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Akinola IJ, Ubuane PO, Dada AO, Chionuma JO, Kuku-Kuye TO, Olalere FD. Association of maternal insulin resistance with neonatal insulin resistance and body composition/size: a prospective cohort study in a sub-Saharan African population. Ann Pediatr Endocrinol Metab 2024; 29:19-28. [PMID: 38461802 PMCID: PMC10925788 DOI: 10.6065/apem.2346136.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/17/2023] [Accepted: 10/30/2023] [Indexed: 03/12/2024] Open
Abstract
PURPOSE We prospectively evaluated the association of the insulin resistance of third-trimester Nigerian pregnant women with their newborn infants' insulin resistance and birth size. Pregnancy-associated insulin resistance (IR), often assessed with homeostatic model assessment of IR (HOMA-IR), is associated, especially among women with gestational diabetes (GDM), with abnormal neonatal birth size and body composition, predisposing the baby to metabolic disorders like diabetes and obesity. The associations of maternal IR with neonatal IR, birth size and body composition are less studied in nondiabetic pregnant women, especially in sub-Saharan settings like Nigeria. METHODS We originally recruited 401 third trimester, nondiabetic pregnant women to a prospective cohort study, followed up until birth. Blood samples of mothers and babies were obtained, respectively, at recruitment and within 24 hours postbirth for fasting serum glucose (FSG) and insulin (FSI) assays, and HOMA-IR was calculated as [(FSI × FSG)/22.5)]. RESULTS Complete data for 150 mother-baby dyads was analysed: the mothers, with a mean (standard deviation [SD]) age of 31.6 (4.5) years, had live births at a mean (SD) gestational age of 39.2 weeks. The proportions of infants with wasting, stunting, impaired fetal growth (either wasting or stunted), small-for-gestation-age, large-for-gestational-age, low birthweight, and macrosomia were 4.2% (95% confidence interval, 1.1-10.3), 19.7% (12.9-28.0), 23.1% (15.8-31.8), 10.1% (5.3-17.0), 12.6% (7.2-19.9), 0.8% (0.02-4.5), and 5.0% (1.8-10.5), respectively. Maternal HOMA-IR was not associated with neonatal HOMA-IR (p=0.837), birth weight (p=0.416) or body composition measured with weight-length ratio (p=0.524), but birth weight was independently predicted by maternal weight (p=0.006), body mass index (p=0.001), and parity (p=0.012). CONCLUSION In this nondiabetic/non-GDM cohort, maternal HOMA-IR was not associated with neonatal IR, body size or body composition. Larger studies are required to confirm these findings, with addi-tional inclusion of mothers with hyperglycaemia for comparison.
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Affiliation(s)
- Ibironke J. Akinola
- Department of Paediatrics and Child Health, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Peter O. Ubuane
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adeyemi O. Dada
- Department of Chemical Pathology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Joy O. Chionuma
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Taiwo O. Kuku-Kuye
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Folasade D. Olalere
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
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Srivastava N, Singh K, Singh N, Mahdi AA. Association between serum interleukin-6, leptin and insulin in gestational diabetes mellitus - a cross- sectional study. J Diabetes Metab Disord 2023; 22:639-648. [PMID: 37255771 PMCID: PMC10225451 DOI: 10.1007/s40200-023-01188-3] [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: 08/19/2022] [Revised: 12/26/2022] [Accepted: 01/14/2023] [Indexed: 06/01/2023]
Abstract
Purpose Gestational diabetes mellitus (GDM) is a state of leptin resistance which develops a vicious cycle of hyperinsulinemia and hyperleptinemia leading to aggravation of an inflammatory situation. This study was done to find out the association between IL-6, leptin and insulin in gestational diabetes among North Indian women. Method This cross-sectional study included 100 GDM, 100 non-GDM and 50 non-pregnant women. DIPSI (Diabetes in Pregnancy Study Group India) criteria was used for screening GDM among pregnant women. GDM and non-GDM pregnant women were further categorized into three groups according to the trimester of pregnancy. Serum IL-6, leptin and insulin were measured in all the enrolled women. Results Serum IL-6 levels were significantly higher among GDM women as compared to non-GDM and non-pregnant women. Although the mean serum leptin and insulin levels were higher in GDM, but the difference was not statistically significant. When GDM and non-GDM women were categorized into three trimester, serum leptin levels were found to be significantly higher in 3rd trimester (p < 0.002) and IL-6 in 1st trimester (p < 0.017) among GDM women. No correlation was found between serum IL-6, leptin and insulin in GDM. Conclusion Absence of any significant association between leptin and IL-6 signifies that leptin may not be associated with inflammation in gestational diabetes. However, IL-6 may serve as an early marker for screening glucose intolerance during pregnancy. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01188-3.
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Affiliation(s)
- Neha Srivastava
- Department of Biochemistry, King George’s Medical University, 226003 Lucknow, Uttar Pradesh India
| | - Kalpana Singh
- Department of Biochemistry, King George’s Medical University, 226003 Lucknow, Uttar Pradesh India
| | - Nisha Singh
- Department of Obstetrics & Gynaecology, King George’s Medical University, 226003 Lucknow, Uttar Pradesh India
| | - Abbas Ali Mahdi
- Department of Biochemistry, King George’s Medical University, 226003 Lucknow, Uttar Pradesh India
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Mao Z, Wu R, Yu H, Zhang Y, Dong W, Zou L, Lei X. Associations of Maternal Fructosamine before Delivery in Gestational Diabetes Mellitus Pregnancies with Neonatal Glucometabolic Disorders. J Diabetes Res 2022; 2022:2478250. [PMID: 36440470 PMCID: PMC9683954 DOI: 10.1155/2022/2478250] [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] [Received: 05/24/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background The offspring of pregnant women with gestational diabetes mellitus (GDM) are vulnerable to be glucometabolic disorders. However, to date, few current studies focused on the associations of maternal accumulated glucose exposure before delivery with neonatal glucometabolic disorders and large for gestational age (LGA) infants. This study is aimed at exploring the associations of maternal fructosamine (FMN) before delivery in GDM pregnant women with neonatal glucometabolic disorders in the first 3 days of life and LGA infants. Methods The study subjects were the GDM pregnant women, who gave birth in our hospital from September 1, 2018 to January 31, 2021, and their newborns. The maternal FMN adjusted by serum albumin (FMNALB) before delivery was selected as exposure factors. A multivariate logistical regression model was used to calculate the odds ratios (OR) for neonatal glucometabolic disorders, hypoglycemia needing intervention (<2.6 mmol/L), and glucose intolerance (>7.0 mmol/L) in the first 3 days and LGA infants. Results In GDM pregnant women, the newborns in the maternal FMNALB ≥ 75th percentile (≥5.89 mmol/g) group had higher risks in neonatal glucometabolic disorders (aOR 2.50, 95% CI 1.34-4.65, P = 0.004) and hypoglycemia (aOR 2.18, 95% CI 1.16-4.10, P = 0.016). However, FMNALB ≥ 75th percentile seemed to be not predictive of the glucose intolerance (aOR 1.76, 95% CI 0.82-3.79, P = 0.149) and LGA (aOR 1.56, 95% CI 0.81-3.02, P = 0.185). Further, in the sensitivity analysis, the newborns in the maternal FMNALB ≥ 90th percentile (≥6.40 mmol/g) group also had higher risks in neonatal glucometabolic disorders (aOR 5.70, 95% CI 2.18-14.89, P < 0.001) and hypoglycemia (aOR 3.72, 95% CI 1.48-9.31, P = 0.005). Conclusions The maternal FMNALB before delivery in GDM pregnant women was a useful biomarker to identify the offspring with high risk of neonatal glucometabolic disorders. However, the association between maternal FMNALB and the risk of LGA infants was not so strong.
