Precision medicine of obesity as an integral part of type 2 diabetes management - past, present, and future

Individual participant data meta-analysis of eating behaviour traits as effect modifiers in acceptance and commitment therapy-based weight management interventions

BACKGROUND

Obesity care may benefit from precision approaches, matching patients to treatment types based on their individual characteristics, including eating behaviour traits (EBTs) like emotional eating, uncontrolled eating, external eating, internal disinhibition and restraint. Initial evidence suggests that Acceptance and Commitment Therapy (ACT)-based interventions might address dysregulated EBTs more effectively than standard behavioural treatments. However, it is unclear if ACT is more effective for certain EBT levels.

METHODS AND ANALYSIS

This pre-registered (CRD42022359691) one-stage Individual Participant Data (IPD) meta-analysis explored the moderating effects of baseline EBTs on weight outcomes in trials of ACT-based interventions for adults with a BMI ≥ 25 kg/m2. Unlike traditional meta-analyses, IPD meta-analyses re-analyse existing data to answer novel research questions. We identified 16 eligible trials through a systematic search of eight databases until June 20, 2022. We obtained, checked, and harmonised data from 15 trials (N = 2535). We used mixed regression models to investigate both continuous and categorical interaction effects.

RESULTS

We found no evidence of interactions between ACT vs. control and baseline EBTs as continuous variables on percentage weight change. However, we found evidence to suggest an added difference in weight change of -4.47% (95%CI -1.15, -7.73) from baseline to 12-months after intervention end in participants with medium levels of internal disinhibition compared to those with high levels. Sensitivity analyses similarly indicated a greater intervention benefit for participants with medium, rather than high, emotional eating levels (in trials that reduced experiential avoidance and in trials using the three-factor eating questionnaire) and internal disinhibition (in analyses of participants with at least 60% attendance). Given the exploratory nature of analyses, results should be interpreted with caution.

CONCLUSION

Findings suggest potential non-linear interaction effects of ACT with internal disinhibition but require replication in confirmatory trials. These results may help guide further research on precision approaches based on EBTs.

Use of Semaglutide (Wegovy) in Adults in France: A Nationwide Drug Utilization Study

BACKGROUND

Glucagon-like peptide 1 receptor agonists have shown promising results in obesity treatment. In France, semaglutide 2.4-mg (Wegovy) has benefited from an early-access program from July 2022 to September 2023.

OBJECTIVE

This study aimed to describe the user profile of semaglutide 2.4-mg and the dosage patterns under real-world conditions during this period.

METHODS

Between July 2022 and September 2023, semaglutide 2.4-mg initiators were identified through the nationwide APMO database (Accès Précoce-Médicaments Onéreux), built from the French National Health Data System (SNDS). The cohort was followed up until 31 December 2023. A sequence analysis was used to build clusters of dose escalation regimens.

RESULTS

Among the 6990 adult patients who started treatment, the median age was 49.0 years, with a majority of women (65.8%). The study revealed significant regional variations in initiation rates, with the highest in Ile-de-France (including Paris). Three groups of users were identified: standard adherence (74.5%), early discontinuation (13.0%), and high-dose initiation (12.5%). Factors influencing these clusters included age, with younger patients (25-34 years) more likely to discontinue early (odds ratio: 1.35 [95% confidence interval 1.05-1.75]). The use of anti-emetics during the first 5 months of the follow-up period was higher in the early-discontinuation group (15.7%) compared with the high-dose initiation group (9.0%) and standard adherence group (12.3%).

CONCLUSIONS

This study involved a substantial number of real-life semaglutide 2.4-mg users and highlights the importance of monitoring treated patients from a public health perspective, given the broad prescription to come and the potential risks associated with misuse.

Feruloylacetone and Its Analog Demethoxyferuloylacetone Mitigate Obesity-Related Muscle Atrophy and Insulin Resistance in Mice

