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Papadimitriou K, Mousiolis AC, Mintziori G, Tarenidou C, Polyzos SA, Goulis DG. Hypogonadism and nonalcoholic fatty liver disease. Endocrine 2024:10.1007/s12020-024-03878-1. [PMID: 38771482 DOI: 10.1007/s12020-024-03878-1] [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: 01/15/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
Nonalcoholic fatty liver disease (NAFLD), recently proposed to be renamed to metabolic dysfunction-associated steatotic liver disease (MASLD), is a major global public health concern, affecting approximately 25-30% of the adult population and possibly leading to cirrhosis, hepatocellular carcinoma, and liver transplantation. The liver is involved in the actions of sex steroids via their hepatic metabolism and production of the sex hormone-binding globulin (SHBG). Liver disease, including NAFLD, is associated with reproductive dysfunction in men and women, and the prevalence of NAFLD in patients with hypogonadism is considerable. A wide spectrum of possible pathophysiological mechanisms linking NAFLD and male/female hypogonadism has been investigated. As therapies targeting NAFLD may impact hypogonadism in men and women, and vice versa, treatments of the latter may affect NAFLD, and an insight into their pathophysiological pathways is imperative. This paper aims to elucidate the complex association between NAFLD and hypogonadism in men and women and discuss the therapeutic options and their impact on both conditions.
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Affiliation(s)
- Kasiani Papadimitriou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Athanasios C Mousiolis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Stergios A Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Livingston M, Heald AH. Adult Male Hypogonadism: A Laboratory Medicine Perspective on Its Diagnosis and Management. Diagnostics (Basel) 2023; 13:3650. [PMID: 38132234 PMCID: PMC10743125 DOI: 10.3390/diagnostics13243650] [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: 08/16/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Testosterone (T), the principal androgen secreted by the testes, plays an essential role in male health. Male hypogonadism is diagnosed based on a combination of associated clinical signs and symptoms and laboratory confirmation of low circulating T levels. In this review, we have highlighted factors, both biological and analytical, that introduce variation into the measurement of serum T concentrations in men; these need to be considered when requesting T levels and interpreting results. There is an ongoing need for analytical standardisation of T assays and harmonisation of pre- and post-analytical laboratory practices, particularly in relation to the laboratory reference intervals provided to clinicians. Further, there is a need to share with service users the most up-to-date and evidence-based action thresholds for serum T as recommended in the literature. Estimation of free testosterone may be helpful. Causes of secondary hypogonadism should be considered. A comprehensive approach is required in the management of male hypogonadism, including lifestyle modification as well as medication where appropriate. The goal of treatment is the resolution of symptoms as well as the optimisation of metabolic, cardiovascular, and bone health. The advice of an endocrinologist should be sought when there is doubt about the cause and appropriate management of the hypogonadism.
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Affiliation(s)
- Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
- School of Medicine and Clinical Practice, The University of Wolverhampton, Wolverhampton WV1 1LY, UK
| | - Adrian H. Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK;
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford M6 8HD, UK
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Heald A, Cook MJ, Antonio L, Tournoy J, Ghaffari P, Mannan F, Fachim H, Vanderschueren D, Laing I, Hackett G, Casanueva FF, Huhtaniemi IT, Maggi M, Rastrelli G, Slowikowska-Hilczer J, Wu F, O'Neill TW. Number of CAG repeats and mortality in middle aged and older men. Clin Endocrinol (Oxf) 2023; 99:559-565. [PMID: 37718889 DOI: 10.1111/cen.14962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023]
Abstract
DESIGN The androgen receptor (AR) mediates peripheral effects of testosterone. Previous data suggests an association between the number of CAG repeats in exon-1 of the AR gene and AR transcriptional activity. The aim of this analysis was to determine the association between the number of AR CAG repeats and all-cause mortality in men and the influence of testosterone level on the association. PATIENTS AND MEASUREMENTS Follow-up data to 27 January 2018 were available for men aged 40-79 years recruited across six countries of the European Male Aging Study between 2003 and 2005. Cox proportional hazards modelling was used to determine the association between CAG repeat number/mortality. Results were expressed as hazard ratios (HR)/95% confidence intervals (CI). RESULTS One thousand nine hundred and seventy-seven men were followed up. Mean baseline age was 60 ± 11.1 years. Mean duration of follow-up was 12.2 years. At follow up 25.1% of men had died. CAG repeat length ranged from 6 to 39, with the highest proportion of CAG repeat number at 21 repeats (16.4%). In a multivariable model, compared to men with 22-23 AR CAG repeats: for men with <22 and >23 AR CAG HR, 95% CI for mortality were, <22 CAG repeats 1.17 (0.93-1.49) and >23 CAG repeats 1.14 (0.88-1.47). In a post-hoc analysis, the association was significant for men in the lowest tertile of baseline testosterone (<14.2 nmol/L) with >23 CAG repeats: in the adjusted model for <22 and >23 CAG repeats, respectively, 1.49 (0.97-2.27) and 1.68 (1.06-2.67) versus 22-23 repeats. CONCLUSIONS Our European-wide cohort data overall found no association of androgen receptor CAG repeat number and mortality in men. However, post hoc analysis suggested that an association might be present in men with lower baseline testosterone concentrations, which merits further investigation.
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Affiliation(s)
- Adrian Heald
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Michael J Cook
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK
| | - Leen Antonio
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, Gerontology and Geriatrics Unit, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Parisa Ghaffari
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
| | - Fahmida Mannan
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Helene Fachim
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Dirk Vanderschueren
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Ian Laing
- Department of Biochemistry, Royal Preston Hospital, Preston, UK
| | | | - Felipe F Casanueva
- Department of Medicine, Santiagode Compostela University, Complejo Hospitalario Universitariode Santiago (CHUS), CIBER de Fisiopatología Obesidady Nutricion (CB06/03), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Ilpo T Huhtaniemi
- Department of Metabolism, Institute of Reproductive and Developmental, Digestion and Reproduction, Imperial College London, London, UK
| | - Mario Maggi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | | | - Fred Wu
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
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Androgen receptor (CAG) n repeat polymorphism contributes to risk of sudden cardiac death originated from coronary artery disease with sex discrepancy. Forensic Sci Int 2023; 343:111563. [PMID: 36630768 DOI: 10.1016/j.forsciint.2023.111563] [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: 11/09/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
Sudden cardiac death (SCD) is the leading cause of natural death worldwide which is responsible for almost half of all heart disease deaths, making it a substantial public health problem. Previous epidemiological studies from different countries have demonstrated the significant SCD incident difference rate between males and females. Besides environmental and social effects, differential genetic architecture also underlines the SCD incidence discrepancy. To this end, the functional (CAG)n repeat polymorphism within Androgen Receptor (AR) gene was analyzed to evaluate its associations with SCD originated from coronary artery disease (SCD-CAD) susceptibility in Chinese populations using 182 SCD-CAD cases and 564 healthy controls. At allelic level, the (CAG)26 allele conferred a lower SCD-CAD risk in males (adjusted odds ratio [OR] = 0.428; 95% confidence interval [CI] = 0.254, 0.915; P = 0.023). On the contrary, the (CAG)26 allele was reversely associated with a higher SCD-CAD risk in females (OR = 2.581; 95% CI = 0.944, 7.056; P = 0.057). Further cutoff strategy analysis revealed that those male subjects carrying shorter allele (≤26 repeats) had significantly lower SCD-CAD risk (OR = 0.343; 95% CI = 0.221, 0.531; P = 8.1653e-7). Additionally, an allele-dependent SCD risk tendency was observed in male subjects. Specifically, compared with males carrying allele longer than 26 repeats, the SCD-CAD risk (OR value) for male subjects carrying shorter alleles (from 25 to 21) gradually increased from 0.437 to 0.533, indicating the (CAG)26 allele of the repeat polymorphism may be the watershed in male SCD etiology. Lastly, the length variations associated with multiple phenotypes were also summarized. Collectively, our results revealed for the first time that the (CAG)n repeat polymorphism within the AR gene was associated with SCD-CAD risk in Chinese populations with sex discrepancy, proposing a new candidate genetic marker for molecular diagnosis of SCD-CAD. Furthermore, a sex-dependent SCD-CAD risk stratification and prevention approach was encouraged. Further studies with more female samples were warranted to validate our findings.
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Heald A, Cook M, Antonio L, Vanderschueren D, Javed A, Fachim H, Hackett G, Wu F, O'Neill T. The number of androgen receptor CAG repeats and mortality in men. Aging Male 2022; 25:167-172. [PMID: 35652888 DOI: 10.1080/13685538.2022.2061452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The androgen receptor (AR) mediates peripheral effects of testosterone. Evidence suggests that the number of CAG repeats in exon-1 of the AR gene negatively correlates with AR transcriptional activity. The aim of this analysis was to determine the association between CAG repeat number and mortality in men. METHODS Men aged 40-79 years were recruited from primary care for participation in the UK arm of the European Male Aging Study between 2003 and 2005. Cox proportional hazards modelling was used to determine the association between CAG repeat number/mortality. Results were expressed as hazard ratios(HR)/95% confidence intervals (CI). RESULTS 312 men were followed up. The mean baseline age was 59.5 years. At follow up, 85/312(27%) men had died. CAG repeat length ranged from 14 to 39, with the highest proportion of CAG repeat number at 21 repeats(16.4%). In a multivariable model, using men with CAG repeat numbers of 22-23 as the reference, men with a lower number of CAG repeats(<22) showed a trend for a higher mortality in the follow-up period (HR 1.46 (0.75, 2.81)) as did men with higher number of repeats (>23) (1.37 (0.65, 2.91)). CONCLUSION Our data suggest that CAG repeat number may partially influence the risk of mortality in men. Further larger studies are required to quantify the effect.
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Affiliation(s)
- Adrian Heald
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Michael Cook
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
| | - Leen Antonio
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Ahmed Javed
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Helene Fachim
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
| | | | - Fred Wu
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
- Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester, UK
| | - Terence O'Neill
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Arefhosseini S, Ebrahimi-Mameghani M, Najafipour F, Tutunchi H. Non-alcoholic fatty liver disease across endocrinopathies: Interaction with sex hormones. Front Endocrinol (Lausanne) 2022; 13:1032361. [PMID: 36419770 PMCID: PMC9676462 DOI: 10.3389/fendo.2022.1032361] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) has emerged as the most frequent chronic liver disease globally. NAFLD is strongly associated with metabolic syndrome and it has been recently suggested that to rename NAFLD as metabolic dysfunction-associated fatty liver disease (MAFLD). NAFLD has been studied in different endocrine axes and accumulating body of clinical and experimental studies have suggested that NAFLD is associated with polycystic ovarian syndrome (PCOS), hypopituitarism, growth hormone deficiency (GHD), hypogonadism and other endocrine disorders. In fact, endocrine dysfunction may be considered as the major contributor for the development, progression, and severity of NAFLD. In the present comprehensive review, we discussed the epidemiological and clinical evidence on the epidemiology, pathophysiology, and management of NAFLD in endocrine disorders, with an emphasis on the effects of sex-specific hormones/conditions as well as molecular basis of NAFLD development in these endocrine diseases.