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Affiliation(s)
- Zhengxia Mao
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Ruilin Wu
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Huan Yu
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yujiao Zhang
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Wenbin Dong
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Lile Zou
- Department of Histology and Embryology, Southwest Medical University, Luzhou, Sichuan, China
| | - Xiaoping Lei
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Cornejo M, Fuentes G, Valero P, Vega S, Grismaldo A, Toledo F, Pardo F, Moore‐Carrasco R, Subiabre M, Casanello P, Faas MM, Goor H, Sobrevia L. Gestational diabesity and foetoplacental vascular dysfunction. Acta Physiol (Oxf) 2021; 232:e13671. [PMID: 33942517 DOI: 10.1111/apha.13671] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/15/2022]
Abstract
Gestational diabetes mellitus (GDM) shows a deficiency in the metabolism of D-glucose and other nutrients, thereby negatively affecting the foetoplacental vascular endothelium. Maternal hyperglycaemia and hyperinsulinemia play an important role in the aetiology of GDM. A combination of these and other factors predisposes women to developing GDM with pre-pregnancy normal weight, viz. classic GDM. However, women with GDM and prepregnancy obesity (gestational diabesity, GDty) or overweight (GDMow) show a different metabolic status than women with classic GDM. GDty and GDMow are associated with altered l-arginine/nitric oxide and insulin/adenosine axis signalling in the human foetoplacental microvascular and macrovascular endothelium. These alterations differ from those observed in classic GDM. Here, we have reviewed the consequences of GDty and GDMow in the modulation of foetoplacental endothelial cell function, highlighting studies describing the modulation of intracellular pH homeostasis and the potential implications of NO generation and adenosine signalling in GDty-associated foetal vascular insulin resistance. Moreover, with an increase in the rate of obesity in women of childbearing age worldwide, the prevalence of GDty is expected to increase in the next decades. Therefore, we emphasize that women with GDty and GDMow should be characterized with a different metabolic state from that of women with classic GDM to develop a more specific therapeutic approach for protecting the mother and foetus.
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Affiliation(s)
- Marcelo Cornejo
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Faculty of Health Sciences Universidad de Talca Talca Chile
- Faculty of Health Sciences Universidad de Antofagasta Antofagasta Chile
| | - Gonzalo Fuentes
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Faculty of Health Sciences Universidad de Talca Talca Chile
- Department of Pathology and Medical Biology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
| | - Paola Valero
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Faculty of Health Sciences Universidad de Talca Talca Chile
| | - Sofía Vega
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Medical School (Faculty of Medicine) Sao Paulo State University (UNESP) Sao Paulo Brazil
| | - Adriana Grismaldo
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Department of Nutrition and Biochemistry Faculty of Sciences Pontificia Universidad Javeriana Bogotá D.C. Colombia
| | - Fernando Toledo
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Department of Basic Sciences Faculty of Sciences Universidad del Bío‐Bío Chillán Chile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Metabolic Diseases Research Laboratory Interdisciplinary Centre of Territorial Health Research (CIISTe) Biomedical Research Center (CIB) School of Medicine Faculty of Medicine Universidad de Valparaíso San Felipe Chile
| | | | - Mario Subiabre
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
| | - Paola Casanello
- Department of Pathology and Medical Biology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
- Department of Obstetrics Division of Obstetrics and Gynaecology, and Department of Neonatology Division of Pediatrics School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
| | - Marijke M Faas
- Department of Pathology and Medical Biology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
| | - Harry Goor
- Department of Pathology and Medical Biology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory Department of Obstetrics Division of Obstetrics and Gynaecology School of Medicine Faculty of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Department of Pathology and Medical Biology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
- Medical School (Faculty of Medicine) Sao Paulo State University (UNESP) Sao Paulo Brazil
- Department of Physiology Faculty of Pharmacy Universidad de Sevilla Seville Spain
- University of Queensland Centre for Clinical Research (UQCCR) Faculty of Medicine and Biomedical Sciences University of Queensland Herston QLD Australia
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Johnson AW, Snegovskikh D, Parikh L, DeAguiar RB, Han CS, Hwang JJ. Characterizing the Effects of Diabetes and Obesity on Insulin and Leptin Levels amongst Pregnant Women. Am J Perinatol 2020; 37:1094-1101. [PMID: 32120424 DOI: 10.1055/s-0040-1702988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In this study, we assess the impact of obesity and diabetes on maternal brain and periphery, as well as fetal exposure to insulin and leptin, and two hormones that play an important role in regulating energy homeostasis. STUDY DESIGN Fasting maternal plasma, fetal cord vein and artery plasma, and maternal cerebrospinal fluid (CSF) were collected in 37 women (12 lean, nondiabetic [prepregnancy body mass index (BMI): 22.9 ± 1.7 kg/m2]; 12 overweight/obese nondiabetic [BMI: 37.8 ± 7.3 kg/m2]; 13 gestational/type 2 diabetes mellitus [BMI: 29.8 ± 7.3 kg/m2]) with uncomplicated singleton pregnancies undergoing elective Cesarean delivery. HbA1C, insulin, glucose, and leptin levels were measured. RESULTS Compared with lean mothers, mothers with obesity and diabetes mellitus (DM) had significantly lower CSF-to-plasma ratios of insulin. Moreover, mothers with obesity and DM had significantly lower cord arterial and cord venous to maternal plasma ratios of insulin, but not leptin, compared with lean mothers. There were no differences in CSF and cord blood insulin and leptin levels between obese and DM mothers. CONCLUSION Compared with lean individuals, mothers with obesity and DM have relative deficiencies in insulin exposure. The patterns observed in mothers with obesity and diabetes were similar highlighting the importance of the maternal metabolic environment in obesity and suggesting obese patients warrant further clinical focus.
