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Kakutani N, Takada S, Nambu H, Maekawa S, Hagiwara H, Yamanashi K, Obata Y, Nakano I, Fumoto Y, Hata S, Furihata T, Fukushima A, Yokota T, Kinugawa S. Angiotensin-converting enzyme inhibitor prevents skeletal muscle fibrosis in diabetic mice. Exp Physiol 2021; 106:1785-1793. [PMID: 33998079 DOI: 10.1113/ep089375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/12/2021] [Indexed: 01/25/2023]
Abstract
NEW FINDINGS What is the central question of this study? We questioned whether an angiotensin-converting enzyme (ACE) inhibitor prevents skeletal muscle fibrosis in diabetic mice. What is the main finding and its importance? Administration of ACE inhibitor prevents the increase in skeletal muscle fibrosis during the early phase after induction of diabetes by streptozotocin. Our findings might provide a new therapeutic target for skeletal muscle abnormalities in diabetes. ABSTRACT Fibrosis is characterized by the excessive production and accumulation of extracellular matrix components, including collagen. Although the extracellular matrix is an essential component of skeletal muscle, fibrosis can have negative effects on muscle function. Skeletal muscle fibrosis was shown to be increased in spontaneously hypertensive rats and to be prevented by an angiotensin-converting enzyme (ACE) inhibitor, an antihypertensive drug, in dystrophic mice or a mouse model of myocardial infarction. In this study, we therefore analysed whether (1) there is increased skeletal muscle fibrosis in streptozotocin (STZ)-induced diabetic mice, and (2) a preventive effect on skeletal muscle fibrosis by administration of an ACE inhibitor. Skeletal muscle fibrosis was significantly increased in STZ-induced diabetic mice compared with control mice from 2 to 14 days post-STZ. The ACE inhibitor prevented both skeletal muscle fibrosis and the reduction in muscle function in STZ-treated mice. Our study demonstrated that administration of an ACE inhibitor prevents the increase in skeletal muscle fibrosis during the early phase after onset of diabetes. Our findings might provide a new therapeutic target for skeletal muscle abnormalities in diabetes. Future studies are required to clarify whether skeletal muscle fibrosis is also linked directly to physical activity.
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Affiliation(s)
- Naoya Kakutani
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Research Fellow of the Japan Society for the Promotion of Science, Japan
| | - Shingo Takada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Sports Education, Faculty of Lifelong Sport, Hokusho University, Ebetsu, Japan.,Department of Molecular Biology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hideo Nambu
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Maekawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hikaru Hagiwara
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Katsuma Yamanashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshikuni Obata
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ippei Nakano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshizuki Fumoto
- Department of Molecular Biology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Soichiro Hata
- Department of Molecular Biology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takaaki Furihata
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Arata Fukushima
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Yokota
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Experimental and Clinical Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Avogaro A, Azzolina D, Fadini GP, Baldi I. Incidence of heart failure in patients with type 1 diabetes: a systematic review of observational studies. J Endocrinol Invest 2021; 44:745-753. [PMID: 32734319 DOI: 10.1007/s40618-020-01368-5] [Citation(s) in RCA: 2] [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: 03/20/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Heart failure (HF) is considered an important contributor to cardiovascular morbidity and mortality in diabetes mellitus. However, a precise identification of hyperglycemia as contributor for HF is missing. OBJECTIVES We performed a review and a meta-regression of the available observational studies on the incidence of HF in type 1 diabetes (T1D). DATA SOURCE AND ANALYSIS We conducted a systematic search of the literature on the incidence of HF in patients with T1D identifying suitable studies published between January 1970 and June 2018 using the following search string: "type 1 diabetes" AND, "heart failure" OR "cardiac failure" OR "congestive heart failure" AND "incidence" NOT "type 2 diabetes" OR "diabetes type 2". Six observational studies were included. A random effect meta-regression model has been estimated to evaluate the incidence rate ratio (IRR) of HF in T1D compared to healthy controls. RESULTS The mean ± SD age of patients with T1D was 42 ± 11 years, the mean HbA1c was 8.4 ± 0.3%, and average follow-up was 11 ± 3 years. The age-adjusted model shows an incidence rate ratio (IRR) effect of 3.18 (p < 0.001), in correspondence of the mean age at enrollment of studies involved in the analysis. A negative correlation was observed between IRR and average age. CONCLUSIONS This review shows that the incidence rate of HF is three times higher in patients with T1D than in controls. A careful surveillance of the risk factors for this condition should be included, since the onset of T1D may be important to reduce HF risk in these patients.