Obesity-induced muscle alterations, such as inflammation, metabolic dysregulation, and myosteatosis, lead to a decline in muscle mass and function, often resulting in sarcopenic obesity. Currently, there are no definitive treatments for sarcopenic obesity beyond lifestyle changes and dietary supplementation. Feruloylacetone (FER), a thermal degradation product of curcumin, and its analog demethoxyferuloylacetone (DFER), derived from the thermal degradation of bisdemethoxycurcumin, have shown potential antiobesity effects in previous studies. This study investigates the impact of FER and DFER on obesity-related glucose intolerance and muscle atrophy. High-fat diet (HFD) feeding resulted in muscle mass reduction and increased intramuscular triglyceride accumulation, both of which were mitigated by FER and DFER supplementation. The supplements activated the PI3K/Akt/mTOR signaling pathway, enhanced muscle protein synthesis, and decreased markers of muscle protein degradation. Additionally, FER and DFER supplementation improved glucose homeostasis in HFD-fed mice. The supplements also promoted the formation of a gut microbial consortium comprising Blautia intestinalis, Dubosiella newyorkensis, Faecalicatena fissicatena, Waltera intestinalis, Clostridium viride, and Caproiciproducens galactitolivorans, which contributed to the reduction of obesity-induced chronic inflammation. These findings suggest, for the first time, that FER and DFER may prevent obesity-related complications, including muscle atrophy and insulin resistance, thereby warranting further research into their long-term efficacy and safety.

A novel human specific lncRNA MEK6-AS1 regulates adipogenesis and fatty acid biosynthesis by stabilizing MEK6 mRNA

BACKGROUND

Obesity is becoming one of the major non-communicable diseases with increasing incidence and risks that cannot be ignored. However effective and safe clinical treatment strategies still need to be deeply explored. Increased number and volume of adipocytes lead to overweight and obesity. The aim of our work is to identify lncRNAs that have important regulatory in differentiation of human mesenchymal stem cells (MSCs) into adipocytes, and to provide effective targets for clinical prevention and treatment of obesity and related metabolic disorders.

METHODS

We extracted primary MSCs from human adipose tissue, and conducted expression profile analysis of lncRNAs during adipogenic differentiation of MSCs to screen changed lncRNAs. Characteristics of lncRNA were revealed mainly by RACE and RNA FISH. Loss- and gain-of function experiments in vivo and in vitro were used to analyze effects of lncRNA. Targeted metabolomics was utilized to detect levels of free fatty acids. RNA pull-down, mRNA stability tests, etc. were employed to explore mechanisms of lncRNA.

RESULTS

Human-specific lncRNA, we named it MEK6-AS1, was the most up-regulated transcript during adipogenic differentiation of MSCs. MEK6-AS1 was highly expressed in adipose tissue samples from individuals with BMI ≥ 25 and positively correlated with adipogenic marker genes in these samples. Knocking down lncRNA inhibited expression of adipogenic differentiation markers and ectopic adipogenesis, reducing contents of various free fatty acids, as well as promoting osteogenic differentiation. Overexpression of lncRNA had the opposite effects to the above processes. We also found that MEK6-AS1 was elevated during hepatic steatosis organoid generation. Mechanistically, MEK6-AS1 worked partially through stabilization of MEK6 mRNA by NAT10.

CONCLUSIONS

We have identified a human-specific lncRNA (MEK6-AS1) with position information in the genomic database but has not been extensively reported. We demonstrated that MEK6-AS1 as a novel lncRNA involved in adipogenic differentiation and adipogenesis, fatty acid metabolism, and osteogenic differentiation. We found that MEK6-AS1 may exert its effect by enhancing MEK6 mRNA stability through NAT10. Our study may provide insights into implication of lncRNAs in stem cell biology and offer a new potential therapeutic target for the prevention and treatment of obesity and other related disease.

Genetic influences, lifestyle and psychosocial aspects in relation to metabolically healthy obesity and conversion to a metabolically unhealthy state

AIMS

About 10%-30% of individuals with obesity are metabolically healthy, but the specific characteristics of the metabolically healthy obesity (MHO) phenotype remain unclear. We aimed to examine how physical activity, education, depressive symptoms and genetic predisposition to obesity differ between individuals with MHO and those with metabolically unhealthy obesity (MUO), and whether these factors predict stability in MHO or conversion to a metabolically unhealthy state.

MATERIALS AND METHODS

We retrieved data on 9809 individuals with obesity from the Health and Retirement Study collected between 2006 and 2016. We compared how physical activity, education, depressive symptoms and a polygenic score for higher body mass index (BMI) (PGSBMI) differed cross-sectionally between MHO and MUO using logistic regression. We then examined if the same factors predict conversion to a metabolically unhealthy state over 4 years in individuals with MHO.

