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Várkonyi T, Körei A, Putz Z, Martos T, Keresztes K, Lengyel C, Nyiraty S, Stirban A, Jermendy G, Kempler P. Advances in the management of diabetic neuropathy. Minerva Med 2017; 108:419-437. [DOI: 10.23736/s0026-4806.17.05257-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jax T, Stirban A, Terjung A, Esmaeili H, Berk A, Thiemann S, Chilton R, von Eynatten M, Marx N. A randomised, active- and placebo-controlled, three-period crossover trial to investigate short-term effects of the dipeptidyl peptidase-4 inhibitor linagliptin on macro- and microvascular endothelial function in type 2 diabetes. Cardiovasc Diabetol 2017; 16:13. [PMID: 28109295 PMCID: PMC5251248 DOI: 10.1186/s12933-016-0493-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/28/2016] [Indexed: 01/15/2023] Open
Abstract
Background Studies of dipeptidyl peptidase (DPP)-4 inhibitors report heterogeneous effects on endothelial function in patients with type 2 diabetes (T2D). This study assessed the effects of the DPP-4 inhibitor linagliptin versus the sulphonylurea glimepiride and placebo on measures of macro- and microvascular endothelial function in patients with T2D who represented a primary cardiovascular disease prevention population. Methods This crossover study randomised T2D patients (n = 42) with glycated haemoglobin (HbA1c) ≤7.5%, no diagnosed macro- or microvascular disease and on stable metformin background to linagliptin 5 mg qd, glimepiride 1–4 mg qd or placebo for 28 days. Fasting and postprandial macrovascular endothelial function, measured using brachial flow-mediated vasodilation, and microvascular function, measured using laser-Doppler on the dorsal thenar site of the right hand, were analysed after 28 days. Results Baseline mean (standard deviation) age, body mass index and HbA1c were 60.3 (6.0) years, 30.3 (3.0) kg/m2 and 7.41 (0.61)%, respectively. After 28 days, changes in fasting flow-mediated vasodilation were similar between the three study arms (treatment ratio, gMean [90% confidence interval]: linagliptin vs glimepiride, 0.884 [0.633–1.235]; linagliptin vs placebo, 0.884 [0.632–1.235]; glimepiride vs placebo, 1.000 [0.715–1.397]; P = not significant for all comparisons). Similarly, no differences were seen in postprandial flow-mediated vasodilation. However, under fasting conditions, linagliptin significantly improved microvascular function as shown by a 34% increase in hyperaemia area (P = 0.045 vs glimepiride), a 34% increase in resting blow flow (P = 0.011 vs glimepiride, P = 0.003 vs placebo), and a 25% increase in peak blood flow (P = 0.009 vs glimepiride, P = 0.003 vs placebo). There were no significant differences between treatments in postprandial changes. Linagliptin had no effect on heart rate or blood pressure. Rates of overall adverse events with linagliptin, glimepiride and placebo were 27.5, 61.0 and 35.0%, respectively. Fewer hypoglycaemic events were seen with linagliptin (5.0%) and placebo (2.5%) than with glimepiride (39.0%). Conclusions Linagliptin had no effect on macrovascular function in T2D, but significantly improved microvascular function in the fasting state. Trial registration ClinicalTrials.gov identifier—NCT01703286; registered October 1, 2012 Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0493-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Jax
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstr. 9, 41460, Neuss, Germany. .,Herzzentrum Wuppertal, Universität Witten/Herdecke, Witten, Germany.
| | - Alin Stirban
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstr. 9, 41460, Neuss, Germany
| | - Arne Terjung
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstr. 9, 41460, Neuss, Germany
| | | | - Andreas Berk
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Sandra Thiemann
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Robert Chilton
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Nikolaus Marx
- RWTH Aachen University, University Hospital Aachen, Aachen, Germany
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Marquard J, Stirban A, Schliess F, Sievers F, Welters A, Otter S, Fischer A, Wnendt S, Meissner T, Heise T, Lammert E. Effects of dextromethorphan as add-on to sitagliptin on blood glucose and serum insulin concentrations in individuals with type 2 diabetes mellitus: a randomized, placebo-controlled, double-blinded, multiple crossover, single-dose clinical trial. Diabetes Obes Metab 2016; 18:100-3. [PMID: 26362564 PMCID: PMC5057326 DOI: 10.1111/dom.12576] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 08/23/2015] [Accepted: 09/09/2015] [Indexed: 02/01/2023]
Abstract
In this clinical trial, we investigated the blood glucose (BG)-lowering effects of 30, 60 and 90 mg dextromethorphan (DXM) as well as 100 mg sitagliptin alone versus combinations of DXM and sitagliptin during an oral glucose tolerance test (OGTT) in 20 men with T2DM. The combination of 60 mg DXM plus 100 mg sitagliptin was observed to have the strongest effect in the OGTT. It lowered maximum BG concentrations and increased the baseline-adjusted area under the curve for serum insulin concentrations in the first 30 min of the OGTT (mean ± standard deviation 240 ± 47 mg/dl and 8.1 ± 6.1 mU/l/h, respectively) to a significantly larger extent than did 100 mg sitagliptin alone (254 ± 50 mg/dl and 5.8 ± 2.5 mU/l/h, respectively; p < 0.05) and placebo (272 ± 49 mg/dl and 3.9 ± 3.0 mU/l/h, respectively; p < 0.001). All study drugs were well tolerated, alone and in combination, without serious adverse events or hypoglycaemia. Long-term clinical trials are now warranted to investigate the potential of the combination of 30 or 60 mg DXM and dipeptidyl peptidase-4 inhibitors in the treatment of individuals with T2DM, in particular as preclinical studies have identified the β-cell protective properties of DXM.