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Affiliation(s)
- Andrea W Johnson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Section of Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Denis Snegovskikh
- Division of Obstetric and Gynecological Anesthesiology, Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Lisa Parikh
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Yale School of Medicine, New Haven, Connecticut
| | - Renata B DeAguiar
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Yale School of Medicine, New Haven, Connecticut
| | - Christina S Han
- Department of Obstetrics, Gynecology and Reproductive Sciences, Section of Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Janice J Hwang
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Yale School of Medicine, New Haven, Connecticut
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Tobiasz AM, Duncan JR, Detti L, Mari G. Lack of Fetal Insulin Resistance in Maternal Polycystic Ovary Syndrome. Reprod Sci 2020; 27:1253-1258. [PMID: 31994004 DOI: 10.1007/s43032-019-00125-1] [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: 08/01/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
Polycystic ovary syndrome (PCOS) affects 8-10% of women. NIH criteria for diagnosis include chronic anovulation and evidence of clinical or biochemical hyperandrogenism. PCOS is associated with adverse neonatal outcomes. Our hypothesis is that insulin resistance is increased in fetuses born to women with PCOS. This is a prospective cohort of women who delivered at our institution. Subjects with a body mass index < 20 or ≥ 50 kg/m2, multiple gestation, and major fetal malformations were excluded. Maternal blood was collected at admission, and umbilical cord blood was collected after delivery. Serum concentrations of insulin and glucose were measured from each sample. The homeostasis model assessment index of insulin resistance (HOMA-IR) was calculated (plasma glucose (mmol/L) × insulin (μU/mL)/22.5). The HOMA-IR from mothers and fetuses with PCOS was compared with mothers and fetuses without PCOS (controls). Mann-Whitney U test was utilized for statistical analysis. Forty-six women and fetal pairs were included; 28 with PCOS and 18 controls. Maternal insulin (20 [7.7-26.5] vs. 6.6 μU/ml [5.1-7.2]; p = 0.005) and HOMA-IR (3.9 [1.6-4.5] vs. 1.1 [0.9-1.3]; p = 0.01) were increased in the PCOS group. There was no statistical difference in fetal insulin, glucose, or HOMA-IR (p = 0.31) in the umbilical artery (p = 0.10; p = 0.34; p = 0.45, respectively) or the umbilical vein (p = 0.13; p = > 0.99; p = 0.31, respectively). Insulin resistance is present in non-diabetic pregnant women with PCOS, however not in their fetuses. This might explain variations in the occurrence of the adverse neonatal and maternal outcomes reported in PCOS.
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Affiliation(s)
- Ana M Tobiasz
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA. .,Department of Obstetrics and Gynecology, Sanford Obstetrics & Gynecology, University of North Dakota, 414 N Seventh Street, Bismarck, ND, 58501, USA.
| | - Jose R Duncan
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Obstetrics and Gynecology, University of South Florida, FL, Tampa, USA
| | - Laura Detti
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Giancarlo Mari
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
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Zhu Z, Cao F, Li X. Epigenetic Programming and Fetal Metabolic Programming. Front Endocrinol (Lausanne) 2019; 10:764. [PMID: 31849831 PMCID: PMC6901800 DOI: 10.3389/fendo.2019.00764] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/21/2019] [Indexed: 12/30/2022] Open
Abstract
Fetal metabolic programming caused by the adverse intrauterine environment can induce metabolic syndrome in adult offspring. Adverse intrauterine environment introduces fetal long-term relatively irreversible changes in organs and metabolism, and thus causes fetal metabolic programming leading metabolic syndrome in adult offspring. Fetal metabolic programming of obesity and insulin resistance plays a key role in this process. The mechanism of fetal metabolic programming is still not very clear. It is suggested that epigenetic programming, also induced by the adverse intrauterine environment, is a critical underlying mechanism of fetal metabolic programming. Fetal epigenetic programming affects gene expression changes and cellular function through epigenetic modifications without DNA nucleotide sequence changes. Epigenetic modifications can be relatively stably retained and transmitted through mitosis and generations, and thereby induce the development of metabolic syndrome in adult offspring. This manuscript provides an overview of the critical role of epigenetic programming in fetal metabolic programming.
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Affiliation(s)
- Ziqiang Zhu
- Children's Hospital of Soochow University, Suzhou, China
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, China
| | - Fang Cao
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, China
| | - Xiaozhong Li
- Children's Hospital of Soochow University, Suzhou, China
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Manoharan B, Bobby Z, Dorairajan G, Vinayagam V, Packirisamy RM. Adipokine levels and their association with insulin resistance and fetal outcomes among the newborns of Indian gestational diabetic mothers. Saudi Med J 2019; 40:353-359. [PMID: 30957128 PMCID: PMC6506657 DOI: 10.15537/smj.2019.4.24058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/03/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate the cord blood levels of adipokine and to assess their association with the fetal insulin resistance and fetal outcomes in newborns of gestational diabetic women (GDM). Methods: This cross-sectional study was performed in 40 GDM women and 40 healthy pregnant women (HPW) in the Department of Obstetrics and Gynecology at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) hospital in Puducherry, India, during the period from May 2016 to December 2017. Cord blood samples were collected at delivery from GDM and HPW groups. Cord plasma biochemical parameters such as insulin, C-peptide, adiponectin, leptin, resistin, and visfatin concentrations were measured. Leptin/adiponectin ratio (L/A), homeostasis model assessment of insulin resistance (HOMA2-IR), insulin sensitivity (HOMA2-%S) and beta cell function (HOMA2-%B) were calculated. The pregnancy outcomes such as birth weight (BW), Ponderal index and Apgar scores of the baby were measured. Results: The BW and Ponderal index of the baby were found to be significantly higher in GDM newborns compared to HPW newborns. Cord plasma insulin, C-peptide, HOMA2 -IR, visfatin, leptin, and L/A ratio were significantly higher whereas adiponectin level was lower in GDM compared to HPW. A significant positive correlation was observed between L/A ratio and fetal HOMA2-IR. Conclusion: Altered adipokine levels with increased L/A ratio was observed among the new-borns of Indian gestational diabetic mothers. There was an association between increased L/A ratio, insulin resistance and increased Ponderal index among the new-borns.
