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Bendotti G, Montefusco L, Pastore I, Lazzaroni E, Lunati ME, Fiorina P. The anti-inflammatory and immunological properties of SGLT-2 inhibitors. J Endocrinol Invest 2023; 46:2445-2452. [PMID: 37535237 DOI: 10.1007/s40618-023-02162-9] [Citation(s) in RCA: 2] [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: 04/17/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic oral drugs that act on proximal renal tubules promoting renal glucose excretion. Although SGLT-2i belong to the class of hypoglycemic agents, in the last years great interest has emerged in studying their pleiotropic effects, beyond their ability to lower glucose levels. PURPOSE In this review we are describing the anti-inflammatory and immunological properties of SGLT-2i; furthermore, we are addressing how the mechanisms associated with the aforementioned anti-inflammatory properties may contribute to the beneficial effects of SGLT-2i in diabetes. METHODS A systematic search was undertaken for studies related the properties of SGLT-2i in reducing the inflammatory milieu of acute and chronic disease by acting on the immune system, independently by glycemia. RESULTS Recently, some data described the anti-inflammatory and immunological properties of SGLT-2 in both pre-clinical and clinical studies. Numerous data confirmed the cardio- and -renal protective effects of SGLT-2i in patients with heart failure and kidney diseases, with or without diabetes. CONCLUSIONS SGLT-2i are promising drugs with anti-inflammatory and immunological properties. Despite the mechanism of action of SGLT-2i is not fully understood, these drugs demonstrated anti-inflammatory effects, which may help in keeping under control the variety of complications associated with diabetes.
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Affiliation(s)
- G Bendotti
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
- Endocrinology and Metabolic Diseases Unit, AO S.S. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - L Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - I Pastore
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - E Lazzaroni
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - M E Lunati
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - P Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy.
- International Center for T1D, Pediatric Clinical Research Center "Romeo ed Enrica Invernizzi", Department of Biomedical and Clinical Science L. Sacco, University of Milan, Milan, Italy.
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave. Enders Building 5th floor En511, Boston, MA, 02115, USA.
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Montefusco L, D'Addio F, Loretelli C, Ben Nasr M, Garziano M, Rossi A, Pastore I, Plebani L, Lunati ME, Bolla AM, Porta MD, Piuri G, Rocchio F, Abdelsalam A, Assi E, Barichella M, Maestroni A, Usuelli V, Loreggian L, Muzio F, Zuccotti GV, Cazzola R, Fiorina P. Anti-inflammatory effects of diet and caloric restriction in metabolic syndrome. J Endocrinol Invest 2021; 44:2407-2415. [PMID: 33686615 PMCID: PMC8502121 DOI: 10.1007/s40618-021-01547-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/24/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Weight loss in patients with metabolic syndrome has positive effects on cardiovascular and type 2 diabetes risks, but its effects on peripheral cytokines and lipid profiles in patients are still unclear. AIM To determine the effects of diet-induced weight loss on metabolic parameters, lipids and cytokine profiles. METHODS Eighteen adult males with metabolic syndrome (defined according to IDF 2009) and Body Mass Index (BMI) between 25 and 35 kg/m2 were subjected to a balanced hypocaloric diet for 6 months to reach at least a 5% body weight loss. RESULTS After weight loss, a significant improvement in BMI, waist circumference, insulin, fasting blood glucose and HOMA-IR (homeostasis model assessment of insulin resistance) was observed. The analysis of LDL (low-density lipoprotein cholesterol) and HDL (high-density lipoprotein cholesterol) lipoproteins showed a change in their composition with a massive transfer of triacylglycerols from HDL to LDL. This was associated with a significant reduction in peripheral pro-inflammatory cytokines such as IL-6, TNF-α, IL-8 and MIP-1β, leading to an overall decreased inflammatory score. An interesting positive correlation was also observed among peripheral cytokines levels after diet and peripheral levels of CETP (cholesteryl ester transfer protein), an enzyme with a key role in lipid change. CONCLUSION Weight loss through caloric restriction is associated with an improvement in peripheral lipid and cytokine profiles that may play a major role in improving cardiovascular risk.