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Affiliation(s)
- A Avogaro
- Unit of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - D Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128, Padua, Italy
| | - G P Fadini
- Unit of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - I Baldi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128, Padua, Italy
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Azmi S, Ferdousi M, Kalteniece A, Petropoulos IN, Ponirakis G, Alam U, Asghar O, Marshall A, Sankar A, Boulton AJM, Soran H, Efron N, Malik RA. Protection from neuropathy in extreme duration type 1 diabetes. J Peripher Nerv Syst 2020; 26:49-54. [PMID: 33236478 PMCID: PMC7983958 DOI: 10.1111/jns.12423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 12/17/2022]
Abstract
A proportion of individuals with type 1 diabetes mellitus for more than 50 years (medallists) may be protected from developing nephropathy, retinopathy and neuropathy. Detailed neuropathy phenotyping was undertaken in a cohort of 33 medallists aged 63.7 ± 1.4 years with diabetes for 58.5 ± 0.8 years and HbA1c of 65.9 ± 2.1 mmol/mmol. Medallists had a significantly higher HbA1c (P < .001), lower estimated glomerular filtration rate (eGFR) (P = .005) and higher albumin creatinine excretion ratio (ACR) (P = .01), but a lower total cholesterol (P < .001), triacylglycerols (P = .001), low density lipoprotein‐cholesterol (P < .001) and higher high density lipoprotein‐cholesterol (P = .03), compared to controls. Twenty‐four percent of participants were identified as “escapers” without confirmed diabetic neuropathy. They had a lower neuropathy symptom profile (P = .002), vibration perception threshold (P = .02), warm threshold (P = .05), higher peroneal amplitude (P = .005), nerve conduction velocity (P = .03), heart rate variability (P = .001), corneal nerve fibre density (P = 0.001), branch density (P < .001) and length (P = .001), compared to medallists with diabetic neuropathy. Escapers had a shorter duration of diabetes (P = .006), lower alcohol consumption (P = .04), lower total cholesterol (P = .04) and LDL (P = .02), higher eGFR (P = .001) and lower ACR (P < .001). Patients with extreme duration diabetes without diabetic neuropathy have a comparable HbA1c, blood pressure and body mass index, but a more favourable lipid profile and consume less alcohol compared to those with diabetic neuropathy.
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Affiliation(s)
- Shazli Azmi
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK
| | - Alise Kalteniece
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK
| | | | | | - Uazman Alam
- Diabetes & Endocrinology Research, Institute of Cardiovascular and Metabolic Medicine and The Pain Research Institute, University of Liverpool and Liverpool University NHS Hospital Trust, Liverpool, UK
| | - Omar Asghar
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK
| | - Andrew Marshall
- Institute of Life course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Adhithya Sankar
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK
| | - Andrew J M Boulton
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
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Šuran D, Kanič V, Naji F, Krajnc I, Čokolič M, Zemljič E, Sinkovič A. Predictors of early cardiac changes in patients with type 1 diabetes mellitus: An echocardiography-based study. Bosn J Basic Med Sci 2019; 19:384-391. [PMID: 31215855 DOI: 10.17305/bjbms.2019.4250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022] Open
Abstract
In patients with type 1 diabetes mellitus (T1DM) imaging studies have demonstrated an increased prevalence of left ventricular diastolic dysfunction and increased left ventricular mass (LVM) unrelated to arterial hypertension and ischemic heart disease. The aim of our study was to identify potential predictors of early subclinical changes in cardiac chamber size and function in such patients. Sixty-one middle-aged asymptomatic normotensive patients with T1DM were included in the study. Conventional and tissue Doppler echocardiography was performed and fasting serum levels of glucose, glycated hemoglobin (HbA1c), lipids, and creatinine were measured. We found moderate bivariate correlations of body mass index (BMI) with left atrial volume (r = 0.47, p < 0.01), LVM (r = 0.42, p < 0.01), left ventricular relative wall thickness (r = 0.32, p = 0.01), and all observed parameters of diastolic function of both ventricles. The five-year average value of HbA1c weakly correlated with the Doppler index of left ventricular filling pressure E/e´sept (r = 0.27, p = 0.04). We found no significant association of diabetes duration, five-year trend of HbA1c, serum lipids, and glomerular filtration rate with cardiac structure and function. After adjusting for other parameters, BMI remained significantly associated with left atrial volume, LVM as well as with the transmitral Doppler ratio E/A. In our study, BMI was the only observed parameter significantly associated with subclinical structural and functional cardiac changes in the asymptomatic middle-aged patients with T1DM.
