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Hu X, Buhl CS, Sjogaard MB, Schousboe K, Mizrak HI, Kufaishi H, Jensen TS, Hansen CS, Yderstræde KB, Zhang MD, Ernfors P, Nyengaard JR, Karlsson P. Structural changes in Schwann cells and nerve fibres in type 1 diabetes: relationship with diabetic polyneuropathy. Diabetologia 2023; 66:2332-2345. [PMID: 37728731 PMCID: PMC10627903 DOI: 10.1007/s00125-023-06009-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023]
Abstract
AIMS/HYPOTHESIS Our aim was to investigate structural changes of cutaneous Schwann cells (SCs), including nociceptive Schwann cells (nSCs) and axons, in individuals with diabetic polyneuropathy. We also aimed to investigate the relationship between these changes and peripheral neuropathic symptoms in type 1 diabetes. METHODS Skin biopsies (3 mm) taken from carefully phenotyped participants with type 1 diabetes without polyneuropathy (T1D, n=25), type 1 diabetes with painless diabetic polyneuropathy (T1DPN, n=30) and type 1 diabetes with painful diabetic polyneuropathy (P-T1DPN, n=27), and from healthy control individuals (n=25) were immunostained with relevant antibodies to visualise SCs and nerve fibres. Stereological methods were used to quantify the expression of cutaneous SCs and nerve fibres. RESULTS There was a difference in the number density of nSCs not abutting to nerve fibres between the groups (p=0.004) but not in the number density of nSCs abutting to nerve fibres, nor in solitary or total subepidermal SC soma number density. The overall dermal SC expression (measured by dermal SC area fraction and subepidermal SC process density) and peripheral nerve fibre expression (measured by intraepidermal nerve fibre density, dermal nerve fibre area fraction and subepidermal nerve fibre density) differed between the groups (all p<0.05): significant differences were seen in participants with T1DPN and P-T1DPN compared with those without diabetic polyneuropathy (healthy control and T1D groups) (all p<0.05). No difference was found between participants in the T1DPN and P-T1DPN group, nor between participants in the T1D and healthy control group (all p>0.05). Correlational analysis showed that cutaneous SC processes and nerve fibres were highly associated, and they were weakly negatively correlated with different neuropathy measures. CONCLUSIONS/INTERPRETATION Cutaneous SC processes and nerves, but not SC soma, are degenerated and interdependent in individuals with diabetic polyneuropathy. However, an increase in structurally damaged nSCs was seen in individuals with diabetic polyneuropathy. Furthermore, dermal SC processes and nerve fibres correlate weakly with clinical measures of neuropathy and may play a partial role in the pathophysiology of diabetic polyneuropathy in type 1 diabetes.
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Affiliation(s)
- Xiaoli Hu
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
| | | | - Marie Balle Sjogaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karoline Schousboe
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | | | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Ming-Dong Zhang
- Department of Medical Biochemistry and Biophysics, Division of Molecular Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Ernfors
- Department of Medical Biochemistry and Biophysics, Division of Molecular Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Jens Randel Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Pall Karlsson
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark.
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Hu X, Buhl CS, Sjogaard MB, Schousboe K, Mizrak HI, Kufaishi H, Hansen CS, Yderstræde KB, Jensen TS, Nyengaard JR, Karlsson P. Structural Changes of Cutaneous Immune Cells in Patients With Type 1 Diabetes and Their Relationship With Diabetic Polyneuropathy. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200144. [PMID: 37527931 PMCID: PMC10393274 DOI: 10.1212/nxi.0000000000200144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/01/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Diabetic polyneuropathy (DPN) is a complication of diabetes characterized by pain or lack of peripheral sensation, but the underlying mechanisms are not yet fully understood. Recent evidence showed increased cutaneous macrophage infiltration in patients with type 2 diabetes and painful DPN, and this study aimed to understand whether the same applies to type 1 diabetes. METHODS The study included 104 participants: 26 healthy controls and 78 participants with type 1 diabetes (participants without DPN [n = 24], participants with painless DPN [n = 29], and participants with painful DPN [n = 25]). Two immune cells, dermal IBA1+ macrophages and epidermal Langerhans cells (LCs, CD207+), were visualized and quantified using immunohistological labeling and stereological counting methods on skin biopsies from the participants. The IBA1+ macrophage infiltration, LC number density, LC soma cross-sectional area, and LC processes were measured in this study. RESULTS Significant difference in IBA1+ macrophage expression was seen between the groups (p = 0.003), with lower expression of IBA1 in participants with DPN. No differences in LC morphologies (LC number density, soma cross-sectional area, and process level) were found between the groups (all p > 0.05). In addition, IBA1+ macrophages, but not LCs, correlated with intraepidermal nerve fiber density, Michigan neuropathy symptom inventory, (questionnaire and total score), severity of neuropathy as assessed by the Toronto clinical neuropathy score, and vibration detection threshold in the whole study cohort. DISCUSSION This study showed expressional differences of cutaneous IBA1+ macrophages but not LC in participants with type 1 diabetes-induced DPN compared with those in controls. The study suggests that a reduction in macrophages may play a role in the development and progression of autoimmune-induced diabetic neuropathy.