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Affiliation(s)
- J Marquard
- Institute of Metabolic Physiology, Department of Biology, Heinrich Heine University, Düsseldorf, Germany
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | | | - A Welters
- Institute of Metabolic Physiology, Department of Biology, Heinrich Heine University, Düsseldorf, Germany
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Beta Cell Biology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Düsseldorf, Germany
- German Centre for Diabetes Research, Partner Institution Düsseldorf, Düsseldorf, Germany
| | - S Otter
- Institute of Metabolic Physiology, Department of Biology, Heinrich Heine University, Düsseldorf, Germany
- Institute for Beta Cell Biology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Düsseldorf, Germany
- German Centre for Diabetes Research, Partner Institution Düsseldorf, Düsseldorf, Germany
| | | | - S Wnendt
- MLM Medical Labs GmbH, Mönchengladbach, Germany
| | - T Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | | | - E Lammert
- Institute of Metabolic Physiology, Department of Biology, Heinrich Heine University, Düsseldorf, Germany
- Institute for Beta Cell Biology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Düsseldorf, Germany
- German Centre for Diabetes Research, Partner Institution Düsseldorf, Düsseldorf, Germany
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Marquard J, Otter S, Welters A, Stirban A, Fischer A, Eglinger J, Herebian D, Kletke O, Klemen MS, Stožer A, Wnendt S, Piemonti L, Köhler M, Ferrer J, Thorens B, Schliess F, Rupnik MS, Heise T, Berggren PO, Klöcker N, Meissner T, Mayatepek E, Eberhard D, Kragl M, Lammert E. Characterization of pancreatic NMDA receptors as possible drug targets for diabetes treatment. Nat Med 2015; 21:363-72. [PMID: 25774850 DOI: 10.1038/nm.3822] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
In the nervous system, NMDA receptors (NMDARs) participate in neurotransmission and modulate the viability of neurons. In contrast, little is known about the role of NMDARs in pancreatic islets and the insulin-secreting beta cells whose functional impairment contributes to diabetes mellitus. Here we found that inhibition of NMDARs in mouse and human islets enhanced their glucose-stimulated insulin secretion (GSIS) and survival of islet cells. Further, NMDAR inhibition prolonged the amount of time that glucose-stimulated beta cells spent in a depolarized state with high cytosolic Ca(2+) concentrations. We also noticed that, in vivo, the NMDAR antagonist dextromethorphan (DXM) enhanced glucose tolerance in mice, and that in vitro dextrorphan, the main metabolite of DXM, amplified the stimulatory effect of exendin-4 on GSIS. In a mouse model of type 2 diabetes mellitus (T2DM), long-term treatment with DXM improved islet insulin content, islet cell mass and blood glucose control. Further, in a small clinical trial we found that individuals with T2DM treated with DXM showed enhanced serum insulin concentrations and glucose tolerance. Our data highlight the possibility that antagonists of NMDARs may provide a useful adjunct treatment for diabetes.
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Affiliation(s)
- Jan Marquard
- 1] Institute of Metabolic Physiology, Heinrich Heine University, Düsseldorf, Germany. [2] Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Silke Otter
- 1] Institute of Metabolic Physiology, Heinrich Heine University, Düsseldorf, Germany. [2] Institute for Beta Cell Biology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany. [3] German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany
| | - Alena Welters
- 1] Institute of Metabolic Physiology, Heinrich Heine University, Düsseldorf, Germany. [2] Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany. [3] Institute for Beta Cell Biology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany. [4] German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany
| | - Alin Stirban
- Profil Institute for Metabolic Research, Neuss, Germany
| | | | - Jan Eglinger
- 1] Institute of Metabolic Physiology, Heinrich Heine University, Düsseldorf, Germany. [2] Institute for Beta Cell Biology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany. [3] German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany
| | - Diran Herebian
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Olaf Kletke
- Institute of Neuro- and Sensory Physiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maša Skelin Klemen
- Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Andraž Stožer
- 1] Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia. [2] Center for Open Innovations and Research, University of Maribor, Maribor, Slovenia
| | | | - Lorenzo Piemonti
- Diabetes Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milano, Italy
| | - Martin Köhler
- The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, Stockholm, Sweden
| | - Jorge Ferrer
- 1] Department of Medicine, Imperial College London, London, UK. [2] Genomic Programming of Beta-Cells Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain
| | - Bernard Thorens
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | | | - Marjan Slak Rupnik
- 1] Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia. [2] Center for Open Innovations and Research, University of Maribor, Maribor, Slovenia. [3] Institute of Physiology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Tim Heise
- Profil Institute for Metabolic Research, Neuss, Germany
| | - Per-Olof Berggren
- The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaj Klöcker
- Institute of Neuro- and Sensory Physiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Daniel Eberhard
- Institute of Metabolic Physiology, Heinrich Heine University, Düsseldorf, Germany
| | - Martin Kragl
- 1] Institute of Metabolic Physiology, Heinrich Heine University, Düsseldorf, Germany. [2] German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany
| | - Eckhard Lammert
- 1] Institute of Metabolic Physiology, Heinrich Heine University, Düsseldorf, Germany. [2] Institute for Beta Cell Biology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany. [3] German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany
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Jax TW, von Eynatten M, Stirban A, Terjung A, Esmaeili H, Berk A, Thiemann S, Chilton R, Marx N. A RANDOMIZED, ACTIVE- AND PLACEBO-CONTROLLED, THREE-PERIOD CROSSOVER TRIAL TO INVESTIGATE SHORT-TERM EFFECTS OF THE DIPEPTIDYL PEPTIDASE-4 INHIBITOR LINAGLIPTIN ON ENDOTHELIAL FUNCTION IN TYPE 2 DIABETES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)62080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Evidence has accumulated lately demonstrating that advanced glycation end products (AGEs) play an important role in the development of diabetic and cardiovascular complications as well as the development of other chronic diseases. AGEs originating from diet have a significant contribution to the AGEs body pool and therefore dietary interventions aiming at reducing AGEs load are believed to exert health promoting effects. This review summarizes the evidence from clinical studies regarding effects of dietary AGEs on the vascular system, highlighting also the different aspects of vascular tests. It also advocates an extension of dietary recommendations towards the promotion of cooking methods that reduce dietary AGEs in consumed foods.
