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Söderström H, Cervin M, Dereke J, Hillman M, Tiberg I, Norström F, Carlsson A. Does a gluten-free diet lead to better glycemic control in children with type 1 diabetes? Results from a feasibility study and recommendations for future trials. Contemp Clin Trials Commun 2022; 26:100893. [PMID: 35243123 PMCID: PMC8866053 DOI: 10.1016/j.conctc.2022.100893] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hanna Söderström
- Department of Clinical Sciences, Pediatrics, Skåne University Hospital Lund, Lund University, Lund, Sweden
- Corresponding author.
| | - Matti Cervin
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Jonatan Dereke
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden
| | - Magnus Hillman
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Iren Tiberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Annelie Carlsson
- Department of Clinical Sciences, Pediatrics, Skåne University Hospital Lund, Lund University, Lund, Sweden
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Melin EO, Dereke J, Hillman M. Galectin-3, metalloproteinase-2 and cardiovascular disease were independently associated with metalloproteinase-14 in patients with type 1 diabetes: a cross sectional study. Diabetol Metab Syndr 2021; 13:118. [PMID: 34702365 PMCID: PMC8549137 DOI: 10.1186/s13098-021-00727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is a major risk factor for cardiovascular disease (CVD). Matrix metalloproteinase-14 (MMP-14) is involved in the development of atherosclerosis and CVD. The main aim was to explore the associations between MMP-14 and selected inflammatory and metabolic variables, CVD, depression, physical activity, smoking and medication in patients with T1D. The secondary aim was to explore associations with CVD. METHODS Cross-sectional design. The participants were consecutively recruited from one specialist diabetes out-patient clinic. Depression was assessed by a self-report instrument. Blood samples, anthropometrics and blood pressure were collected, supplemented with data from electronic health records. High MMP-14 was defined as ≥ 5.81 ng/mL. Non-parametric tests, Chi2 tests and multiple logistic regression analyses were performed. RESULTS Two hundred and sixty-eighth T1D patients aged 18-59 years participated (men 58%, high MMP-14 25%, CVD 3%). Sixty-seven patients with high MMP-14, compared to 201 patients with lower MMP-14, had higher prevalence of CVD (8% versus 1%, p = 0.012), and had higher levels of galectin-3 (p < 0.001) and MMP-2 (p = 0.018). Seven patients with CVD, compared to 261 without, were older (p = 0.003), had longer diabetes duration (p = 0.027), and had higher prevalence of high MMP-14 (71% versus 24%, p = 0.012), abdominal obesity (p = 0.014), depression (p = 0.022), usage of antidepressants (p = 0.008), antihypertensive drugs (p = 0.037) and statins (p = 0.049). Galectin-3 (per ng/mL) [adjusted odds ratio (AOR) 2.19, p < 0.001], CVD (AOR 8.1, p = 0.027), and MMP-2 (per ng/mL) (AOR 1.01, p = 0.044) were associated with high MMP-14. Depression (AOR 17.4, p = 0.006), abdominal obesity (15.8, p = 0.006), high MMP-14 (AOR 14.2, p = 0.008), and diabetes duration (AOR 1.10, p = 0.012) were associated with CVD. CONCLUSIONS The main findings of this study were that galecin-3, MMP-2, and CVD were independently associated with high levels of MMP-14 in T1D patients. The association between MMP-14 and galectin-3 is a new finding. No traditional risk factors for CVD were associated with MMP-14. Depression, abdominal obesity and MMP-14 were independently associated with CVD.
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Affiliation(s)
- Eva Olga Melin
- Department of Clinical Sciences, Diabetes Research Laboratory, Faculty of Medicine, Lund University, Lund, Sweden.