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Affiliation(s)
- Xiaoli Hu
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Christian S Buhl
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Marie B Sjogaard
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Karoline Schousboe
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Hatice I Mizrak
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Huda Kufaishi
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Christian S Hansen
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Knud B Yderstræde
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Troels S Jensen
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Jens R Nyengaard
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark
| | - Pall Karlsson
- From the Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University (X.H., M.B.S., J.R.N., P.K.); Steno Diabetes Center Copenhagen (H.I.M., H.K., C.S.H.); Steno Diabetes Center Aarhus (C.B., P.K.); Steno Diabetes Center Odense (K.S., K.B.Y.); Aarhus University Hospital (T.S.J., J.R.N.), Denmark.
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Reinhard M, Schousboe K, Andersen UB, Buus NH, Rantanen JM, Bech JN, Mafi HM, Langfeldt S, Bharadwaz A, Hørlyck A, Jensen MK, Jeppesen J, Olsen MH, Jacobsen IA, Bibby BM, Christensen KL. Renal Artery Stenting in Consecutive High-Risk Patients With Atherosclerotic Renovascular Disease: A Prospective 2-Center Cohort Study. J Am Heart Assoc 2022; 11:e024421. [PMID: 35322677 PMCID: PMC9075498 DOI: 10.1161/jaha.121.024421] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Indexed: 01/22/2023]
Abstract
Background The aim of this study was to prospectively evaluate the effects of renal artery stenting in consecutive patients with severe atherosclerotic renal artery stenosis and high‐risk clinical presentations as defined in a national protocol developed in 2015. Methods and Results Since the protocol was initiated, 102 patients have been referred for revascularization according to the following high‐risk criteria: severe renal artery stenosis (≥70%) with true resistant hypertension, rapidly declining kidney function, or recurrent heart failure/sudden pulmonary edema. At baseline, the mean 24‐hour ambulatory systolic blood pressure was 166.2 mm Hg (95% CI, 162.0–170.4), the defined daily dose of antihypertensive medication was 6.5 (95% CI, 5.8–7.3), and the estimated glomerular filtration rate was 41.1 mL/min per 1.73m2 (95% CI, 36.6–45.6). In 96 patients with available 3‐month follow‐up data, mean 24‐hour ambulatory systolic blood pressure decreased by 19.6 mm Hg (95% CI, 15.4–23.8; P<0.001), the defined daily dose of antihypertensive medication was reduced by 52% (95% CI, 41%–62%; P<0.001), and estimated glomerular filtration rate increased by 7.8 mL/min per 1.73m2 (95% CI, 4.5–11.1; P<0.001). All changes persisted after 24 month follow‐up. Among 17 patients with a history of hospitalization for acute decompensated heart failure, 14 patients had no new episodes after successful revascularization. Conclusions In this prospective cohort study, we observed a reduction in blood pressure and antihypertensive medication, an increase in estimated glomerular filtration rate, and a decrease in new hospital admissions attributable to heart failure/sudden pulmonary edema after renal artery stenting. Registration URL: https://clinicaltrials.gov. Identifier: NCT02770066.
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Affiliation(s)
- Mark Reinhard
- Department of Renal Medicine and The Clinic of Hypertension Aarhus University Hospital Denmark.,Department of Clinical Medicine Aarhus University Denmark
| | - Karoline Schousboe
- Department of Endocrinology/Steno Diabetes Center Odense and The Clinic of Hypertension Odense University Hospital Denmark
| | - Ulrik B Andersen
- Department of Clinical Physiology and Nuclear Medicine Rigshospitalet, GlostrupUniversity of Copenhagen Glostrup Denmark
| | - Niels Henrik Buus
- Department of Renal Medicine and The Clinic of Hypertension Aarhus University Hospital Denmark.,Department of Clinical Medicine Aarhus University Denmark
| | | | - Jesper Nørgaard Bech
- Department of Medicine University Clinic in Nephrology and HypertensionGodstrup Regional Hospital Denmark
| | | | - Sten Langfeldt
- Department of Radiology Aarhus University Hospital Aarhus N Denmark
| | | | - Arne Hørlyck
- Department of Radiology Aarhus University Hospital Aarhus N Denmark
| | | | - Jørgen Jeppesen
- Department of Medicine Amager Hvidovre Hospital GlostrupUniversity of Copenhagen Glostrup Denmark.,Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine Holbaek Hospital Denmark.,Centre for Individualized Medicine in Arterial Diseases (CIMA) Department of Regional Health Research University of Southern Denmark Odense C Denmark
| | - Ib Abildgaard Jacobsen
- Department of Endocrinology/Steno Diabetes Center Odense and The Clinic of Hypertension Odense University Hospital Denmark
| | | | - Kent Lodberg Christensen
- Department of Clinical Medicine Aarhus University Denmark.,Department of Cardiology and The Clinic of Hypertension Aarhus University Hospital Denmark
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Henriksen DP, Ennis ZN, Panou V, Hangaard J, Jensen PB, Johansson SL, Nagarajah S, Poulsen MK, Rothmann MJ, Schousboe K, Bugge SJ, Jessen LB, Schneider IR, Olsen Zwisler AD, Højlund K, Damkier P. Physician-led in-hospital multidisciplinary team conferences with multiple medical specialities present - A scoping review. J Multimorb Comorb 2022; 12:26335565221141745. [PMID: 36518524 PMCID: PMC9742578 DOI: 10.1177/26335565221141745] [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] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Multidisciplinary Team Conferences (MDTs) are complex interventions in the modern healthcare system and they promote a model of coordinated patient care and management. However, MDTs within chronic diseases are poorly defined. Therefore, the aim of this scoping review was to summarise the current literature on physician-led in-hospital MDTs in chronic non-malignant diseases. METHOD Following the PRISMA-ScR guideline for scoping reviews, a search on MDT interventions in adult patients, with three or more medical specialties represented, was performed. RESULTS We identified 2790 studies, from which 8 studies were included. The majority of studies were non-randomised and focused on a single disease entity such as infective endocarditis, atrial fibrillation, IgG4-related disease, or arterial and venous thrombosis. The main reason for referral was confirmation or establishment of a diagnosis, and the MDT members were primarily from medical specialties gathered especially for the MDT. Outcomes of the included studies were grouped into process indicators and outcome indicators. Process indicators included changes in diagnostic confirmation as well as therapeutic strategy and management. All studies reporting process indicators demonstrated significant changes before and after the MDT. CONCLUSION MDTs within chronic diseases appeared highly heterogeneous with respect to structure, reasons for referral, and choice of outcomes. While process indicators, such as change in diagnosis, and treatment management/plan seem improved, such have not been demonstrated through outcome indicators.