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Affiliation(s)
- Alin Stirban
- Profil Institute for Metabolic Research, Hellersbergstraße 9, 41460 Neuss, Germany
- *Alin Stirban:
| | - Diethelm Tschöpe
- Diabetes Clinic, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
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Stirban A, Heinemann L. Skin Autofluorescence - A Non-invasive Measurement for Assessing Cardiovascular Risk and Risk of Diabetes. Eur Endocrinol 2014; 10:106-110. [PMID: 29872473 DOI: 10.17925/ee.2014.10.02.106] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/28/2014] [Indexed: 01/13/2023]
Abstract
The results of the Diabetes Control and Complications Trial-Epidemiology of Diabetes Interventions and Complications (DCCT-EDIC) study have strengthened the 'glycaemic memory' concept, postulating that the quality of metabolic control over several years predicts the development of diabetic complications. To mirror long-term metabolic control, the degree of glycated haemoglobin (HbA1c) might not represent the optimal biomarker. Other substances with a longer persistence, like the so-called advanced glycation end-products (AGEs), which probably form the substrate of the glycaemic memory, might perform better. Newly developed methods such as the assessment of skin autofluorescence (SAF), enable fast, uncomplicated and non-invasive AGEs assessment. SAF was validated for diabetes screening and shows a good predictive value for the development of diabetic and cardiovascular complications. This article deals with the theoretical background and with available clinical data on this new variable.
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Affiliation(s)
- Alin Stirban
- Director Endocrinology and Diabetes Complications
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Stirban A, Nandrean S, Götting C, Stratmann B, Tschoepe D. Effects of n-3 polyunsaturated fatty acids (PUFAs) on circulating adiponectin and leptin in subjects with type 2 diabetes mellitus. Horm Metab Res 2014; 46:490-2. [PMID: 24356795 DOI: 10.1055/s-0033-1363225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Recent evidence suggests that omega-3 polyunsaturated fatty acids [n-3 PUFAs: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)], improve insulin sensitivity in humans. In a double-blind, placebo-controlled, randomized, crossover study, we investigated the effects of EPA/DHA on paraoxonase-1 activity as well as fasting and postprandial levels of circulating adiponectin and leptin in 34 subjects with type 2 diabetes mellitus who received daily for 6 weeks either 2 g purified EPA/DHA or olive oil (placebo), separated by a 6 weeks washout. At the end of each treatment, measurements were performed in fasting state and 2, 4, and 6 h following a standardized high-fat meal (600 kcal). No significant differences in fasting and postprandial circulating adiponectin, leptin, and paraoxonase-1 activity were seen between n-3 PUFAs and placebo. Our data do not support an insulin sensitizing effect of n-3 PUFAs by means of influencing circulating adipocytokines in this population. Clinical Trial Register Number: NCT00328536.
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Affiliation(s)
- A Stirban
- Diabetes Center of the Heart and Diabetes Center NRW, University Clinic of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - S Nandrean
- Diabetes Center of the Heart and Diabetes Center NRW, University Clinic of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - C Götting
- Institute for Laboratory and Transfusion Medicine of the Heart and Diabetes Center NRW, University Clinic of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - B Stratmann
- Diabetes Center of the Heart and Diabetes Center NRW, University Clinic of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - D Tschoepe
- Diabetes Center of the Heart and Diabetes Center NRW, University Clinic of the Ruhr-University Bochum, Bad Oeynhausen, Germany
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Polidori D, Sha S, Heise T, Natarajan J, Artis E, Wang SS, Vaccaro N, Rothenberg P, Stirban A. Effect of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on C-peptide kinetics. Clin Pharmacol Drug Dev 2014; 4:12-7. [DOI: 10.1002/cpdd.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/05/2014] [Indexed: 12/17/2022]
Affiliation(s)
| | - Sue Sha
- Janssen Research & Development; LLC; Raritan NJ USA
| | | | | | - Eunice Artis
- Janssen Research & Development; LLC; Raritan NJ USA
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Abstract
Many efforts have been made lately to develop cost-effective, simple, and reproducible tests for diabetes screening besides the already established fasting plasma glucose, the oral glucose tolerance test, and the glycated hemoglobin A1c. Several tests have been proposed lately, based on the measurement of the so-called advanced glycation endproducts (AGEs). AGEs production is exacerbated during hyperglycemia, and their accumulation in different tissues reflects the degree and duration of dysglycemia. The human lens represents a tissue where AGEs accumulation can be particularly well assessed. The present article comments on the article by Cahn et al. published in this issue of the Journal of Diabetes Science and Technology. Cahn and coauthors tested a new scanning confocal biomicroscope for its accuracy to detect noninvasively subjects with diabetes or at risk for developing diabetes.
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Affiliation(s)
- Alin Stirban
- Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany
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Abstract
Microvascular dysfunction in diabetes plays a crucial role in the development of diabetic complications. The skin, as one of the most accessible organs, serves as a model for the investigation of microvascular dysfunction. Several non-invasive, mostly laser-Doppler-based methods have been developed lately to assess microvascular function in the skin. Microvascular functional changes occur even in the prediabetic state and become more complex with overt diabetes, being exacerbated by the presence of peripheral and/or autonomic diabetic neuropathy. The present article aims at shedding light on the implication of endothelial and neurovascular dysfunction in microvascular changes in diabetes, highlighting the contribution of different forms of diabetic neuropathy.
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Affiliation(s)
- Alin Stirban
- Profil Institute for Metabolic Research, Hellersbergstr. 9, 41460, Neuss, Germany,
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Stirban A, Gawlowski T, Roden M. Vascular effects of advanced glycation endproducts: Clinical effects and molecular mechanisms. Mol Metab 2013; 3:94-108. [PMID: 24634815 DOI: 10.1016/j.molmet.2013.11.006] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 12/17/2022] Open
Abstract
The enhanced generation and accumulation of advanced glycation endproducts (AGEs) have been linked to increased risk for macrovascular and microvascular complications associated with diabetes mellitus. AGEs result from the nonenzymatic reaction of reducing sugars with proteins, lipids, and nucleic acids, potentially altering their function by disrupting molecular conformation, promoting cross-linking, altering enzyme activity, reducing their clearance, and impairing receptor recognition. AGEs may also activate specific receptors, like the receptor for AGEs (RAGE), which is present on the surface of all cells relevant to atherosclerotic processes, triggering oxidative stress, inflammation and apoptosis. Understanding the pathogenic mechanisms of AGEs is paramount to develop strategies against diabetic and cardiovascular complications.