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Jonatan Dereke
- Department of Clinical Sciences, Diabetes Research Laboratory, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Diabetes Research Laboratory, Faculty of Medicine, Lund University, Lund, Sweden
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Melin EO, Svensson R, Dereke J, Hillman M. Galectin-3 Binding Protein, Depression, and Younger Age Were Independently Associated With Alexithymia in Adult Patients With Type 1 Diabetes. Front Psychiatry 2021; 12:672931. [PMID: 34045984 PMCID: PMC8144300 DOI: 10.3389/fpsyt.2021.672931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/26/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022] Open
Abstract
Aims: Alexithymia has been linked to cardiovascular disease. The aim was to explore whether the immuno-inflammatory variables galectin-3 binding protein (Gal3BP), soluble (s)CD163 and galectin-3 were independently associated with alexithymia, while controlling for known risk factors for cardiovascular disease, such as depression, anxiety, impaired glycemic control, obesity, smoking, and physical inactivity in patients with type 1 diabetes (T1D). Methods: Cross-sectional design. The participants were consecutively recruited from one diabetes out-patient clinic. Alexithymia, depression and anxiety were assessed by self-report instruments. Blood samples, anthropometrics, and blood pressure were collected, supplemented with data from electronic health records. High Gal3BP was defined as ≥3.3 μg/ml, high sCD163 as ≥0.6 μg/ml, high galectin-3 as ≥2.6 ng/ml, impaired glycemic control as HbA1c >70 mmol/mol (>8.6%) and abdominal obesity as waist circumference ≥ 1.02 m for men and ≥ 0.88 m for women. Results: Two hundred and ninety two patients participated (men 56%, aged 18-59 years, alexithymia prevalence 15%). Patients with alexithymia had higher prevalence of depression (34 vs. 6%, p < 0.001), anxiety (61 vs. 30%, p < 0.001), high Gal3BP levels (39 vs. 17%, p = 0.004), high HbA1c levels (46 vs. 24%, p = 0.006), and abdominal obesity (29 vs. 15%, p = 0.045). Depression [adjusted odds ratio (AOR) 6.5, p < 0.001], high Gal3BP levels (AOR 2.4, p = 0.035), and age (AOR 0.96, p = 0.027) were independently associated with alexithymia. Abdominal obesity (AOR 4.0, p < 0.001), high Gal3BP levels (AOR 2.8, p = 0.002), and depression (AOR 2.9, p = 0.014) were associated with high HbA1c. Abdominal obesity and anxiety were associated [Crude odds ratio (COR) 2.4, p = 0.006]. Conclusions: T1D patients with alexithymia had higher prevalence of high Gal3BP levels, depression, impaired glycemic control, anxiety, and abdominal obesity, which are known risk factors for cardiovascular disease. Only high Gal3BP levels, depression, and younger age were independently associated with alexithymia in adult patients with T1D.
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Affiliation(s)
- Eva O Melin
- Diabetes Research Laboratory, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Region Kronoberg, Department of Research and Development, Växjö, Sweden
| | - Ralph Svensson
- Department of Psychology, Linnaeus University, Växjö, Sweden
| | - Jonatan Dereke
- Diabetes Research Laboratory, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Hillman
- Diabetes Research Laboratory, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Melin EO, Dereke J, Hillman M. Low levels of soluble TWEAK, indicating on-going inflammation, were associated with depression in type 1 diabetes: a cross-sectional study. BMC Psychiatry 2020; 20:574. [PMID: 33261587 PMCID: PMC7709277 DOI: 10.1186/s12888-020-02977-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Low levels of the soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK) and depression are linked to cardiovascular disease. Galectin-3, inadequate glycemic control and low high-density lipoprotein (HDL)-cholesterol levels were previously linked to depression in these patients with type 1 diabetes mellitus (T1DM). The main aim was to explore whether sTWEAK was associated with depression. A secondary aim was to explore diabetes related variables associated with low sTWEAK. METHODS Cross-sectional design. T1DM patients (n = 283, men 56%, age18-59 years) were consecutively recruited from one specialist diabetes clinic. Depression was defined as Hospital Anxiety and Depression Scale-Depression sub scale ≥8 points. Blood samples, anthropometrics and blood pressure were collected, supplemented with data from electronic health records. Enzyme linked immunosorbent assays were used to measure sTWEAK and galectin-3. Low sTWEAK was defined as < 7.2 ng/ml and high galectin-3 as ≥2.6 ng/ml. Multiple logistic regression analyses were performed, calibrated and validated for goodness of fit. We adjusted for age, sex, diabetes duration, galectin-3, metabolic variables, serum-creatinine, smoking, physical inactivity, medication, and cardiovascular complications. RESULTS For 29 depressed versus 254 non-depressed patients the prevalence rates were for low sTWEAK: 93 and 68% (p = 0.003) and for high galectin-3: 34 and 13% (p = 0.005) respectively. HDL-cholesterol levels were lower for the depressed (p = 0.015). Patients with low sTWEAK versus high sTWEAK had lower usage of continuous subcutaneous insulin infusion (CSII) (6% versus 17%, p = 0.005). Low sTWEAK (adjusted odds ratio (AOR) 9.0, p = 0.006), high galectin-3 (AOR 6.3, p = 0.001), HDL-cholesterol (per mmol/l) (AOR 0.1, p = 0.006), use of antidepressants (AOR 8.4, p < 0.001), and age (per year) (AOR 1.05, p = 0.027) were associated with depression. CSII (AOR 0.3, p = 0.003) and depression (AOR 7.1, p = 0.009) were associated with low sTWEAK. CONCLUSIONS Lower levels of sTWEAK and HDL-cholesterol and higher levels of galectin-3 were independently associated with depression in T1DM. These factors might all contribute to the increased risk for cardiovascular disease and mortality previously demonstrated in patients with depression. CSII (inversely) and depression were independently associated with low sTWEAK levels.