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Affiliation(s)
- Daniel Pilsgaard Henriksen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Zandra Nymand Ennis
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Vasiliki Panou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Jørgen Hangaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Per Bruno Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Sofie Lock Johansson
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Subagini Nagarajah
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Marianne Kjær Poulsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Karoline Schousboe
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Stine Jorstad Bugge
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Ida Ransby Schneider
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ann Dorthe Olsen Zwisler
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Per Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Oxlund CS, Buhl KB, Jacobsen IA, Hansen MR, Gram J, Henriksen JE, Schousboe K, Tarnow L, Jensen BL. Amiloride lowers blood pressure and attenuates urine plasminogen activation in patients with treatment-resistant hypertension. ACTA ACUST UNITED AC 2015; 8:872-81. [PMID: 25492830 DOI: 10.1016/j.jash.2014.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 09/21/2014] [Accepted: 09/22/2014] [Indexed: 01/13/2023]
Abstract
In conditions with albuminuria, plasminogen is aberrantly filtered across the glomerular barrier and activated along the tubular system to plasmin. In the collecting duct, plasmin activates epithelial sodium channels (ENaC) proteolytically. Hyperactivity of ENaC could link microalbuminuria/proteinuria to resistant hypertension. Amiloride, an ENaC inhibitor, inhibits urokinase-type plasminogen activator. We hypothesized that amiloride (1) reduces blood pressure (BP); (2) attenuates plasminogen-to-plasmin activation; and (3) inhibits urine urokinase-type plasminogen activator in patients with resistant hypertension and type 2 diabetes mellitus (T2DM).In an open-label, non-randomized, 8-week intervention study, a cohort (n = 80) of patients with resistant hypertension and T2DM were included. Amiloride (5 mg/d) was added to previous triple antihypertensive treatment (including a diuretic and an inhibitor of the renin-angiotensin-aldosterone system) and increased to 10 mg if BP control was not achieved at 4 weeks. Complete dataset for urine analysis was available in 60 patients. Systolic and diastolic BP measured by ambulatory BP monitoring and office monitoring were significantly reduced. Average daytime BP was reduced by 6.3/3.0 mm Hg. Seven of 80 cases (9%) discontinued amiloride due to hyperkalemia >5.5 mol/L, the most frequent adverse event. Urinary plasmin(ogen) and albumin excretions were significantly reduced after amiloride treatment (P < .0001). Urokinase activity was detectable in macroalbuminuric urine, with a tendency toward reduction in activity after amiloride treatment. Amiloride lowers BP, urine plasminogen excretion and activation, and albumin/creatinine ratio, and is a relevant add-on medication for the treatment of resistant hypertension in patients with T2DM and microalbuminuria.
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Affiliation(s)
- Christina S Oxlund
- Research Unit for Cardiovascular and Metabolic Prevention, Department of Endocrinology, Odense University Hospital, Odense, Denmark.
| | - Kristian B Buhl
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Ib A Jacobsen
- Research Unit for Cardiovascular and Metabolic Prevention, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Mie R Hansen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jeppe Gram
- Department of Endocrinology, Sydvestjysk Sygehus, Esbjerg, Denmark
| | - Jan Erik Henriksen
- Research Unit for Cardiovascular and Metabolic Prevention, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | | | - Lise Tarnow
- Steno Diabetes Center, Nordsjaellands Hospital, Århus University, Århus, Denmark
| | - Boye L Jensen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Oxlund CS, Cangemi C, Henriksen JE, Jacobsen IA, Gram J, Schousboe K, Tarnow L, Argraves WS, Rasmussen LM. Low-dose spironolactone reduces plasma fibulin-1 levels in patients with type 2 diabetes and resistant hypertension. J Hum Hypertens 2014; 29:28-32. [PMID: 24739800 DOI: 10.1038/jhh.2014.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/03/2014] [Accepted: 02/21/2014] [Indexed: 12/20/2022]
Abstract
Diabetic patients with hypertension are at particularly high risk of vascular damage and consequently cardiovascular and renal disease. Fibulin-1, an extracellular matrix glycoprotein, is increased in arterial tissue and plasma from individuals with type 2 diabetes. This study aimed to evaluate whether antihypertensive treatment with spironolactone changes plasma fibulin-1 levels. In a multicenter, double-blind, randomized, placebo-controlled study, 119 patients with type 2 diabetes and resistant hypertension were included. A dose of spironolactone 25 mg or matching placebo was added to previous treatment at randomization. Blood pressure (BP) and plasma fibulin-1 were measured at baseline and at 16 weeks follow-up. Overall, 112 patients completed the study. All measures of BP were reduced in the spironolactone group at follow-up. Plasma fibulin-1 was significantly reduced after spironolactone treatment (P=0.009), but increased after placebo (P=0.017). Baseline plasma fibulin-1 correlated with BP and estimated glomerular filtration rate. Increased levels of plasma fibulin-1 (P=0.004) were observed in diabetic participants reporting erectile dysfunction as compared with participants who did not. Treatment with low-dose spironolactone reduced plasma fibulin-1 levels in patients with type 2 diabetes and resistant hypertension. This supports the hypothesis that the antihypertensive effect of the mineralocorticoid receptor blocker in part may be due to regression of vascular remodeling.