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Affiliation(s)
- Alin Stirban
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstrasse 9, 41460 Neuss, Germany
| | - Thomas Gawlowski
- University of Paderborn, Warburger Str. 100, 33098 Paderborn, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany ; Division of Endocrinology and Diabetology, University Clinics Düsseldorf, 40225 Düsseldorf, Germany
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Stirban A, Tschoepe D. Comment on "Advanced glycation endproducts in food and their effects on health" by Poulsen et al. (2013) Food and Chemical Toxicology 60, 10-37. Food Chem Toxicol 2013; 64:411. [PMID: 24316312 DOI: 10.1016/j.fct.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Diethelm Tschoepe
- Diabetes Clinic, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
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Stirban A, Pop A, Tschoepe D. A randomized, double-blind, crossover, placebo-controlled trial of 6 weeks benfotiamine treatment on postprandial vascular function and variables of autonomic nerve function in Type 2 diabetes. Diabet Med 2013; 30:1204-8. [PMID: 23701274 DOI: 10.1111/dme.12240] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 02/06/2023]
Abstract
AIMS In a pilot study we suggested that benfotiamine, a thiamine prodrug, prevents postprandial endothelial dysfunction in people with Type 2 diabetes mellitus. The aim of this study was to test these effects in a larger population. METHODS In a double-blind, placebo-controlled, randomized, crossover study, 31 people with Type 2 diabetes received 900 mg/day benfotiamine or a placebo for 6 weeks (with a washout period of 6 weeks between). At the end of each treatment period, macrovascular and microvascular function were assessed, together with variables of autonomic nervous function in a fasting state, as well as 2, 4 and 6 h following a heated, mixed test meal. RESULTS Participants had an impaired baseline flow-mediated dilatation (2.63 ± 2.49%). Compared with the fasting state, neither variable changed postprandially following the placebo treatment. The 6 weeks' treatment with high doses of benfotiamine did not alter this pattern, either in the fasting state or postprandially. Among a subgroup of patients with the highest flow-mediated dilatation, following placebo treatment there was a significant postprandial flow-mediated dilatation decrease, while this effect was attenuated by benfotiamine pretreatment. CONCLUSIONS In people with Type 2 diabetes and markedly impaired fasting flow-mediated dilatation, a mixed test meal does not further deteriorate flow-mediated dilatation or variables of microvascular or autonomic nervous function. Because no significant deterioration of postprandial flow-mediated dilatation, microvascular or autonomic nervous function tests occurred after placebo treatment, a prevention of the postprandial deterioration of these variables with benfotiamine was not feasible.
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Affiliation(s)
- A Stirban
- Diabetes Clinic, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany; Profil Institute for Metabolic Research GmbH, Neuss, Germany
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15
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Stirban A, Pop A, Fischer A, Heckermann S, Tschoepe D. Variability of skin autofluorescence measurement over 6 and 12 weeks and the influence of benfotiamine treatment. Diabetes Technol Ther 2013; 15:733-7. [PMID: 23964994 DOI: 10.1089/dia.2013.0103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Measurements of skin autofluorescence (SAF) allow for a simple and noninvasive quantification of tissue advanced glycation end-products (AGEs), a marker linked to the risk of diabetes complications. The aim of this study was to test the repeatability of SAF over 6 and 12 weeks and to test whether benfotiamine, a thiamine prodrug suggested to reduce AGEs formation under hyperglycemic conditions, is able to attenuate SAF when administered over 6 weeks. PATIENTS AND METHODS In a double-blind, placebo-controlled, randomized, crossover study, 22 patients with type 2 diabetes mellitus (T2DM) received 900 mg/day benfotiamine or placebo for 6 weeks (washout period of 6 weeks between). At the beginning and at the end of each treatment period, SAF was assessed in the fasting state, as well as 2, 4, and 6 h following a mixed test meal. RESULTS The respective intra-individual and inter-individual variability of fasting SAF was 6.9% and 24.5% within 6 weeks and 10.9% and 23.1% within 12 weeks. The respective variability calculated for triplicate comparisons was 9.9% and 27.7%. A short-term therapy with benfotiamine did not influence SAF significantly, nor did we find a significant postprandial SAF increase. CONCLUSIONS In patients with T2DM, repeated, timely spaced SAF measurements have an intra-subject variability of below 11%. Using these data, sample sizes were calculated for interventional studies aiming at reducing SAF. Benfotiamine treatment for 6 weeks did not significantly influence SAF; for this, a longer-term therapy is probably needed.
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Affiliation(s)
- Alin Stirban
- Diabetes Clinic, Heart and Diabetes Center NR, Ruhr University Bochum, Bad Oeynhausen, Germany.
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Abstract
The development of cost-effective, simple, and reproducible tests for diabetes screening represents a priority of modern medicine in light of the increasing prevalence of diabetes mellitus. Besides fasting plasma glucose, the oral glucose tolerance test, and glycated hemoglobin A1c, several tests have been proposed, among them the assessment of skin fluorescence spectroscopy (SFS). This article comments on the article by Olson and coauthors published in this issue of Journal of Diabetes Science and Technology and comprehensively reviews related available information. Overall, SFS seems to represent an easy-to-use, noninvasive tool that adds value to existing tests for diabetes screening.