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Affiliation(s)
- Sara Arefhosseini
- Student Research Committee, Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrangiz Ebrahimi-Mameghani
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Najafipour
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Helda Tutunchi
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Alex AM, Ruvio T, Xia K, Jha SC, Girault JB, Wang L, Li G, Shen D, Cornea E, Styner MA, Gilmore JH, Knickmeyer RC. Influence of gonadal steroids on cortical surface area in infancy. Cereb Cortex 2022; 32:3206-3223. [PMID: 34952542 PMCID: PMC9340392 DOI: 10.1093/cercor/bhab410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/27/2022] Open
Abstract
Sex differences in the human brain emerge as early as mid-gestation and have been linked to sex hormones, particularly testosterone. Here, we analyzed the influence of markers of early sex hormone exposure (polygenic risk score (PRS) for testosterone, salivary testosterone, number of CAG repeats, digit ratios, and PRS for estradiol) on the growth pattern of cortical surface area in a longitudinal cohort of 722 infants. We found PRS for testosterone and right-hand digit ratio to be significantly associated with surface area, but only in females. PRS for testosterone at the most stringent P value threshold was positively associated with surface area development over time. Higher right-hand digit ratio, which is indicative of low prenatal testosterone levels, was negatively related to surface area in females. The current work suggests that variation in testosterone levels during both the prenatal and postnatal period may contribute to cortical surface area development in female infants.
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Affiliation(s)
- Ann Mary Alex
- Neuroengineering Division, Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Tom Ruvio
- Neuroengineering Division, Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Kai Xia
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
| | - Shaili C Jha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jessica B Girault
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Li Wang
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gang Li
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Dinggang Shen
- School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China
- Department of Artificial Intelligence, Korea University, Seoul 02841, Republic of Korea
| | - Emil Cornea
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
| | - Martin A Styner
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rebecca C Knickmeyer
- Neuroengineering Division, Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI 48824, USA
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI 48824, USA
- Center for Research in Autism, Intellectual, and Other Neurodevelopmental Disabilities, Michigan State University, East Lansing, MI 48824, USA
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Morgado A, Silva AC, Diniz P, Silva CM. Can we rely on total testosterone measurement to exclude hypogonadism in erectile dysfunction? Int J Impot Res 2022:10.1038/s41443-022-00565-5. [DOI: 10.1038/s41443-022-00565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 11/09/2022]
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Giwercman A, Sahlin KB, Pla Parada I, Pawlowski K, Fehninger C, Lundberg Giwercman Y, Leijonhufvud I, Appelqvist R, Marko-Varga G, Sanchez A, Malm J. Novel protein markers of androgen activity in humans: proteomic study of plasma from young chemically castrated men. eLife 2022; 11:74638. [PMID: 35230239 PMCID: PMC8993215 DOI: 10.7554/elife.74638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Reliable biomarkers of androgen activity in humans are lacking. The aim of this study was, therefore, to identify new protein markers of biological androgen activity and test their predictive value in relation to low vs. normal testosterone values and some androgen deficiency linked pathologies. Methods Blood samples from 30 healthy GnRH-antagonist treated males were collected at three time points: a) before GnRH antagonist administration; b) 3 weeks later, just before testosterone undecanoate injection, and c) after additional 2 weeks. Subsequently they were analysed by mass spectrometry to identify potential protein biomarkers of testosterone activity. Levels of proteins most significantly associated with testosterone fluctuations were further tested in a cohort of 75 hypo- and eugonadal males suffering from infertility. Associations between levels of those markers and cardio-metabolic parameters, bone mineral density as well as androgen receptor CAG repeat lengths, were explored. Results Using ROC analysis, 4-hydroxyphenylpyruvate dioxygenase (4HPPD), insulin-like growth factor-binding protein 6 (IGFBP6) and fructose-bisphosphate aldolase (ALDOB), as well as a Multi Marker Algorithm, based on levels of 4HPPD and IGFBP6, were shown to be best predictors of low (< 8 nmol/L) vs. normal (> 12 nmol/L) testosterone. They were also more strongly associated with metabolic syndrome and diabetes than testosterone levels. Levels of ALDOB and 4HPPD levels also showed association with AR CAG-repeat lengths. Conclusions We identified potential new protein biomarkers of testosterone action. Further investigations to elucidate their clinical potential are warranted. Funding The work was supported by ReproUnion 2.0 (grant no 20201846), which is funded by the Interreg V EU program.
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Affiliation(s)
| | - K Barbara Sahlin
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Krzysztof Pawlowski
- Department of Experimental Design and Bioinformatics, Warsaw University of Life Sciences, Warszawa, Poland
| | - Carl Fehninger
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | | | - Roger Appelqvist
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Aniel Sanchez
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Johan Malm
- Department of Translational Medicine, Lund University, Malmo, Sweden
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Androgen receptor-reduced sensitivity is associated with increased mortality and poorer glycaemia in men with type 2 diabetes mellitus: a prospective cohort study. Cardiovasc Endocrinol Metab 2020; 10:37-44. [PMID: 33634254 DOI: 10.1097/xce.0000000000000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
Abstract
Introduction Hypogonadism is associated with poorer glycaemic outcomes/increased all-cause and cardiovascular morbidity/mortality in type 2 diabetes mellitus (T2DM). Increasing CAG repeat number within exon-1 of the androgen receptor (AR) gene is associated with increased AR resistance/insulin resistance. Methods We determined in a long-term 14-year follow-up cohort of 423 T2DM Caucasian men, the association between baseline androgen status/CAG repeat number (by PCR then Sequenom sequencing) and metabolic/cardiovascular outcomes. Results Metabolic outcomes: Lower total testosterone was associated with higher BMI (kg/m2) at 14-year-follow-up: regression coefficient -0.30 (95% confidence interval -0.445 to -0.157), P = 0.0001. The range of CAG repeat number was 9-29 repeats. Higher CAG repeat number in exon-1 of the AR gene was associated with higher follow-up HbA1c2016 - each unit increase in CAG repeat-associated with an increment of 0.1% in HbA1C2016 (P = 0.04), independent of baseline testosterone. Cardiovascular outcomes and mortality: At an average of 14-year-follow-up, 55.8% of hypogonadal men had died vs 36.1% of eugonadal men (P = 0.001). There was a 'u' shaped relation between number of CAG repeats and mortality. Twenty-one CAG repeats were associated with an up to nearly 50% lower mortality rate than <21 CAG repeats and >21 CAG repeats - independent of baseline testosterone level. Conclusion A higher number of CAG repeats at the AR gene associates with higher future HbA1c. There was a 'u' shaped relation between CAG repeat number and mortality rate. Determination of CAG repeat number may become part of assessment of androgen status/its consequences for men with T2DM.
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Swift-Gallant A, Johnson BA, Di Rita V, Breedlove SM. Through a glass, darkly: Human digit ratios reflect prenatal androgens, imperfectly. Horm Behav 2020; 120:104686. [PMID: 32014464 DOI: 10.1016/j.yhbeh.2020.104686] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 01/07/2023]
Abstract
On average, the length of the index finger (digit 2) divided by the length of the ring finger (digit 4) on the right hand, is greater in women than in men. Converging evidence makes it clear that prenatal androgens affect the development of digit ratios in humans and so are likely responsible for this sex difference. Thus, differences in 2D:4D between groups within a sex may be due to average differences between those groups in prenatal androgen exposure. There have been many reports that lesbians, on average, have a smaller (more masculine) digit ratio than straight women, which has been confirmed by metaanalysis. These findings indicate that lesbians were, on average, exposed to greater prenatal androgen than straight women, which further indicates that greater levels of prenatal androgen predispose humans to be attracted to women in adulthood. Nevertheless, these results only apply to group differences between straight women and lesbians; digit ratios cannot be used to classify individual women as gay or straight.
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Affiliation(s)
- Ashlyn Swift-Gallant
- Department of Psychology, Memorial University of Newfoundland, St. Johns, NL A1B 3X9, Canada
| | - Brandon A Johnson
- Neuroscience Program, Michigan State University, United States of America
| | - Victor Di Rita
- Neuroscience Program, Michigan State University, United States of America
| | - S Marc Breedlove
- Neuroscience Program, Michigan State University, United States of America; Department of Psychology, Michigan State University, United States of America.
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Cruz-Topete D, Dominic P, Stokes KY. Uncovering sex-specific mechanisms of action of testosterone and redox balance. Redox Biol 2020; 31:101490. [PMID: 32169396 PMCID: PMC7212492 DOI: 10.1016/j.redox.2020.101490] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/17/2020] [Accepted: 03/01/2020] [Indexed: 12/11/2022] Open
Abstract
The molecular and pharmacological manipulation of the endogenous redox system is a promising therapy to limit myocardial damage after a heart attack; however, antioxidant therapies have failed to fully establish their cardioprotective effects, suggesting that additional factors, including antioxidant system interactions with other molecular pathways, may alter the pharmacological effects of antioxidants. Since gender differences in cardiovascular disease (CVD) are prevalent, and sex is an essential determinant of the response to oxidative stress, it is of particular interest to understand the effects of sex hormone signaling on the activity and expression of cellular antioxidants and the pharmacological actions of antioxidant therapies. In the present review, we briefly summarize the current understanding of testosterone effects on the modulation of the endogenous antioxidant systems in the CV system, cardiomyocytes, and the heart. We also review the latest research on redox balance and sexual dimorphism, with particular emphasis on the role of the natural antioxidant system glutathione (GSH) in the context of myocardial infarction, and the pro- and antioxidant effects of testosterone signaling via the androgen receptor (AR) on the heart. Finally, we discuss future perspectives regarding the potential of using combing antioxidant and testosterone replacement therapies to protect the aging myocardium.
