Treatment Avenues for Type 2 Diabetes and Current Perspectives on Adipokines

Repurposing Pitavastatin and L-Glutamine: Replenishing β-Cells in Hyperlipidemic Type 2 Diabetes Mouse Model

Type 2 diabetes (T2D) is associated with obesity and declining β-cells. L-glutamine has been implicated in the amelioration of T2D by virtue of its incretin secretagogue property while, there are mixed reports on pitavastatin’s adiponectin potentiating ability. We aimed to investigate the effect of pitavastatin (P), L-glutamine (LG), and combination (P + LG) on glycemic control and β-cell regeneration in a high-fat diet (HFD) + streptozotocin (STZ)-induced T2D mouse model. C57BL6/J mice treated with HFD + STZ were divided into four groups: diabetes control (HFD + STZ), P, LG, and P + LG, while the control group (NCD) was fed with the normal-chow diet. Significant amelioration was observed in the combination therapy as compared to monotherapies in respect of (i) insulin resistance, glucose intolerance, lipid profile, adiponectin levels, and mitochondrial complexes I, II, and III activities, (ii) reduced phosphoenolpyruvate carboxykinase, glucose 6-phophatase, glycogen phosphorylase, and GLUT2 transcript levels with increased glycogen content in the liver, (iii) restoration of insulin receptor 1β, pAkt/Akt, and AdipoR1 protein levels in skeletal muscle, and (iv) significant increase in islet number due to β-cell regeneration and reduced β-cell death. L-glutamine and pitavastatin in combination can ameliorate T2D by inducing β-cell regeneration and regulating glucose homeostasis.

Hypolipidemic activity and safety evaluation of a rhamnan-type sulfated polysaccharide-chromium (III) complex

BACKGROUND

Hyperlipidaemia is a chronic disorder characterized by imbalance of energy metabolism and high blood lipid level. The rhamnan-type sulfated polysaccharide is an excellent metal-ion chelating ligands. In this study, hypolipidemic activity and safety evaluation of a rhamnan-type sulfated polysaccharide-chromium (III) complex (RSPC) were studied.

METHODS

Scanning electron microscopy (SEM) and atomic force microscopy (AFM) were used to characterize the structure of RSPC. The effects of the RSPC on lipid metabolism in hyperlipidemic mice were evaluated by lipid contents, histopathological observation, immunofluorescent analysis, and adipocytokine levels. Moreover, sub-acute toxicity evaluation of RSPC was carried out on ICR mice.

RESULTS

SEM and AFM further demonstrated formation of the polysaccharide-chromium (III) complex and revealed the intertwined network of RSPC. The RSPC significantly (p < 0.05) regulated lipid levels in the mice. The RSPC inhibited over-growth of adipocytes and reduced inflammatory infiltration induced by hyperlipidemia. The RSPC promoted differentiation of white adipose tissue into beige adipocytes and increased expression of uncoupling protein 1 (UCP1), thereby eliminating fat accumulation. Moreover, RSPC (5 mg/kg for mice; equivalent to 924 µg/d for adults) promoted secretion of adiponectin and suppressed resistin, leptin, and tumor necrosis factor alpha. Sub-acute toxicity evaluation showed that 1500 mg/kg of RSPC exhibited no apparent adverse effects on the mice.

CONCLUSION

These results indicated that RSPC could be safely used to prevent hyperlipidemia and inflammation and may provide a new idea for the prevention of hyperlipidaemia and the related metabolic disorders.

Calorie restriction potentiates the therapeutic potential of GABA in managing type 2 diabetes in a mouse model

