Genetic polymorphism of APOB is associated with diabetes mellitus in sickle cell disease

Predictive value of perioperative fasting blood glucose for post pancreatectomy diabetes mellitus in pancreatic ductal carcinoma patients

BACKGROUND

To explore the risk factors of post pancreatectomy diabetes mellitus (PPTDM)in pancreatic ductal carcinoma (PDAC) patients and the value of perioperative fasting blood glucose (FBG) level expression on the long-term survival after surgery.

MATERIALS AND METHODS

Between December 2015 and December 2019, a cohort of 509 patients diagnosed with PDAC and undergoing resection at our hospital was analyzed. They were stratified into two groups, Control group (Control) and study group (PPTDM), depending on the onset of postoperative diabetes mellitus. We analyzed the survival rates at 6 months, 12 months and 24 months post-operation in the two groups. We use univariate and logostic multivariate regressions to analyze the risk factors for PPTDM. ROC curve analysis was conducted to assess the diagnostic significance of perioperative FBG levels regarding patients' long-term survival rates. The Kaplan-Meier method was employed to assess the impact of both preoperative and postoperative FBG levels on the survival rates within 24 months for each patient group.

RESULTS

The comparison of general clinical data between the two groups shows marginal differences without statistical significance(P > 0.05); Patients in PPTDM group had significantly higher BMI, preoperative jaundice proportion, larger tumor diameter, higher TNM stage and higher proportion of distal pancreatectomy (DP), with P values of 0.023, 0.010, 0.040, 0.012 and 0.005, respectively. The levels of preoperative FBG and postoperative FBG in PPTDM patients exhibited statistically significant elevation compared to the control group (P < 0.05). There were no significant differences in surgery-related indicators between the two groups in operative time, number of dissected positive lymph nodes, total number of dissected lymph nodes, intraoperative blood loss and other related data (P > 0.05). Hospitalization duration of PPTDM patients was longer than control group (P = 0.047). PPTDM group had significantly higher expression concentrations of BUN, Cr, TG, LDL and Apo-B factors (P = 0.023, 0.024, 0.013, 0.045 and 0.017). 17 patients (5.03%) died in the PPTDM group and 4 patients (2.35%) in control group which had significantly difference (P = 0.020). In univariate and logostic multivariate regression analysis indicated tumor size, jaundice, BUN, Cr, TG, LDL, Apo-B concentrations and DP approach were significantly correlated to the risk for PPTDM (P < 0.05). ROC curve analysis results showed combining of preoperative and postoperation FBG showed the highest diagnostic efficacy, followed by postoperation FBG and preoperative FBG. The AUC areas of the three groups were 0.745, 0.623 and 0.588, respectively, and the critical values of the three groups were 9.81/9.95 mmol/L, 10.18 mmol/L and 10.23 mmol/L, respectively, with statistical significance (P < 0.05). Results were considered statistically significant if the p-value was less than 0.05.

CONCLUSION

PPTDM stands as a significant postoperative complication following pancreatic cancer surgery, characterized by a high incidence and severity. Several risk factors have garnered considerable attention among clinical surgeon. PPTDM may be an influential factor in postoperative prognosis of pancreatic cancer. The expression levels of preoperative and postoperative blood glucose hold diagnostic value for the long-term prognosis of pancreatic cancer patients. Early regulation and intervention by surgeons concerning perioperative FBG could potentially mitigate the risk of PPTDM.

Endocrinopathies in Hemoglobinopathies: What Is the Role of Iron?

Hemoglobinopathies, including β-thalassemia and sickle cell disease (SCD), are common genetic blood disorders. Endocrine disorders are frequent manifestations of organ damage observed mainly in patients with β-thalassemia and rarely in SCD. Iron overload, oxidative stress-induced cellular damage, chronic anemia, and HCV infection contribute to the development of endocrinopathies in β-thalassemia. The above factors, combined with vaso-occlusive events and microcirculation defects, are crucial for endocrine dysfunction in SCD patients. These endocrinopathies include diabetes mellitus, hypothyroidism, parathyroid dysfunction, gonadal and growth failure, osteoporosis, and adrenal insufficiency, affecting the quality of life of these patients. Thus, we aim to provide current knowledge and data about the epidemiology, pathogenesis, diagnosis, and management of endocrine disorders in β-thalassemia and SCD. We conducted a comprehensive review of the literature and examined the available data, mostly using the PubMed and Medline search engines for original articles. In the era of precision medicine, more studies investigating the potential role of genetic modifiers in the development of endocrinopathies in hemoglobinopathies are essential.