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Affiliation(s)
- Eva O Melin
- Lund University, Faculty of Medicine, Clinical Sciences, Diabetes Research Laboratory, Lund, Sweden.
- Department of Research and Development, Region Kronoberg, Box 1223, SE-351 12, Växjö, Sweden.
| | - Jonatan Dereke
- Lund University, Faculty of Medicine, Clinical Sciences, Diabetes Research Laboratory, Lund, Sweden
| | - Magnus Hillman
- Lund University, Faculty of Medicine, Clinical Sciences, Diabetes Research Laboratory, Lund, Sweden
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Melin EO, Dereke J, Hillman M. Higher levels of the soluble receptor for advanced glycation end products and lower levels of the extracellular newly identified receptor for advanced glycation end products were associated with lipid-lowering drugs in patients with type 1 diabetes: a comparative cross-sectional study. Lipids Health Dis 2020; 19:223. [PMID: 33054750 PMCID: PMC7557054 DOI: 10.1186/s12944-020-01397-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/30/2020] [Indexed: 02/10/2023] Open
Abstract
Background The receptors for advanced glycation end products (RAGE) are increased in atherosclerotic plaques. Soluble (s)RAGE decreases, whereas the extracellular newly identified receptor for advanced glycation end products (EN-RAGE) increases inflammatory responses mediated by RAGE. The aims were to explore whether sRAGE, EN-RAGE and the EN-RAGE/sRAGE ratio, were associated with the use of lipid-lowering drugs (LLD) and/or antihypertensive drugs (AHD) in patients with type 1 diabetes (T1D). Methods Cross-sectional design. T1D patients were consecutively recruited from one diabetes clinic. Blood samples were collected, supplemented with data from electronic health records. sRAGE and EN-RAGE were analysed by enzyme linked immunosorbent assays. An EN-RAGE/sRAGE ratio was calculated. Adjustments were performed with inflammatory and metabolic variables, s-creatinine, depression, smoking, physical inactivity, medication, and cardiovascular complications. Multiple regression analyses were performed. Results In this study 283 T1D patients (men 56%, 18–59 years) were included. One-hundred and thirty LLD users compared to 153 non-users had lower levels of the EN-RAGE/sRAGE ratio (P = 0.009), and 89 AHD users compared to 194 non-users had lower levels of sRAGE (P = 0.031). The use of LLD (inversely) (B coefficient − 0.158, P = 0.033) and the use of AHD (B coefficient 0.187, P = 0.023) were associated with the EN-RAGE/sRAGE ratio. sRAGE (Lg10) (per unit) (adjusted odds ratio (AOR) = 3.5, 95% CI = 1.4–9.1, P = 0.009), EN-RAGE (Lg10) (per unit) (inversely) (AOR 0.4, 95% CI = 0.2–1.0, P = 0.046), age (P < 0.001), and triglycerides (P < 0.029), were associated with LLD. sRAGE (Lg10) (per unit) (inversely) (AOR = 0.2, 95% CI = 0.1–0.5, P = 0.001), diabetes duration, triglycerides, s-creatinine, and systolic BP (all P values < 0.043), were associated with AHD. Conclusions Higher sRAGE levels and lower EN-RAGE levels were linked to the use of LLD, whereas lower sRAGE levels were linked to the use of AHD. No other variables but the use of LLD and the use of AHD were linked to the EN-RAGE/sRAGE ratio. This may be of major importance as sRAGE is an inhibitor and EN-RAGE is a stimulator of inflammatory processes mediated by RAGE.