Dysfunctional adipocytes/β-cells advance type 2 diabetes (T2D). Calorie restriction (CR) improves insulin sensitivity and fasting blood glucose (FBG) levels, while γ-aminobutyric acid (GABA) exerts regenerative effects. The impact of therapies was assessed by a high-fat diet (HFD) + streptozotocin (STZ) induced T2D mouse model. The mice were fed a CR diet (30% reduction of HFD) and treated with GABA (2.5 mg/kg i.p) for 5 weeks. Standard protocols were used to assess metabolic parameters. The mRNA expression was monitored by SYBR Green-qPCR in the targeted tissues. Oxygen consumption rate in the mitochondrial complexes was evaluated by oxytherm clark-type oxygen electrode. Pancreatic β-cell regeneration and apoptosis were analysed by immunohistochemistry. CR + GABA combination therapy showed improved metabolic parameters compared to the monotherapies. We have observed improved transcript levels of G6Pase, PEPCK, Glycogen Phosphorylase, GLUT2 and GCK in liver; ACC and ATGL in adipose tissue. Also increased SIRT-1, PGC-1α and TFAM expression; up-regulated mitochondrial complexes I-III activities were observed. We have seen increased BrdU/Insulin and PDX1/Ngn3/Insulin co-positive cells in CR + GABA treated group with a reduction in apoptotic marker (TUNEL/Insulin co-positive cells). Our results indicate that CR in combination with GABA ameliorates T2D in HFD + STZ treated mice by GABA induced β-cell regeneration, and CR mediated insulin sensitivity.

Diabetes mellitus and melatonin: Where are we?

Diabetes mellitus (DM) and diabetes-related complications are amongst the leading causes of mortality worldwide. The international diabetes federation (IDF) has estimated 592 million people to suffer from DM by 2035. Hence, finding a novel biomolecule that can effectively aid diabetes management is vital, as other existing drugs have numerous side effects. Melatonin, a pineal hormone having antioxidative and anti-inflammatory properties, has been implicated in circadian dysrhythmia-linked DM. Reduced levels of melatonin and a functional link between melatonin and insulin are implicated in the pathogenesis of type 2 diabetes (T2D) Additionally, genomic studies revealed that rare variants in melatonin receptor 1b (MTNR1B) are also associated with impaired glucose tolerance and increased risk of T2D. Moreover, exogenous melatonin treatment in cell lines, rodent models, and diabetic patients has shown a potent effect in alleviating diabetes and other related complications. This highlights the role of melatonin in glucose homeostasis. However, there are also contradictory reports on the effects of melatonin supplementation. Thus, it is essential to explore if melatonin can be taken from bench to bedside for diabetes management. This review summarizes the therapeutic potential of melatonin in various diabetic models and whether it can be considered a safe drug for managing diabetic complications and diabetic manifestations like oxidative stress, inflammation, ER stress, mitochondrial dysfunction, metabolic dysregulation, etc.

Effects of Non-periodized and Linear Periodized Combined Exercise Training on Insulin Resistance Indicators in Adults with Obesity: A Randomized Controlled Trial

BACKGROUND

The aim was to verify the effect of non-periodized and linear periodized combined (aerobic plus resistance) exercise training on insulin resistance markers in adults with obesity.

METHODS

A blinded randomized control trial was conducted with three groups of individuals with obesity (BMI, 30-39.9 kg/m²): control group (CG, n = 23), non-periodized group (NG, n = 23), and linear periodized group (PG, n = 23). The NG and PG performed aerobic and resistance exercises in the same session in aerobic-resistance order for 16 weeks. Both intervention groups trained three sessions weekly, with a total duration of 60 min each. The aerobic training of the NG had a duration of 30 min always between 50% and 59% of the reserve heart rate (HRres), while resistance exercise was comprised of 6 exercises, performed always in 2 × 10-12 maximum repetitions (MRs). The PG progressed the aerobic and resistance training from 40%-49% to 60%-69% (HRres) and from 2 × 12-14 to 2 × 8-10 RM, respectively, along the intervention period. The evaluated indicators of insulin resistance included fasting glucose, fasting insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) collected pre- and post-intervention. The analyses to verify the exercise training effect were performed using generalized estimating equations.

RESULTS

After 16 weeks of training, per protocol analysis (n = 39) showed significant reductions in HOMA-IR only in the training groups (NG: Δ = - 1.6, PG: Δ = - 0.6; p = 0.094). Intention-to-treat analysis demonstrated significant reductions in fasting insulin levels (NG: Δ = - 1.4, PG: Δ = - 1.0; p = 0.004) and HOMA-IR (NG: Δ = - 5.5, PG: Δ = - 3.8; p = 0.002).

CONCLUSION

Periodized and non-periodized combined exercise training similarly reduces insulin resistance markers in adults with obesity.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials, RBR-3c7rt3. Registered 07 February 2019- https://ensaiosclinicos.gov.br/trial/5970/1 .