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Affiliation(s)
- Diana Cruz-Topete
- Department of Molecular and Cellular Physiology, Shreveport, LA, USA; Center for Cardiovascular Diseases and Sciences, Shreveport, LA, USA.
| | - Paari Dominic
- Center for Cardiovascular Diseases and Sciences, Shreveport, LA, USA; Department of Cardiology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Karen Y Stokes
- Department of Molecular and Cellular Physiology, Shreveport, LA, USA; Center for Cardiovascular Diseases and Sciences, Shreveport, LA, USA
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13
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Zhang K, Yang X, Zhang M, Wang C, Fang P, Xue M, Zhao J, Gao X, Pan R, Gong P. Revisiting the relationships of 2D:4D with androgen receptor (AR) gene and current testosterone levels: Replication study and meta-analyses. J Neurosci Res 2019; 98:353-370. [PMID: 31359506 DOI: 10.1002/jnr.24502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 01/07/2023]
Abstract
The relationships of digit ratio (2D:4D) with the length of AR (CAG)n, and testosterone levels from saliva and blood have been extensively debated over the years. This research including three studies further clarifies such controversies. To do so, we re-examined the relationships between the length of AR (CAG)n, 2D:4D, and current testosterone levels, through replication study and meta-analysis for each study. The results indicate: (a) the length of AR (CAG)n is not significantly associated with 2D:4D; (b) current testosterone levels are not significantly associated with the ratio; and (c) the length is not significantly associated with testosterone levels. Thus, AR (CAG)n and current testosterone levels are not significantly related to 2D:4D at individual level.
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Affiliation(s)
- Kejin Zhang
- Shaanxi Key Laboratory for Animal Conservation, Northwest University, Xi'an, China.,College of Life Science, Northwest University, Xi'an, China
| | - Xing Yang
- College of Life Science, Northwest University, Xi'an, China
| | - Mengfei Zhang
- College of Life Science, Northwest University, Xi'an, China
| | - Chunlan Wang
- College of Life Science, Northwest University, Xi'an, China
| | - Pengpeng Fang
- College of Life Science, Northwest University, Xi'an, China
| | - Mengying Xue
- College of Life Science, Northwest University, Xi'an, China
| | - Jing Zhao
- College of Life Science, Northwest University, Xi'an, China
| | - Xiaocai Gao
- Institute of Population and Health, Northwest University, Xi'an, China
| | - Ruliang Pan
- Shaanxi Key Laboratory for Animal Conservation, Northwest University, Xi'an, China.,School of Human Sciences, Centre for Evolutionary Biology, The University of Western Australia, Perth, WA, Australia.,School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
| | - Pingyuan Gong
- Shaanxi Key Laboratory for Animal Conservation, Northwest University, Xi'an, China.,College of Life Science, Northwest University, Xi'an, China.,Institute of Population and Health, Northwest University, Xi'an, China.,Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Northwest University, Xi'an, China
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14
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Malipatil NS, Yadegarfar G, Lunt M, Keevil B, Siddals K, Livingston M, Roberts S, Narayanan P, Rutter M, Gibson JM, Donn R, Hackett G, Jones TH, Heald A. Male hypogonadism: 14-year prospective outcome in 550 men with type 2 diabetes. Endocrinol Diabetes Metab 2019; 2:e00064. [PMID: 31294081 PMCID: PMC6613223 DOI: 10.1002/edm2.64] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Hypogonadism is more prevalent in men with type 2 diabetes (T2DM) (25%-40%) than in men without T2DM. Hypogonadism has been associated with poorer glycaemic outcomes and increased cardiovascular morbidity/mortality. We report a 14-year follow-up study to evaluate the influence of baseline testosterone level on T2DM outcomes. RESEARCH DESIGN AND METHODS A total of 550 men with T2DM underwent baseline total testosterone and dihydrotestosterone measurement by tandem mass spectrometry. Mean age of the men was 59.7 ± 12 (mean ± SD) years. Sex hormone-binding globulin (SHBG) was measured and free testosterone estimated. Patients were followed up between 2002 and 2016. Mean follow-up period was 12.2 ± 4 years using the Salford (UK) Integrated Health Records system. RESULTS Mean baseline total testosterone was 13.7 ± 5.8 nmol/L, and mean free testosterone was 245.7 ± 88.0 pmol/L. Mean for low total testosterone (<10 nmol/L) was 7.6 ± 2.0 nmol/L (n = 154) and 142 men had a free testosterone <190 pmol/L. During the 14-year duration follow-up, 22% of men experienced a myocardial infarction, 18% experienced a stroke, 11% developed angina, 14% underwent coronary revascularization. About 38% of the men initially recruited died. A lower total testosterone was associated with a higher body mass index (kg/m2) at follow-up: regression coefficient -0.30 (95% CI -0.445 to -0.157), P = 0.0001. The mortality rate was higher in patients with lower total testosterone compared to normal baseline total testosterone (5.0% vs 2.8% per year, P < 0.0001). A similar phenomenon was seen for dihydrotestosterone (4.3% vs 2.9% per year, P = 0.002) for normal vs low dihydrotestosterone) and for lower SHBG. Over the whole follow-up period 36.1% (143/396), men with normal baseline testosterone died vs 55.8% (86/154) of hypogonadal men at baseline. In Cox regression, the age-adjusted hazard ratio (HR) for higher mortality associated with low total testosterone was 1.54 (95% CI: 1.2-2.0, P < 0.002), corresponding to a 3.2 year reduced life expectancy for hypogonadal T2DM men. CONCLUSION Low testosterone and dihydrotestosterone levels are associated with higher all-cause mortality in T2DM men. Hypogonadal men with T2DM should be considered as very high risk for cardiovascular events/death.
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Affiliation(s)
- Nagaraj S. Malipatil
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
| | - Ghasem Yadegarfar
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Heart Failure Research Centre (HF/PROVE), School of Public HealthIsfahan University of Medical SciencesIsfahanIran
| | - Mark Lunt
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Brian Keevil
- University of South Manchester NHS Foundation TrustManchesterUK
| | - Kirk Siddals
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | | | - Siriol Roberts
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Prakash Narayanan
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Martin Rutter
- Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester University NHS Foundation TrustManchesterUK
| | - J. Martin Gibson
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
| | - Rachelle Donn
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Geoff Hackett
- Department of Sexual MedicineHeartlands HospitalBirminghamUK
| | - T. Hugh Jones
- Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
| | - Adrian Heald
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
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15
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Hastings WJ, Chang AM, Ebstein RP, Shalev I. Neuroendocrine stress response is moderated by sex and sex hormone receptor polymorphisms. Horm Behav 2018; 106:74-80. [PMID: 30300610 PMCID: PMC6324727 DOI: 10.1016/j.yhbeh.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023]
Abstract
Sex hormones are significant regulators of stress reactivity, however, little is known about how genetic variation in hormone receptors contributes to this process. Here we report interactions between biological sex and repeat polymorphisms in genes encoding sex hormone receptors, and their effects on salivary cortisol reactivity in a sample of 100 participants (47 men & 53 women; 24.7 ± 3.23 years). Three genes were investigated: estrogen receptors alpha (ESR1) and beta (ESR2), and the androgen receptor (AR). Participants were classified as carrying 'Short' or 'Long' alleles based on median splits of the repeat distribution for each gene. Measures of physiological reactivity were collected before and after exposure to a canonical laboratory stressor and converted to traditional summary measures for analyses. Overall, men exhibited greater cortisol (p = 0.001) and mean arterial pressure reactivity (p = 0.002), while women displayed elevated heart rate throughout the session (p = 0.02). The effect of polymorphisms on salivary cortisol was sex sensitive. ESR1 was associated with differential reactivity in men (p = 0.04), but not women (p = 0.24). ESR2 genotype interacted with sex such that each additional 'Long' allele was associated with a 6.4% decrease in salivary cortisol in men, but a 9.5% increase in the levels of women (p = 0.02 for interaction). For the X-linked AR, the 'Long' allele was associated with decreased cortisol levels in men (p = 0.047), but in women had no effect (p = 0.75). Together, these results provide evidence for the saliency of genetic variation in sex hormone receptors on stress reactivity in humans and highlight their important role as mediators of hormonal activity.
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Affiliation(s)
- W J Hastings
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA
| | - A M Chang
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA
| | - R P Ebstein
- Department of Psychology, National University of Singapore, Singapore
| | - I Shalev
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA.
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16
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Skøtt JW, Lauritsen J, Kreiberg M, Daugaard G, Bandak M. Quality of Life in Long-Term Testicular Cancer Survivors With Compensated Leydig Cell Dysfunction. Clin Genitourin Cancer 2018; 17:e65-e71. [PMID: 30293923 DOI: 10.1016/j.clgc.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Compensated Leydig cell (LC) dysfunction, defined by elevated serum levels of luteinizing hormone (LH) in combination with normal total testosterone levels, is common in testicular cancer (TC) survivors. The association between this condition and quality of life is unknown. We aimed to clarify if TC survivors with compensated LC dysfunction have impaired quality of life. PATIENTS AND METHODS In total, 147 long-term TC survivors were included. On the basis of a single measurement of testosterone and LH, compensated LC dysfunction was defined by age-adjusted levels of LH above normal range combined with testosterone levels within the normal range. Quality-of-life outcomes including sexual function, anxiety and depression, fatigue, and overall self-evaluated quality of life were compared between patients with and without compensated LC dysfunction with adjustment for age. RESULTS In total, 60 TC survivors had compensated LC dysfunction and 87 TC survivors had normal LC function. TC survivors with compensated LC dysfunction had lower serum levels of total testosterone (11 vs. 13 nmol/L, P = .016). There were no significant differences in the investigated quality-of-life outcomes (anxiety, depression, sexual function, fatigue) between the 2 groups. CONCLUSION Compensated LC dysfunction in TC survivors was not associated with symptoms of depression, anxiety, sexual dysfunction, fatigue, or impaired overall self-evaluated quality of life. Limitations include the few cases of symptoms of depression (n = 7). Our findings do not suggest that testosterone substitution is indicated in TC survivors with compensated LC dysfunction.
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Affiliation(s)
- Julie Wang Skøtt
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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17
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Yang P, Liu X, Gao J, Qu S, Zhang M. Complete androgen insensitivity syndrome in a young woman with metabolic disorder and diabetes: A case report. Medicine (Baltimore) 2018; 97:e11353. [PMID: 30113450 PMCID: PMC6112890 DOI: 10.1097/md.0000000000011353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Androgen insensitivity syndrome (CAIS) is a rare X-linked recessive androgen receptor disorder characterized by complete resistance to the actions of androgen in an individual with 46,XY karyotype. Metabolic disorder and diabetes has been rarely reported in these patients. PATIENT CONCERNS A 22-year-old female patient was admitted to our center for the evaluation of high blood sugar. The central obesity, lipid dysfunction, and diabetes were found in the patient. The patient also presented as primary amenorrhea and poor secondary sex characteristics after puberty. DIAGNOSES The diagnosis of CAIS in this patient was established by infantile female genitalia, absence of ovary and uterus, history of gonadectomy, 46,XY karyotype, and carried a mutation c.2751C>G (p.917F > L) in androgen receptor gene. INTERVENTION The patient was treated by insulin, metformin, statins and estrogen. OUTCOMES After 6 months follow-up, blood sugar and lipid profiles were normal, but breast development and weight loss were not obvious. LESSONS We report a case of CAIS in a 22-year-old female accompanying central obesity, dyslipidemia, and diabetes mellitus. It is extremely important to recognize special type diabetes among the young-onset diabetic patients, and this case will provide further evidence of a link between impaired androgen receptor signaling and metabolic regulation.