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Affiliation(s)
- C S Oxlund
- 1] Research Unit for Cardiovascular and Metabolic Prevention, Department of Endocrinology, Odense University Hospital, Odense C, Denmark [2] Centre for individualized Medicine in Arterial Diseases, Odense University Hospital, Odense C, Denmark
| | - C Cangemi
- 1] Centre for individualized Medicine in Arterial Diseases, Odense University Hospital, Odense C, Denmark [2] Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - J E Henriksen
- Research Unit for Cardiovascular and Metabolic Prevention, Department of Endocrinology, Odense University Hospital, Odense C, Denmark
| | - I A Jacobsen
- Research Unit for Cardiovascular and Metabolic Prevention, Department of Endocrinology, Odense University Hospital, Odense C, Denmark
| | - J Gram
- Department of Endocrinology, Esbjerg, Denmark
| | | | - L Tarnow
- Steno Diabetes Centre, Gentofte, Denmark
| | - W S Argraves
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - L M Rasmussen
- 1] Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark [2] Department of Endocrinology, Esbjerg, Denmark
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Marmolin ES, Brødsgaard J, Gjessing HJ, Schousboe K, Grodum E, Jørgensen UL, Møller CC, Pedersen J. Better treatment of outpatients with type 1 diabetes after introduction of continuous subcutaneous insulin infusion. Dan Med J 2012; 59:A4445. [PMID: 22677243] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Continuous subcutaneous insulin infusion (CSII) was introduced in the outpatient diabetes clinic in Fredericia, Denmark, in 2005. The aim of this study was to evaluate the quality of metabolic control and patient satisfaction in type 1 diabetic patients treated with CSII. MATERIAL AND METHODS In 2009-2010, a database with registration of metabolic variables and patient satisfaction was established. The collected material is a combination of retrospective and prospective data. Patient satisfaction was measured by use of the Diabetes Treatment Satisfaction Questionnaire Status (DTSQs) and change (DTSQc) versions. RESULTS By 31 December 2010, the database contained data from 68 active patients. Compared with before the initiation of CSII, glycohaemoglobin (HbA1c) had decreased significantly from 8.0% (5.8-13.7%) to 7.6% (6.1-9.5%). The improved glycaemic control was maintained each year until ≤ 4 years after initiation of CSII (p < 0.01).The fraction of patients with an HbA1c ≤ 7% had increased from 13% to 24%, the fraction of patients with an HbA1c > 9% had decreased from 18% to 3%, and the number of serious attacks of hypoglycaemia had decreased (p < 0.05). Only three episodes of ketoacidosis were observed. The DTSQs and DTSQc showed a higher patient satisfaction during CSII treatment (p < 0.01) than before its introduction. Compared with before the introduction of CSII, the patient satisfaction score had increased from 19 (12-33) to 34.5 (27-36) (p < 0.01). CONCLUSION Type 1 diabetes patients who were changed from treatment with multi-injection therapy to CSII showed improved glycaemic control, a reduced number of hypoglycaemic attacks and improved and very high levels of patient satisfaction.
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Schousboe K, Titlestad K, Baudier F, Hansen LU, Bistrup C. ABO-incompatible kidney transplantation. Dan Med Bull 2010; 57:A4197. [PMID: 21040684] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Kidney transplantation is the optimal treatment for many patients with end-stage renal disease (ESRD). Due to shortage of donor kidneys in Denmark, there is a need to expand the possibilities for donation. At the Odense University Hospital (OUH), we have introduced ABO-incompatible kidney transplantation. We used antigenspecific immunoadsorptions to remove blood group antibodies and anti-CD20 antibody (rituximab) to inhibit the antibody production. The aim of introducing the ABO-incompatible kidney transplantation at the OUH was to increase the rate of living donor kidney transplantation without increasing rejection or mortality rates. MATERIAL AND METHODS Retrospective evaluation. Eleven patients received ABO-incompatible kidney transplantation. The patients were followed for 3-26 months. RESULTS One patient had an antibody-mediated rejection, one patient suffered T-cell-mediated rejection, and one patient died of myocardial infarction with a functioning graft on the third post-operative day. Both rejections were treated effectively. Among the patients, the average serum creatinine level was 128 micromol/l. CONCLUSION The rejection and mortality rates for ABO-incompatible kidney transplantation at the OUH are similar to the results from ABO-compatible kidney transplantations performed at the OUH and at other hospitals.