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Affiliation(s)
- David Šuran
- Department of Cardiology and Angiology, University Medical Centre Maribor, Maribor, Slovenia.
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Armstrong AC, Ambale-Venkatesh B, Turkbey E, Donekal S, Chamera E, Backlund JY, Cleary P, Lachin J, Bluemke DA, Lima JAC. Association of Cardiovascular Risk Factors and Myocardial Fibrosis With Early Cardiac Dysfunction in Type 1 Diabetes: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2017; 40:405-411. [PMID: 27986796 PMCID: PMC5319473 DOI: 10.2337/dc16-1889] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/20/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated the association of cardiovascular risk factors and myocardial fibrosis with early cardiac dysfunction in type 1 diabetes. RESEARCH DESIGN AND METHODS Participants with type 1 diabetes aged 13-39 years without a known history of cardiovascular disease (CVD) (n = 1,441) were recruited into the Diabetes Control and Complications Trial (1983-1993) and subsequently followed in the Epidemiology of Diabetes Interventions and Complications study (1994 to present). Seven hundred fourteen participants underwent cardiac magnetic resonance (CMR) imaging (2007-2009) with late gadolinium enhancement sequences to assess ischemic and nonischemic scars and tagging sequences to evaluate circumferential strain. CMR-derived T1 mapping also was used to assess interstitial fibrosis. The influence of cardiovascular risk factors and myocardial scar on circumferential strain was assessed using linear regression. RESULTS Circumferential dysfunction was consistently associated with older age, male sex, smoking history, obesity, higher blood pressure, lower HDL cholesterol, and higher mean HbA1c. Participants with nonischemic scars (n = 16) had the worst circumferential function compared with those without scars (β ± SE 1.32 ± 0.60; P = 0.03). In sex-adjusted models, the correlation between T1 times and circumferential strain was not significant. In the fully adjusted models, a trend toward circumferential dysfunction in participants with nonischemic scars was found. Left ventricular ejection fraction was not associated with risk factors but was significantly lower if a myocardial scar was present. CONCLUSIONS Traditional CVD risk factors and elevated HbA1c levels are major factors related to early cardiac dysfunction in type 1 diabetes. Nonischemic myocardial scar, possibly as a marker of chronic exposure to known risk factors, may predict early cardiac dysfunction mediated by diffuse myocardial fibrosis as seen in diabetic cardiomyopathy.