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Affiliation(s)
- Eva O Melin
- Faculty of Medicine, Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Box 1223, SE-35112, Växjö, Sweden.
| | - Jonatan Dereke
- Faculty of Medicine, Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden
| | - Magnus Hillman
- Faculty of Medicine, Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden
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Dereke J, Nilsson C, Strevens H, Landin-Olsson M, Hillman M. Pregnancy-associated plasma protein-A2 levels are increased in early-pregnancy gestational diabetes: a novel biomarker for early risk estimation. Diabet Med 2020; 37:131-137. [PMID: 31340069 DOI: 10.1111/dme.14088] [Citation(s) in RCA: 3] [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] [Accepted: 07/23/2019] [Indexed: 01/13/2023]
Abstract
AIM To determine whether pregnancy-associated plasma protein-A2 levels are increased in early pregnancies complicated by gestational diabetes and whether gestation age influences levels. The possible use of pregnancy-associated plasma protein-A2 as a pre-screening biomarker to reduce the need for performing oral glucose tolerance tests in pregnant women was also investigated. METHODS Pregnant women were diagnosed with gestational diabetes in early pregnancy after a 2-hour 75 g oral glucose tolerance test in the catchment area of Skåne University Hospital, Lund, Sweden during 2011-2015 (n = 99). Age- and BMI-matched pregnant women without diabetes were recruited at similar gestational ages from maternal healthcare centres in the same geographical area during 2014-2015 to act as controls (n = 100). Circulating pregnancy-associated plasma protein-A2 was analysed in participant serum using commercially available enzyme-linked immunosorbent assay kits. RESULTS Circulating pregnancy-associated plasma protein-A2 was increased in women diagnosed with gestational diabetes [13.5 (9.58-18.8) ng/ml] compared with controls [8.11 (5.74-11.3) ng/ml; P < 0.001]. Pregnancy-associated plasma protein-A2 was associated with gestational diabetes independent of age, BMI, C-peptide and adiponectin (P < 0.001). Pregnancy-associated plasma protein-A2 as a pre-screening biomarker to identify women at a decreased risk of gestational diabetes resulted in a negative predictive value of 99.7%, with a sensitivity of 96% and a specificity of 30% at a cut-off level of 6 ng/ml. CONCLUSIONS This is the first study to show increased pregnancy-associated plasma protein-A2 levels in gestational diabetes. Pregnancy-associated plasma protein-A2 also shows promise as a pre-screening biomarker with the potential to reduce the need for performing oral glucose tolerance tests in early pregnancy. Future prospective cohort studies in a larger group of both high- and low-risk women are, however, needed to further confirm this observation.
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Affiliation(s)
- J Dereke
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
| | - C Nilsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
- Department of Paediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - H Strevens
- Department of Obstetrics, Skåne University Hospital Lund, Lund, Sweden
| | - M Landin-Olsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital Lund, Lund, Sweden
| | - M Hillman
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
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Melin EO, Dereke J, Hillman M. Female sex, high soluble CD163, and low HDL-cholesterol were associated with high galectin-3 binding protein in type 1 diabetes. Biol Sex Differ 2019; 10:51. [PMID: 31752995 PMCID: PMC6868807 DOI: 10.1186/s13293-019-0268-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/26/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background Galectin-3 binding protein (Gal3BP), sCD163, galectin-3, and depression have been linked to cardiovascular disease and mortality. In patients with type 1 diabetes, female sex has also been linked to cardiovascular disease and mortality. The aim was to explore whether female sex, sCD163, galectin-3, and depression were associated with Gal3BP in patients with type 1 diabetes. We adjusted for metabolic variables, creatinine, smoking, physical inactivity, and cardiovascular disease. Methods Cross-sectional design. Patients with type 1 diabetes (n = 285, women 44%, age18–59 years, diabetes duration 1–55 years) were consecutively recruited from one diabetes outpatient clinic. Blood samples, anthropometrics, and blood pressure were collected, supplemented with data from electronic medical records. High Gal3BP was defined as ≥3.3 mg/l (≥80th percentile). Depression was assessed by a self-report instrument. Linear and logistic regression models were elaborated for the associations and calibrated and validated for goodness of fit with the data variables. Results Median (q1, q3) Gal3BP was 2.3 (1.8, 3.1) mg/l. The prevalence of high Gal3BP for women was 30% and 14% for men (p = 0.001). Female sex (adjusted odds ratio (AOR) 3.0), sCD163 (per μg/l) (AOR 6.6), and total cholesterol (per mmol/l) (AOR 1.6) were positively associated with high Gal3BP, and HDL-cholesterol (per mmol/l) (AOR 0.2) was negatively associated with high Gal3BP. Conclusions High Gal3BP levels were associated with female sex, increasing sCD163 and total cholesterol levels, and decreasing HDL-cholesterol levels in patients with type 1 diabetes. The prevalence of high Gal3BP was more than twice as high in the women as in the men.