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Affiliation(s)
- Peng Yang
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Xiang Liu
- Department of Urology, Putuo District People's Hospital, Shanghai, China
| | - Jingyang Gao
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Shen Qu
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Manna Zhang
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine
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18
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Kim JW, Bae YD, Ahn ST, Kim JW, Kim JJ, Moon DG. Androgen Receptor CAG Repeat Length as a Risk Factor of Late-Onset Hypogonadism in a Korean Male Population. Sex Med 2018; 6:203-209. [PMID: 29706560 PMCID: PMC6085405 DOI: 10.1016/j.esxm.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/21/2018] [Accepted: 04/01/2018] [Indexed: 01/02/2023] Open
Abstract
Background Testosterone action is mediated through the androgen receptor (AR), whose sensitivity is influenced by the AR CAG repeat polymorphism. However, the relation between late-onset hypogonadism (LOH) and AR CAG repeat length is unclear and studies of Asian populations are limited. Aim To investigate the relation between AR CAG repeat length and LOH in Korean men. Methods 263 Korean men (mean age = 63.43 ± 10.9 years) were enrolled from 2014 to 2015. LOH diagnosis was based on a serum testosterone level lower than 3.5 ng/mL and positive androgen deficiency according to the Aging Males’ Symptom Scale (AMS). Total testosterone levels and answers to the LOH-related questionnaire were analyzed. Outcomes The relation between AR CAG repeat length and LOH was determined. Results Mean CAG repeat length was 22.1 ± 4.6 and mean serum testosterone levels were 2.6 ± 0.7 and 6.0 ± 2.0 ng/mL in men with and without LOH, respectively. Men with LOH showed significantly longer AR CAG repeat lengths than men without LOH (26.1 vs 21.6, P < .001). Longer CAG repeat lengths were correlated with higher AMS total scores (r = 0.454, P = .001) and AMS psychotic, somatic, and sexual sub-scores (r = 0.276, 0.246, and 0.571, P = .006, .007, .001, respectively) and significantly lower 5-item International Index of Erectile Function scores (r = −0.261, P = .001). Multivariate analysis showed that patient age and CAG repeat length were independently associated with LOH (odds ratio = 1.05 and 1.29, P = .041 and <.001, respectively). Clinical Implications A longer CAG repeat length is associated with LOH symptoms and LOH. Strengths and Limitations Associations between CAG repeats and LOH were verified in Korean patients. Moreover, a longer CAG repeat length was shown to be an independent risk factor for LOH. Limitations included the small number of LOH patients studied and that other sex hormone-associated factors were not measured. Conclusions AR CAG repeat length was associated with LOH prevalence and clinical symptoms in this Korean male population. Thus, it is important to measure CAG repeat length for patients with LOH symptoms with normal testosterone levels. Kim JW, Bae YD, Ahn ST, et al. Androgen Receptor CAG Repeat Length as a Risk Factor of Late-Onset Hypogonadism in a Korean Male Population. Sex Med 2018;6:203–209.
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Affiliation(s)
- Jong Wook Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Young Dae Bae
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Sun Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Jin Wook Kim
- Institute of Regenerative Medicine, Korea University, Seoul, Korea; Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea.
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19
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Beking T, Geuze RH, van Faassen M, Kema IP, Kreukels BPC, Groothuis TGG. Prenatal and pubertal testosterone affect brain lateralization. Psychoneuroendocrinology 2018; 88:78-91. [PMID: 29195161 DOI: 10.1016/j.psyneuen.2017.10.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 11/15/2022]
Abstract
After decades of research, the influence of prenatal testosterone on brain lateralization is still elusive, whereas the influence of pubertal testosterone on functional brain lateralization has not been investigated, although there is increasing evidence that testosterone affects the brain in puberty. We performed a longitudinal study, investigating the relationship between prenatal testosterone concentrations in amniotic fluid, pubertal testosterone concentrations in saliva, and brain lateralization (measured with functional Transcranial Doppler ultrasonography (fTCD)) of the Mental Rotation, Chimeric Faces and Word Generation tasks. Thirty boys and 30 girls participated in this study at the age of 15 years. For boys, we found a significant interaction effect between prenatal and pubertal testosterone on lateralization of Mental Rotation and Chimeric Faces. In the boys with low prenatal testosterone levels, pubertal testosterone was positively related to the strength of lateralization in the right hemisphere, while in the boys with high prenatal testosterone levels, pubertal testosterone was negatively related to the strength of lateralization. For Word Generation, pubertal testosterone was negatively related to the strength of lateralization in the left hemisphere in boys. For girls, we did not find any significant effects, possibly because their pubertal testosterone levels were in many cases below quantification limit. To conclude, prenatal and pubertal testosterone affect lateralization in a task-specific way. Our findings cannot be explained by simple models of prenatal testosterone affecting brain lateralization in a similar way for all tasks. We discuss alternative models involving age dependent effects of testosterone, with a role for androgen receptor distribution and efficiency.
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Affiliation(s)
- T Beking
- University of Groningen, Faculty of Behavioural and Social Sciences, Department Clinical & Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
| | - R H Geuze
- University of Groningen, Faculty of Behavioural and Social Sciences, Department Clinical & Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
| | - M van Faassen
- University Medical Center Groningen, University of Groningen, Laboratory Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - I P Kema
- University Medical Center Groningen, University of Groningen, Laboratory Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - B P C Kreukels
- VU University Medical Center Amsterdam, Department of Medical Psychology, Center of Expertise on Gender Dysphoria, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - T G G Groothuis
- University of Groningen, Groningen Institute for Evolutionary Life Sciences, Nijenborgh 7, 9747 AG Groningen, The Netherlands.
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20
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Kim JW, Bae YD, Ahn ST, Kim JW, Kim JJ, Moon DG. Positive Correlation between Androgen Receptor CAG Repeat Length and Metabolic Syndrome in a Korean Male Population. World J Mens Health 2018; 36:73-78. [PMID: 29299905 PMCID: PMC5756810 DOI: 10.5534/wjmh.17029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jong Wook Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
- Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Young Dae Bae
- Department of Urology, Korea University College of Medicine, Seoul, Korea
- Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Sun Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea
- Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Jin Wook Kim
- Institute of Regenerative Medicine, Korea University, Seoul, Korea
- Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
- Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
- Institute of Regenerative Medicine, Korea University, Seoul, Korea
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21
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Malavige LS, Jayawickrama S, Ranasinghe P, Levy JC. Androgen receptor CAG repeat polymorphism is not associated with insulin resistance and diabetes among South Asian males. BMC Res Notes 2017; 10:685. [PMID: 29202793 PMCID: PMC5716056 DOI: 10.1186/s13104-017-3035-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022] Open
Abstract
Objective To study relationship between androgen receptor (AR) CAG repeat polymorphism, insulin resistance (IR), β-cell function and other clinical/biochemical parameters in ethnic South Asian adults. A case (males with diabetes), control (males without diabetes) study, was conducted and 110 males were invited. Anthropometry, blood pressure and biochemical parameters (fasting Insulin, blood sugar, HbA1c and lipid profile) were measured. IR and β-cell function was calculated. A multiple-linear-regression analysis was performed, using number of AR CAG repeats as the continuous dependent variable. Results Sample size was 100 (response rate—90.9%, cases—53). Mean age was 49.6 ± 10.7 years. CAG repeat length did not show any significant correlation with IR or β-cell function. In all males there was a significant correlation between number of AR CAG repeats and systolic blood pressure (r = 0.25; p = 0.016), diastolic blood pressure (r = 0.21; p = 0.045), total cholesterol (r = − 0.22; p = 0.037) and low-density lipoprotein cholesterol (r = − 0.22; p = 0.037). Only total cholesterol (β = − 4.41; p < 0.001) and estrogen (β = 2.25; p = 0.03) were significantly associated with number of AR CAG repeats in regression analysis. In conclusion, AR CAG repeat length did not show any significant correlation with IR or β-cell function. Positive association of AR CAG with systolic and diastolic blood pressure and negative association of AR CAG with total and low-density lipoprotein cholesterol deserves further attention.
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Affiliation(s)
- Lasantha S Malavige
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK. .,Oxford Radcliffe Trust, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK.
| | | | - Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Jonathan C Levy
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK.,Oxford Radcliffe Trust, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
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22
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Chasland LC, Knuiman MW, Divitini ML, Chan YX, Handelsman DJ, Naylor LH, Green DJ, Yeap BB. Greater physical activity and higher androgen concentrations are independently associated with lower cardiometabolic risk in men. Clin Endocrinol (Oxf) 2017; 87:466-474. [PMID: 28656662 DOI: 10.1111/cen.13407] [Citation(s) in RCA: 5] [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] [Received: 02/22/2017] [Revised: 05/21/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Abstract
CONTEXT Male ageing is associated with lower circulating testosterone (T) and increased incidence of cardiovascular disease (CVD). Whether physical activity (PA) interacts with hormones to modify CVD risk is unclear. OBJECTIVE We assessed whether PA and sex hormone concentrations were independently associated with measures of CVD risk. PARTICIPANTS A total of 1649 men. METHODS Leisure, home, work and total PA were ascertained. At baseline, serum T, dihydrotestosterone (DHT) and oestradiol (E2) were assayed. Men were stratified into high PA+high hormone (H/H); low PA+high hormone (L/H); high PA+low hormone (H/L); and low PA+low hormone (L/L). RESULTS Mean age was 49.8 years at outset with 415 CVD events and 127 CVD deaths occurring during 20-year follow-up. Men with higher PA and higher T or DHT had lower odds of metabolic syndrome (eg leisure H/H vs L/L odds ratio [OR] 0.17 P<.001 for T, 0.26 P<.001 for DHT). Men with higher PA and E2 had lower risk of metabolic syndrome (eg leisure PA H/H vs L/L OR 0.51, P=.001). Men with higher leisure, work or total PA and higher DHT had the lowest risk of CVD death (eg leisure H/H hazard ratio [HR] 0.55 vs L/L, P=.033). Men with lower leisure, home or work PA and higher E2 were at greater risk of CVD death (eg leisure L/H HR 1.60 vs L/L, P=.039). CONCLUSIONS Considering T, DHT and E2 in the context of PA better informs consideration of cardiovascular risk. A 2×2 factorial RCT assessing PA and androgens would illuminate the scope for preventing CVD in men.