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Affiliation(s)
- Anderson C Armstrong
- Johns Hopkins University, Baltimore, MD.,Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | | | - Evrim Turkbey
- Johns Hopkins University, Baltimore, MD.,Department of Radiology, National Institutes of Health, Bethesda, MD
| | | | | | | | | | - John Lachin
- The George Washington University, Washington, DC
| | - David A Bluemke
- Department of Radiology, National Institutes of Health, Bethesda, MD
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Asghar O, Miller C, Ray S, Schmitt M, Malik RA. Subjects With Extreme-Duration Type 1 Diabetes Exhibit No Structural or Functional Abnormality on Cardiac MRI. Diabetes Care 2016; 39:e167-8. [PMID: 27489337 PMCID: PMC5033085 DOI: 10.2337/dc16-0760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/05/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Omar Asghar
- Institute of Cardiovascular Sciences, The University of Manchester and Manchester Heart Centre, Central Manchester University Hospitals, Manchester, U.K
| | - Christopher Miller
- North West Heart Centre, University Hospital of South Manchester, Manchester, U.K
| | - Simon Ray
- North West Heart Centre, University Hospital of South Manchester, Manchester, U.K
| | - Matthias Schmitt
- North West Heart Centre, University Hospital of South Manchester, Manchester, U.K
| | - Rayaz A Malik
- Institute of Cardiovascular Sciences, The University of Manchester and Manchester Heart Centre, Central Manchester University Hospitals, Manchester, U.K. Weill Cornell Medicine-Qatar, Doha, Qatar
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Suran D, Sinkovic A, Naji F. Tissue Doppler imaging is a sensitive echocardiographic technique to detect subclinical systolic and diastolic dysfunction of both ventricles in type 1 diabetes mellitus. BMC Cardiovasc Disord 2016; 16:72. [PMID: 27102111 PMCID: PMC4840968 DOI: 10.1186/s12872-016-0242-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/08/2016] [Indexed: 01/18/2023] Open
Abstract
Background Subclinical left (LV) and right ventricular (RV) dysfunction has been demonstrated in type 2 diabetes mellitus and evidence indicates impaired LV diastolic function in type 1 diabetes mellitus (T1DM) as well. The aim of our study was to evaluate the role of tissue Doppler imaging (TDI) in assessment of global LV and RV function in T1DM patients. Methods A detailed two-dimensional, pulsed wave Doppler and pulsed wave TDI analysis was performed in 53 normotensive middle-aged T1DM patients and compared to healthy controls. Results In T1DM patients TDI analysis revealed reduced mean mitral septal and lateral E’ velocities as well as reduced mean tricuspid E˙t velocity compared to healthy controls (E’sept 8.89 ± 1.89 cm/s vs. 11.50 ± 2.41 cm/s, p < 0.001; E’lat 12.29 ± 2.58 cm/s vs.15.30 ± 2.95 cm/s, p < 0,001; E’t 13.56 ± 2.91 cm/s vs. 15.60 ± 2.99 cm/s, p = 0.001). Mean ratios E/E’sept, E/E’lat and E/E’t were significantly higher in diabetics with cutoff value of 7.4 for E/E’sept and 3.4 for E/E’t, differentiating diabetics with LV and RV diastolic impairement from matched healthy controls (sensitivity 76.5 %, specificity 73.8 % for E/E’sept and sensitivity 72.1 %, specificity 66.7 % for E/E’t). Myocardial acceleration during isovolumetric contraction (IVA) measured at the septal mitral (LV IVA) and lateral tricuspid annulus (RV IVA) was the only parameter indicating reduced contractility of both ventricles in diabetics compared to controls (LV IVA 230.70 ± 61.26 cm/s2 vs. 283.32 ± 59.74 cm/s2, p < 0,001; RV IVA 275.48 ± 68.08 cm/s2 vs. 316.86 ± 80.95 cm/s2, p = 0.011). LV IVA had better diagnostic accuracy than RV IVA to predict early contractile impairement in T1DM patients (area under the curve 0.758, p < 0.001 for LV IVA and 0.648, p = 0.017 for RV IVA). Conclusions TDI is essential to detect subclinical diastolic deterioration of both ventricles in T1DM patients. TDI-derived IVA might be useful to assess early systolic alterations of both ventricles in T1DM patients.
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Affiliation(s)
- David Suran
- Department of Cardiology and Angiology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
| | - Andreja Sinkovic
- Department of Medical Intensive Care, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Franjo Naji
- Department of Cardiology and Angiology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
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