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Affiliation(s)
- Balachandiran Manoharan
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. E-mail.
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Dong Y, Luo ZC, Nuyt AM, Audibert F, Wei SQ, Abenhaim HA, Bujold E, Julien P, Huang H, Levy E, Fraser WD. Large-for-Gestational-Age May Be Associated With Lower Fetal Insulin Sensitivity and β-Cell Function Linked to Leptin. J Clin Endocrinol Metab 2018; 103:3837-3844. [PMID: 30032199 PMCID: PMC6179169 DOI: 10.1210/jc.2018-00917] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/13/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Fetal overgrowth is associated with increased risk for type 2 diabetes in adulthood. It is unclear whether there are alterations in insulin sensitivity and β-cell function in early life. OBJECTIVE To determine whether large-for-gestational-age (LGA) (birth weight > 90th percentile), an indicator of fetal overgrowth, is associated with altered fetal insulin sensitivity and β-cell function. STUDY DESIGN, POPULATION, AND OUTCOMES In the Design, Development, and Discover birth cohort in Canada, we studied 106 pairs of LGA and optimal-for-gestational-age (OGA; birth weight, 25th to 75th percentiles) infants matched by maternal ethnicity, smoking status, and gestational age. Cord plasma glucose-to-insulin ratio was used as an indicator of fetal insulin sensitivity, and proinsulin-to-insulin ratio was used as an indicator of β-cell function. Cord plasma leptin and high-molecular-weight (HMW) adiponectin concentrations were measured. RESULTS Comparisons of infants who were born LGA vs OGA, adjusted for maternal and newborn characteristics, showed that cord blood insulin, proinsulin, and leptin concentrations were significantly higher, whereas HWM adiponectin concentrations were similar. Glucose-to-insulin ratios were significantly lower (15.4 ± 28.1 vs 22.0 ± 24.9; P = 0.004), and proinsulin-to-insulin ratios significantly higher (0.73 ± 0.82 vs 0.60 ± 0.78; P = 0.005) in LGA vs OGA newborns, indicating lower insulin sensitivity and β-cell function in LGA newborns. These significant differences were almost unchanged after further adjustment for cord blood adiponectin levels but disappeared upon additional adjustment for cord blood leptin levels. CONCLUSIONS This study demonstrates that LGA may be associated with decreases in both fetal insulin sensitivity and β-cell function. The alterations appear to be linked to elevated leptin levels.
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Affiliation(s)
- Yu Dong
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Pediatric Nephrology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zhong-Cheng Luo
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Pediatric Nephrology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Correspondence and Reprint Requests: Zhong-Cheng Luo, MD, PhD, Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, 700 University Avenue, Room 8-936, Toronto, Ontario M5G 1X5, Canada. E-mail: , ; or William D. Fraser, MD, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Room 2975, Sherbrooke, Quebec J1H 5N4, Canada. E-mail:
| | - Anne Monique Nuyt
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Francois Audibert
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Shu-Qin Wei
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Haim A Abenhaim
- Jewish General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Emmanuel Bujold
- CHU-Quebec Laval University Research Center, Laval University, Quebec City, Quebec, Canada
| | - Pierre Julien
- CHU-Quebec Laval University Research Center, Laval University, Quebec City, Quebec, Canada
| | - Hong Huang
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Pediatric Nephrology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Emile Levy
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - William D Fraser
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Correspondence and Reprint Requests: Zhong-Cheng Luo, MD, PhD, Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, 700 University Avenue, Room 8-936, Toronto, Ontario M5G 1X5, Canada. E-mail: , ; or William D. Fraser, MD, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Room 2975, Sherbrooke, Quebec J1H 5N4, Canada. E-mail:
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10
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Wang GH, Jin J, Sun LZ. Effect of lipoprotein-associated phospholipase A2 inhibitor on insulin resistance in streptozotocin-induced diabetic pregnant rats. Endocr J 2018; 65:903-913. [PMID: 29925744 DOI: 10.1507/endocrj.ej17-0351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper aims to investigate the influence of lipoprotein-associated phospholipase A2 (Lp-PLA2) inhibitor, darapladib, on insulin resistance (IR) in streptozotocin (STZ)-induced diabetic pregnant rats. The rat models were divided into Control (normal pregnancy), STZ + saline (STZ-induced diabetic pregnant rats), STZ + Low-dose and STZ + High-dose darapladib (STZ-induced diabetic pregnant rats treated with low-/high-dose darapladib) groups. Pathological changes were observed by Hematoxylin-eosin (HE) and Immunohistochemistry staining. Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay (ELISA). An automatic biochemical analyzer was used to measure the serum levels of biochemical indicators, and homeostatic model assessment for insulin resistance (HOMA-IR) and insulin sensitivity index (ISI) were calculated. Western blot was applied to determine levels of inflammatory cytokines. Compared with Control group, rats in the STZ + saline group were significantly decreased in body weight, the number of embryo implantation, the number of insulin positive cells and pancreatic islet size as well as the islet endocrine cells, and high-density lipoprotein (HDL-C) level, but substantially increased in Lp-PLA2, low-density lipoprotein (LDL-C), fatty acids (FFA), serum total cholesterol (TC), triglyceride (TG) levels. Moreover, the increased fasting plasma glucose (FPG) and HOMA-IR and inflammatory cytokines but decreased fasting insulin (FINS) and ISI were also found in diabetic pregnant rats. On the contrary, rats in the darapladib-treated groups were just opposite to the STZ + saline group, and STZ + High-dose group improved better than STZ + Low-dose group. Thus, darapladib can improve lipid metabolism, and enhance insulin sensitivity of diabetic pregnant rats by regulating inflammatory cytokines.