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Affiliation(s)
- Lauren C Chasland
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Matthew W Knuiman
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Mark L Divitini
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Yi X Chan
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Louise H Naylor
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Daniel J Green
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
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23
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Yang D, Tian J, Zhang X, Yu J, Li S, Wang Z, Ma Y, Liu L, Huang Q, Ma R, Wang J, Li X, Jiang M. The polymorphic CAG repeat in exon 1 of androgen receptor is associated with level of HDL cholesterol and hypertension in Chinese middle-aged and elderly men. Clin Endocrinol (Oxf) 2017; 87:29-34. [PMID: 28295444 DOI: 10.1111/cen.13326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/15/2017] [Accepted: 03/05/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The length of the CAG repeats in exon 1 of the androgen receptor (AR) gene has been shown to be inversely correlated with AR transcriptional activity. This study aimed to investigate the correlations between the length of CAG repeat in AR and serum lipids and hypertension in Chinese men. DESIGN AND PATIENTS The relationship between length of the CAG repeat in exon 1 of AR with prevalence of hypertension and the levels of serum lipids among Chinese men (aged ≥40 years). MEASUREMENTS The physical condition of the subjects was examined and recorded. The concentrations of blood lipids and sex hormones were measured, and the CAG repeat lengths of the AR gene were determined. RESULTS The length of the AR CAG repeats was associated with HDL cholesterol (HDL-C) concentration, and the stepwise multiple regression model showed that this association was independent of body mass index (BMI), triglycerides (TG) and total cholesterol (TC), although these factors influence HDL-C concentration. Furthermore, men with <22 vs men with ≥22 CAG repeats showed higher blood pressure and higher prevalence of hypertension. Shorter CAG repeat numbers were associated with the increased risk of hypertension in a multivariate logistic regression analysis (odds ratio = 0·715; 95% confidence interval, 0·517-0·989; P = 0·043). No significant correlation of AR CAG repeat polymorphism with sex hormone levels, TG, LDL cholesterol (LDL-C) or TC was found. CONCLUSIONS This study provides evidence that men carrying shorter (<22) AR CAG repeats have lower HDL-C level and increased risk of hypertension. The androgenic activity may differ due to the polymorphic length of CAG repeats of the AR gene.
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Affiliation(s)
- Deyu Yang
- Graduate School of Ningxia Medical University, Yinchuan, China
| | - Jinhai Tian
- National Engineering Research Center for Beijing Biochip Technology, Sub-center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xu Zhang
- National Engineering Research Center for Beijing Biochip Technology, Sub-center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jingjing Yu
- National Engineering Research Center for Beijing Biochip Technology, Sub-center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Shuya Li
- Graduate School of Ningxia Medical University, Yinchuan, China
| | - Zhizhong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Yuying Ma
- Health Examination Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Lan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Qi Huang
- National Engineering Research Center for Beijing Biochip Technology, Sub-center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Rong Ma
- National Engineering Research Center for Beijing Biochip Technology, Sub-center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jia Wang
- National Engineering Research Center for Beijing Biochip Technology, Sub-center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xin Li
- Graduate School of Ningxia Medical University, Yinchuan, China
| | - Min Jiang
- National Engineering Research Center for Beijing Biochip Technology, Sub-center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, China
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24
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Ryan CP, Georgiev AV, McDade TW, Gettler LT, Eisenberg DTA, Rzhetskaya M, Agustin SS, Hayes MG, Kuzawa CW. Androgen receptor polyglutamine repeat length (AR‐CAGn) modulates the effect of testosterone on androgen‐associated somatic traits in Filipino young adult men. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 163:317-327. [DOI: 10.1002/ajpa.23208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/16/2017] [Accepted: 02/25/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Calen P. Ryan
- Department of AnthropologyNorthwestern UniversityEvanston Illinois
| | | | - Thomas W. McDade
- Department of AnthropologyNorthwestern UniversityEvanston Illinois
- Institute for Policy ResearchNorthwestern UniversityEvanston Illinois
| | - Lee T. Gettler
- Department of AnthropologyUniversity of Notre DameNotre Dame Indiana
- The Eck Institute for Global HealthUniversity of Notre DameNotre Dame Indiana
| | - Dan T. A. Eisenberg
- Department of AnthropologyUniversity of WashingtonSeattle Washington
- Center for Studies in Demography and EcologyUniversity of WashingtonSeattle Washington
| | - Margarita Rzhetskaya
- Division of EndocrinologyMetabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineChicago Illinois
| | - Sonny S. Agustin
- USC‐Office of Population Studies FoundationUniversity of San CarlosCebu City Philippines
| | - M. Geoffrey Hayes
- Department of AnthropologyNorthwestern UniversityEvanston Illinois
- Division of EndocrinologyMetabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineChicago Illinois
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicago Illinois
| | - Christopher W. Kuzawa
- Department of AnthropologyNorthwestern UniversityEvanston Illinois
- Institute for Policy ResearchNorthwestern UniversityEvanston Illinois
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25
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Tirabassi G, Cutini M, Beltrami B, Delli Muti N, Lenzi A, Balercia G. Androgen receptor GGC repeat might be more involved than CAG repeat in the regulation of the metabolic profile in men. Intern Emerg Med 2016; 11:1067-1075. [PMID: 27251588 DOI: 10.1007/s11739-016-1479-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/26/2016] [Indexed: 11/30/2022]
Abstract
The influence of androgen receptor (AR) GGC repeat polymorphism on the metabolic profile of men has been much less studied than the one of CAG tract polymorphism. Therefore, in this study, we looked for the association of GGC and CAG tract with cardiovascular risk factors in men. Ninety-eight men followed by our andrological unit were retrospectively reviewed. Clinical and biochemical parameters on cardiovascular risk were considered. AR CAG and GGC polymorphisms were studied. GGC triplets were found to be positively and significantly correlated with several cardiovascular risk factors. On the other hand, inverse and significant correlations of CAG triplets were found with insulin and HOMA. As expected, age was positively correlated with cardiovascular risk, whereas total testosterone was inversely correlated with metabolic profile. Estradiol was not found to be correlated with any of the metabolic parameters. In the total sample, multivariate linear regression analysis confirms the positive and independent association of GGC triplets with glycemia, glycated hemoglobin, total cholesterol, triglycerides and homeostasis model assessment of insulin resistance (HOMA), whereas CAG repeat length is negatively associated with insulin and HOMA. Such associations are also substantially confirmed in non-diabetic subjects, whereas in diabetic patients only the GGC tract seems to be involved in the metabolic profile regulation. Our work shows a relevant role for GGC repeat tract in conditioning male cardiovascular risk, thus rendering necessary a deeper analysis on the role of GGC polymorphism both from the molecular and the clinical point of view.
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Affiliation(s)
- Giacomo Tirabassi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Via Conca 71, Umberto I Hospital, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Melissa Cutini
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Via Conca 71, Umberto I Hospital, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Benedetta Beltrami
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Via Conca 71, Umberto I Hospital, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Nicola Delli Muti
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Via Conca 71, Umberto I Hospital, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Andrea Lenzi
- Andrology, Pathophysiology of Reproduction and Endocrine Diagnosis Unit, Policlinic Umberto I, University of Rome ''La Sapienza'', Rome, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Via Conca 71, Umberto I Hospital, Polytechnic University of Marche, 60126, Ancona, Italy.
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26
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Ryan CP, McDade TW, Gettler LT, Eisenberg DTA, Rzhetskaya M, Hayes MG, Kuzawa CW. Androgen receptor CAG repeat polymorphism and hypothalamic-pituitary-gonadal function in Filipino young adult males. Am J Hum Biol 2016; 29. [PMID: 27417274 DOI: 10.1002/ajhb.22897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/30/2016] [Accepted: 06/22/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Testosterone (T), the primary androgenic hormone in males, is stimulated through pulsatile secretion of LH and regulated through negative feedback inhibition at the hypothalamus and pituitary. The hypothalamic-pituitary-gonadal (HPG) axis also controls sperm production through the secretion of follicle-stimulating hormone (FSH). Negative feedback in the HPG axis is achieved in part through the binding of T to the androgen receptor (AR), which contains a highly variable trinucleotide repeat polymorphism (AR-CAGn). The number of repeats in the AR-CAGn inversely correlates with transcriptional activity of the AR. Thus, we predicted longer AR-CAGn to be associated with higher T, LH, and FSH levels. METHODS We examined the relationship between AR-CAGn and total plasma T, LH, and FSH, as well as "bioavailable" morning (AM-T) and evening (PM-T) testosterone in 722 young (21.5 ± 0.5 years) Filipino males. RESULTS There was no relationship between AR-CAGn and total T, AM-T, or LH (P > .25 for all). We did observe a marginally non-significant (P = .066) correlation between AR-CAGn and PM-T in the predicted direction, and a negative correlation between AR-CAGn and FSH (P = .005). CONCLUSIONS Our results both support and differ from previous findings in this area, and study parameters that differ between our study and others, such as participant age, sample time, and the role of other hormones should be considered when interpreting our findings. While our data point to a modest effect of AR-CAGn on HPG regulation at best, the AR-CAGn may still affect somatic traits by regulating androgenic activity at peripheral tissues.
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Affiliation(s)
- Calen P Ryan
- Department of Anthropology, Northwestern University, Evanston, 60208, Illinois
| | - Thomas W McDade
- Department of Anthropology, Northwestern University, Evanston, 60208, Illinois.,Institute for Policy Research, Northwestern University, Evanston, 60208, Illinois
| | - Lee T Gettler
- Department of Anthropology, University of Notre Dame, South Bend, Indiana
| | - Dan T A Eisenberg
- Department of Anthropology, University of Washington, Seattle, Washington
| | - Margarita Rzhetskaya
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, 60611, Illinois
| | - M Geoffey Hayes
- Department of Anthropology, Northwestern University, Evanston, 60208, Illinois.,Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, 60611, Illinois.,Northwestern University Feinberg School of Medicine, Center for Genetic Medicine, Chicago, 60611, Illinois
| | - Christopher W Kuzawa
- Department of Anthropology, Northwestern University, Evanston, 60208, Illinois.,Institute for Policy Research, Northwestern University, Evanston, 60208, Illinois
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27
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Gragnoli C, Reeves GM, Reazer J, Postolache TT. Dopamine-prolactin pathway potentially contributes to the schizophrenia and type 2 diabetes comorbidity. Transl Psychiatry 2016; 6:e785. [PMID: 27093067 PMCID: PMC4872408 DOI: 10.1038/tp.2016.50] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/15/2016] [Accepted: 02/19/2016] [Indexed: 01/10/2023] Open
Abstract
Schizophrenia (SCZ) and type 2 diabetes (T2D) are clinically associated, and common knowledge attributes this association to side effects of antipsychotic treatment. However, even drug-naive patients with SCZ are at increased risk for T2D. Dopamine dysfunction has a central role in SCZ. It is well-known that dopamine constitutively inhibits prolactin (PRL) secretion via the dopamine receptor 2 (DR2D). If dopamine is increased or if dopamine receptors hyperfunction, PRL may be reduced. During the first SCZ episode, low PRL levels are associated with worse symptoms. PRL is essential in human and social bonding, as well as it is implicated in glucose homeostasis. Dopamine dysfunction, beyond contributing to SCZ symptoms, may lead to altered appetite and T2D. To our knowledge, there are no studies of the genetics of the SCZ-T2D comorbidity focusing jointly on the dopamine and PRL pathway in the attempt to capture molecular heterogeneity correlated to possible disease manifestation heterogeneity. In this dopamine-PRL pathway-focused-hypothesis-driven review on the association of SCZ with T2D, we report a specific revision of what it is known about PRL and dopamine in relation to what we theorize is one of the missing links between the two disorders. We suggest that new studies are necessary to establish the genetic role of PRL and dopamine pathway in SCZ-T2D comorbidity.