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Affiliation(s)
- Eva Olga Melin
- Diabetes Research Laboratory, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Box 1223, SE-351 12, Växjö, Sweden.
| | - Jonatan Dereke
- Diabetes Research Laboratory, Lund University, Lund, Sweden
| | - Magnus Hillman
- Diabetes Research Laboratory, Lund University, Lund, Sweden
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Dereke J, Nilsson J, Nilsson C, Strevens H, Landin-Olsson M, Hillman M. Soluble CD163 and TWEAK in early pregnancy gestational diabetes and later glucose intolerance. PLoS One 2019; 14:e0216728. [PMID: 31071174 PMCID: PMC6508637 DOI: 10.1371/journal.pone.0216728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/28/2019] [Indexed: 01/17/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is today universally diagnosed during late pregnancy. Treating hyperglycaemia during pregnancy reduces the risk of complications, the effect of interventions is however limited due to the late diagnosis. It is thus important to identify biomarkers reaching a high precision for GDM development in early pregnancy. Here we aim to investigate soluble CD163 (sCD163) and soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK) in early pregnancy GDM and their association to the development of later glucose intolerance. In this case-control study, women diagnosed with GDM in early pregnancy (n = 70) at Lund University Hospital, Lund, Sweden in 2011-2015 were age- and BMI matched to pregnant volunteers without diabetes (n = 70) recruited in early pregnancy from maternal health care centres in 2014-2015. Plasma levels of sCD163 and sTWEAK were analysed using commercial ELISA. Plasma levels of sCD163 did not differ between patients with and without GDM in early pregnancy (p = 0.86), plasma levels of sTWEAK however was decreased in women with GDM (0.71 [0.4-1.75] ng/ml) compared to controls (1.38 [0.63-4.86] ng/ml; p = 0.003). Women with sTWEAK levels in the lowest tertile had an increased risk of GDM in early pregnancy (p = 0.014). Neither sCD163 nor sTWEAK were associated with later glucose intolerance in women with GDM. This study reports decreased levels of sTWEAK in women with early pregnancy GDM, independent of age and BMI. Neither sCD163 nor sTWEAK were found to be associated to later glucose intolerance.
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Affiliation(s)
- Jonatan Dereke
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
- * E-mail:
| | - Jacob Nilsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
| | - Charlotta Nilsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
- Department of Paediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - Helena Strevens
- Department of Obstetrics, Skåne University Hospital Lund, Lund, Sweden
| | - Mona Landin-Olsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital Lund, Lund, Sweden
| | - Magnus Hillman
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund, Sweden
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Melin EO, Dereke J, Thunander M, Hillman M. Soluble CD163 was linked to galectin-3, diabetic retinopathy and antidepressants in type 1 diabetes. Endocr Connect 2018; 7:1343-1353. [PMID: 30400063 PMCID: PMC6280594 DOI: 10.1530/ec-18-0336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/10/2018] [Accepted: 10/24/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Depression has been associated with diabetic retinopathy and increased plasma levels of galectin-3, a lectin expressed in activated macrophages. Increased levels of sCD163, the soluble form of a macrophage expressed scavenger receptor involved in several inflammatory processes, have been demonstrated in the vitreous of the eye in type 1 diabetes (T1D) patients with severe diabetic retinopathy. The aim was to explore whether circulating sCD163 was associated with diabetic retinopathy, depression and/or galectin-3 in T1D patients, controlling for gender, metabolic factors, other diabetes complications, life style and medication. DESIGN Cross sectional. METHODS Two hundred eighty-seven T1D patients, men 56%, age 18-59 years, diabetes duration ≥1 year, were consecutively recruited from one specialist diabetes clinic. Depression was assessed by Hospital Anxiety and Depression Scale-Depression subscale. Blood samples, anthropometrics and blood pressure values were collected, supplemented with data from electronic medical records and the Swedish National Diabetes Registry. High plasma sCD163 was defined as ≥0.575 mg/L (corresponding to the 80th percentile) and high plasma galectin-3 as ≥4.659 µg/L (corresponding to the 95th percentile). RESULTS The prevalence of depression was 10%, antidepressant medication 8%, diabetic retinopathy 72%, high sCD163 20% and high galectin 3 5%. High galectin-3 (AOR 9.7), antidepressants (AOR 3.8), diabetic retinopathy (AOR 2.4) and systolic blood pressure (per mmHg) (AOR 1.03) were associated with high sCD163. CONCLUSIONS This is the first study to show that circulating sCD163 was independently associated with galectin-3, the use of antidepressants and diabetic retinopathy, in patients with T1D. Depression was not associated with sCD163.