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Affiliation(s)
- Alin Stirban
- Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
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Varkonyi T, Putz Z, Keresztes K, Martos T, Lengyel C, Stirban A, Jermendy G, Kempler P. Current Options and Perspectives in the Treatment of Diabetic Neuropathy. Curr Pharm Des 2013; 19:4981-5007. [DOI: 10.2174/13816128113199990310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 12/24/2012] [Indexed: 11/22/2022]
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Stirban A, Kotsi P, Franke K, Strijowski U, Cai W, Götting C, Tschoepe D. Acute macrovascular dysfunction in patients with type 2 diabetes induced by ingestion of advanced glycated β-lactoglobulins. Diabetes Care 2013; 36:1278-82. [PMID: 23238657 PMCID: PMC3631855 DOI: 10.2337/dc12-1489] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Recent evidence indicates that heat-enhanced food advanced glycation end products (AGEs) adversely affect vascular function. The aim of this study was to examine the acute effects of an oral load of heat-treated, AGE-modified β-lactoglobulins (AGE-BLG) compared with heat-treated, nonglycated BLG (C-BLG) on vascular function in patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS In a double-blind, controlled, randomized, crossover study, 19 patients with T2DM received, on two different occasions, beverages containing either AGE-BLG or C-BLG. We measured macrovascular [brachial ultrasound of flow-mediated dilatation (FMD)] and microvascular (laser-Doppler measurements of reactive hyperemia in the hand) functions at baseline (T0), 90 (T90), and 180 (T180) min. RESULTS Following the AGE-BLG, FMD decreased at T90 by 80% from baseline and remained decreased by 42% at T180 (P < 0.05 vs. baseline, P < 0.05 vs. C-BLG at T90). By comparison, following C-BLG, FMD decreased by 27% at T90 and 51% at T180 (P < 0.05 vs. baseline at T180). A significant decrease in nitrite (T180) and nitrate (T90 and T180), as well as a significant increase in N(ε)-carboxymethyllisine, accompanied intake of AGE-BLG. There was no change in microvascular function caused by either beverage. CONCLUSIONS In patients with T2DM, acute oral administration of a single AGE-modified protein class significantly though transiently impaired macrovascular function in concert with decreased nitric oxide bioavailability. These AGE-related changes were independent of heat treatment.
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Affiliation(s)
- Alin Stirban
- Ruhr University Bochum, Bad Oeynhausen, Germany.
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Abstract
Advanced glycation end products (AGEs) are among the "newcomers" of metabolic research during the last 2-3 decades. Also known as Maillard products, they have belonged to the everyday life of food research for a long time, but their role in the development of diabetes and cardiovascular complications has been suggested only recently. Even though multiple studies have recently dealt with the role of AGEs and their receptors in mediating pathomechanisms, we are still far from understanding them completely and maybe even farther from developing effective therapeutic approaches. Nevertheless, the present article attempts to offer an overview of known associations between AGEs and vascular complications, in order to draw attention to a less known subject--the AGEs--and, maybe, to stimulate further research in this very exciting field.
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Affiliation(s)
- Alin Stirban
- Diabetesklinik, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
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Stirban A, Nandrean S, Götting C, Tschoepe D, Tamler R. Reply to C Opländer. Am J Clin Nutr 2010. [DOI: 10.3945/ajcn.2010.29821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alin Stirban
- Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | | | | | | | - Ronald Tamler
- Division of Endocrinology, Diabetes, and Bone Diseases, The Mount Sinai Medical Center, New York, NY
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Stirban A, Nandrean S, Götting C, Tamler R, Pop A, Negrean M, Gawlowski T, Stratmann B, Tschoepe D. Effects of n-3 fatty acids on macro- and microvascular function in subjects with type 2 diabetes mellitus. Am J Clin Nutr 2010; 91:808-13. [PMID: 20071644 DOI: 10.3945/ajcn.2009.28374] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent evidence supports the protective effects of n-3 (omega-3) fatty acids (n-3 FAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on vascular function. OBJECTIVE We investigated the effects of EPA and DHA on postprandial vascular function in subjects with type 2 diabetes mellitus. DESIGN In a double-blind, placebo-controlled, randomized, crossover manner, 34 subjects with type 2 diabetes mellitus received daily either 2 g purified EPA/DHA (termed n-3 FAs) or olive oil (placebo) for 6 wk. At the end of this period, we measured macrovascular (brachial ultrasound of flow-mediated dilatation; FMD) and microvascular [laser-Doppler measurements of reactive hyperemia (RH) of the hand] function at fasting and 2, 4, and 6 h after a high-fat meal (600 kcal, 21 g protein, 41 g carbohydrates, 40 g fat). RESULTS Fasting vascular function remained unchanged after n-3 FAs and placebo. Postprandial FMD decreased from fasting after placebo, with a maximum decrease (38%) at 4 h-an effect that was significantly reduced (P = 0.03 for time x treatment interaction) by n-3 FA supplementation (maximum decrease in FMD was at 4 h: 13%). RH remained unchanged after placebo, whereas it improved significantly (P = 0.04 for time x treatment interaction) after n-3 FA supplementation (maximum increase was at 2 h: 27%). CONCLUSIONS In subjects with type 2 diabetes mellitus, 6 wk of supplementation with n-3 FAs reduced the postprandial decrease in macrovascular function relative to placebo. Moreover, n-3 FA supplementation improved postprandial microvascular function. These observations suggest a protective vascular effect of n-3 FAs.
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Affiliation(s)
- Alin Stirban
- Diabetes Center, Heart and Diabetes Center NRW Bad Oeynhausen, Ruhr-University Bochum, Bochum, Germany
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Stirban A, Lentrodt S, Nandrean S, Pop A, Tschoepe D, Scherbaum WA. Functional changes in microcirculation during hyperbaric and normobaric oxygen therapy. Undersea Hyperb Med 2009; 36:381-390. [PMID: 20112529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Treatment of cutaneous wounds is one of the many applications of hyperbaric oxygen therapy (HBO). However, the complex regulation of skin microcirculation during different phases of HBO is not completely understood. We therefore investigated skin microcirculation and oxygenation during HBO and normobaric oxygen (NBO) exposure. METHODS Seven healthy volunteers were investigated using measurements of transcutaneous oxygen pressure (PtcO2), tissue spectrophotometry and laser Doppler flowmetry recorded simultaneously in the hand and foot during HBO and NBO in 2- and 4-mm depths. We defined tissue hypoxia as a PtcO2 below 30 mmHg. RESULTS At the hand, in 2 mm depth, NBO induced a mild vasoconstriction (-37%, p=0.07), but a significant increase in PtcO2 (+380%, p<0.001). HBO induced a mild vasoconstriction (-45%, p=0.08), significantly increasing PtcO2 (+1430%, p<0.001). Hand changes in 2 and 4 mm were comparable. Foot changes were smaller than at the hand and more pronounced in 4 mm than in 2 mm depth during NBO and compression. No episodes of tissue hypoxia occurred at any time. CONCLUSIONS In healthy subjects, NBO and especially HBO significantly improve tissue oxygenation, despite vasoconstriction. Differences in vascular regulation between hand and foot and especially at the latter site between 2 and 4 mm depth exist.