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Affiliation(s)
- C Gragnoli
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA,Molecular Biology Laboratory, Bios Biotech Multi-Diagnostic Health Center, Rome, Italy,Division of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, 653-1 West 8th Street, Learning Resource Center, L14, Jacksonville, FL 32209, USA. E-mail:
| | - G M Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Reazer
- Borland Health Sciences Library, University of Florida, Jacksonville, FL, USA
| | - T T Postolache
- Rocky Mountain Mental Illness Research Education and Clinical Center, Denver, CO, USA,Veterans Integrated Service Network 5 MIRECC, Baltimore, MD, USA,Department of Psychiatry, University of Maryland, Baltimore, MD, USA
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28
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Ponce-González JG, Rodríguez-Garcia L, Losa-Reyna J, Guadalupe-Grau A, Rodriguez-Gonzalez FG, Díaz-Chico BN, Dorado C, Serrano-Sanchez JA, Calbet JAL. Androgen receptor gene polymorphism influence fat accumulation: A longitudinal study from adolescence to adult age. Scand J Med Sci Sports 2015; 26:1313-1320. [PMID: 26634957 DOI: 10.1111/sms.12587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2015] [Indexed: 01/08/2023]
Abstract
To determine the influence of androgen receptor CAG and GGN repeat polymorphisms on fat mass and maximal fat oxidation (MFO), CAG and GGN repeat lengths were measured in 128 young boys, from which longitudinal data were obtained in 45 of them [mean ± SD: 12.8 ± 3.6 years old at recruitment, and 27.0 ± 4.8 years old at adult age]. Subjects were grouped as CAG short (CAGS ) if harboring repeat lengths ≤ 21, the rest as CAG long (CAGL ); and GGN short (GGNS ) if GGN repeat lengths ≤ 23, or long if > 23 (GGNL ). CAGS and GGNS were associated with lower adiposity than CAGL or GGNL (P < 0.05). There was an association between the logarithm of CAG repeats polymorphism and the changes of body mass (r = 0.34, P = 0.03). At adult age, CAGS men showed lower accumulation of total body and trunk fat mass, and lower resting metabolic rate (RMR) and MFO per kg of total lean mass compared with CAGL (P < 0.05). GGNS men also showed lower percentage of body fat (P < 0.05). In summary, androgen receptor CAG and GGN repeat polymorphisms are associated with RMR, MFO, fat mass, and its regional distribution in healthy male adolescents, influencing fat accumulation from adolescence to adult age.
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Affiliation(s)
- J G Ponce-González
- Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - L Rodríguez-Garcia
- Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - J Losa-Reyna
- Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - A Guadalupe-Grau
- Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - F G Rodriguez-Gonzalez
- Department of Biochemistry and Physiology, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Canary Islands Cancer Research Institute (ICIC), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - B N Díaz-Chico
- Department of Biochemistry and Physiology, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Canary Islands Cancer Research Institute (ICIC), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - C Dorado
- Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - J A Serrano-Sanchez
- Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - J A L Calbet
- Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. .,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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29
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Interactions among impulsiveness, testosterone, sex hormone binding globulin and androgen receptor gene CAG repeat length. Physiol Behav 2015; 147:91-6. [DOI: 10.1016/j.physbeh.2015.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 01/02/2023]
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30
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Abstract
Testosterone is a key hormone in the pathology of metabolic diseases such as obesity. Low testosterone levels are associated with increased fat mass (particularly central adiposity) and reduced lean mass in males. These morphological features are linked to metabolic dysfunction, and testosterone deficiency is associated with energy imbalance, impaired glucose control, reduced insulin sensitivity and dyslipidaemia. A bidirectional relationship between testosterone and obesity underpins this association indicated by the hypogonadal-obesity cycle and evidence weight loss can lead to increased testosterone levels. Androgenic effects on enzymatic pathways of fatty acid metabolism, glucose control and energy utilization are apparent and often tissue specific with differential effects noted in different regional fat depots, muscle and liver to potentially explain the mechanisms of testosterone action. Testosterone replacement therapy demonstrates beneficial effects on measures of obesity that are partially explained by both direct metabolic actions on adipose and muscle and also potentially by increasing motivation, vigour and energy allowing obese individuals to engage in more active lifestyles. The degree of these beneficial effects may be dependent on the treatment modality with longer term administration often achieving greater improvements. Testosterone replacement may therefore potentially be an effective adjunctive treatment for weight management in obese men with concomitant hypogonadism.
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Affiliation(s)
- D M Kelly
- Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield, UK
| | - T H Jones
- Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield, UK.,Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
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31
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Tirabassi G, Cignarelli A, Perrini S, delli Muti N, Furlani G, Gallo M, Pallotti F, Paoli D, Giorgino F, Lombardo F, Gandini L, Lenzi A, Balercia G. Influence of CAG Repeat Polymorphism on the Targets of Testosterone Action. Int J Endocrinol 2015; 2015:298107. [PMID: 26421011 PMCID: PMC4572434 DOI: 10.1155/2015/298107] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/09/2015] [Indexed: 01/11/2023] Open
Abstract
In the last decade, ample evidence has demonstrated the growing importance of androgen receptor (AR) CAG repeat polymorphism in andrology. This genetic parameter is able to condition the peripheral effects of testosterone and therefore to influence male sexual function and fertility, cardiovascular risk, body composition, bone metabolism, the risk of prostate and testicular cancer, the psychiatric status, and the onset of neurodegenerative disorders. In this review, we extensively discuss the literature data and identify a role for AR CAG repeat polymorphism in conditioning the systemic testosterone effects. In particular, our main purpose was to provide an updated text able to shed light on the many and often contradictory findings reporting an influence of CAG repeat polymorphism on the targets of testosterone action.
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Affiliation(s)
- Giacomo Tirabassi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Angelo Cignarelli
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Sebastio Perrini
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola delli Muti
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Giorgio Furlani
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Mariagrazia Gallo
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesco Pallotti
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Donatella Paoli
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesco Lombardo
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Loredana Gandini
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Andrea Lenzi
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
- *Giancarlo Balercia:
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32
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Ma YM, Wu KJ, Ning L, Zeng J, Kou B, Xie HJ, Ma ZK, Wang XY, Gong YG, He DL. Relationships among androgen receptor CAG repeat polymorphism, sex hormones and penile length in Han adult men from China: a cross-sectional study. Asian J Androl 2014; 16:478-81. [PMID: 24589466 PMCID: PMC4023382 DOI: 10.4103/1008-682x.124560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study aimed to investigate the correlations among androgen receptor (AR) CAG repeat polymorphism, sex hormones and penile length in healthy Chinese young adult men. Two hundred and fifty-three healthy men (aged 22.8 ± 3.1 years) were enrolled. The individuals were grouped as CAG short (CAGS) if they harbored repeat length of ≤20 or as CAG long (CAGL) if their CAG repeat length was >20. Body height/weight, penile length and other parameters were examined and recorded by the specified physicians; CAG repeat polymorphism was determined by the polymerase chain reaction (PCR) method; and the serum levels of the sex hormones were detected by radioimmunoassay. Student's t-test or linear regression analysis was used to assess the associations among AR CAG repeat polymorphism, sex hormones and penile length. This investigation showed that the serum total testosterone (T) level was positively associated with the AR CAG repeat length (P = 0.01); whereas, no significant correlation of T or AR CAG repeat polymorphism with the penile length was found (P = 0.593). Interestingly, an inverse association was observed between serum prolactin (PRL) levels and penile length by linear regression analyses (β= −0.024, P = 0.039, 95% confidence interval (CI): −0.047, 0). Collectively, this study provides the first evidence that serum PRL, but not T or AR CAG repeat polymorphism, is correlated with penile length in the Han adult population from northwestern China.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yong-Guang Gong
- Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
| | - Da-Lin He
- Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University; Oncology Research Lab, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of the People's Republic of China, Xi'an, China
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Yu IC, Lin HY, Sparks JD, Yeh S, Chang C. Androgen receptor roles in insulin resistance and obesity in males: the linkage of androgen-deprivation therapy to metabolic syndrome. Diabetes 2014; 63:3180-8. [PMID: 25249645 PMCID: PMC4171661 DOI: 10.2337/db13-1505] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Prostate cancer (PCa) is one of the most frequently diagnosed malignancies in men. Androgen-deprivation therapy (ADT) is the first-line treatment and fundamental management for men with advanced PCa to suppress functions of androgen/androgen receptor (AR) signaling. ADT is effective at improving cancer symptoms and prolonging survival. However, epidemiological and clinical studies support the notion that testosterone deficiency in men leads to the development of metabolic syndrome that increases cardiovascular disease risk. The underlying mechanisms by which androgen/AR signaling regulates metabolic homeostasis in men are complex, and in this review, we discuss molecular mechanisms mediated by AR signaling that link ADT to metabolic syndrome. Results derived from various AR knockout mouse models reveal tissue-specific AR signaling that is involved in regulation of metabolism. These data suggest that steps be taken early to manage metabolic complications associated with PCa patients receiving ADT, which could be accomplished using tissue-selective modulation of AR signaling and by treatment with insulin-sensitizing agents.