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Silventoinen K, Hasselbalch AL, Lallukka T, Bogl L, Pietiläinen KH, Heitmann BL, Schousboe K, Rissanen A, Kyvik KO, Sørensen TIA, Kaprio J. Modification effects of physical activity and protein intake on heritability of body size and composition. Am J Clin Nutr 2009; 90:1096-103. [PMID: 19710197 PMCID: PMC2744628 DOI: 10.3945/ajcn.2009.27689] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [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 The development of obesity is still a poorly understood process that is dependent on both genetic and environmental factors. OBJECTIVE The objective was to examine how physical activity and the proportion of energy as protein in the diet modify the genetic variation of body mass index (BMI), waist circumference, and percentage body fat. DESIGN Twins from Denmark (756 complete pairs) and Finland (278 complete pairs) aged 18-67 and 21-24 y, respectively, participated. The proportion of energy as protein in the diet was estimated by using food-frequency questionnaires. The participants reported the frequency and intensity of their leisure time physical activity. Waist circumference and BMI were measured. Percentage body fat was assessed in Denmark by using a bioelectrical impedance method. The data were analyzed by using gene-environment interaction models for twin data with the Mx statistical package (Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA). RESULTS High physical activity was associated with lower mean values, and a high proportion of protein in the diet was associated with higher mean BMI, waist circumference, and percentage body fat and a reduction in genetic and environmental variances. Genetic modification by physical activity was statistically significant for BMI (-0.18; 95% CI: -0.31, -0.05) and waist circumference (-0.14; 95% CI: -0.22, -0.05) in the merged data. A high proportion of protein in the diet reduced genetic and environmental variances in BMI and waist circumference in Danish men but not in women or in Finnish men. CONCLUSIONS Our results suggest that, in physically active individuals, the genetic variation in weight is reduced, which possibly suggests that physical activity is able to modify the action of the genes responsible for predisposition to obesity, whereas the protein content of the diet has no appreciable effect.
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Benyamin B, Sørensen TIA, Schousboe K, Fenger M, Visscher PM, Kyvik KO. Are there common genetic and environmental factors behind the endophenotypes associated with the metabolic syndrome? Diabetologia 2007; 50:1880-1888. [PMID: 17624514 DOI: 10.1007/s00125-007-0758-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [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] [Received: 08/21/2006] [Accepted: 06/05/2007] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS The cluster of obesity, insulin resistance, dyslipidaemia and hypertension, called the metabolic syndrome, has been suggested as a risk factor for cardiovascular disease and type 2 diabetes. The aim of the present study was to evaluate whether there are common genetic and environmental factors influencing this cluster in a general population of twin pairs. MATERIALS AND METHODS A multivariate genetic analysis was performed on nine endophenotypes associated with the metabolic syndrome from 625 adult twin pairs of the GEMINAKAR study of the Danish Twin Registry. RESULTS All endophenotypes showed moderate to high heritability (0.31-0.69) and small common environmental variance (0.05-0.21). In general, genetic and phenotypic correlations between the endophenotypes were strong only within sets of physiologically similar endophenotypes, but weak to moderate for other pairs of endophenotypes. However, moderate correlations between insulin resistance indices and either obesity-related endophenotypes or triacylglycerol levels indicated that some common genetic backgrounds are shared between those components. CONCLUSIONS/INTERPRETATION We demonstrated that, in a general population, the endophenotypes associated with the metabolic syndrome apparently do not share a substantial common genetic or familial environmental background.
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Affiliation(s)
- B Benyamin
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, Scotland, UK
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - T I A Sørensen
- Danish Epidemiology Science Centre, Institute of Preventive Medicine, Copenhagen University Hospitals, Centre for Health and Society, Copenhagen, Denmark
| | - K Schousboe
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Sdr. Boulevard 23A, 5000, Odense C, Denmark
| | - M Fenger
- Department of Clinical Biochemistry, University Hospital of Copenhagen, Hvidovre, Denmark
| | - P M Visscher
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, Scotland, UK
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - K O Kyvik
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Sdr. Boulevard 23A, 5000, Odense C, Denmark.
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Fenger M, Benyamin B, Schousboe K, Sørensen TIA, Kyvik KO. Variance decomposition of apolipoproteins and lipids in Danish twins. Atherosclerosis 2006; 191:40-7. [PMID: 16730014 DOI: 10.1016/j.atherosclerosis.2006.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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] [Received: 01/03/2006] [Revised: 04/25/2006] [Accepted: 04/25/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Twin studies are used extensively to decompose the variance of a trait, mainly to estimate the heritability of the trait. A second purpose of such studies is to estimate to what extent the non-genetic variance is shared or specific to individuals. To a lesser extent the twin studies have been used in bivariate or multivariate analysis to elucidate common genetic factors to two or more traits. METHODS AND RESULTS In the present study the variances of traits related to lipid metabolism is decomposed in a relatively large Danish twin population, including bivariate analysis to detect possible common genetic factors of the traits. CONCLUSIONS The heritabilities of apolipoprotein B and E, cholesterol, LDL, and high density lipoprotein (HDL) were significant in the general population, although gender-specific levels and significance were detected. Heritabilities of apolipoprotein A1, triglycerides, and very low density protein (VLDL) were only significant when the population was stratified according to gender.