Genetic Variation and Sickle Cell Disease Severity: A Systematic Review and Meta-Analysis

Importance

Sickle cell disease (SCD) is a monogenic disorder, yet clinical outcomes are influenced by additional genetic factors. Despite decades of research, the genetics of SCD remain poorly understood.

Objective

To assess all reported genetic modifiers of SCD, evaluate the design of associated studies, and provide guidelines for future analyses according to modern genetic study recommendations.

Data Sources

PubMed, Web of Science, and Scopus were searched through May 16, 2023, identifying 5290 publications.

Study Selection

At least 2 reviewers identified 571 original, peer-reviewed English-language publications reporting genetic modifiers of human SCD phenotypes, wherein the outcome was not treatment response, and the comparison was not between SCD subtypes or including healthy controls.

Data Extraction and Synthesis

Data relevant to all genetic modifiers of SCD were extracted, evaluated, and presented following STREGA and PRISMA guidelines. Weighted z score meta-analyses and pathway analyses were conducted.

Main Outcomes and Measures

Outcomes were aggregated into 25 categories, grouped as acute complications, chronic conditions, hematologic parameters or biomarkers, and general or mixed measures of SCD severity.

Results

The 571 included studies reported on 29 670 unique individuals (50% ≤ 18 years of age) from 43 countries. Of the 17 757 extracted results (4890 significant) in 1552 genes, 3675 results met the study criteria for meta-analysis: reported phenotype and genotype, association size and direction, variability measure, sample size, and statistical test. Only 173 results for 62 associations could be cross-study combined. The remaining associations could not be aggregated because they were only reported once or methods (eg, study design, reporting practice) and genotype or phenotype definitions were insufficiently harmonized. Gene variants regulating fetal hemoglobin and α-thalassemia (important markers for SCD severity) were frequently identified: 19 single-nucleotide variants in BCL11A, HBS1L-MYB, and HBG2 were significantly associated with fetal hemoglobin (absolute value of Z = 4.00 to 20.66; P = 8.63 × 10-95 to 6.19 × 10-5), and α-thalassemia deletions were significantly associated with increased hemoglobin level and reduced risk of albuminuria, abnormal transcranial Doppler velocity, and stroke (absolute value of Z = 3.43 to 5.16; P = 2.42 × 10-7 to 6.00 × 10-4). However, other associations remain unconfirmed. Pathway analyses of significant genes highlighted the importance of cellular adhesion, inflammation, oxidative and toxic stress, and blood vessel regulation in SCD (23 of the top 25 Gene Ontology pathways involve these processes) and suggested future research areas.

Conclusions and Relevance

The findings of this comprehensive systematic review and meta-analysis of all published genetic modifiers of SCD indicated that implementation of standardized phenotypes, statistical methods, and reporting practices should accelerate discovery and validation of genetic modifiers and development of clinically actionable genetic profiles.

RASA3 is a candidate gene in sickle cell disease-associated pulmonary hypertension and pulmonary arterial hypertension

Pulmonary hypertension (PH) is associated with significant morbidity and mortality. RASA3 is a GTPase activating protein integral to angiogenesis and endothelial barrier function. In this study, we explore the association of RASA3 genetic variation with PH risk in patients with sickle cell disease (SCD)-associated PH and pulmonary arterial hypertension (PAH). Cis-expression quantitative trait loci (eQTL) were queried for RASA3 using whole genome genotype arrays and gene expression profiles derived from peripheral blood mononuclear cells (PBMC) of three SCD cohorts. Genome-wide single nucleotide polymorphisms (SNPs) near or in the RASA3 gene that may associate with lung RASA3 expression were identified, reduced to 9 tagging SNPs for RASA3 and associated with markers of PH. Associations between the top RASA3 SNP and PAH severity were corroborated using data from the PAH Biobank and analyzed based on European or African ancestry (EA, AA). We found that PBMC RASA3 expression was lower in patients with SCD-associated PH as defined by echocardiography and right heart catheterization and was associated with higher mortality. One eQTL for RASA3 (rs9525228) was identified, with the risk allele correlating with PH risk, higher tricuspid regurgitant jet velocity and higher pulmonary vascular resistance in patients with SCD-associated PH. rs9525228 associated with markers of precapillary PH and decreased survival in individuals of EA but not AA. In conclusion, RASA3 is a novel candidate gene in SCD-associated PH and PAH, with RASA3 expression appearing to be protective. Further studies are ongoing to delineate the role of RASA3 in PH.