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Affiliation(s)
- I-Chen Yu
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Hung-Yun Lin
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Janet D Sparks
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Shuyuan Yeh
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Chawnshang Chang
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY Sex Hormone Research Center, China Medical University/Hospital, Taichung, Taiwan
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Mettman DJ, Butler MG, Poje AB, Penick EC, Manzardo AM. A preliminary case study of androgen receptor gene polymorphism association with impulsivity in women with alcoholism. ADVANCES IN GENOMICS AND GENETICS 2014; 4:5-13. [PMID: 24966714 PMCID: PMC4067054 DOI: 10.2147/agg.s57771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The androgen receptor (AR) gene, located on the X chromosome, contains a common polymorphism involving cytosine-adenine-guanine (CAG) repeats, which impacts disease and could contribute to the unequal sex ratio in alcoholism. CAG repeats in the AR gene are known to correlate with impulsivity in males. We report the first preliminary study examining the association between the number of CAG repeats and measures of impulsivity in females with chronic alcoholism. METHODS A total of 35 women and 85 men with chronic alcoholism were previously recruited for a nutritional clinical trial, and 26 well-characterized females (19 African-American and seven Caucasian) with alcoholism agreed to participate for genetic testing. Genomic deoxyribonucleic acid (DNA) was isolated from peripheral blood and CAG repeats determined by analyzing polymerase chain reaction (PCR)-amplified products, using the polymorphic AR gene assay. CAG repeat length was correlated with raw scores from the Barratt Impulsivity Scale, version 11 and the Alcoholism Severity Scale. RESULTS CAG repeat lengths were significantly longer in Caucasian alcoholic women compared with African-Americans, and the average number of CAG repeats were significantly, positively correlated (P<0.05) with impulsivity scores. Women with average CAG repeat length (CAGave) ≥18, representing the upper quartile of the repeat range, showed significantly greater mean raw impulsivity scores. CAG repeat length appeared to have less effect in African-American compared with Caucasian women, possibly due to a shorter average repeat length. CONCLUSION We found an association between the number of CAG repeats and impulsivity in females with chronic alcoholism, specifically in women with CAGave ≥18, seen more commonly in Caucasian compared with African-American women.
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Affiliation(s)
- Daniel J Mettman
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, MS 4015, Kansas University Medical Center, Kansas City, KS, USA
| | - Merlin G Butler
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, MS 4015, Kansas University Medical Center, Kansas City, KS, USA
| | - Albert B Poje
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, MS 4015, Kansas University Medical Center, Kansas City, KS, USA
| | - Elizabeth C Penick
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, MS 4015, Kansas University Medical Center, Kansas City, KS, USA
| | - Ann M Manzardo
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, MS 4015, Kansas University Medical Center, Kansas City, KS, USA
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Stanworth RD, Akhtar S, Channer KS, Jones TH. The role of androgen receptor CAG repeat polymorphism and other factors which affect the clinical response to testosterone replacement in metabolic syndrome and type 2 diabetes: TIMES2 sub-study. Eur J Endocrinol 2014; 170:193-200. [PMID: 24165020 DOI: 10.1530/eje-13-0703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
CONTEXT The TIMES2 (testosterone replacement in hypogonadal men with either metabolic syndrome or type 2 diabetes) study reported beneficial effects of testosterone replacement therapy (TRT) on insulin resistance and other variables in men with diabetes or metabolic syndrome. The androgen receptor CAG repeat polymorphism (AR CAG) is known to affect stimulated AR activity and has been linked to various clinically relevant variables. OBJECTIVE To assess the role of AR CAG in the alteration of clinical response to TRT in the TIMES2 study. DESIGN Subgroup analysis from a multicentre, randomised, double-blind, placebo-controlled and parallel group study. SETTING Outpatient study recruiting from secondary and primary care. PATIENTS A total of 139 men with hypogonadism and type 2 diabetes or metabolic syndrome, of which 73 received testosterone during the TIMES2 study. INTERVENTION Testosterone 2% transdermal gel vs placebo. MAIN OUTCOME MEASURE Regression coefficient of AR CAG from linear regression models for each variable. RESULTS AR CAG was independently positively associated with change in fasting insulin, triglycerides and diastolic blood pressure during TRT with a trend to association with HOMA-IR - the primary outcome variable. There was a trend to negative association between AR CAG and change in PSA. There was no association of AR CAG with change in other glycaemic variables, other lipid variables or obesity. CONCLUSION AR CAG affected the response of some variables to TRT in the TIMES2 study, although the association with HOMA-IR did not reach significance. Various factors may have limited the power of our study to detect the significant associations between AR CAG, testosterone levels and change in variables with testosterone treatment. Analysis of similar data sets from other clinical trials is warranted.
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Affiliation(s)
- R D Stanworth
- Department of Diabetes and Endocrinology, Derby Hospitals NHS Foundation Trust, Derby, UK
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Beatrice AM, Dutta D, Kumar M, Kumbenahalli Siddegowda S, Sinha A, Ray S, Chowdhury S. Testosterone levels and type 2 diabetes in men: current knowledge and clinical implications. Diabetes Metab Syndr Obes 2014; 7:481-6. [PMID: 25349479 PMCID: PMC4208349 DOI: 10.2147/dmso.s50777] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The relationship between testosterone and diabetes is an important issue, given the fact that diabetes is becoming a fast-growing epidemic, the morbidity associated with which is more disabling than the disease itself. Various studies have demonstrated the increasing prevalence of hypogonadism in diabetic subjects, but whether this is a cause or effect is still an area of active research. The past couple of decades have witnessed an increasing rate of testosterone prescriptions, even though the relationship between testosterone therapy and cardiovascular effects is still not conclusive. The studies done in this regard have shown conflicting results, and there is still a dearth of long-term, follow-up studies in this field. This paper reviews in brief the postulated mechanisms, observational studies, and interventional data regarding the adverse effects of testosterone therapy in type 2 diabetes mellitus, stressing the cardiovascular risks.
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Affiliation(s)
- Anne M Beatrice
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
| | - Deep Dutta
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
| | - Manoj Kumar
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
- Correspondence: Manoj Kumar, Room 9A, 4th Floor, Ronald Ross Building, Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, 244 AJC Bose Road, Calcutta 700020, India, Email
| | - Shivaprasad Kumbenahalli Siddegowda
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
| | - Ankur Sinha
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
| | - Sayantan Ray
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
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Zitzmann M. Hypogonadism: Biochemical Diagnosis, Treatment, and the Myth of Uniform Thresholds. JOURNAL OF MEN'S HEALTH 2013. [DOI: 10.1089/jomh.2009.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Obesity, type 2 diabetes mellitus and the metabolic syndrome are major risk factors for cardiovascular disease. Studies have demonstrated an association between low levels of testosterone and the above insulin-resistant states, with a prevalence of hypogonadism of up to 50% in men with type 2 diabetes mellitus. Low levels of testosterone are also associated with an increased risk of all-cause and cardiovascular mortality. Hypogonadism and obesity share a bidirectional relationship as a result of the complex interplay between adipocytokines, proinflammatory cytokines and hypothalamic hormones that control the pituitary-testicular axis. Interventional studies have shown beneficial effects of testosterone on components of the metabolic syndrome, type 2 diabetes mellitus and other cardiovascular risk factors, including insulin resistance and high levels of cholesterol. Biochemical evidence indicates that testosterone is involved in promoting glucose utilization by stimulating glucose uptake, glycolysis and mitochondrial oxidative phosphorylation. Testosterone is also involved in lipid homeostasis in major insulin-responsive target tissues, such as liver, adipose tissue and skeletal muscle.
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Affiliation(s)
- Preethi M Rao
- Academic Unit of Diabetes, Endocrinology and Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, UK
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Uribe JF. Persistent Sexual Dysfunction and 5 Alpha Reductase Inhibitors. J Sex Med 2012; 9:2475. [DOI: 10.1111/j.1743-6109.2012.02676.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ryan JG, Gajraj J. Erectile dysfunction and its association with metabolic syndrome and endothelial function among patients with type 2 diabetes mellitus. J Diabetes Complications 2012; 26:141-7. [PMID: 22437118 DOI: 10.1016/j.jdiacomp.2011.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 12/16/2022]
Abstract
CONTEXT Evidence suggests that numerous comorbid conditions contribute to erectile dysfunction (ED) among patients with type 2 diabetes mellitus (T2DM). OBJECTIVE To review the relationship and mechanism between diabetes, metabolic syndrome, cardiovascular disease (CVD), and ED. METHODS A manual review of authoritative literature from peer-reviewed publications from January 2001 through July 2010 was performed. These publications were further mined to consider the impact of metabolic syndrome as a comorbid condition. Publications from key references were also consulted. RESULTS The associations between obesity, dyslipidemia, metabolic syndrome, T2DM, CVD, and depression with sexual dysfunction suggest that sexual dysfunction, particularly ED, is a precursor to CVD. Because these conditions share important risk factors with CVD, identifying them and their relationships with the pathogenesis of ED is likely to be critical to the manner in which primary care physicians screen for and manage this condition. CONCLUSIONS Primary care physicians ought to establish trusting relationships with their patients, providing opportunities for them to probe such sensitive issues as sexual activities, as a means of addressing the possibility of ED. When making the new diagnosis of sexual dysfunction in the absence of metabolic disease or CVD, physicians ought to consider the risk for T2DM and CVD. Associations between metabolic disease, heart disease, and sexual dysfunction further suggest that all patients who are obese and have dyslipidemia, T2DM, and/or depression should be further screened for ED.
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Affiliation(s)
- John G Ryan
- Division of Primary Care/Health Services Research and Development, Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, FL, USA.
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Bojesen A, Hertz JM, Gravholt CH. Genotype and phenotype in Klinefelter syndrome - impact of androgen receptor polymorphism and skewed X inactivation. ACTA ACUST UNITED AC 2011; 34:e642-8. [DOI: 10.1111/j.1365-2605.2011.01223.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Haring R, Ernst F, Schurmann C, Homuth G, Völker U, Völzke H, Nauck M, Wallaschofski H. The androgen receptor CAG repeat polymorphism as a risk factor of low serum testosterone and its cardiometabolic effects in men. ACTA ACUST UNITED AC 2011; 35:511-20. [DOI: 10.1111/j.1365-2605.2011.01220.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Schipf S, Haring R, Friedrich N, Nauck M, Lau K, Alte D, Stang A, Völzke H, Wallaschofski H. Low total testosterone is associated with increased risk of incident type 2 diabetes mellitus in men: results from the Study of Health in Pomerania (SHIP). Aging Male 2011; 14:168-75. [PMID: 21039324 DOI: 10.3109/13685538.2010.524955] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE There is increasing evidence suggesting that low total testosterone concentration is associated with incident type 2 diabetes mellitus (T2DM) in men. The aim of this study was to evaluate the association between total testosterone and incident T2DM in a large population-based cohort. METHODS Of 2117 men at baseline, 1589 were followed up 5 years later. Low total testosterone concentration at baseline determined by <10th percentile (10-year age-strata) were used as a risk factor for incident T2DM at follow-up. To evaluate for potential non-response bias, drop out weights were used in sensitivity analysis. RESULTS From 1339 men eligible for analyses, 68 (5.1%) developed T2DM. Men with low total testosterone concentration had an increased risk of developing T2DM (odds ratio [OR] 3.4, 95% CI 1.9-6.1), even after adjustment for age, waist circumference and smoking, OR 3.0; (95% CI 1.6-5.7). Recalculated weighted models revealed almost identical estimates indicating no relevant non-response bias. DISCUSSION Our prospective findings suggest that low total testosterone concentration is associated with incident T2DM in men and might represent a biomarker that might causally be involved in the risk of T2DM. This underlines the importance of measuring total testosterone in men as the predominant male sex hormone.