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Affiliation(s)
- Eva O Melin
- Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden
- Department of Research and Development, Växjö, Sweden
- Primary Care, Växjö, Sweden
- Correspondence should be addressed to E O Melin:
| | - Jonatan Dereke
- Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund University, Lund, Sweden
| | - Maria Thunander
- Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden
- Department of Research and Development, Växjö, Sweden
- Department of Internal Medicine, Endocrinology and Diabetes, Central Hospital, Växjö, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund University, Lund, Sweden
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Melin EO, Dereke J, Thunander M, Hillman M. Depression in type 1 diabetes was associated with high levels of circulating galectin-3. Endocr Connect 2018; 7:819-828. [PMID: 29760188 PMCID: PMC6000756 DOI: 10.1530/ec-18-0108] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Neuroinflammatory responses are implicated in depression. The aim was to explore whether depression in patients with type 1 diabetes (T1D) was associated with high circulating galectin-3, controlling for metabolic variables, s-creatinine, life style factors, medication and cardiovascular complications. DESIGN Cross-sectional. METHODS Participants were T1D patients (n = 283, 56% men, age 18-59 years, diabetes duration ≥1 year). Depression was assessed by Hospital Anxiety and Depression Scale-depression subscale. Blood samples, anthropometrics and blood pressure were collected, and supplemented with data from medical records and the Swedish National Diabetes Registry. Galectin-3 ≥2.562 µg/l, corresponding to the 85th percentile, was defined as high galectin-3. RESULTS Median (quartile1, quartile3) galectin-3 (µg/l) was 1.3 (0.8, 2.9) for the 30 depressed patients, and 0.9 (0.5, 1.6) for the 253 non-depressed, P = 0.009. Depression was associated with high galectin-3 in all the 283 patients (adjusted odds ratio (AOR) 3.5), in the 161 men (AOR 3.4), and in the 122 women (AOR 3.9). HbA1c, s-lipids, s-creatinine, blood pressure, obesity, smoking, physical inactivity, cardiovascular complications and drugs (antihypertensive, lipid lowering, oral antidiabetic drugs and antidepressants) were not associated with high galectin-3. CONCLUSIONS This is the first study to show an association between depression and galectin-3. Depression was the only explored parameter associated with high circulating galectin-3 levels in 283 T1D patients. High galectin-3 levels might contribute to the increased risk for Alzheimer's disease, cardiovascular and all-cause mortality observed in persons with depression. Potentially, in the future, treatment targeting galactin-3 might improve the prognosis for patients with high galectin-3 levels.
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Affiliation(s)
- Eva Olga Melin
- Department of Clinical SciencesEndocrinology and Diabetes, Lund University, Faculty of Medicine, Lund, Sweden
- Department of Research and DevelopmentRegion Kronoberg, Växjö, Sweden
- Region KronobergPrimary Care, Växjö, Sweden
| | - Jonatan Dereke
- Department of Clinical Sciences LundLund University, Faculty of Medicine, Diabetes Research Laboratory, Lund, Sweden
| | - Maria Thunander
- Department of Clinical SciencesEndocrinology and Diabetes, Lund University, Faculty of Medicine, Lund, Sweden
- Department of Research and DevelopmentRegion Kronoberg, Växjö, Sweden
- Department of Internal MedicineEndocrinology and Diabetes, Central Hospital, Växjö, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences LundLund University, Faculty of Medicine, Diabetes Research Laboratory, Lund, Sweden
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Dereke J, Hillman M. The significance of biomarkers such as FABP4 in gestational diabetes mellitus and the importance of rigorous peer review. Acta Diabetol 2017; 54:885-886. [PMID: 28741103 DOI: 10.1007/s00592-017-1026-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 12/21/2016] [Accepted: 07/07/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Jonatan Dereke
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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Alonso Lopez Y, Dereke J, Landin-Olsson M, Strevens H, Nilsson C, Hillman M. Plasma levels of relaxin-2 are higher and correlated to C-peptide levels in early gestational diabetes mellitus. Endocrine 2017; 57:545-547. [PMID: 28664310 DOI: 10.1007/s12020-017-1354-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Yoatzin Alonso Lopez
- Faculty of Medicine, Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden
| | - Jonatan Dereke
- Faculty of Medicine, Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden
| | - Mona Landin-Olsson
- Faculty of Medicine, Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden
- Skåne University Hospital, Department of Endocrinology, Lund University, Lund, Sweden
| | - Helena Strevens
- Skåne University Hospital, Department of Obstetrics, Lund University, Lund, Sweden
| | | | - Magnus Hillman
- Faculty of Medicine, Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden.