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Affiliation(s)
- Alin Stirban
- Medical Clinic I, Hospital Bielefeld Center, Bielefeld, Germany
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Pop A, Nandrean S, Tschöpe D, Stirban A. Postprandiale Regulationsstörungen der Mikrozirkulation bei Patienten mit diabetischer Polyneuropathie. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1222065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stirban A, Laude D, Elghozi JL, Sander D, Agelink MW, Hilz MJ, Ziegler D. Acute effects of sildenafil on flow mediated dilatation and cardiovascular autonomic nerve function in type 2 diabetic patients. Diabetes Metab Res Rev 2009; 25:136-43. [PMID: 19116943 DOI: 10.1002/dmrr.921] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sildenafil, frequently used as on demand medication for the treatment of erectile dysfunction (ED), has been suggested to improve endothelial function but also to alter blood pressure (BP) and induce sympathetic activation. In people with type 2 diabetes mellitus (T2DM), a high-risk population, the safety profile and the effects on endothelial function of a maximal sildenafil dose (100 mg) have not been investigated and therefore constituted the aim of our study. METHODS A double-blind, placebo-controlled, cross-over trial using a single dose of 100 mg sildenafil or placebo has been conducted in 40 subjects with T2DM without known CVD. Haemodynamic parameters, flow mediated dilatation (FMD) in brachial artery, cardiovascular autonomic function tests and spontaneous baroreflex sensitivity (BRS) were measured. RESULTS Sixty minutes after administration of sildenafil but not placebo, a fall of supine systolic blood pressure (SBP) (-5.41 +/- 1.87 vs. + 0.54 +/- 1.71 mmHg) and diastolic blood pressure (DBP) (-4.46 +/- 1.13 vs. + 0.89 +/- 0.94 mmHg), as well as orthostatic SBP (-7.41 +/- 2.35 vs. + 0.94 +/- 2.06 mmHg) and DBP (-5.65 +/- 1.45 vs. + 1.76 +/- 1.00 mmHg) during standing occurred, accompanied by an increase in heart rate (+1.98 +/- 0.69 vs. - 2.42 +/- 0.59 beats/min) (all p < 0.01 vs. placebo). Changes in BP to standing up, FMD, time domain and frequency domain indices of heart rate variability (HRV) and BRS were comparable between sildenafil and placebo. CONCLUSIONS Sildenafil administered at a maximum single dose to T2DM men results in a mild increase in heart rate and decrease in BP, but it induces neither an acute improvement of FMD nor any adverse effects on orthostatic BP regulation, HRV and BRS.
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Affiliation(s)
- Alin Stirban
- Diabetes Clinic, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Germany.
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Stirban A, Negrean M, Götting C, Stratmann B, Gawlowski T, Mueller-Roesel M, Kleesiek K, Koschinsky T, Tschoepe D. Leptin decreases postprandially in people with type 2 diabetes, an effect reduced by the cooking method. Horm Metab Res 2008; 40:896-900. [PMID: 18792885 DOI: 10.1055/s-0028-1083784] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Leptin modulates satiety and increases in obesity and type 2 diabetes mellitus in parallel with leptin resistance. Postprandial leptin regulation has been previously postulated to depend on meal composition, but data are controversial. The hypothesis of our study was that in people with type 2 diabetes mellitus, a postprandial leptin regulation exists that can be regulated not only by meal composition but also by the cooking method. In 20 inpatients with type 2 diabetes (mean age: 55.9 years), the acute effects of 2 meals, a high-heat-processed meal HHPM or a low-heat-processed meal LHPM, on leptin levels were studied on 2 different days in a randomized, crossover design. Both test meals had similar ingredients and differed only in the cooking method used. Parameters were measured after an overnight fast and at 2, 4, and 6 h postprandially. The HHPM induced a marked decrease in leptin levels, from 8 717+/-2 079 pg/ml at baseline to 6 788+/-1 598 pg/ml at 2 h postprandially (-1 929 pg/ml, -22%*), an effect significantly reduced by the LHPM, where values were 8 563+/-1 900 pg/ml at baseline and 7 425+/-1 591 pg/ml at 2 h postprandially (-1 138 pg/ml, -13%* (double dagger)) (*p<0.05 vs. baseline, (double dagger)p<0.05 vs. HHPM). Parameters of oxidative stress and blood AGEs increased only following the HHPM, while postprandial glucose, triglycerides, and insulin excursions were similar between meals. Postprandial leptin decreases following a HHPM meal in people with T2DM, an effect reduced by the cooking method.
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Affiliation(s)
- A Stirban
- Diabetes Center, Heart and Diabetes Center NRW Bad Oeynhausen, Ruhr-University Bochum, Germany.
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Abstract
BACKGROUND Skin autofluorescence (SAF) is a property used for the noninvasive assessment of skin advanced glycation end products (AGEs) and concentration of redox-regulated fluorophores. SAF was shown to closely mirror cardiovascular risk and to constitute a more sensitive parameter for diabetes screening than fasting glucose and hemoglobin A1c. It has also been suggested that SAF measurement is independent of fasting status. Our study was designed in order to test whether SAF changes postprandially. METHODS We have investigated 21 Caucasian subjects (10 healthy subjects, 11 subjects with type 2 diabetes mellitus). SAF was measured in the fasting state, as well as 2 and 4 h following a meal with a medium AGE content. RESULTS Two hours postprandially, SAF significantly increased by 10.2% in the whole group, by 11.6% in the group of individuals with diabetes, and by 8.7% in healthy subjects (for all measurements P < 0.05 vs. baseline). CONCLUSIONS SAF increases postprandially in individuals with diabetes mellitus and in healthy subjects. Therefore, we suggest that measurements of SAF should be performed in the fasting state in order to increase sensitivity and specificity of the method for assessing cardiovascular risk and diabetes screening.