RESULTS

Individuals with MHO had higher physical activity (odds ratio [OR] = 0.81), higher education (OR = 0.83) and lower depressive symptoms (OR = 1.14) compared to those with MUO but did not differ in the PGSBMI. The associations were slightly attenuated in mutually adjusted models. None of the factors were associated with conversion from MHO to a metabolically unhealthy state. However, a higher PGSBMI indicated 24% lower risk of conversion to a metabolically unhealthy state (p = 0.07).

CONCLUSIONS

Physical activity, education and depressive symptoms differed between MHO and MUO, even when mutually adjusted for, but did not predict conversion from a metabolically healthy to unhealthy state. Although not statistically significant, the results indicated that those with genetically predicted high BMI are more likely to maintain MHO and not convert to a metabolically unhealthy state.

Associations of Serum Lipid Traits With Fracture and Osteoporosis: A Prospective Cohort Study From the UK Biobank

BACKGROUND

Previous studies reveal inconsistent associations between serum lipid traits and the risks of fractures and osteoporosis in the general population.

METHODS

This prospective cohort study analysed data from 414 302 UK Biobank participants (223 060 women and 191 242 men, aged 37-73 years) with serum lipid measurements: apolipoprotein A (Apo A), apolipoprotein B (Apo B), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and lipoprotein A (Lp(a)). Multivariable Cox proportional hazard models with penalized cubic splines were used to explore potential nonlinear associations of each lipid trait with the risks of fractures and osteoporosis. Subgroup analyses by age, sex, BMI categories and pre-existing cardiovascular disease were conducted. Mediation analyses using the g-formula were performed to quantify to which extent bone mineral density (BMD) may mediate the association between serum lipids and fracture risk.

RESULTS

Over a median follow-up period of 13.8 years, 25 918 (6.8%) of the 383 530 participants without prior fracture had incident fracture cases, and 7591 (4.1%) of the 184 919 participants with primary care data and without baseline osteoporosis were diagnosed with osteoporosis. TG had nonlinear associations with fractures and osteoporosis, whereas Apo B, TC and LDL-C had linear associations. There were also nonlinear associations of Apo A and HDL-C with fractures. Individuals in the highest quintiles for Apo A (fracture: HR 1.15 [95% CI 1.10, 1.21]; osteoporosis: HR 1.13 [1.02, 1.25]) and HDL-C (fracture: HR 1.27 [1.20, 1.34]; osteoporosis: HR 1.31 [1.18, 1.46]) were associated with higher risks of fractures and osteoporosis. Conversely, those in the highest quintile for Apo B (fracture: HR 0.85 [0.81, 0.89]; osteoporosis: HR 0.86 [0.79, 0.94]), LDL-C (fracture: HR 0.89 [0.85, 0.93]; osteoporosis: HR 0.91 [0.83, 1.00]) and TG (fracture: HR 0.78 [0.74, 0.82]; osteoporosis: HR 0.75 [0.68, 0.82]) were associated with lower risks. The associations of Apo A (ratio of HR [RHR] 1.05 [1.02, 1.09]) and HDL-C (RHR 1.06 [1.03, 1.09]) with fracture risk were more pronounced in men compared to women. Except for TG and Lp(a), the associations between serum lipids and fractures appear to be partially mediated through BMD (mediation proportions: 5.30% to 40.30%), assuming causality.

CONCLUSIONS

Our study reveals a complex interplay between different lipid markers and skeletal health, potentially partially mediated through BMD. Routine lipid profile assessments, including HDL-C and Apo A among other lipid traits, may be integrated into the strategies for fracture risk stratification.

Exploring flavonoid intake and all-cause mortality in diverse health conditions: Insights from NHANES 2007-2010 and 2017-2018

OBJECTIVES

Flavonoids exhibit antioxidative, anti-inflammatory, and anticancer properties, yet the relationship between flavonoid intake and all-cause mortality in the obese population remains unclear.

METHODS

This study included NHANES participants from 2007 to 2010 and 2017 to 2018. Cox regression analysis evaluated the impact of total flavonoid intake on all-cause mortality among participants with varying comorbidity profiles. Subgroup analysis was conducted by separately analyzing the six sub-classes of total flavonoids (anthocyanidins, flavan-3-ols, flavanones, flavones, flavonols, and isoflavones). Sensitivity analysis was used to investigate the impact of total flavonoid intake on all-cause mortality among patients with different comorbidities.