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Affiliation(s)
- L Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - F D'Addio
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - C Loretelli
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - M Ben Nasr
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - M Garziano
- Department of Biomedical and Clinical Sciences, "L. Sacco", Università Di Milano, Milan, Italy
| | - A Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - I Pastore
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - L Plebani
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - M E Lunati
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - A M Bolla
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - M D Porta
- Department of Biomedical and Clinical Sciences, "L. Sacco", Università Di Milano, Milan, Italy
| | - G Piuri
- Department of Biomedical and Clinical Sciences, "L. Sacco", Università Di Milano, Milan, Italy
| | - F Rocchio
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - A Abdelsalam
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
- Department of Biochemistry and Biotechnology, Heliopolis University, Cairo, Egypt
| | - E Assi
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - M Barichella
- Clinical Nutrition Unit, Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | - A Maestroni
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - V Usuelli
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - L Loreggian
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - F Muzio
- Clinical Nutrition and Dietetic Unit, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - G V Zuccotti
- Department of Pediatrics, V. Buzzi Childrens' Hospital and Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Degli Studi Di Milano, Milan, Italy
| | - R Cazzola
- Department of Biomedical and Clinical Sciences, "L. Sacco", Università Di Milano, Milan, Italy
| | - P Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy.
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy.
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
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Montefusco L, Harari S, Elia D, Rossi A, Specchia C, Torre O, Adda G, Arosio M. Endocrine and metabolic assessment in adults with Langerhans cell histiocytosis. Eur J Intern Med 2018; 51:61-67. [PMID: 29198444 DOI: 10.1016/j.ejim.2017.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT Diabetes insipidus (DI) is one of most common complications of Langerhans cell histiocytosis (LCH) but prevalence of anterior pituitary deficiencies and metabolic alterations have not been clearly defined yet. OBJECTIVES Evaluate prevalence of endocrine and metabolic manifestations in a cohort of patients affected by Pulmonary LCH. METHODS Observational cross-sectional study on 18 adults (7 M/11 F, 42±12years) studied for complete basal and dynamic endocrine lab tests and glucose metabolism. RESULTS Hypothalamic-pituitary endocrine alterations were found in 9 patients: 9 had DI, 5 Growth Hormone Deficiency (GHD), 5 central hypogonadism, 3 central hypothyroidism and 1 central hypoadrenalism. Hyperprolactinemia and hypothalamic syndrome were found in 2 patients each. All these central endocrine alterations were always associated to DI. Five of the 10 MRI performed showed abnormalities. Prevalence of obesity and glucose alterations (either DM or IFG/IGT) were respectively 39% and 33%, higher than expected basing on epidemiological data on general Italian population. Multi-system-LCH without risk-organ involvement (LCH MS-RO-) seems to have slightly higher prevalence of insulin resistance, glucose alterations and metabolic syndrome than LCH with isolated lung involvement (LCH SS lung+). A papillary BRAFV600E positive thyroid carcinoma was diagnosed in one patient. CONCLUSIONS The presence of anterior pituitary deficiencies should be systematically sought in all LCH patients with DI both at diagnosis and during the follow-up by basal and dynamic hormonal assessment. Patients with pulmonary LCH, particularly those with MS disease, have a worse metabolic profile than general population. Occurrence of papillary thyroid carcinoma has been reported.
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Affiliation(s)
- L Montefusco
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - S Harari
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy.