Cross-sectional and longitudinal associations of apolipoprotein A1 and B with glycosylated hemoglobin in Chinese adults

Apolipoproteins exert a key role on glucose metabolism; however, scarce data have examined the relationship between apolipoproteins and glycated haemoglobin (HbA1c) in Chinese adults. This study determined the cross-sectional and longitudinal associations of serum Apolipoprotein A1 (ApoA1), Apolipoprotein B (ApoB) and the ApoB/A1 ratio with HbA1c in Chinese adults. A total of 1448 subjects (584 men and 864 women) aged 54.8 years were included in a baseline survey, and the concentrations of Apo and HbA1c were measured. A total of 826 participants were followed up approximately once after 3.94 ± 0.62 years. In cross-sectional analysis, serum ApoA1 was inversely associated with HbA1c, while ApoB and the ApoB/A1 ratio were positively associated with HbA1c. After further adjusting for the potential covariates, a higher ApoA1 was associated with lower HbA1c (Quartile 4 [Q4] vs. Q1 = 5.673% vs. 5.796%, P-trend = 0.014). In contrast, positive association of ApoB concentration and the ApoB/A1 ratio with HbA1c level were showed (Q4 vs. Q1 = 5.805% vs. 5.589% for ApoB; Q4 vs. Q1 = 5.841% vs. 5.582% for ApoB/A1 ratio). The longitudinal results showed no significant associations of ApoA1, ApoB levels and the ApoB/A1 ratio with HbA1c changes (all P-trends > 0.05). Path analysis suggested that body mass index did not have mediating effect on Apo-HbA1c association. Our findings revealed that higher ApoA1, lower ApoB concentrations and the ApoB/A1 ratio were associated with lower HbA1c level in Chinese adults.

Dietary quality indices modify the effects of apolipoprotein B polymorphisms on biochemical and anthropometric factors in type 2 diabetes mellitus

We tried to identify the interaction between dietary quality indices and apolipoprotein B Ins/Del and EcoR1 polymorphisms on biochemical and anthropometric factors in patients with type 2 diabetes mellitus (T2DM). This cross-sectional study recruited 700 adults with T2DM in Tehran. The genotypes of Ins/Del and EcoR1 single nucleotide polymorphisms (SNP) were explored via polymerase chain reaction (PCR). Dietary quality index-international (DQI-I), healthy eating index-2015 (HEI-2015) and dietary phytochemical index (DPI) were calculated by semi-quantitative food frequency questionnaire (FFQ). In both crude and adjusted model for confounding factors, we observed significant interactions between DQI-I and Ins/Del SNP on leptin in and 8-iso-prostaglandin F2 α (8-iso-PGF2α), DPI and EcoR1 SNP on total cholesterol (TC) and between Ins/Del SNP and HEI-2015 on interleukin-18 (IL-18). Furthermore, in crude model there were close to meaningful interactions between EcoR1 SNP and DQI-I on total antioxidant capacity (TAC) and between EcoR1 SNP and HEI-2015 on serum leptin and superoxide dismutase (SOD) levels. Our finding indicated that the association between DQI-I, HEI-2015 and DPI with IL-18, TC, leptin and 8-iso-PGF2α in patients with T2DM might be dependent on Ins/Del and EcoR1 variants in ApoB gene.

Association of apolipoproteins A1 and B with type 2 diabetes and fasting blood glucose: a cross-sectional study

BACKGROUND

Apolipoprotein (Apo) may be associated with type 2 diabetes (T2D), however, little is known whether or not serum apolipoproteins are correlated with fasting blood glucose (FBG) and the prevalence of T2D in Chinese populations. In this study, we examined the association of serum ApoA1, ApoB, and the ratio of ApoB/ApoA1 (ApoB/A1 ratio) with T2D and FBG level, and compared apolipoprotein indicators in predicting T2D in Chinese adults.

METHODS

A total of 1027 subjects were enrolled in this cross-sectional study. The association of ApoA1, ApoB, and ApoB/A1 ratio with T2D prevalence was determined using logistic regression models. Multivariate-analysis of covariance (ANCOVA) was performed for comparisons of the mean difference in FBG level.

RESULTS

We found that ApoB and ApoB/A1 ratio were positively associated with T2D prevalence and FBG, while inverse association was noted between ApoA1 and T2D prevalence as well as FBG. Stratified analyses for sex, age, body mass index (BMI), smoking, and alcohol consumption showed no significant difference for the association of ApoA1, ApoB, and ApoB/A1 ratio with the prevalence of T2D among subgroups (all p-interactions> 0.05). Nonetheless, ApoA1 poorly performed in predicting T2D as it provided an AUC value of 0.310 that was significantly lower than those observed for ApoB (AUC value: 0.631) and ApoB/A1 ratio (AUC value: 0.685). Finally, path analyses indicated that the association between ApoB and T2D was mediated by BMI.