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Affiliation(s)
- Guo-Hua Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
- Department of Obstetrics and Gynecology, The First People's Hospital of Lianyungang City, Affiliated Hospital of Xuzhou Medical University, Lianyungang 222000, China
| | - Jun Jin
- Department of Clinical Laboratory, The First People's Hospital of Lianyungang City, Affiliated Hospital of Xuzhou Medical University, Lianyungang 222000, China
| | - Li-Zhou Sun
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
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11
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Villalobos-Labra R, Silva L, Subiabre M, Araos J, Salsoso R, Fuenzalida B, Sáez T, Toledo F, González M, Quezada C, Pardo F, Chiarello DI, Leiva A, Sobrevia L. Akt/mTOR Role in Human Foetoplacental Vascular Insulin Resistance in Diseases of Pregnancy. J Diabetes Res 2017; 2017:5947859. [PMID: 29104874 PMCID: PMC5618766 DOI: 10.1155/2017/5947859] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/15/2017] [Indexed: 12/25/2022] Open
Abstract
Insulin resistance is characteristic of pregnancies where the mother shows metabolic alterations, such as preeclampsia (PE) and gestational diabetes mellitus (GDM), or abnormal maternal conditions such as pregestational maternal obesity (PGMO). Insulin signalling includes activation of insulin receptor substrates 1 and 2 (IRS1/2) as well as Src homology 2 domain-containing transforming protein 1, leading to activation of 44 and 42 kDa mitogen-activated protein kinases and protein kinase B/Akt (Akt) signalling cascades in the human foetoplacental vasculature. PE, GDM, and PGMO are abnormal conditions coursing with reduced insulin signalling, but the possibility of the involvement of similar cell signalling mechanisms is not addressed. This review aimed to determine whether reduced insulin signalling in PE, GDM, and PGMO shares a common mechanism in the human foetoplacental vasculature. Insulin resistance in these pathological conditions results from reduced Akt activation mainly due to inhibition of IRS1/2, likely due to the increased activity of the mammalian target of rapamycin (mTOR) resulting from lower activity of adenosine monophosphate kinase. Thus, a defective signalling via Akt/mTOR in response to insulin is a central and common mechanism of insulin resistance in these diseases of pregnancy. In this review, we summarise the cell signalling mechanisms behind the insulin resistance state in PE, GDM, and PGMO focused in the Akt/mTOR signalling pathway in the human foetoplacental endothelium.
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Affiliation(s)
- Roberto Villalobos-Labra
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
| | - Luis Silva
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9700 RB Groningen, Netherlands
| | - Mario Subiabre
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
| | - Joaquín Araos
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
| | - Rocío Salsoso
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, 41012 Seville, Spain
| | - Bárbara Fuenzalida
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
| | - Tamara Sáez
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9700 RB Groningen, Netherlands
| | - Fernando Toledo
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
- Department of Basic Sciences, Faculty of Sciences, Universidad del Bío-Bío, 3780000 Chillán, Chile
| | - Marcelo González
- Vascular Physiology Laboratory, Department of Physiology, Faculty of Biological Sciences, Universidad de Concepción, 4070386 Concepción, Chile
| | - Claudia Quezada
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, 5110566 Valdivia, Chile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
- Metabolic Diseases Research Laboratory, Center of Research, Development and Innovation in Health-Aconcagua Valley, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, San Felipe Campus, 2172972 San Felipe, Chile
| | - Delia I. Chiarello
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
| | - Andrea Leiva
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, 41012 Seville, Spain
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, Brisbane, QLD 4029, Australia
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12
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Xie X, Gao H, Wu S, Zhao Y, Du C, Yuan G, Ning Q, McCormick K, Luo X. Increased Cord Blood Betatrophin Levels in the Offspring of Mothers with Gestational Diabetes. PLoS One 2016; 11:e0155646. [PMID: 27196053 PMCID: PMC4873017 DOI: 10.1371/journal.pone.0155646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 05/02/2016] [Indexed: 02/06/2023] Open
Abstract
Aim Exposing a fetus to hyperglycemia can increase the risk for later-life metabolic disorders. Betatrophin has been proposed as a key regulator of pancreatic beta cell proliferation and lipid regulation. Highly responsive to nutritional signals, serum betatrophin concentrations have been found to be altered by various physiological and pathological conditions. We hypothesized that betatrophin levels are increased in the cord blood in offspring exposed to intrauterine hyperglycemia. Methods This was a cross-sectional study including 54 mothers who underwent uncomplicated Cesarean delivery in a university hospital. Maternal gestational glucose concentration was determined at 24–48 weeks gestation after a 75-g OGTT. Cord blood and placental tissue was collected immediately post delivery. Metabolic parameters were determined in the Clinical Laboratory. Cord blood betatrophin levels were assayed using a commercially available ELISA kit. Placental mitochondrial content was determined by real-time PCR. Results Cord blood betatrophin levels were increased in the gestational diabetes mellitus (GDM) group compared with the normoglycemic group. Furthermore, betatrophin levels were positively correlated with maternal gestational 2h post-OGTT glucose, cord blood insulin, HOMA-IR, and inversely correlated with placental mitochondrial content. Conclusions Cord blood betatrophin may function as a potential biomarker of maternal intrauterine hyperglycemia and fetal insulin resistance, which may presage for long-term metabolic impact of GDM on offspring.
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Affiliation(s)
- Xuemei Xie
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Endocrinology and Metabolism, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, PR China
- Department of Pediatrics, Division of Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Hongjie Gao
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shimin Wu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Zhao
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caiqi Du
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guandou Yuan
- Department of Hepatobiliary Surgery, Guilin Medical University, Affiliated Hospital, Guilin, Guangxi, 541001, P.R. China
| | - Qin Ning
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kenneth McCormick
- Department of Pediatrics, Division of Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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13
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Bari MF, Ngo S, Bastie CC, Sheppard AM, Vatish M. Gestational diabetic transcriptomic profiling of microdissected human trophoblast. J Endocrinol 2016; 229:47-59. [PMID: 26869332 DOI: 10.1530/joe-15-0424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/11/2016] [Indexed: 12/16/2022]
Abstract
Gestational diabetes mellitus (GDM), the most common metabolic complication of pregnancy, is influenced by the placenta, and its prevalence directly increases with obesity. Therefore, to define the aetiology of GDM requires that the confounding influence of obesity and the heterogeneous nature of the placenta impairing accurate quantitative studies be accounted for. Using laser capture microdissection (LCM), we optimized RNA extraction from human placental trophoblast, the metabolic cellular interface between mother and foetus. This allowed specific transcriptomic profiling of trophoblast isolated from GDM, and obese and normal human placentae. Genome-wide gene expression analysis was performed on the RNA extracted from the trophoblast of GDM and obese and normal placentae. Forty-five differentially expressed genes (DEGs) specifically discriminated GDM from matched obese subjects. Two genes previously linked with GDM, pregnancy specific beta-1 glycoprotein 6 (PSG6) and placental system A sodium-dependent transporter system (SLC38A1), were significantly increased in GDM. A number of these DEGs (8 ubiquitin-conjugating enzymes (UBE) splice variants (UBE2D3 variants 1, 3, 4, 5, 6, 7, and 9) and UBE2V1 variant 4)) were involved in RNA processing and splicing, and a significant number of the DEGs, including the UBE variants, were associated with increased maternal fasting plasma glucose.It is concluded that DEGs discriminating GDM from obese subjects were pinpointed. Our data indicate a biological link between genes involved in RNA processing and splicing, ubiquitination, and fasting plasma glucose in GDM taking into account obesity as the confounder.