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Affiliation(s)
- Mogens Fenger
- Department of Clinical Biochemistry and Molecular Biology, University Hospital of Copenhagen, KBA339, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
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Christiansen L, Frederiksen H, Schousboe K, Skytthe A, von Wurmb-Schwark N, Christensen K, Kyvik K. Age- and sex-differences in the validity of questionnaire-based zygosity in twins. Twin Res 2005. [PMID: 14511432 DOI: 10.1375/twin.6.4.275] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Questionnaire-based zygosity assessment in twins has generally been found to be valid. In this report we evaluate sex- and age-differences in the validity of such questionnaire-based classification when using the four questions that have been the basis of zygosity assessment in The Danish Twin Registry for half a century. Three hundred and forty-two male and 531 female twin pairs were zygosity diagnosed using genetic markers and the results compared with the original questionnaire based classification. We found significant differences in the accuracy of questionnaire based zygosity diagnosis when stratifying the data for sex as well as age: males and monozygotic having the highest misclassification. However, even in the group with the highest misclassification rate the frequency was less than 8%. The overall misclassification rate was only 4%, with a clear tendency towards a higher proportion of misclassified monozygotic than dizygotic twins. The results demonstrate that questionnaire based zygosity diagnosis can still be regarded as a valid and valuable classification method for most purposes.
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Affiliation(s)
- Lene Christiansen
- The Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Christiansen L, Frederiksen H, Schousboe K, Skytthe A, von Wurmb-Schwark N, Christensen K, Kyvik K. Age- and sex-differences in the validity of questionnaire-based zygosity in twins. ACTA ACUST UNITED AC 2005; 6:275-8. [PMID: 14511432 DOI: 10.1375/136905203322296610] [Citation(s) in RCA: 200] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Questionnaire-based zygosity assessment in twins has generally been found to be valid. In this report we evaluate sex- and age-differences in the validity of such questionnaire-based classification when using the four questions that have been the basis of zygosity assessment in The Danish Twin Registry for half a century. Three hundred and forty-two male and 531 female twin pairs were zygosity diagnosed using genetic markers and the results compared with the original questionnaire based classification. We found significant differences in the accuracy of questionnaire based zygosity diagnosis when stratifying the data for sex as well as age: males and monozygotic having the highest misclassification. However, even in the group with the highest misclassification rate the frequency was less than 8%. The overall misclassification rate was only 4%, with a clear tendency towards a higher proportion of misclassified monozygotic than dizygotic twins. The results demonstrate that questionnaire based zygosity diagnosis can still be regarded as a valid and valuable classification method for most purposes.
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Affiliation(s)
- Lene Christiansen
- The Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Glintborg D, Henriksen JE, Andersen M, Hagen C, Hangaard J, Rasmussen PE, Schousboe K, Hermann AP. Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 caucasian premenopausal women with hirsutism as the referral diagnosis. Fertil Steril 2004; 82:1570-9. [PMID: 15589862 DOI: 10.1016/j.fertnstert.2004.06.040] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 06/16/2004] [Accepted: 06/16/2004] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To perform an audit on the examination of hirsute patients and to establish a rational routine examination program in an outpatient endocrine clinic. DESIGN Systematic, retrospective audit. SETTING Academic tertiary-care medical center. PATIENT(S) Three hundred forty women with hirsutism as the referral diagnosis. INTERVENTION(S) Hormone analyses and ACTH tests during cycle days 2-8, 2 hours of oral glucose tolerance test (OGTT), and vaginal ultrasound. MAIN OUTCOME MEASURE(S) End diagnosis, fasting, 30-, 60-, and 120-minute oral glucose-stimulated levels of insulin and capillary blood glucose. RESULT(S) Two hundred one patients were diagnosed as having idiopathic hirsutism (IH) and 134 as having polycystic ovary syndrome (PCOS). End diagnosis: prolactinoma: n = 1, Cushing's syndrome: n = 1, androgen-producing ovarian tumor: n = 1, late-onset 21-hydroxylase defects: n = 2. During OGTT, 4.9% (13 of 263) had previously undiagnosed diabetes; no significant difference in diabetes prevalence was found between idiopathic hirsutism and PCOS. For 50.8%, fasting insulin values were in the upper quartile for a reference population. CONCLUSION(S) Initial evaluation of hirsute patients with irregular menses should include serum (s)-17alpha-hydroxyprogesterone, s-prolactin, s-Testosterone (T), and s-sex hormone-binding globulin. Further evaluation is needed in patients with markedly elevated s-T or with clinical Cushing's syndrome. Hirsute patients have a high risk of diabetes, although this could be due to the high number of overweight patients among this population.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
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Schousboe K, Visscher PM, Erbas B, Kyvik KO, Hopper JL, Henriksen JE, Heitmann BL, Sørensen TIA. Twin study of genetic and environmental influences on adult body size, shape, and composition. Int J Obes (Lond) 2004; 28:39-48. [PMID: 14610529 DOI: 10.1038/sj.ijo.0802524] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [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: 12/15/2022]
Abstract
OBJECTIVE To investigate the genetic and environmental influences on adult body size, shape, and composition in women and men, and to assess the impact of age. MATERIALS AND METHODS In this cross-sectional study of 325 female and 299 male like-sex healthy twin pairs, on average 38 y old (18-67 y), we determined zygosity by DNA similarity, and performed anthropometry and bioelectrical impedance analysis of body composition. The contribution to the total phenotypic variance of genetic, common environment, and individual environment was estimated in multivariate analysis using the FISHER program. Further, these variance components were analysed as linear functions of age. RESULTS In both women and men genetic contributions were significant for all phenotypes. Heritability for body mass index was 0.58 and 0.63; for body fat%, 0.59 and 0.63; for total skinfolds, 0.61 and 0.65; for extremity skinfolds 0.65 and 0.62; for truncal skinfolds, 0.50 and 0.69; for suprailiac skinfolds, 0.49 and 0.48; for waist circumference, 0.48 and 0.61; for hip, 0.52 and 0.58; for lean body mass/height2, 0.61 and 0.56; and for height, 0.81 and 0.69, respectively. There was no strong evidence of common environmental effects under the assumptions of no nonadditive effect. The pattern of age trends was inconsistent. However, when significant there was a decrease in heritability with advancing age. DISCUSSION These findings suggest that adult body size, shape, and composition are highly heritable in both women and men, although a decreasing tendency is seen with advancing age.