CONCLUSIONS

This study reveals the association of serum ApoA1, ApoB, and ApoB/A1 ratio with T2D and FBG in Chinese adults, suggesting that ApoB and ApoB/A1 ratio may be early indicators for predicting T2D. Prospective investigation in large cohort is needed.

Type 2 diabetes mellitus: pathogenesis and genetic diagnosis

Type 2 diabetes mellitus (T2DM) is a heterogeneous condition that is related to both defective insulin secretion and peripheral insulin resistance. Beta cells are the major organ for secreting insulin hence, it is important to maintain an adequate beta-cell mass in response to various changes. Insulin resistance is a major cause of T2DM leads to elevated free fatty acid (FFA) levels which increases beta-cell mass and insulin secretion to compensate for insulin insensitivity. Chronic increase of plasma FFA levels results in disturbances in lipid metabolism, which contributes to decreased beta-cell function and lipotoxicity thus promoting T2DM. In the present review, we have discussed the process of beta-cell destruction, the role of genes in contributing to the fast increase in the progression of T2DM in detail. More than 130 variants in various T2DM susceptibility and candidate genes have been discovered to be associated with T2DM. Still, these variants elucidate only a small amount of total heritability of T2DM. Further, there is also an inventory of presently used therapeutic tools and a review of novel therapeutic approaches like incretin-based therapies or sodium-glucose transporter-2 inhibitors. Additionally, providing a concise but comprehensive update, this review will be essential to every clinician involved in the treatment of diabetes mellitus.

Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus

Metformin was recently found to increase fetal hemoglobin, which is protective in sickle cell disease (SCD). We tested the hypothesis that, among adults with SCD and diabetes mellitus (DM), metformin use is associated with fewer adverse SCD clinical outcomes and lower health care utilization. This is a retrospective cohort study using the MarketScan Medicaid claims database for 2006 to 2016, comparing metformin users and nonusers. Patients on hydroxyurea, insulin, or iron chelation were excluded. Main outcomes included annual rates of all-cause inpatient encounters, all-cause emergency department (ED) encounters, inpatient and ED encounters with SCD codes, vaso-occlusive episodes (VOEs), strokes, acute chest syndrome (ACS), avascular necrosis (AVN), and gallstones. Of 457 adults (median age [interquartile range], 43 years [33-52 years]; 72% female), 142 (31%) were treated with metformin. Adjusted for age, sex, and Charlson Comorbidity Index, metformin users had significantly lower rate ratios of all-cause inpatient encounters (0.68; 95% confidence interval [CI], 0.52-0.88; P < .01), inpatient encounters with SCD codes (0.45; 95% CI, 0.30-0.66; P < .01), ED encounters with SCD codes (0.34; 95% CI, 0.21-0.54; P < .01), VOE (0.22; 95% CI, 0.12-0.41; P < .01), ACS (0.17; 95% CI, 0.05-0.60; P = .01), and AVN (0.30; 95% CI, 0.11-0.87; P = .03). A subgroup analysis of 54 enrollees preinitiation and postinitiation of metformin did not indicate significant changes in rates of clinical events. Metformin was associated with significantly fewer inpatient and ED SCD encounters in adults with SCD and DM; however, confounding of underlying SCD severity cannot be excluded.

Effect of folic acid supplementation on nerve conduction velocity in diabetic polyneuropathy patients

OBJECTIVES

In diabetic polyneuropathy (DPN) patients, the effect of folic acid and homocysteine has been related to components of nerve conduction velocity (NCV). The objective of this study was to determine the effect of folic acid supplementation on NCV in DPN patients.

METHODS

Patients were randomized to receive either 1 mg of folic acid (n = 40) or placebo (n = 40) for 16 weeks. Blood samples were collected to assess serum folic acid and homocysteine concentrations, and NCV was performed for assessment of diabetic neuropathy.

RESULTS

At 16 weeks, in the supplemented group, serum levels of folic acid (p < 0.001) increased, homocysteine concentrations decreased (p < 0.001), with no change in serum vitamin B12 levels. There was a significant increase in sensory sural amplitude (p < 0.001), and components of motor nerves, including amplitude (p = 0.001) and velocity (p < 0.001), but decreased onset latency of peroneal (p = 0.019) and tibial (p = 0.011) motor nerves.

CONCLUSION

Our data suggest that supplementation with 1 mg of folic acid for 16 weeks may be useful for enhancing NCV in DPN patients.