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Affiliation(s)
| | - Sherry Ngo
- Liggins InstituteUniversity of Auckland, Auckland, New Zealand
| | - Claire C Bastie
- Division of Biomedical SciencesWarwick Medical School, Coventry, UK
| | | | - Manu Vatish
- Nuffield Department of Obstetrics and GynaecologyUniversity of Oxford, John Radcliffe Hospital, Oxford, UK
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Guzmán-Gutiérrez E, Armella A, Toledo F, Pardo F, Leiva A, Sobrevia L. Insulin requires A1 adenosine receptors expression to reverse gestational diabetes-increased L-arginine transport in human umbilical vein endothelium. Purinergic Signal 2015; 12:175-90. [PMID: 26710791 DOI: 10.1007/s11302-015-9491-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/17/2015] [Indexed: 01/06/2023] Open
Abstract
Gestational diabetes mellitus (GDM) associates with increased L-arginine transport and extracellular concentration of adenosine in human umbilical vein endothelial cells (HUVECs). In this study we aim to determine whether insulin reverses GDM-increased L-arginine transport requiring adenosine receptors expression in HUVECs. Primary cultured HUVECs from full-term normal (n = 38) and diet-treated GDM (n = 38) pregnancies were used. Insulin effect was assayed on human cationic amino acid transporter 1 (hCAT1) expression (protein, mRNA, SLC7A1 promoter activity) and activity (initial rates of L-arginine transport) in the absence or presence of adenosine receptors agonists or antagonists. A1 adenosine receptors (A1AR) and A2AAR expression (Western blot, quantitative PCR) was determined. Experiments were done in cells expressing or siRNA-suppressed expression of A1AR or A2AAR. HUVECs from GDM exhibit higher maximal transport capacity (maximal velocity (V max)/apparent Michaelis Menten constant (K m), V max/K m), which is blocked by insulin by reducing the V max to values in cells from normal pregnancies. Insulin also reversed the GDM-associated increase in hCAT-1 protein abundance and mRNA expression, and SLC7A1 promoter activity for the fragment -606 bp from the transcription start point. Insulin effects required A1AR, but not A2AAR expression and activity in this cell type. In the absence of insulin, GDM-increased hCAT-1 expression and activity required A2AAR expression and activity. HUVECs from GDM pregnancies exhibit a differential requirement of A1AR or A2AAR depending on the level of insulin, a phenomenon that represent a condition where adenosine or analogues of this nucleoside could be acting as helpers of insulin biological effects in GDM.
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Affiliation(s)
- Enrique Guzmán-Gutiérrez
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, P.O. Box 114-D, Santiago, 8330024, Chile.,Faculty of Health Sciences, Universidad San Sebastián, Concepción, 4080871, Chile
| | - Axel Armella
- Faculty of Health Sciences, Universidad San Sebastián, Concepción, 4080871, Chile
| | - Fernando Toledo
- Department of Basic Sciences, Faculty of Sciences, Universidad del Bío-Bío, Chillán, 3780000, Chile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, P.O. Box 114-D, Santiago, 8330024, Chile
| | - Andrea Leiva
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, P.O. Box 114-D, Santiago, 8330024, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, P.O. Box 114-D, Santiago, 8330024, Chile. .,Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, E-41012, Spain. .,University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, 4029, Australia.
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15
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Ma RCW, Tutino GE, Lillycrop KA, Hanson MA, Tam WH. Maternal diabetes, gestational diabetes and the role of epigenetics in their long term effects on offspring. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2015; 118:55-68. [PMID: 25792090 DOI: 10.1016/j.pbiomolbio.2015.02.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/27/2015] [Accepted: 02/23/2015] [Indexed: 01/18/2023]
Abstract
There is a global epidemic of obesity and diabetes, and current efforts to curb the diabetes epidemic have had limited success. Epidemiological studies have highlighted increased risk of obesity, diabetes and cardiovascular complications in offspring exposed to maternal diabetes, and gestational diabetes increases the risk of diabetes in subsequent generations, thereby setting up a vicious cycle of "diabetes begetting diabetes". This relationship between maternal hyperglycaemia and long-term health in the offspring is likely to become even more important with an increasing proportion of young woman being affected by diabetes, and the number of pregnancies complicated by hyperglycaemia continuing to rise. Animal models of gestational diabetes or maternal hyperglycaemia have highlighted long-term changes in the offspring with some instances of sex bias, including increased adiposity, insulin resistance, β-cell dysfunction, hypertension, as well as other structural and functional changes. Furthermore, several of these changes appear to be transmissible to later generations through the maternal line. Epigenetic changes play an important role in regulating gene expression, especially during early development. Recent studies have identified a number of epigenetic modifications in the offspring associated with maternal hyperglycaemia. In this review, we provide an overview of the epidemiological evidence linking maternal hyperglycaemia with adverse long-term outcome in the offspring, as well as of some of the studies that explore the underlying epigenetic mechanisms. A better understanding of the pathways involved may provide novel approaches for combating this global epidemic.
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Affiliation(s)
- Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China.
