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Svart M, Nielsen MM, Rittig N, Hansen M, Møller N, Gravholt CH. Oral 3-hydroxybuturate ingestion acutely lowers circulating testosterone concentrations in healthy young males. Scand J Med Sci Sports 2023; 33:1976-1983. [PMID: 37377131 DOI: 10.1111/sms.14441] [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] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Abstract
Ketone bodies, such as 3-hydroxybutyrate (3-OHB), have been frequently used by endurance athletes, such as cyclists, to enhance performance and recovery and are recognized for their health benefits and therapeutic effects for decades. Testosterone is a potent regulator of red blood cell production. Evidence suggests that ketone bodies can increase the production of erythropoietin, which stimulates red blood cell production. Therefore, we investigated whether an acute increase in 3-OHB levels affects testosterone levels in healthy young men. We studied six healthy, young male participants who fasted overnight and were tested twice: (i) after drinking 37.5 g of Na-D/L-3-OHB dissolved in 500 mL of distilled water (KET), and (ii) after drinking 500 mL of placebo saline water (0.9% NaCl) (CTR). During the KET trial, 3-OHB levels increased to approximately 2.5 mM. Testosterone levels decreased significantly by 20% during KET compared to 3% during CTR. A simultaneous increase in luteinizing hormone was observed in KET. We observed no changes in other adrenal androgens, such as androstenedione and 11-keto androgens. In conclusion, an acute increase in 3-OHB levels decreases testosterone levels. Concomitantly, an increase in luteinizing hormone was observed. This suggests that 3-OHB may counteract some of the beneficial effects of endurance training. Further studies, involving larger sample sizes and performance outcomes, are required to fully understand this phenomenon.
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Affiliation(s)
- Mads Svart
- Department of Endocrinology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Steno Diabetes Center Aarhus, Aahus University Hospital, Aarhus N, Denmark
| | - Mette Mølby Nielsen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N, Denmark
| | - Nikolaj Rittig
- Department of Endocrinology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Steno Diabetes Center Aarhus, Aahus University Hospital, Aarhus N, Denmark
| | - Mette Hansen
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus N, Denmark
| | - Niels Møller
- Department of Endocrinology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
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2
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Loft A, Schmidt SF, Caratti G, Stifel U, Havelund J, Sekar R, Kwon Y, Sulaj A, Chow KK, Alfaro AJ, Schwarzmayr T, Rittig N, Svart M, Tsokanos FF, Maida A, Blutke A, Feuchtinger A, Møller N, Blüher M, Nawroth P, Szendrödi J, Færgeman NJ, Zeigerer A, Tuckermann J, Herzig S. A macrophage-hepatocyte glucocorticoid receptor axis coordinates fasting ketogenesis. Cell Metab 2022; 34:473-486.e9. [PMID: 35120589 DOI: 10.1016/j.cmet.2022.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/30/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022]
Abstract
Fasting metabolism and immunity are tightly linked; however, it is largely unknown how immune cells contribute to metabolic homeostasis during fasting in healthy subjects. Here, we combined cell-type-resolved genomics and computational approaches to map crosstalk between hepatocytes and liver macrophages during fasting. We identified the glucocorticoid receptor (GR) as a key driver of fasting-induced reprogramming of the macrophage secretome including fasting-suppressed cytokines and showed that lack of macrophage GR impaired induction of ketogenesis during fasting as well as endotoxemia. Mechanistically, macrophage GR suppressed the expression of tumor necrosis factor (TNF) and promoted nuclear translocation of hepatocyte GR to activate a fat oxidation/ketogenesis-related gene program, cooperatively induced by GR and peroxisome proliferator-activated receptor alpha (PPARα) in hepatocytes. Together, our results demonstrate how resident liver macrophages directly influence ketogenesis in hepatocytes, thereby also outlining a strategy by which the immune system can set the metabolic tone during inflammatory disease and infection.