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Affiliation(s)
- Sabine Schipf
- Institute of Clinical Chemistry and Laboratory Medicine, Ernst Moritz Arndt-University Greifswald, Germany.
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Simanainen U, Brogley M, Gao YR, Jimenez M, Harwood DT, Handelsman DJ, Robins DM. Length of the human androgen receptor glutamine tract determines androgen sensitivity in vivo. Mol Cell Endocrinol 2011; 342:81-6. [PMID: 21664242 PMCID: PMC3148310 DOI: 10.1016/j.mce.2011.05.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 05/07/2011] [Accepted: 05/22/2011] [Indexed: 11/15/2022]
Abstract
A well established functional polymorphism of the human androgen receptor (hAR) is the length of AR's N-terminal glutamine tract (Q-tract). This tract is encoded by a CAG trinucleotide repeat and varies from 8 to 33 codons in the healthy population. Q-tract length is inversely correlated with AR transcriptional activity in vitro, but whether endogenous androgen action is affected is not consistently supported by results of clinical and epidemiological studies. To test whether Q-tract length influences androgen sensitivity in vivo, we examined effects of controlled androgen exposure in "humanized" mice with hAR knock-in alleles bearing 12, 21 or 48 CAGs. Mature male mice were analyzed before or 2weeks after orchidectomy, with or without a subdermal dihydrotestosterone (DHT) implant to attain stable levels of this non-aromatizable androgen. The validity of this DHT clamp was demonstrated by similar serum levels of DHT and its two primary 3αDiol and 3βDiol metabolites, regardless of AR Q-tract length. Q-tract length was inversely related to DHT-induced suppression of castrate serum LH (p=0.005), as well as seminal vesicle (SV) weight (p=0.005) and prostate lobe weights (p<0.006). This confirms that the hAR Q-tract polymorphism mediates in vivo tissue androgen sensitivity by impacting negative hypothalamic feedback and trophic androgen effects on target organs. In this manner, AR Q-tract length variation may influence numerous aspects of male health, from virilization to fertility, as well as androgen-dependent diseases, such as prostate cancer.
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Affiliation(s)
- Ulla Simanainen
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia.
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Abstract
The controversies surrounding testosterone replacement therapy (TRT) have been addressed in the past few years. Although the androgenic effects of TRT on normal and malignant prostate cells have been studied for over 70 years, little clinical prospective research exists on the physiological responses of prostate tissues to a wide range of serum testosterone levels. The prostate is both an androgen-dependent and an androgen-sensitive organ; active processes are triggered at a 'threshold' or 'saturation' level of testosterone. Despite decades of research, no compelling evidence exists that increasing testosterone beyond this threshold level has a causative role in prostate cancer, or indeed changes the biology of the prostate. Testosterone deficiency has marked physiological and clinical effects on men in middle age and beyond. With subnormal testosterone levels, the potential positive benefits of TRT on factors such as muscle mass, libido or erectile function are likely a dose-response phenomenon, and should be considered differently than the threshold influence on the prostate. This Review will re-examine classic androgen research and reflect on whether testosterone actually stimulates prostatic cellular growth and progression in a 'threshold' or a 'dose-response' (or both) manner, as well as discuss the influence of testosterone on prostate cells in the hypogonadal and eugonadal states.
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Ackerman CM, Lowe LP, Lee H, Hayes MG, Dyer AR, Metzger BE, Lowe WL, Urbanek M. Ethnic variation in allele distribution of the androgen receptor (AR) (CAG)n repeat. ACTA ACUST UNITED AC 2011; 33:210-5. [PMID: 21597087 DOI: 10.2164/jandrol.111.013391] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The androgen receptor (AR) is important in reproductive organ development, as well as tissue homeostasis of the pancreas, liver, and skeletal muscle in adulthood. The trinucleotide (CAG)(n) repeat polymorphism in exon 1 of the AR gene is thought to regulate AR activity, with longer alleles conferring reduced receptor activity. Therefore, the evaluation of the allelic distribution of the AR (CAG)(n) repeat in various ethnic groups is crucial in understanding the interindividual variability in AR activity. We evaluated ethnic variation of this AR polymorphism by genotyping individuals from the multiethnic Hyperglycemia and Adverse Pregnancy Outcome study cohort. We genotyped 4421 Caucasian mothers and 3365 offspring of European ancestry; 1494 Thai mothers and 1742 offspring; 1119 Afro-Caribbean mothers and 1142 offspring; and 780 Hispanic mothers and 770 offspring of Mexican ancestry from Bellflower, California. The distributions of (CAG)(n) alleles among all 4 ethnic groups are significantly different (P < .0001). Pairwise tests confirmed significant differences between each pair of ethnicities tested (P < 10(-28)). The relative AR (CAG)(n) repeat length in the different groups was as follows: Afro-Caribbean (shortest repeat lengths and greatest predicted AR activity) < Caucasian < Hispanic < Thai (longest repeat length and lowest predicted AR activity). Significant interethnic differences in the allele frequencies of the AR exon 1 (CAG)(n) polymorphism exist. Our results suggest that there may be potential ethnic differences in androgenic pathway activity and androgen sensitivity.
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Affiliation(s)
- Christine M Ackerman
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University, Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA
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Stanworth RD, Kapoor D, Channer KS, Jones TH. Dyslipidaemia is associated with testosterone, oestradiol and androgen receptor CAG repeat polymorphism in men with type 2 diabetes. Clin Endocrinol (Oxf) 2011; 74:624-30. [PMID: 21470285 DOI: 10.1111/j.1365-2265.2011.03969.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is a high prevalence of low testosterone and dyslipidaemia in men with type 2 diabetes. The androgen receptor CAG repeat polymorphism (AR CAG) affects receptor transcriptional activity (the shorter repeats the more sensitive AR) and is associated with androgenic parameters and obesity. This study describes the relationships between testosterone, AR CAG and serum lipids in men with type 2 diabetes. DESIGN AND PATIENTS Cross-sectional study of men with type 2 diabetes in a District General Hospital Diabetes Centre. MEASUREMENTS Correlation between testosterone, AR CAG and serum lipids. RESULTS HDL cholesterol (HDL-C) correlated with total testosterone (TT) (r = 0·251, P < 0·001), bioavailable testosterone (BT) (r = 0·19, P = 0·001), free testosterone (FT) (r = 0·165, P = 0·005) and sex hormone-binding globulin (SHBG) (r = 0·147, P = 0·014). HDL-C did not correlate with oestradiol, but men with the lowest quartile of oestradiol had lower HDL-C compared to highest quartile (P = 0·046). Triglycerides correlated negatively with TT (r = -0·195, P = 0·001), BT (r = -0·148, P = 0·013) and SHBG (-0·14, P = 0·019) but not with FT or oestradiol. Total and LDL cholesterol (LDL-C) correlated negatively with oestradiol (r = -0·121, P = 0·05) but not with testosterone or SHBG. One-way anova testing across four quartiles of AR CAG showed a trend to alteration in HDL-C across groups of AR CAG (P = 0·08). HDL-C was significantly higher in men with the longest AR CAG compared with the shortest (1·19 vs 1·08 mmol/l, P = 0·02). CONCLUSIONS Lower testosterone and oestradiol levels in men with diabetes are associated with an adverse lipid profile. Shorter AR CAG is associated with low HDL-C and testosterone. The paradox that HDL-C is associated with low testosterone levels and a more active AR may suggest divergent effect of testosterone on HDL-C via genomic vs nongenomic mechanisms.
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Affiliation(s)
- R D Stanworth
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
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Wang HY, Hu Y, Wang SH, Shan QL, Li YC, Nie J, Yi LY, Bao DP, Xu CY, He ZH. Association of androgen receptor CAG repeat polymorphism with VO₂max response to hypoxic training in North China Han men. ACTA ACUST UNITED AC 2011; 33:794-9. [PMID: 20374306 DOI: 10.1111/j.1365-2605.2009.01027.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purposes of this study were to investigate the distribution characteristics of CAG repeat polymorphism in exon 1 of androgen receptor gene and the association of CAG polymorphism with VO₂max response to hypoxic training in North China Han men. Sixty-five healthy young men completed a 30-day HiHiLo training (living high, exercise high and training low) in a simulated normobaric hypoxic environment. All subjects slept in 14.3-14.8% O₂ concentration, and participated in hypoxic training three times a week in 15.4% O₂ concentration. VO₂max (peak oxygen consumption) and body weight were measured before and after hypoxic training. A total of 15 repeat alleles were observed by CAG genotype analyze, in which (CAG)22 was most common. When using 21 and 22 alleles, respectively, as cut-off points, we found that the baseline body weight of two shorter genotype groups was significantly lower than that of longer ones, and that the ΔVO₂max and ΔrVO₂max (Δrelative value of VO₂max) of two shorter genotype groups were significantly higher than those of longer ones after hypoxic training. These findings indicated that AR CAG repeat polymorphism was associated with the exercise performance after simulated normobaric hypoxic HiHiLo training in North China Han men, and that the shorter genotypes had a better individual response to hypoxic training.
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Affiliation(s)
- H Y Wang
- Science and Research Center of Beijing Sports University, Beijing, China
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Saad F, Gooren LJ. The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and diabetes mellitus type 2. J Obes 2011; 2011:471584. [PMID: 20847893 PMCID: PMC2931403 DOI: 10.1155/2011/471584] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 07/06/2010] [Indexed: 12/12/2022] Open
Abstract
Obesity has become a major health problem. Testosterone plays a significant role in obesity, glucose homeostasis, and lipid metabolism. The metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis, and cardiovascular morbidity and mortality. The main components of the syndrome are visceral obesity, insulin resistance, glucose intolerance, raised blood pressure and dyslipidemia (elevated triglycerides, low levels of high-density lipoprotein cholesterol), and a proinflammatory and thrombogenic state. Cross-sectional epidemiological studies have reported a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus, dramatically illustrated by androgen deprivation in men with prostate carcinoma. Lower total testosterone and sex hormone-binding globulin (SHBG) predict a higher incidence of the metabolic syndrome. Administration of testosterone to hypogonadal men reverses part of the unfavorable risk profile for the development of diabetes and atherosclerosis.
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Affiliation(s)
- Farid Saad
- Bayer Schering Pharma AG, Scientific Affairs Men's Healthcare, D-13342 Berlin, Germany
- Gulf Medical University School of Medicine, Ajman, UAE
- *Farid Saad:
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