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Affiliation(s)
- K Schousboe
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Denmark.
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Schousboe K, Willemsen G, Kyvik KO, Mortensen J, Boomsma DI, Cornes BK, Davis CJ, Fagnani C, Hjelmborg J, Kaprio J, De Lange M, Luciano M, Martin NG, Pedersen N, Pietiläinen KH, Rissanen A, Saarni S, Sørensen TIA, Van Baal GCM, Harris JR. Sex differences in heritability of BMI: a comparative study of results from twin studies in eight countries. ACTA ACUST UNITED AC 2004; 6:409-21. [PMID: 14624725 DOI: 10.1375/136905203770326411] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Body mass index (BMI), a simple anthropometric measure, is the most frequently used measure of adiposity and has been instrumental in documenting the worldwide increase in the prevalence of obesity witnessed during the last decades. Although this increase in overweight and obesity is thought to be mainly due to environmental changes, i.e., sedentary lifestyles and high caloric diets, consistent evidence from twin studies demonstrates high heritability and the importance of genetic differences for normal variation in BMI. We analysed self-reported data on BMI from approximately 37,000 complete twin pairs (including opposite sex pairs) aged 20-29 and 30-39 from eight different twin registries participating in the GenomEUtwin project. Quantitative genetic analyses were conducted and sex differences were explored. Variation in BMI was greater for women than for men, and in both sexes was primarily explained by additive genetic variance in all countries. Sex differences in the variance components were consistently significant. Results from analyses of opposite sex pairs also showed evidence of sex-specific genetic effects suggesting there may be some differences between men and women in the genetic factors that influence variation in BMI. These results encourage the continued search for genes of importance to the body composition and the development of obesity. Furthermore, they suggest that strategies to identify predisposing genes may benefit from taking into account potential sex specific effects.
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Affiliation(s)
- Karoline Schousboe
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Denmark
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Hyltoft Petersen P, Blaabjerg O, Andersen M, Jørgensen LGM, Schousboe K, Jensen E. Graphical interpretation of confidence curves in rankit plots. ACTA ACUST UNITED AC 2004; 42:715-24. [PMID: 15327005 DOI: 10.1515/cclm.2004.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
AbstractA well-known transformation from the bell-shaped Gaussian (normal) curve to a straight line in the rankit plot is investigated, and a tool for evaluation of the distribution of reference groups is presented. It is based on the confidence intervals for percentiles of the calculated Gaussian distribution and the percentage of cumulative points exceeding these limits.The process is to rank the reference values and plot the cumulative frequency points in a rankit plot with a logarithmic (ln=logThis is a conservative validation, which is more demanding than the Kolmogorov-Smirnov test. The graphical presentation, however, makes it easy to disclose deviations from ln-Gaussianity, and to make other interpretations of the distributions, e.g., comparison to non-Gaussian distributions in the same plot, where the cumulative frequency percentage can be read from the ordinate. A long list of examples of ln-Gaussian distributions of subgroups of reference values from healthy individuals is presented. In addition, distributions of values from well-defined diseased individuals may showup as ln-Gaussian.It is evident from the examples that the rankit transformation and simple graphical evaluation for non-Gaussianity is a useful tool for the description of sub-groups.
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Affiliation(s)
- Per Hyltoft Petersen
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.
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Schousboe K, Visscher PM, Henriksen JE, Hopper JL, Sørensen TIA, Kyvik KO. Twin study of genetic and environmental influences on glucose tolerance and indices of insulin sensitivity and secretion. Diabetologia 2003; 46:1276-83. [PMID: 12898014 DOI: 10.1007/s00125-003-1165-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [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] [Received: 02/10/2003] [Revised: 04/29/2003] [Indexed: 12/29/2022]
Abstract
AIMS/HYPOTHESIS Family and twin studies have reported different estimates of the relative contribution of genetic and environmental factors to the quantitative traits glucose tolerance, insulin secretion, and insulin sensitivity. Our aims were to estimate these relative influences in a large sample of twins from the population and to assess the effect of age. METHODS In this population-based, cross-sectional study we gave an oral glucose tolerance test to 317 women and 290 men who were same-sex healthy twin pairs between 18 to 67 years of age. The genetic, common environmental and individual environmental variance components for fasting and 120-min glucose and for fasting and 30-min insulin as well as the linear effects of age on these components were estimated by multivariate analysis (using the software FISHER). RESULTS In women and men the heritability for fasting glucose was 12 and 38%, for 120-min glucose it was 38 and 43%, for fasting insulin it was 54 and 37%, and for 30-min insulin it was 57 and 47%, respectively. Under the assumption of no non-additive genetic effects (no intra- or inter-gene interaction) there was no strong evidence for common environmental effects, barring significant effects for fasting glucose in women. Heritability decreased with age for 120-min glucose in women and fasting insulin in men, whereas it increased for 120-min glucose in men. CONCLUSION/INTERPRETATION This study indicates a limited additive genetic influence on the result of an OGTT, possibly with sex-specific age effects, and generally little or no influence of the common environment. Accordingly, there is a considerable individual environmental variation.