RESULTS

During a median follow-up period of 9.92 years (interquartile range (IQR), 5.54-14.29 years), a total of 639 participants died. COX regression analysis revealed a positive impact of flavonoid intake on all-cause mortality among participants with chronic kidney disease, with greater benefits observed in obese participants [hazard ratio (HR): 0.22, 95% CI: 0.11-0.44). In metabolically healthy obese participants (HR: 0.15, 95% CI: 0.07-0.35), obese individuals with diabetes (HR: 0.51, 95% CI: 0.29-0.88), and obese individuals with comorbid cardiovascular disease (HR: 0.37, 95% CI: 0.17-0.83), flavonoid intake was associated with a reduced risk of all-cause mortality. Restricted cubic spline (RCS) analysis indicated a non-linear relationship in obese participants, with optimal intake levels ranging from 319.4978 to 448.6907 mg/day, varying based on different comorbidity profiles. Subgroup analysis revealed varying effects of total flavonoid components in different health conditions, with hazard ratios ranging from 0.06 for higher levels of flavonol to 0.59 for higher levels of anthocyanidins in the Cox model. Sensitivity analyses further indicated that individuals with obesity and comorbid diabetes or CKD see the greatest benefit from flavonoid intake.

CONCLUSIONS

The consumption of flavonoids may be associated with a decreased risk of all-cause mortality. Consumption of flavonoids is particularly beneficial for individuals with obesity and comorbidities.

Single-Administration Self-Boosting Microneedle Patch for The Treatment of Obesity

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are one of the most effective treatments for obesity. The current therapy associated with repeated subcutaneous injections to maintain the drug therapeutic effect causes patient compliance issues and raises environmental concerns (due to sharp biohazard waste from disposed syringes/needles). Herein, we report a programmable scheduled release microneedles (PSR-MNs) system for delivering Semaglutide (a GLP-1 RA agent with a half-life of ~ 7 days) to manage and treat obesity. A single skin administration of a PSR-MNs patch (2 cm × 2 cm) which contains 4 programmable core-shell MNs patches (1 cm2 each, so-called pixels) enables the repeated release of Semaglutide every 7 days and sustains the drug efficacy for an unprecedented one-month period, simulating the effect of using four bolus injections spaced 7 days apart. Our PSR-MNs system provides an advanced injection-free platform to significantly enhance the current treatment of obesity with GLP-1RAs, addressing concerns related to pain, needle phobia, high cost and the need of medical facilities/personnel in traditional injections to administer the drug.

The enduring metabolic improvement of combining dual amylin and calcitonin receptor agonist and semaglutide treatments in a rat model of obesity and diabetes

Long-acting dual amylin and calcitonin receptor agonists (DACRAs) are novel candidates for the treatment of type 2 diabetes and obesity due to their beneficial effects on body weight, glucose control, and insulin action. However, how the metabolic benefits are maintained after long-lasting treatment is unknown. This study investigates the long-term anti-obesity and anti-diabetic treatment efficacy of the DACRA KBP-336 alone and combined with the GLP-1 analog semaglutide. Zucker diabetic Sprague Dawley (ZDSD) rats with obesity and diabetes received KBP-336 (4.5 nmol/kg Q3D), semaglutide (50 nmol/kg Q3D), or the combination for 7 mo, and the treatment impact on body weight, food intake, glucose control, and insulin action was evaluated. Furthermore, serum levels of the cardiac fibrosis biomarker endotrophin were evaluated. KBP-336, semaglutide, and the combination lowered body weight significantly compared with the vehicle, with the combination inducing a larger and more sustained weight loss than either monotherapy. All treatments resulted in reduced fasting blood glucose levels and HbA1c levels and improved glucose tolerance compared with vehicle-treated rats. Furthermore, all treatments protected against lost insulin secretory capacity and improved insulin action. Serum levels of endotrophin were significantly lowered by KBP-336 compared with vehicle. This study shows the benefit of combining KBP-336 and semaglutide to obtain significant and sustained weight loss, as well as improved glucose control. Furthermore, KBP-336-driven reductions in circulating endotrophin indicate a clear reduction in the risk of complications. Altogether, KBP-336 is a promising candidate for the treatment of obesity and type 2 diabetes both alone and in combination with GLP-1 analogs.NEW & NOTEWORTHY These studies describe the benefit of combining dual amylin and calcitonin receptor agonists (DACRA) with semaglutide for long-term treatment of obesity and type 2 diabetes. Combination treatment induced sustained weight loss and improved glucose control. A DACRA-driven reduction in a serological biomarker of cardiac fibrosis indicated a reduced risk of complications. These results highlight DACRAs as a promising candidate for combination treatment of obesity and type 2 diabetes and related long-term complications.