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Samuelsson M, Dereke J, Svensson MK, Landin-Olsson M, Hillman M. Soluble plasma proteins ST2 and CD163 as early biomarkers of nephropathy in Swedish patients with diabetes, 15-34 years of age: a prospective cohort study. Diabetol Metab Syndr 2017; 9:41. [PMID: 28559931 PMCID: PMC5445394 DOI: 10.1186/s13098-017-0240-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/17/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate plasma levels of sST2 and sCD163 to determine whether they at an early stage could predict development of diabetic nephropathy and/or diabetic retinopathy in patients at clinical onset. METHODS Patients diagnosed with diabetes mellitus at age 15-34 years between 1987 and 1988 (n = 220) were included. Data such as BMI, smoking, HbA1c and islet cell antibodies were collected at time of diagnosis. Within the 10 year follow-up period, 112 patients (51%) developed following diabetes related complications; retinopathy (n = 91), nephropathy (n = 12) or both (n = 9). Plasma concentrations of sST2 and sCD163 were measured at time of diagnosis and levels compared between different complication groups. RESULTS Plasma levels of sST2 were significantly higher in patients who later developed nephropathy (n = 21; 1012 [773-1493] pg/ml) compared to those who did not (n = 199; 723 [449-1084] pg/ml; p = 0.006). A tendency for higher plasma levels of sCD163 was observed but not statistically significant (p = 0.058). CONCLUSIONS sST2 and sCD163 show promise as potential biomarkers for the development of nephropathy already at clinical onset. sST2 and/or sCD163 could possibly be part of a biomarker panel aimed to find patients at high risk of developing nephropathy. Both markers need to be investigated in a larger prospective study.
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Affiliation(s)
- My Samuelsson
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, BMC, B11, 221 84 Lund, Sweden
| | - Jonatan Dereke
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, BMC, B11, 221 84 Lund, Sweden
| | | | - Mona Landin-Olsson
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, BMC, B11, 221 84 Lund, Sweden
- Department of Endocrinology, Skåne University Hospital Lund, Lund, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, BMC, B11, 221 84 Lund, Sweden
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Dereke J, Palmqvist S, Nilsson C, Landin-Olsson M, Hillman M. The prevalence and predictive value of the SLC30A8 R325W polymorphism and zinc transporter 8 autoantibodies in the development of GDM and postpartum type 1 diabetes. Endocrine 2016; 53:740-6. [PMID: 27003436 DOI: 10.1007/s12020-016-0932-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
The objectives were to evaluate possible associations between the SLC30A8 R325W polymorphism and gestational diabetes mellitus (GDM) as well as postpartum development of type 2 diabetes. Furthermore, we wanted to confirm the prevalence of zinc transporter 8 autoantibodies (ZnT8A), as previously reported, in a larger population and study its predictive value in relation to other β cell specific autoantibodies in postpartum development of type 1 diabetes. Women diagnosed with GDM (n = 776) and women without diabetes (n = 511) were included in the study. Autoantibodies were analyzed in all women using enzyme-linked immunosorbent assay. DNA was extracted when possible from women with GDM (n = 536) and all of the controls. R325W was detected through polymerase chain reaction and specific restriction digestion. The R325W C-allele were more frequent in women with GDM compared to in controls (OR 1.47, 95 % CI 1.16-1.88, p = 0.0018) but not significantly increased in women with GDM and postpartum development of type 2 diabetes. Autoantibodies were found in 6.8 % (53/776) of the women with GDM and approximately 3.2 % (25/776) were ZnT8A positive. Approximately 19 % (10/53) of the autoantibody positive women with GDM developed postpartum type 1 diabetes. In conclusion, this is the first study to report a significant association between the R325W C-allele and increased risk of developing GDM. All of the autoantibody positive women with GDM who developed postpartum type 1 diabetes were positive for autoantibodies against glutamic acid decarboxylase (GADA). Thus ZnT8A did not have any additional predictive value in postpartum development of type 1 diabetes.