| | - Greg E Tutino
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Karen A Lillycrop
- Centre for Biological Sciences, Life Sciences Building 85, University of Southampton, Southampton, UK
| | - Mark A Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Wing Hung Tam
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
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Westermeier F, Salomón C, Farías M, Arroyo P, Fuenzalida B, Sáez T, Salsoso R, Sanhueza C, Guzmán‐Gutiérrez E, Pardo F, Leiva A, Sobrevia L. Insulin requires normal expression and signaling of insulin receptor A to reverse gestational diabetes‐reduced adenosine transport in human umbilical vein endothelium. FASEB J 2015; 29:37-49. [DOI: 10.1096/fj.14-254219] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Francisco Westermeier
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Advanced Center for Chronic Diseases (ACCDIS)Faculty of Chemical & Pharmaceutical SciencesUniversidad de ChileSantiagoChile
| | - Carlos Salomón
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
- University of Queensland Centre for Clinical Research (UQCCR)Faculty of Medicine and Biomedical SciencesUniversity of QueenslandHerstonQueenslandAustralia
| | - Marcelo Farías
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Pablo Arroyo
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Bárbara Fuenzalida
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Tamara Sáez
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Rocío Salsoso
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Carlos Sanhueza
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Enrique Guzmán‐Gutiérrez
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Faculty of Health SciencesUniversidad San SebastiánConcepciónChile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Andrea Leiva
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL)Division of Obstetrics and GynaecologySchool of MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
- University of Queensland Centre for Clinical Research (UQCCR)Faculty of Medicine and Biomedical SciencesUniversity of QueenslandHerstonQueenslandAustralia
- Faculty of PharmacyUniversidad de SevillaSevilleSpain
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17
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Abstract
OBJECTIVE The efficacy of injection therapy in diabetes depends on correct injection technique. To provide patients with guidance in this area and help patients inject themselves correctly, we must understand how they currently inject; therefore, the purpose of this study was to assess the current situation of insulin injection technique in patients with diabetes in mainland China. DESIGN AND METHODS From October 2010 to November 2010, a cross-sectional survey of 380 diabetes patients from 20 centers in mainland China was conducted regarding their daily insulin pen injection practice. RESULTS Overall, 35.26% of patients had lipohypertrophy; 58.68% of patients had bleeding and bruising, and abdominal lipohypertrophy at injection sites. Bleeding and bruising were more frequent. We found a significant relationship between the frequency of a single needle reuse and lipohypertrophy (r = 0.426, P = 0.000). In addition, there was a significant relationship between the frequency of daily insulin injection and lipohypertrophy (r = 0.146, P = 0.004), between rolling the pen while pulling out the needle after injection and lipohypertrophy (χ(2 )= 7.355, P = 0.007). Bleeding and bruising at injection sites were found to be related to HbA1c levels (r = 0.151, P = 0.003). LIMITATIONS A few limitations linked with this survey should be noted. Because of the limited budget, the ultrasound was not used to evaluate lipodystrophy and the photographs of lipodystrophy were not taken. On the other hand, specific size of lipodystrophy and the cost of insulin wastage were not evaluated. Furthermore, the population of this survey is limited, and it was only done in general hospitals and not in community hospitals, therefore, a larger study sample is advisable. CONCLUSIONS The insulin injection skill of patients with diabetes in mainland China was poor, and the incidence of lipohypertrophy, bleeding, and needle reuse was high. Frequency of daily insulin injection and needle reuse may relate to the incidence of lipohypertrophy and bleeding. The bleeding and bruising at the injection sites may be associated with suboptimal absorption of injected insulin. Improved education in optimal insulin injection technique, including reducing needle reuse and correct rotation of injection sites should be emphasized.
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Affiliation(s)
- Jiajia Ji
- Nanjing University of Chinese Medicine , Nanjing , PR China
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Li P, Tong Y, Yang H, Zhou S, Xiong F, Huo T, Mao M. Mitochondrial translocation of human telomerase reverse transcriptase in cord blood mononuclear cells of newborns with gestational diabetes mellitus mothers. Diabetes Res Clin Pract 2014; 103:310-8. [PMID: 24480248 DOI: 10.1016/j.diabres.2013.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 11/08/2013] [Accepted: 12/21/2013] [Indexed: 01/21/2023]
Abstract
AIMS To better understand the role of oxidative stress in fetal programming, we assessed the hypothesis that the mitochondrial translocation of human telomerase reverse transcriptase (hTERT) could protect neonatal mitochondrial DNA (mtDNA) from oxidative damage during pregnancies complicated by gestational diabetes mellitus (GDM). METHODS 26 GDM mothers and 47 controls and their newborns were enrolled. The plasma levels of 8-isoprostaglandin F(2α) in maternal and cord blood were measured to evaluate oxidative stress. Western blotting was then used to assess the mitochondrial localization of hTERT in cord blood mononuclear cells (CBMCs). Finally, the relative mtDNA content was analyzed by real-time PCR. RESULTS GDM mothers and their newborns had significantly higher levels of oxidative stress than controls. hTERT was localized in both the nuclei and mitochondria of CBMCs, and the increased CBMC mitochondrial hTERT levels were significantly correlated with elevated oxidative stress in newborns. The neonatal mtDNA content in the GDM group was comparable to controls, and was positively correlated with mitochondrial hTERT levels in CBMCs, suggesting that mitochondrial hTERT in CBMCs may have a protective effect on neonatal mtDNA in GDM pregnancies. CONCLUSIONS This study is the first to suggest that the mitochondrial translocation of hTERT in CBMCs under heightened oxidative stress might protect neonatal mtDNA from oxidative damage in GDM pregnancies. This could be an in utero adaptive response of a fetus that is suffering from elevated oxidative stress, and could help our understanding of the roles of oxidative stress in fetal programming.
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Affiliation(s)
- Ping Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 17, People's South Road, Chengdu 610041, Sichuan Province, PR China; Laboratory of Early Developmental and Injuries, West China Institute of Woman and Children's Health, West China Second University Hospital, Sichuan University, PR China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, PR China
| | - Yu Tong
- Laboratory of Early Developmental and Injuries, West China Institute of Woman and Children's Health, West China Second University Hospital, Sichuan University, PR China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, PR China
| | - Huiming Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 17, People's South Road, Chengdu 610041, Sichuan Province, PR China
| | - Shu Zhou
- Department of Obstetrics, West China Second University Hospital, Sichuan University, No. 17, People's South Road, Chengdu 610041, Sichuan Province, PR China
| | - Fei Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 17, People's South Road, Chengdu 610041, Sichuan Province, PR China
| | - Tingzhu Huo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 17, People's South Road, Chengdu 610041, Sichuan Province, PR China
| | - Meng Mao
- Laboratory of Early Developmental and Injuries, West China Institute of Woman and Children's Health, West China Second University Hospital, Sichuan University, PR China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, PR China; Chengdu Women's and Children's Central Hospital, No. 1617, Riyue Avenue, Chengdu 610091, Sichuan Province, PR China.