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Affiliation(s)
- Alin Stirban
- Diabetes Center, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
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Nandrean S, Stirban A, Negrean M, Tschoepe D. BENFOTIAMINE PREVENTS ACUTE VASCULAR DYSFUNCTION INDUCED BY SMOKING IN HEALTHY SUBJECTS. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stirban A, Negrean M, Götting C, Uribarri J, Gawlowski T, Stratmann B, Kleesiek K, Koschinsky T, Vlassara H, Tschoepe D. Dietary Advanced Glycation Endproducts and Oxidative Stress. Ann N Y Acad Sci 2008; 1126:276-9. [DOI: 10.1196/annals.1433.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nandrean S, Stirban A, Pop A, Negrean M, Tschöpe D. Postprandiale Regulation der Microzirkulation bei Patienten mit Typ-2-Diabetes mellitus. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kirana S, Stratmann B, Lammers D, Quast T, Minartz P, Negrean M, Stirban A, Petrule S, Gastens MH, Götting C, Prohaska W, Prante C, Körperich H, Kleesiek K, Tschöpe D. Therapie mit expandierten autologen Knochenmark-Stammzellen bei Ischämie-bedingtem chronischen diabetischen Fußsyndom – Follow up Daten einer kontrollierten Studie. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stirban A, Negrean M, Stratmann B, Götting C, Salomon J, Kleesiek K, Tschoepe D. Adiponectin decreases postprandially following a heat-processed meal in individuals with type 2 diabetes: an effect prevented by benfotiamine and cooking method. Diabetes Care 2007; 30:2514-6. [PMID: 17630265 DOI: 10.2337/dc07-0302] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alin Stirban
- Heart and Diabetes Center NRW, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
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Uribarri J, Stirban A, Sander D, Cai W, Negrean M, Buenting CE, Koschinsky T, Vlassara H. Single oral challenge by advanced glycation end products acutely impairs endothelial function in diabetic and nondiabetic subjects. Diabetes Care 2007; 30:2579-82. [PMID: 17496238 DOI: 10.2337/dc07-0320] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The current study was designed to test the acute effects of dietary advanced glycation end products (AGEs) on endothelial function of diabetic and nondiabetic subjects. RESEARCH DESIGN AND METHODS Flow-mediated dilation (FMD) of the brachial artery and serum levels of AGEs, plasminogen activator inhibitor 1 (PAI-1), vascular cell adhesion molecule 1 (VCAM-1), and glucose were assessed before and after a single oral AGE challenge (approximately 1.8 x 10(6) AGE units) in 44 diabetic and 10 nondiabetic subjects. RESULTS The diabetic patients had higher baseline levels of serum AGEs (P = 0.020), PAI-1 (NS), and VCAM-1 (P = 0.033) and lower baseline values of FMD compared with nondiabetic subjects (P = 0.032). Ninety minutes after a single oral AGE challenge, serum AGEs and PAI-1 levels increased and FMD decreased significantly in both healthy subjects (AGEs: 7.2 +/- 0.5 to 9.3 +/- 1 units/ml, P = 0.014; PAI-1: 5.4 +/- 0.4 to 6.8 +/- 0.4 ng/ml, P = 0.007; and FMD: 9.9 +/- 0.7 to 7.4 +/- 0.9%, P = 0.019) and diabetic subjects (AGEs: 10.5 +/- 0.7 to 14.2 +/- 1 units/ml, P = 0.020; PAI-1: 6.5 +/- 1 to 10 +/- 2 ng/ml, P = 0.030; and FMD: 5.4 +/- 0.4 to 4.0 +/- 0.3%, P = 0.032). Serum glucose and VCAM-1 levels remained unchanged. CONCLUSIONS Significant increases in serum AGEs can occur together with altered clinical measures of endothelial function in diabetic and nondiabetic subjects after a single modest AGE-rich beverage. Thus, repeated or chronic exposure to high AGE diets could over time lead to and/or accelerate vascular disease.
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Affiliation(s)
- Jaime Uribarri
- Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, One Gustave Levy Pl., New York, NY 10029, USA.
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Negrean M, Stirban A, Stratmann B, Gawlowski T, Horstmann T, Götting C, Kleesiek K, Mueller-Roesel M, Koschinsky T, Uribarri J, Vlassara H, Tschoepe D. Effects of low- and high-advanced glycation endproduct meals on macro- and microvascular endothelial function and oxidative stress in patients with type 2 diabetes mellitus. Am J Clin Nutr 2007; 85:1236-43. [PMID: 17490958 DOI: 10.1093/ajcn/85.5.1236] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND An advanced glycation endproducts (AGEs)-rich diet induces significant increases in inflammatory and endothelial dysfunction markers in type 2 diabetes mellitus (T2DM). OBJECTIVE The aim was to investigate the acute effects of dietary AGEs on vascular function in T2DM patients. DESIGN Twenty inpatients with T2DM [x (+/-SEM) age: 55.4 +/- 2.2 y; glycated hemoglobin: 8.8 +/- 0.5%] were investigated. In a randomized crossover design, the effects of a low-AGE (LAGE) and high-AGE (HAGE) meal on macrovascular [by flow-mediated dilatation (FMD)] and microvascular (by Laser-Doppler flowmetry) function, serum markers of endothelial dysfunction (E-selectin, intracellular adhesion molecule 1, and vascular cell adhesion molecule 1), oxidative stress, and serum AGE were assessed. The meals had identical ingredients but different AGE amounts (15.100 compared with 2.750 kU AGE for the HAGE and LAGE meals, respectively), which were obtained by varying the cooking temperature and time. The measurements were performed at baseline and 2, 4, and 6 h after each meal. RESULTS After the HAGE meal, FMD decreased by 36.2%, from 5.77 +/- 0.65% (baseline) to 3.93 +/- 0.48 (2 h), 3.70 +/- 0.42 (4 h), and 4.42 +/- 0.54% (6 h) (P<0.01 for all compared with baseline). After the LAGE meal, FMD decreased by 20.9%, from 6.04 +/- 0.68% (baseline) to 4.75 +/- 0.48% (2 h), 4.69 +/- 0.51% (4 h), and 5.62 +/- 0.63% (6 h), respectively (P<0.01 for all compared with baseline; P<0.001 for all compared with the HAGE meal). This impairment of macrovascular function after the HAGE meal was paralleled by an impairment of microvascular function (-67.2%) and increased concentrations of serum AGE and markers of endothelial dysfunction and oxidative stress. CONCLUSIONS In patients with T2DM, a HAGE meal induces a more pronounced acute impairment of vascular function than does an otherwise identical LAGE meal. Therefore, chemical modifications of food by means of cooking play a major role in influencing the extent of postprandial vascular dysfunction.
