRN2, SLC6A18, ASTN2, IQCA1, GRIN1, and PDE2A genes with FPG were further identified using ICE FALCON method. Pathways potentially related to FPG were also identified, such as phospholipid-hydroperoxide glutathione peroxidase activity and mitogen-activated protein kinase p38 binding. Three CpGs mapped to SLC6A18 gene were validated in a community population, with a hypermethylated direction in diabetic patients. The expression levels of 18 genes (including SLC6A18 and TLCD1) were positively correlated with FPG levels. CONCLUSIONS We detect many DNAm variants that may be associated with FPG in whole blood, particularly the loci within SLC6A18 gene. Our findings provide important reference for the epigenetic regulation of elevated FPG levels and diabetes.
Collapse
Affiliation(s)
- Weijing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, No. 308 Ningxia Road, Qingdao, 266071 Shandong Province China
| | - Wenqin Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, No. 308 Ningxia Road, Qingdao, 266071 Shandong Province China
- Shandong Province Center for Disease Control and Prevention, Shandong, China
| | - Qihua Tan
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Shuxia Li
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Haiping Duan
- Qingdao Municipal Center for Disease Control and Prevention/Qingdao Institute of Preventive Medicine, Qingdao, Shandong China
| | - Xiaocao Tian
- Qingdao Municipal Center for Disease Control and Prevention/Qingdao Institute of Preventive Medicine, Qingdao, Shandong China
| | - Chunsheng Xu
- Qingdao Municipal Center for Disease Control and Prevention/Qingdao Institute of Preventive Medicine, Qingdao, Shandong China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, No. 308 Ningxia Road, Qingdao, 266071 Shandong Province China
| |
Collapse
|