In vitro, in vivo and in silico Antihyperglycemic Activity of Some Semi-synthetic Phytol Derivatives

BACKGROUND

Due to the prevalence of type-2 diabetes across the globe, there is unmet need to explore new molecular targets for the development of cost-effective and safer antihyperglycemic agents.

OBJECTIVE

Structural modification of phytol and evaluation of in vitro, in vivo and in silico antihyperglycemic activity of derivatives establishing the preliminary structure activity relationship (SAR).

METHODS

The semi-synthetic derivatives of phytol were prepared following previously described methods. The antihyperglycemic potential was measured in vitro in terms of increase in 2-deoxyglucose (2-DG) uptake by L-6 rat skeletal muscle cells as well as in vivo in sucrose-loaded (SLM) and streptozotocin (STZ)-induced diabetic rat models. The blood glucose profile was measured at 30, 60, 90, 120, 180, 240, 300 and 1440 min post administration of sucrose in rats. The in silico docking was performed on peroxisome proliferator-activated receptor gamma (PPARγ) as anti-diabetic target along with absorption, distribution, metabolism, excretion and toxicity (ADMET) studies.

RESULTS

Nine semi-synthetic ester derivatives: acetyl (1), lauroyl (2), palmitoyl (3), pivaloyl (4), trans-crotonyl (5), benzoyl (6), m-anisoyl (7), 3,4,5-trimethoxy benzoyl (8) cinnamoyl (9) along with bromo derivative (10) of phytol were prepared. The derivatives 9, 8 and 2 caused 4.5, 3.2 and 2.7 times more in vitro uptake of 2-DG respectively than rosiglitazone (ROSI). The derivatives showed significant improvement on oral glucose tolerance both in SLM (29.6-21%) as well as STZ-induced diabetic (30.8-19.0%) rats. The in silico ADMET, docking studies showed non-toxicity and high binding affinity with PPARγ.

CONCLUSION

The potent antihyperglycemic activity with favorable pharmacokinetics supports phytol derivatives as suitable antidiabetic lead.

β-cell replenishment: Possible curative approaches for diabetes mellitus

AIMS

Diabetes mellitus (DM) is a disorder of heterogeneous etiology marked by persistent hyperglycemia. Exogenous insulin is the only treatment for type 1 diabetes (T1D). Islet transplantation is a potential long cure for T1D but is disapproved due to the possibility of immune rejection in the later stage. The approaches used for treating type 2 diabetes (T2D) include diet restrictions, weight management and pharmacological interventions. These procedures have not been able to boost the quality of life for diabetic patients owing to the complexity of the disorder.

DATA SYNTHESIS

Hence, research has embarked on permanent ways of managing, or even curing the disease. One of the possible approaches to restore the pancreas with new glucose-responsive β-cells is by their regeneration. Regeneration of β-cells include islet neogenesis, dedifferentiation, and trans-differentiation of the already differentiated cells.

CONCLUSIONS

This review briefly describes the islet development, functions of β-cells, mechanism and factors involved in β-cell death. It further elaborates on the potential of the existing and possible therapeutic modalities involved in the in-vivo replenishment of β-cells with a focus on exercise, diet, hormones, small molecules, and phytochemicals.

[Research progress on the role of adipokines in intervertebral disc degeneration]

Objective

To review the research progress of the role and mechanism of adipokines in intervertebral disc degeneration (IVDD) in recent years.

Methods

The domestic and foreign literature related to adipokines in the process of IVDD was extensively reviewed. The types and functions of adipokines, the role and mechanism in the process of IVDD, and the application prospects of intervertebral disc biotherapy were reviewed.

Results

As a kind of bioactive substance secreted by adipose tissue, adipokine plays an important role in bone and joint diseases, metabolic diseases, and breast cancer. During IVDD, most adipokines can activate multiple signaling pathways by binding to autoreceptors, cause the proliferation and apoptosis of cells and proinflammatory and anti-inflammatory factors parasecretions in the intervertebral disc, and lead to imbalance of intradiscal metabolism and establishment of the initial inflammatory environment, and finally cause the IVDD.