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Affiliation(s)
- Anne Loft
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany; Department of Biochemistry and Molecular Biology, University of Southern Denmark (SDU), Odense 5230, Denmark; Center for Functional Genomics and Tissue Plasticity (ATLAS), SDU, Odense 5230, Denmark
| | - Søren Fisker Schmidt
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany; Department of Biochemistry and Molecular Biology, University of Southern Denmark (SDU), Odense 5230, Denmark; Center for Functional Genomics and Tissue Plasticity (ATLAS), SDU, Odense 5230, Denmark.
| | - Giorgio Caratti
- Institute for Comparative Molecular Endocrinology, Universität Ulm, Ulm 89081, Germany
| | - Ulrich Stifel
- Institute for Comparative Molecular Endocrinology, Universität Ulm, Ulm 89081, Germany
| | - Jesper Havelund
- Department of Biochemistry and Molecular Biology, University of Southern Denmark (SDU), Odense 5230, Denmark
| | - Revathi Sekar
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Yun Kwon
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Alba Sulaj
- German Center for Diabetes Research, Neuherberg 85764, Germany; Department of Endocrinology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg 69120, Germany
| | - Kan Kau Chow
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Ana Jimena Alfaro
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Thomas Schwarzmayr
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Nikolaj Rittig
- Department of Internal Medicine and Endocrinology (Multilateral Environmental Agreement) and Medical Research Laboratory, Aarhus University Hospital, Aarhus C 8000, Denmark; Steno Diabetes Center Aarhus, Aarhus University, Hedeager 3, 2nd Floor, 8200 Aarhus N, Denmark
| | - Mads Svart
- Department of Internal Medicine and Endocrinology (Multilateral Environmental Agreement) and Medical Research Laboratory, Aarhus University Hospital, Aarhus C 8000, Denmark; Steno Diabetes Center Aarhus, Aarhus University, Hedeager 3, 2nd Floor, 8200 Aarhus N, Denmark
| | - Foivos-Filippos Tsokanos
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Adriano Maida
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Andreas Blutke
- Research Unit Analytical Pathology, Helmholtz Center Munich, Neuherberg 85764, Germany
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Helmholtz Center Munich, Neuherberg 85764, Germany
| | - Niels Møller
- Department of Internal Medicine and Endocrinology (Multilateral Environmental Agreement) and Medical Research Laboratory, Aarhus University Hospital, Aarhus C 8000, Denmark
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG), Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig 04103, Germany
| | - Peter Nawroth
- Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Department of Endocrinology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg 69120, Germany
| | - Julia Szendrödi
- Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Department of Endocrinology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg 69120, Germany
| | - Nils J Færgeman
- Department of Biochemistry and Molecular Biology, University of Southern Denmark (SDU), Odense 5230, Denmark
| | - Anja Zeigerer
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Jan Tuckermann
- Institute for Comparative Molecular Endocrinology, Universität Ulm, Ulm 89081, Germany.
| | - Stephan Herzig
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg 85764, Germany; Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine, Heidelberg University Hospital, Heidelberg 69120, Germany; Molecular Metabolic Control, Technical University Munich, Munich 80333, Germany; German Center for Diabetes Research, Neuherberg 85764, Germany.
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Svart M, Gormsen LC, Espersen R, Rittig N, Starup-Linde J, Møller N, Rejnmark L. 3-Hydroxybutyrate administration elevates plasma parathyroid hormone in a pilot human randomized, controlled, cross over trial. Bone 2021; 153:116166. [PMID: 34464780 DOI: 10.1016/j.bone.2021.116166] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/07/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022]
Abstract
CONTENT Ketone bodies, in particular 3-hydroxybutyrate (3OHB), are known to possess important energetic and signaling capacities. There is a growing block of evidence, that ketogenic dieting (KD), fasting, and sodium glucose transporter 2 inhibitor (SGLT2i) treatment are associated with hyperparathyroidism and negative bone health. OBJECTIVE We aimed to study the effect of exogenous 3OHB administration on bone metabolism, specifically the effect on parathyroid hormone (PTH) and calcium/phosphate homeostasis. DESIGN A randomized, controlled, cross over study with two arms: i) saline infusion and ii) 3OHB infusion. SETTING The study was conducted at Aarhus University Hospital. PARTICIPANTS We examined eight healthy human subjects aged 50-70 years. INTERVENTION Continuous intravenous DL-3OHB-NaCl infusion or 0.9% NaCl was administered for 390 min. MAIN OUTCOME MEASURES The study was designed to test the impact of 3OHB on PTH, calcium-phosphate, C-terminal Telopeptide (CTX), and Procollagen I N-terminal Propeptide (PINP). The study was a post hoc study. RESULTS The PTH concentration increased by 25% with a concomitant drop in phosphate of 30% in the 3OHB group. 3OHB infusion increased concentrations of CTX by 5%, without changes in PINP and albumin corrected calcium concentrations. CONCLUSION In conclusion, 3OHB administration increases PTH concentration and markers of bone resorption. These findings suggest a possible negative effect on bone health, which needs to be determined in future studies.