| | - D Elia
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - A Rossi
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - C Specchia
- MultiMedica IRCCS, Milan, Italy; Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy
| | - O Torre
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - G Adda
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - M Arosio
- U.O. di Endocrinologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
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Ronchi CL, Giavoli C, Ferrante E, Verrua E, Bergamaschi S, Ferrari DI, Corbetta S, Montefusco L, Arosio M, Ambrosi B, Spada A, Beck-Peccoz P. Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments. Eur J Endocrinol 2009; 161:37-42. [PMID: 19351744 DOI: 10.1530/eje-09-0222] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [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: 11/08/2022]
Abstract
OBJECTIVE Radiotherapy (RT) for pituitary adenomas, including GH-secreting ones, frequently leads to GH deficiency (GHD). Data on the effects of surgery alone (S) on dynamic GH secretion are limited. The aim of the study was to investigate the occurrence of GHD in acromegalic patients treated with different therapeutic options. DESIGN AND METHODS Fifty-six patients in remission from acromegaly, (33 F & 23 M, age: 54+/-13 years, body mass index (BMI): 28.4+/-4.1 kg/m(2), 21 with adequately substituted pituitary deficiencies) treated by S alone (n=33, group 1) or followed by RT (n=23, group 2), were investigated for GHD by GHRH plus arginine testing, using BMI-adjusted cut-offs. Several metabolic and cardiovascular parameters (waist circumference, body fat percentage, blood pressure, fasting and post-oral glucose tolerance test glucose, HbA1c, insulin resistance and lipid profile) were evaluated in all the patients and 28 control subjects with known diagnosis of GHD. RESULTS Serum GH peak after challenge was 8.0+/-9.7 microg/l, without any correlation with post-glucose GH nadir and IGF-1 levels. The GH response indicated severe GHD in 34 patients (61%) and partial GHD in 15 patients (27%). IGF-1 were below the normal range in 14 patients (25%). The frequency of GHD was similar in the two treatment groups (54% in group 1 and 70% in group 2). No significant differences in metabolic parameters were observed between acromegalic patients and controls with GHD. CONCLUSIONS Severe GHD may occur in about 60% of patients treated for acromegaly, even when cured after S alone. Thus, a stimulation test (i.e. GHRH plus arginine) is recommended in all cured acromegalic patients, independently from previous treatment.
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Affiliation(s)
- C L Ronchi
- Department of Medical Sciences, University of Milan, 20122 Milan, Italy.
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Ronchi CL, Coletti F, Fesce E, Montefusco L, Ogliari C, Verrua E, Epaminonda P, Ferrante E, Malchiodi E, Morelli V, Beck-Peccoz P, Arosio M. Detection of small bowel tumors by videocapsule endoscopy in patients with acromegaly. J Endocrinol Invest 2009; 32:495-500. [PMID: 19494714 DOI: 10.1007/bf03346495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 02/06/2023]
Abstract
The prevalence of colon polyposis andmalignancies is increased in acromegalic patients as compared to the general population. An epidemiological study suggests a high prevalence also of small bowel (SB) tumors that nowadays may be detected by videocapsule endoscopy (VCE). The aim of the study was to assess the prevalence of SB neoplasms using VCE in acromegalic patients in comparison to control subjects and to correlate it with cancer risk factors and acromegaly-related parameters. Eighteen acromegalic patients (6 males and 12 females, age+/-SD: 54+/-10 yr), 5 cured after surgery (followed by radiotherapy in 3 cases) and 13 on pharmacological treatment were enrolled, and 36 sex- and age-matched non-acromegalic subjects served as a control group. Cancer risk factors, duration of acromegaly, GH and IGF-I levels, IGF binding protein 3 and IGF-II concentrations, metabolic parameters, tumor markers, colonic lesions by total colonoscopy, and SB lesions by VCE were investigated. VCE images suggestive of SB lesions were detected in 5/36 controls [14%, 4 described as gastrointestinal stromal nodular tumors (GIST), and 1 as polyp] and in 5/18 acromegalic patients [28%, 2 GIST and 3 polyps]. In acromegaly, the calculated relative risk for all SB lesions was 1.69 [95%confidence interval (CI): 0.78-3.65], while the relative risk for SB polyps was 2.50 (95% CI: 1.23-5.07). The effective duration of active disease was longer in patients with positive than in those with negative VCE (112+/-89 vs 49+/-40 months, p=0.06). In conclusion, these preliminary results suggest that acromegalic patients might have a high risk of SB polyp development. VCE might be a useful adjunctive diagnostic tool in acromegaly.
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Affiliation(s)
- C L Ronchi
- Department of Medical Sciences, University of Milan, Milan, Italy
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