Tracking correlations and predictors of plasma glucose in young adulthood: A comprehensive analysis from adolescence to young adulthood in TLGS study

AIMS

We investigated the tracking correlations between fasting plasma glucose (FPG) in adolescence with both FPG and 2-hour post-load glucose (2 h-PG) in adulthood, and identified the predictors of FPG and 2 h-PG in young adulthood using traditional risk factors during adolescence and adulthood.

METHODS

We included 2188 participants (1033 male) from the Tehran lipid and glucose study within the age ranges 11-18 and 19-40 years during 1999-2018. The area under the curve (AUC) was computed using the growth curve models, and predictors were identified by the linear regression model.

RESULTS

The partial correlation between AUCs of FPG in adolescence and adulthood was 0.37 (P < 0.001). The correlation between AUCs of FPG in adolescence and 2 h-PG in adulthood was 0.17 (P < 0.001). The AUC of FPG was a significant positive predictor for both FPG and 2 h-PG in young adulthood. Other predictors of adult FPG included sex, as well as BMI and the ratio of triglycerides to HDL-cholesterol during both adolescence and adulthood.

CONCLUSIONS

Tracking correlation was observed for FPG, suggesting that monitoring and managing risk factors in adolescence may have implications for future glucose metabolism in young adulthood.

In vitro biological studies and computational prediction-based analyses of pyrazolo[1,5-a]pyrimidine derivatives

There is a need for new pharmaceutical discoveries from bioactive nitrogenous derivatives due to the emergence of scourges, numerous pandemics, and diverse health problems. In this context, pyrazolo[1,5-a]pyrimidine derivatives 12a and 12b were synthesized and screened to evaluate their biological potentials in vitro as antioxidants, anti-diabetics, anti-Alzheimer's, anti-arthritics, and anti-cancer agents. Additionally, the computational pharmacokinetic and toxicity properties of the two pyrazolo[1,5-a]pyrimidines 12a and 12b were calculated and analyzed. The preliminary studies and results of this work represent the initial steps toward more advanced studies and define the bioactive chemical structure of pyrazolo[1,5-a]pyrimidine derivatives with the goal of exploring new drugs to address numerous health problems.

The Multifaceted S100B Protein: A Role in Obesity and Diabetes?

The S100B protein is abundant in the nervous system, mainly in astrocytes, and is also present in other districts. Among these, the adipose tissue is a site of concentration for the protein. In the light of consistent research showing some associations between S100B and adipose tissue in the context of obesity, metabolic disorders, and diabetes, this review tunes the possible role of S100B in the pathogenic processes of these disorders, which are known to involve the adipose tissue. The reported data suggest a role for adipose S100B in obesity/diabetes processes, thus putatively re-proposing the role played by astrocytic S100B in neuroinflammatory/neurodegenerative processes.

The case for precision medicine in the prevention, diagnosis, and treatment of cardiometabolic diseases in low-income and middle-income countries

Cardiometabolic diseases are the leading preventable causes of death in most geographies. The causes, clinical presentations, and pathogenesis of cardiometabolic diseases vary greatly worldwide, as do the resources and strategies needed to prevent and treat them. Therefore, there is no single solution and health care should be optimised, if not to the individual (ie, personalised health care), then at least to population subgroups (ie, precision medicine). This optimisation should involve tailoring health care to individual disease characteristics according to ethnicity, biology, behaviour, environment, and subjective person-level characteristics. The capacity and availability of local resources and infrastructures should also be considered. Evidence needed for equitable precision medicine cannot be generated without adequate data from all target populations, and the idea that research done in high-income countries will transfer adequately to low-income and middle-income countries (LMICs) is problematic, as many migration studies and transethnic comparisons have shown. However, most data for precision medicine research are derived from people of European ancestry living in high-income countries. In this Series paper, we discuss the case for precision medicine for cardiometabolic diseases in LMICs, the barriers and enablers, and key considerations for implementation. We focus on three propositions: first, failure to explore and implement precision medicine for cardiometabolic disease in LMICs will enhance global health disparities. Second, some LMICs might already be placed to implement cardiometabolic precision medicine under appropriate circumstances, owing to progress made in treating infectious diseases. Third, improvements in population health from precision medicine are most probably asymptotic; the greatest gains are more likely to be obtained in countries where health-care systems are less developed. We outline key recommendations for implementation of precision medicine approaches in LMICs.