Conclusion

Adipokines, as a biologically active substance with metabolic and immunomodulatory functions, play important roles in the occurrence, development, and biological treatment of IVDD.

Altered adipocytokine profile predicts early stage of left ventricular remodeling in hypertensive patients with type 2 diabetes mellitus

BACKGROUND AND AIM

Adipocytokine dysfunction is considered as causative factor of target organ damage in metabolic disease. The aim of the study was to investigate whether altered adipocytokine profile predicts left ventricular (LV) remodeling in hypertensive patients with type 2 diabetes mellitus (T2DM).

METHODS

A total of 186 patients (125 hypertensive and 61 non-hypertensive individuals) with established T2DM and 20 healthy volunteers were enrolled in the study. LV remodeling was determined at baseline. Concentrations of adipocytokines were measured with ELISA at baseline.

RESULTS

The most important predictors of LV hypertrophy in T2DM patients were serum levels of omentin-1 (B-coefficient = -0.64, p = 0.001), Zinc-α2-glycoprotein [ZA2G] (B-coefficient = -0.57, p = 0.002), visfatin (B-coefficient = 0.26, p = 0.034), hs-CRP (B-coefficient = 0.38, p = 0.002), HOMA-IR (B-coefficient = 0.34, p = 0.001), age (B-coefficient = 0.31, p = 0.022), glypican-4 (B-coefficient = -0.23, p = 0.042), and male sex (B-coefficient = 0.11, p = 0.048). After entering combined depending variable (LV hypertrophy and LV diastolic dysfunction) to the model the significant predictors remained serum levels of omentin-1 (B-coefficient = -0.82, p = 0.001), ZA2G (B-coefficient = -0.54, p = 0.001) and HOMA-IR (B-coefficient = 0.44, p = 0.001). Regression analyses showed that the most influential determinants of depending variable (LV hypertrophy + LV diastolic dysfunction) in T2DM patients were omentin-1 (B-coefficient = -1.6, p = 0.001) and ZA2G (B-coefficient = -0.78, p = 0.044).

CONCLUSION

We found that serum levels of omentin-1 and ZA2G were the most important predictors for LV hypertrophy + LV diastolic dysfunction in T2DM patients. Large clinical trials are required to confirm this assumption and get clear explanation of issues unveiled.

A genetic analysis identifies a haplotype at adiponectin locus: Association with obesity and type 2 diabetes

Adiponectin is a prime determinant of the status of insulin resistance. Association studies between adiponectin (ADIPOQ) gene single nucleotide polymorphisms (SNPs) and metabolic diseases have been reported earlier. However, results are ambiguous due to apparent contradictions. Hence, we investigated (1) the association between ADIPOQ SNPs: −11377C/G, +10211T/G, +45T/G and +276G/T for the risk towards type 2 diabetes (T2D) and, (2) genotype-phenotype association of these SNPs with various biochemical parameters in two cohorts. Genomic DNA of diabetic patients and controls from Gujarat and, Jammu and Kashmir (J&K) were genotyped using PCR-RFLP, TaqMan assay and MassArray. Transcript levels of ADIPOQ were assessed in visceral adipose tissue samples, and plasma adiponectin levels were estimated by qPCR and ELISA respectively. Results suggest: (i) reduced HMW adiponectin/total adiponectin ratio in Gujarat patients and its association with +10211T/G and +276G/T, and reduced ADIPOQ transcript levels in T2D, (ii) association of the above SNPs with increased FBG, BMI, TG, TC in Gujarat patients and (iii) increased GGTG haplotype in obese patients of Gujarat population and, (iv) association of −11377C/G with T2D in J&K population. Reduced HMW adiponectin, in the backdrop of obesity and ADIPOQ genetic variants might alter metabolic profile posing risk towards T2D.