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Affiliation(s)
- Monica Negrean
- Diabetes Clinic, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Germany
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Kirana S, Stratmann B, Lammers D, Negrean M, Stirban A, Minartz P, Koerperich H, Gastens MH, Götting C, Prohaska W, Kleesiek K, Tschoepe D. Wound therapy with autologous bone marrow stem cells in diabetic patients with ischaemia-induced tissue ulcers affecting the lower limbs. Int J Clin Pract 2007; 61:690-2. [PMID: 17394441 DOI: 10.1111/j.1742-1241.2007.01303.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Previous studies suggest that autologous transplantation of bone marrow mononuclear cells is safe and effective in inducing therapeutic angiogenesis in patients with peripheral arterial occlusive disease (PAOD). Here we discuss a multidisciplinary approach to treating PAOD with a focus on the use of angiological diagnostic tools. We conclude that our autologous stem cell therapy is working in this patient and it is a potential new therapeutic option for diabetic patients with chronic foot ulcers induced by critical limb ischaemia.
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Petrule S, Stirban A, Negrean M, Tschöpe D. Benfotiamin beugt der Gefäßdysfunktion nach dem Rauchen einer Zigarette bei gesunden Probanden vor. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kirana S, Stratmann B, Lammers D, Minartz P, Quast T, Negrean M, Stirban A, Petrule S, Gastens M, Goetting C, Prohaska W, Körperich H, Kleesiek K, Tschöpe D. Studie zur induzierten Wundheilung durch Applikation expandierter autologer Knochenmark-Stammzellen bei Diabetikern mit Ischämie-bedingten chronischen Gewebesulzera der unteren Gliedmaße. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stirban A, Negrean M, Stratmann B, Gawlowski T, Horstmann T, Götting C, Kleesiek K, Mueller-Roesel M, Koschinsky T, Uribarri J, Vlassara H, Tschoepe D. Benfotiamine prevents macro- and microvascular endothelial dysfunction and oxidative stress following a meal rich in advanced glycation end products in individuals with type 2 diabetes. Diabetes Care 2006; 29:2064-71. [PMID: 16936154 DOI: 10.2337/dc06-0531] [Citation(s) in RCA: 197] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is characterized by marked postprandial endothelial dysfunction induced by hyperglycemia, hypertriglyceridemia, advanced glycation end products (AGEs), and dicarbonyls (e.g., methylglyoxal [MG]). In vitro hyperglycemia-induced MG formation and endothelial dysfunction could be blocked by benfotiamine, but in vivo effects of benfotiamine on postprandial endothelial dysfunction and MG synthesis have not been investigated in humans until now. RESEARCH DESIGN AND METHODS Thirteen people with type 2 diabetes were given a heat-processed test meal with a high AGE content (HAGE; 15.100 AGE kU, 580 kcal, 54 g protein, 17 g lipids, and 48 g carbohydrates) before and after a 3-day therapy with benfotiamine (1,050 mg/day). Macrovascular flow-mediated dilatation (FMD) and microvascular reactive hyperemia, along with serum markers of endothelial disfunction (E-selectin, vascular cell adhesion molecule-1, and intracellular adhesion molecule-1), oxidative stress, AGE, and MG were measured during both test meal days after an overnight fast and then at 2, 4, and 6 h postprandially. RESULTS The HAGE induced a maximum reactive hyperemia decrease of -60.0% after 2 h and a maximum FMD impairment of -35.1% after 4 h, without affecting endothelium-independent vasodilatation. The effects of HAGE on both FMD and reactive hyperemia were completely prevented by benfotiamine. Serum markers of endothelial dysfunction and oxidative stress, as well as AGE, increased after HAGE. These effects were significantly reduced by benfotiamine. CONCLUSIONS Our study confirms micro- and macrovascular endothelial dysfunction accompanied by increased oxidative stress following a real-life, heat-processed, AGE-rich meal in individuals with type 2 diabetes and suggests benfotiamine as a potential treatment.
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Affiliation(s)
- Alin Stirban
- Heart and Diabetes Center NRW, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
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Negrean M, Stirban A, Stratmann B, Gawlowski T, Horstmann T, Götting C, Kleesiek K, Müller-Rösel M, Koschinsky T, Uribarri J, Vlassara H, Tschöpe D. Nahrungs-AGE (Advanced Glycation Endproducts)-induzierte Endotheldysfunktion und oxidativer Stress bei Patienten mit Typ-2 Diabetes mellitus (T2DM). DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stirban A, Negrean M, Gawlowski T, Stratmann B, Horstmann T, Götting C, Kleesiek K, Müller-Rösel M, Koschinsky T, Uribarri J, Vlassara H, Tschöpe D. Benfotiamin kann bei Patienten mit Typ 2 Diabetes mellitus (T2DM) dem akuten Anstieg der Serummarker der Endotheldysfunktion und oxidativem Stress induziert durch eine AGE-reiche (Advanced Glycation Endproducts) Mahlzeit vorbeugen. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gawlowski T, Stratmann B, Stirban A, Negrean M, Tschoepe D. Gesteigerte Gerinnungsneigung des Diabetikers – Einflüsse von Methylglyoxal. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stratmann B, Gawlowski T, Stirban A, Negrean M, Mattern Y, Tschoepe D. Effekte von nutritiven Advanced Glycation Endproducts (AGE) auf Plasmaspiegel von sCD40L bei Patienten mit Diabetes mellitus – Effekte von Benfotiamin. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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