Similar burden of type 2 diabetes among adult patients with sickle cell disease relative to African Americans in the U.S. population: a six-year population-based cohort analysis

Conflicting evidence exists on the epidemiology of type 2 diabetes mellitus (T2DM) among patients with sickle cell disease (SCD). This study measured the prevalence, incidence and clinical outcomes associated with T2DM in a large US population of commercially-insured adults aged ≥20 years with SCD between 2009 and 2014. Among 7070 patients with SCD, the mean age (median) was 39 (37) years and 60·8% were female. The standardized prevalence of T2DM among patients with SCD showed a modest increase, from 15·7% to 16·5% (P trend = 0·026), and was comparable to African-American respondents to the National Health and Nutrition Examination Survey (18·2%). Over 17 024 person-years, the crude incidence rate for T2DM was 25·4 per 1000 person-years. Incident T2DM was associated with comorbid hypertension (hazard ratio [HR] = 1·45, 95% confidence interval [CI] 1·14-1·83), and dyslipidaemia (HR = 1·43, 95%CI 1·04-1·96). Compared to SCD patients without T2DM, more SCD patients with T2DM had diagnoses of nephropathy (28·0% vs. 9·5%; P < 0·001), neuropathy (17·7% vs. 5·2%; P < 0·001) and stroke (24·1% vs. 9·2%; P < 0·001). Prevalence of T2DM in SCD patients is similar to the general African American population with an increasing trend in recent years. These trends support routine screening for T2DM in aging patients with SCD, especially those with comorbid hypertension and/or dyslipidaemia.

Sickle cell disease prevents diabetes mellitus occurrence: A hospital based cross-sectional study

BACKGROUND

Sickle cell disease is the commonest inherited hemoglobinopathy. There are few reports point towards decrease incidence of diabetes mellitus in sickle cell disease patients.

MATERIALS AND METHODS

This cross-sectional study was conducted in VIMSAR, Burla, Odisha between Nov 2014 to Oct 2016. FBS and 2 hours OGTT reports of adult sickle cell disease patients were compared with the same reports from equal no of adult persons without sickle cell disease (controls) to found out any significant difference in prevalence of diabetes mellitus in sickle cell disease patients versus controls.

RESULTS

A total of 137 adult patients of sickle cell disease out of which males were 94 (68.61%) and females were 43 (31.38%) with an average age of (26.7 ± 10.9) years and an equal number of controls [males 87 (63.8%) and females 50 (36.5%)] with an average age of (47.6 ± 13.6) years were included in the study. We found diabetes mellitus in 2 (1.46%) out of 137 sickle cell disease patients with an average BMI 18.5 kg/m2 versus 12 (8.76%) in equal number of controls with an average BMI of 22.6 kg/m2.

CONCLUSION

This study concludes that prevalence of diabetes mellitus in sickle cell disease patients is significantly lower than non-sickle cell disease persons. This may be due to less longevity and low BMI in sickle cell disease patients.

A genetic variation associated with plasma erythropoietin and a non-coding transcript of PRKAR1A in sickle cell disease

Blood erythropoietin (EPO) increases primarily to hypoxia. In sickle cell anaemia (homozygous HBBE6V; HbSS), plasma EPO is elevated due to hemolytic anaemia-related hypoxia. Hydroxyurea treatment reduces haemolysis and anaemia by increasing foetal haemoglobin, which leads to lower hypoxic transcriptional responses in blood mononuclear cells but paradoxically further increases EPO. To investigate this apparent hypoxia-independent EPO regulation, we assessed two sickle cell disease (SCD) cohorts for genetic associations with plasma EPO, by prioritizing 237,079 quantitative trait loci for expression level and/or transcript isoform variations of 12,727 genes derived from SCD blood mononuclear cells. We found an association between the T allele of SNP rs60684937 and increased plasma EPO (n = 567, combined P = 5.5 × 10 − 8 adjusted for haemoglobin and hydroxyurea) and validated it in independent SCD patients (n = 183, P = 0.018). The T allele of rs60684937 was associated with a relatively increased expression of a non-coding transcript of PRKAR1A (cAMP-dependent protein kinase type I-alpha regulatory subunit) in 58 SCD patients (P = 7.9 × 10 − 7) and 58 HapMap Yoruba samples (P = 0.0011). In conclusion, we demonstrate that plasma EPO elevation with hydroxyurea in SCD is independent of hypoxic responses and that genetic variation at SNP rs60684937 may contribute to EPO regulation through a cAMP-dependent protein kinase A pathway.