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Affiliation(s)
- K Schousboe
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Denmark.
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Schousboe K, Henriksen JE, Kyvik KO, Sørensen TIA, Hyltoft Petersen P. Reproducibility of S-insulin and B-glucose responses in two identical oral glucose tolerance tests. Scand J Clin Lab Invest 2003; 62:623-30. [PMID: 12564620 DOI: 10.1080/003655102764654358] [Citation(s) in RCA: 29] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recently, the diagnostic criteria for type 2 diabetes mellitus have been changed, but there are disagreements about which measurements should be used. In contrast to the American Diabetes Association (ADA), The World Health Organization (WHO) still recognizes fasting and 2-h glucose concentrations measured on either plasma or whole blood as diagnostic tools. Insulin sensitivity and insulin secretion are both assumed to be involved in the pathogenesis of type 2 diabetes. The oral glucose tolerance test (OGTT) for estimating insulin sensitivity and secretion is increasingly used, e.g. in intervention trials. The objectives of this study were to estimate the coefficients of intra-individual variation (CVw) of blood glucose and serum insulin concentrations from an OGTT as well as indices of insulin sensitivity (HOMA) and insulin secretion (delta insulin30/delta glucose30) derived from this test. Following duplicate OGTTs with a median interval of 13 days (range 1-87 days), the analytical, inter-individual, and intra-individual coefficients of variation were calculated by nested ANOVA. The CVw for fasting blood glucose (7%) was considerably lower than that for 2-h post-load glucose (15%), which was again lower than for the insulin concentrations and indices of insulin sensitivity and secretion. In conclusion, the intra-individual variation is larger for 2-h post-load glucose than for fasting glucose and may question the continued use of the 2-h post-load glucose value in the diagnosis of type 2 diabetes.
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Affiliation(s)
- K Schousboe
- The Danish Twin Register, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Bardi G, Pandis N, Schousboe K, Hølund B, Heim S. Near-diploid karyotypes with recurrent chromosome abnormalities characterize early-stage endometrial cancer. Cancer Genet Cytogenet 1995; 80:110-4. [PMID: 7736425 DOI: 10.1016/0165-4608(94)00171-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cytogenetic investigation was attempted on 15 endometrial tumors. Whenever possible, a combination of direct harvesting and short-term culture (with or without prior methotrexate synchronization) was used. The analysis was successful in 13 cases: 12 carcinomas of stage I and one atypical hyperplasia. Clonal abnormalities were found in 10 tumors, whereas the remaining three showed a normal karyotype. The modal chromosome number was near-diploid. The abnormal karyotypes contained relatively simple numerical or structural aberrations in all but one tumor, a serous papillary carcinoma with multiple complex changes as well as cytogenetic evidence of intratumor heterogeneity. Gain of 1q, trisomy for chromosomes 2, 7, 10 (this trisomy was shown by in situ hybridization to be present also in a large number of interphase cells), and 12, and loss of chromosome 22 were recurrent aberrations; these are also the cytogenetic anomalies that have been consistently associated with endometrial carcinomas in previous studies. The utilization of both direct harvesting and short-term culture in several cases increased the frequency with which abnormal karyotypes were found; sometimes aberrations were found by the first method but not by the other, and vice versa. Never were different clonal anomalies found by the two approaches in the same case. Synchronization of the cultures generally led to chromosome preparations with more mitoses and of better quality. Again, no different anomalies were found in synchronized and standard cultures from the same tumor.
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Affiliation(s)
- G Bardi
- Department of Medical Genetics, Odense University Hospital, Denmark
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Schousboe K, Brøndum-Nielsen K. [Interphase cytogenetics--a new technique for analysis of acquired genetic changes in tumor cells]. Ugeskr Laeger 1993; 155:4158-62. [PMID: 8273238] [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: 01/29/2023]
Abstract
Newer genetic investigations of solid tumours by means of in situ hybridization (ISH) is reviewed. In situ hybridization, ISH, is a relatively new molecular biological method which can be used as a supplement to analysis of chromosome aberrations in tumour cells. Labelled DNA or RNA sequences (probes) are bound to specific sequences on cell chromosomes. After hybridization, the complementary sequences of the probe can be visualized and observed in a microscope. In contrast to classical cytogenetics where the chromosomes are studied in the mitosis, ISH can also be carried out on non-mitotic cells. The term "interphase cytogenetics" refers to this application of ISH, which can demonstrate the distribution of cells with different genotype without previous cell culturing. Interphase cytogenetics has been used for the analysis of several different tumour types where it gives fast and reliable information about specific cytogenetic aberrations in tumour cells. It is to be anticipated that this laboratory technique will be employed increasingly in the diagnosis and follow-up of certain malignancies.
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Affiliation(s)
- K Schousboe
- Institut for Sygdomsforebyggelse og Helsetjenesteforskning, Odense Universitet
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