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19
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Zhao JP, Levy E, Fraser WD, Julien P, Delvin E, Montoudis A, Spahis S, Garofalo C, Nuyt AM, Luo ZC. Circulating docosahexaenoic acid levels are associated with fetal insulin sensitivity. PLoS One 2014; 9:e85054. [PMID: 24454790 PMCID: PMC3890289 DOI: 10.1371/journal.pone.0085054] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/21/2013] [Indexed: 01/22/2023] Open
Abstract
Background Arachidonic acid (AA; C20∶4 n-6) and docosahexaenoic acid (DHA; C22∶6 n-3) are important long-chain polyunsaturated fatty acids (LC-PUFA) in maintaining pancreatic beta-cell structure and function. Newborns of gestational diabetic mothers are more susceptible to the development of type 2 diabetes in adulthood. It is not known whether low circulating AA or DHA is involved in perinatally “programming” this susceptibility. This study aimed to assess whether circulating concentrations of AA, DHA and other fatty acids are associated with fetal insulin sensitivity or beta-cell function, and whether low circulating concentrations of AA or DHA are involved in compromised fetal insulin sensitivity in gestational diabetic pregnancies. Methods and Principal Findings In a prospective singleton pregnancy cohort, maternal (32-35 weeks gestation) and cord plasma fatty acids were assessed in relation to surrogate indicators of fetal insulin sensitivity (cord plasma glucose-to-insulin ratio, proinsulin concentration) and beta-cell function (proinsulin-to-insulin ratio) in 108 mother-newborn pairs. Cord plasma DHA levels (in percentage of total fatty acids) were lower comparing newborns of gestational diabetic (n = 24) vs. non-diabetic pregnancies (2.9% vs. 3.5%, P = 0.01). Adjusting for gestational age at blood sampling, lower cord plasma DHA levels were associated with lower fetal insulin sensitivity (lower glucose-to-insulin ratio, r = 0.20, P = 0.036; higher proinsulin concentration, r = −0.37, P <0.0001). The associations remained after adjustment for maternal and newborn characteristics. Cord plasma saturated fatty acids C18∶0 and C20∶0 were negatively correlated with fetal insulin sensitivity, but their levels were not different between gestational diabetic and non-diabetic pregnancies. Cord plasma AA levels were not correlated with fetal insulin sensitivity. Conclusion Low circulating DHA levels are associated with compromised fetal insulin sensitivity, and may be involved in perinatally “programming” the susceptibility to type 2 diabetes in the offspring of gestational diabetic mothers.
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Affiliation(s)
- Jin-Ping Zhao
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Emile Levy
- Department of Nutrition, University of Montreal, Montreal, Quebec, Canada
| | - William D. Fraser
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Pierre Julien
- Endocrinology and Nephrology, Laval University Hospital Research Centre, and Department of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Edgard Delvin
- Department of Biochemistry, University of Montreal, Montreal, Quebec, Canada
| | - Alain Montoudis
- Department of Nutrition, University of Montreal, Montreal, Quebec, Canada
| | - Schohraya Spahis
- Department of Nutrition, University of Montreal, Montreal, Quebec, Canada
| | - Carole Garofalo
- Department of Nutrition, University of Montreal, Montreal, Quebec, Canada
| | - Anne Monique Nuyt
- Department of Pediatrics, Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- * E-mail:
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20
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Guzmán-Gutiérrez E, Arroyo P, Salsoso R, Fuenzalida B, Sáez T, Leiva A, Pardo F, Sobrevia L. Role of Insulin and Adenosine in the Human Placenta Microvascular and Macrovascular Endothelial Cell Dysfunction in Gestational Diabetes Mellitus. Microcirculation 2014; 21:26-37. [DOI: 10.1111/micc.12077] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/18/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Enrique Guzmán-Gutiérrez
- Cellular and Molecular Physiology Laboratory (CMPL); Division of Obstetrics and Gynaecology; Medical Research Centre (CIM); School of Medicine; Faculty of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Pablo Arroyo
- Cellular and Molecular Physiology Laboratory (CMPL); Division of Obstetrics and Gynaecology; Medical Research Centre (CIM); School of Medicine; Faculty of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Rocío Salsoso
- Cellular and Molecular Physiology Laboratory (CMPL); Division of Obstetrics and Gynaecology; Medical Research Centre (CIM); School of Medicine; Faculty of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Bárbara Fuenzalida
- Cellular and Molecular Physiology Laboratory (CMPL); Division of Obstetrics and Gynaecology; Medical Research Centre (CIM); School of Medicine; Faculty of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
- Biomedical Department; Faculty of Health Sciences; Universidad de Antofagasta; Antofagasta Chile
| | - Tamara Sáez
- Cellular and Molecular Physiology Laboratory (CMPL); Division of Obstetrics and Gynaecology; Medical Research Centre (CIM); School of Medicine; Faculty of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Andrea Leiva
- Cellular and Molecular Physiology Laboratory (CMPL); Division of Obstetrics and Gynaecology; Medical Research Centre (CIM); School of Medicine; Faculty of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory (CMPL); Division of Obstetrics and Gynaecology; Medical Research Centre (CIM); School of Medicine; Faculty of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL); Division of Obstetrics and Gynaecology; Medical Research Centre (CIM); School of Medicine; Faculty of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
- University of Queensland Centre for Clinical Research; Herston Queensland Australia
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21
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Pardo F, Arroyo P, Salomón C, Westermeier F, Salsoso R, Sáez T, Guzmán-Gutiérrez E, Leiva A, Sobrevia L. Role of equilibrative adenosine transporters and adenosine receptors as modulators of the human placental endothelium in gestational diabetes mellitus. Placenta 2013; 34:1121-7. [PMID: 24119573 DOI: 10.1016/j.placenta.2013.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/27/2013] [Accepted: 09/13/2013] [Indexed: 01/13/2023]
Abstract
Gestational diabetes mellitus (GDM) is a diseases that alters human placenta macro and microvascular reactivity as a result of endothelial dysfunction. The human placenta is a highly vascularized organ which lacks innervation, so blood flux is governed by locally released vasoactive molecules, including the endogenous nucleoside adenosine and the free radical nitric oxide (NO). Altered adenosine metabolism and uptake by the endothelium leads to increased NO synthesis which then turns-off the expression of genes coding for a family of nucleoside membrane transporters belonging to equilibrative nucleoside transporters, particularly isoforms 1 (hENT1) and 2 (hENT2). This mechanism leads to increased extracellular adenosine and, as a consequence, activation of adenosine receptors to further sustain a tonic activation of NO synthesis. This is a phenomenon that seems operative in the placental macro and microvascular endothelium in GDM. We here summarize the findings available in the literature regarding these mechanisms in the human feto-placental circulation. This phenomenon is altered in the feto-placental vasculature, which could be crucial for understanding GDM deleterious effects in fetal growth and development.
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Affiliation(s)
- F Pardo
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, P.O. Box 114-D, Santiago, Chile.
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