Intron specific polymorphic site of vaspin gene along with vaspin circulatory levels can influence pathophysiology of type 2 diabetes

Vaspin, an insulin-sensitizing adipokine, has been associated with type 2 diabetes (T2D). The present study aimed to investigate the distribution of genotypes and high-risk alleles of vaspin genetic variants (rs77060950 G/T and rs2236242 A/T), in Gujarat subpopulation (India). Genomic DNA isolated from PBMCs was used to genotype vaspin polymorphisms by PCR-RFLP and ARMS-PCR from 502 controls and 478 patients. RNA isolated from visceral adipose tissue (VAT) of 22 controls and 20 patients was used to assess vaspin transcript levels by qPCR while the vaspin titre of the subjects was assayed using ELISA. Phenotypic characteristics of Fasting Blood Glucose (FBG), BMI and plasma lipid profile were estimated and analyzed for the genotype-phenotype correlation. We identified a significant association of rs2236242 A/T with T2D as the TT genotype conferred a 3.087-fold increased risk. The TT genotype showed association with increased FBG, BMI and Triglycerides levels. Increased GA, GT and TA haplotype frequencies, decreased VAT transcript and vaspin protein levels in T2D patients was observed, which were further negatively correlated with FBG and BMI. In conclusion, rs2274907 A/T polymorphism is strongly associated with reduced vaspin transcript and protein levels, and related metabolic alterations that may play a role in the advancement of T2D.

Seaweed-derived bioactives as potential energy regulators in obesity and type 2 diabetes

There is epidemiological evidence that dietary intake of seaweeds is associated with a lower prevalence of chronic diseases. While seaweeds are of high nutritious value, due to their high content of fiber, polyunsaturated fatty acids and minerals, they also contain an abundance of bioactive compounds. There is a growing body of scientific data that these bioactive moieties exert effects that could correct the metabolic dysregulation that is present in obesity and Type 2 diabetes (T2D). In this review we describe how the molecular mechanisms, specific to different tissues, that underly obesity and T2D are influenced by both seaweed extracts and seaweed-derived bioactive molecules. In obesity, modulation of antioxidant capacity and reduction of intracellular ROS levels within tissues, and regulation of signaling pathways involved in enhancing browning of white adipose tissue, have been highlighted as key mechanism and identified as a potential target for optimal energy metabolism. In T2D, management of post-prandial blood glucose by modulating α-glucosidase or α-amylase activities, modulation of the AMPK signaling pathway, and similarly to obesity, reduction of ROS and NO production with subsequent increased expression of antioxidant enzymes have been shown to play a key role in glucose metabolism and insulin signaling. Future studies aimed at discovering new therapeutic drugs from marine natural products should, therefore, focus on bioactive compounds from seaweed that exert antioxidant activity and regulate the expression of key signaling pathways involved in glucose homeostasis, mechanisms that are common to both obesity and T2D management. In addition, more data is required to provide evidence of clinical benefit.

Circulatory Omentin-1 levels but not genetic variants influence the pathophysiology of Type 2 diabetes

OBJECTIVE

Omentin-1, an anti-inflammatory protein, is secreted by the visceral adipose tissue. Altered levels of Omentin-1 are associated with obesity and Type 2 Diabetes (T2D). Although Omentin-1 is implicated in the insulin signaling pathway, the relationship between the genetic variants of Omentin-1 and T2D is not yet explored. The current study evaluates the association of Omentin-1 polymorphisms (rs2274907 A/T and rs1333062 G/T), its transcript and protein levels, and genotype-phenotype correlation with metabolic parameters and T2D susceptibility.

METHODS

Plasma and Peripheral Blood Mononuclear Cells (PBMCs) were separated from venous blood taken from 250 controls and 250 T2D patients recruited from Gujarat, India. Genomic DNA was isolated from PBMCs and genotyping of Omentin-1 variants was performed by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). RNA was isolated from Visceral Adipose Tissue (VAT) samples of 12 controls and 10 patients, and transcript levels of Omentin-1 were assessed by qPCR. Plasma Omentin-1 levels were estimated by ELISA. Fasting Blood Glucose, Body Mass Index (BMI) and plasma lipid profile were considered for the genotype-phenotype correlation analysis.

RESULTS

Our study revealed no association of Omentin-1 genetic variants with T2D risk (p > 0.05). However, the AT genotype of Omentin-1 rs2274907 A/T polymorphism was associated with increased BMI (p = 0.0247). Plasma Omentin-1 levels were significantly decreased (p < 0.0001) however, increased VAT Omentin-1 transcript levels (p = 0.0127) were observed in T2D patients.

CONCLUSION

Our findings suggest that decreased circulatory Omentin-1 levels could pose a risk towards T2D susceptibility.