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Affiliation(s)
- Jonatan Dereke
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, B11, BMC, 221 84, Lund, Sweden.
| | - Sanna Palmqvist
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, B11, BMC, 221 84, Lund, Sweden
| | - Charlotta Nilsson
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, B11, BMC, 221 84, Lund, Sweden
- Department of Pediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - Mona Landin-Olsson
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, B11, BMC, 221 84, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, B11, BMC, 221 84, Lund, Sweden
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Dereke J, Nilsson C, Strevens H, Landin-Olsson M, Hillman M. IgG4 subclass glutamic acid decarboxylase antibodies (GADA) are associated with a reduced risk of developing type 1 diabetes as well as increased C-peptide levels in GADA positive gestational diabetes. Clin Immunol 2015; 162:45-8. [PMID: 26548838 DOI: 10.1016/j.clim.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 01/01/2023]
Abstract
Some women with gestational diabetes (GDM) present with autoantibodies associated with type 1 diabetes. These are usually directed against glutamic acid decarboxylase (GADA) and suggested to predict development of type 1 diabetes. The primary aim of this study was to investigate if GADA IgG subclasses at onset of GDM could assist in predicting postpartum development. Of 1225 women diagnosed with first-time GDM only 51 were GADA-positive. Total GADA was determined using ELISA. GADA subclasses were determined with radioimmunoassay. Approximately 25% of GADA-positive women developed type 1 diabetes postpartum. Titers of total GADA were higher in women that developed type 1 diabetes (142.1 vs 74.2u/mL; p=0.04) and they also had lower titers of GADA IgG4 (index=0.01 vs 0.04; p=0.03). In conclusion we found that that women with high titers of total GADA but low titers of GADA IgG4 were more prone to develop type 1 diabetes postpartum.
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Affiliation(s)
- Jonatan Dereke
- Lund University, Department of Clinical Sciences, Diabetes Research Laboratory, Lund, Sweden.
| | - Charlotta Nilsson
- Lund University, Department of Clinical Sciences, Diabetes Research Laboratory, Lund, Sweden; Helsingborg Hospital, Department of Pediatrics, Helsingborg, Sweden.
| | - Helena Strevens
- Skåne University Hospital Lund, Department of Obstetrics, Lund, Sweden.
| | - Mona Landin-Olsson
- Lund University, Department of Clinical Sciences, Diabetes Research Laboratory, Lund, Sweden; Skåne University Hospital Lund, Department of Endocrinology, Lund, Sweden.
| | - Magnus Hillman
- Lund University, Department of Clinical Sciences, Diabetes Research Laboratory, Lund, Sweden.
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Abstract
AIMS Gestational diabetes mellitus affects approximately 7% of all pregnant women. Some of these women develop autoantibodies that are generally characteristic of Type 1 diabetes. Autoantibodies targeting glutamic acid decarboxylase and tyrosine phosphatase-like protein are the most frequently reported. A recently identified autoantigen in Type 1 diabetes is zinc transporter 8. Some reports suggest that the frequency of zinc transporter 8 antibodies is as high as glutamic acid decarboxylase antibodies in Type 1 diabetes and thus a good diagnostic marker for autoimmune diabetes. There are currently no reports of zinc transporter 8 antibodies in gestational diabetes. The aim of this pilot study was to investigate the frequency of zinc transporter 8 antibodies in patients at clinical onset of gestational diabetes mellitus. METHODS Subjects included in this pilot study were all diagnosed with gestational diabetes at Skåne University Hospital, Lund, Sweden, 2009-2010 (n = 193). Sera samples were analysed for antibodies using a commercial enzyme-linked immunosorbent assay according to the manufacturers' instructions. RESULTS We found that 19/193 patients with gestational diabetes, diagnosed in 2009-2010, were positive for at least one autoantibody. Glutamic acid decarboxylase was the most common single autoantibody (52.6%; 10/19), followed by zinc transporter 8 (21.1%; 4/19) and tyrosine phosphatase-like protein (15.8%; 3/19). Combinations of two or more antibodies were rare (10.5%; 2/19). CONCLUSIONS In this study, we found that zinc transporter 8 added 2.1% (4/193) of autoantibody positivity in women with gestational diabetes who were negative for glutamic acid decarboxylase and tyrosine phosphatase-like protein antibodies. Glutamic acid decarboxylase was still the most prevalent autoantibody in gestational diabetes, but, as zinc transporter 8 was present even in the absence of glutamic acid decarboxylase, this autoantibody could be an important independent marker of autoimmunity in gestational diabetes.
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Affiliation(s)
- J Dereke
- Department of Clinical Sciences, Lund University, Lund, Sweden
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