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Affiliation(s)
- Mads Svart
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark.
| | - Lars Christian Gormsen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Rasmus Espersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nikolaj Rittig
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Jakob Starup-Linde
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Møller
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark; Medical Research Laboratory, Aarhus University, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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4
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Svart M, Rittig N, Pedersen SB, Jessen N, Møller N. Oral 3-hydroxybutyrate ingestion decreases endogenous glucose production, lipolysis, and hormone-sensitive lipase phosphorylation in adipose tissue in men: a human randomized, controlled, crossover trial. Diabet Med 2021; 38:e14385. [PMID: 32794582 DOI: 10.1111/dme.14385] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/19/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/25/2023]
Abstract
AIMS To test whether oral administration of D/L-3-hydroxybutyrate as a sodium salt inhibits lipolysis and intracellular lipid signalling, in particular, hormone-sensitive lipase, and whether D/L-3-hydroxybutyrate alters endogenous glucose production. METHODS We studied six young men in a randomized, controlled, crossover study after ingestion of Na-D/L-3-hydroxybutyrate (hyperketotic condition) or saline (placebo control). We quantified lipolysis and endogenous glucose production using [9,10-3 H]-palmitate and [3-3H]glucose tracers, and adipose tissue biopsies were collected to investigate key lipolytic enzymes. RESULTS After ingestion, D/L-3-hydroxybutyrate increased by more than 2.5 mmol/l, free fatty acid concentrations decreased by >70%, and palmitate rate of appearance was halved. Protein kinase A phosphorylation of perilipin was reduced and hormone-sensitive lipase 660 phosphorylation in adipose tissue biopsies was 70-80% decreased in the hyperketotic condition and unchanged in the control. Compared to the control, endogenous glucose production was reduced by close to 20% (P<0.05) after 3-hydroxybutyrate ingestion. CONCLUSION We conclude that oral D/L-Na-3-hydroxybutyrate increases D/L-3-hydroxybutyrate concentrations within half an hour, decreases free fatty acid concentrations, lowers lipolysis and endogenous glucose production, and dephosphorylates hormone-sensitive lipase. Collectively these phenomena may be viewed as an orchestrated feedback loop, controlling endogenous glucose production, lipolysis and ketogenesis. Such effects would be beneficial in insulin-resistant states. (www.clinicaltrials.gov ID number: NCT02917252).
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Affiliation(s)
- M Svart
- Departments of Endocrinology and Internal Medicine, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - N Rittig
- Departments of Endocrinology and Internal Medicine, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S B Pedersen
- Departments of Endocrinology and Internal Medicine, Aarhus, Denmark
| | - N Jessen
- Departments of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- Institute of Biomedicine, Aarhus University, Aarhus, Denmark
| | - N Møller
- Departments of Endocrinology and Internal Medicine, Aarhus, Denmark
- Departments of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
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5
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Rittig N, Svart M, Thomsen HH, Vestergaard ET, Rehfeld JF, Hartmann B, Holst JJ, Johannsen M, Møller N, Jessen N. Oral D/L-3-Hydroxybutyrate Stimulates Cholecystokinin and Insulin Secretion and Slows Gastric Emptying in Healthy Males. J Clin Endocrinol Metab 2020; 105:5876925. [PMID: 32717058 DOI: 10.1210/clinem/dgaa483] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/27/2020] [Accepted: 07/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND D-3-hydroxybutyrate (D-3-OHB) is a ketone body that serves as an alternative nutritional fuel but also as an important signaling metabolite. Oral ketone supplements containing D/L-3-OHB are becoming a popular approach to achieve ketosis. AIM To explore the gut-derived effects of ketone supplements. METHODS Eight healthy lean male volunteers were investigated on 2 separate occasions:An acetaminophen test was performed to evaluate gastric emptying and blood samples were obtained consecutively throughout the study period. RESULTS We show that oral consumption of D/L-3-OHB stimulates cholecystokinin release (P = 0.02), elevates insulin (P = 0.03) and C-peptide (P < 0.001) concentrations, and slows gastric emptying (P = 0.01) compared with matched intravenous D/L-3-OHB administration. Measures of appetite and plasma concentrations of glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were unaffected by interventions. CONCLUSION Our findings show that D/L-3-OHB exert incretin effects and indicate luminal sensing in the gut endothelium. This adds to our understanding of ketones as signaling metabolites and displays the important difference between physiological ketosis and oral ketone supplements.
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Affiliation(s)
- Nikolaj Rittig
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
- Department and laboratories of Diabetes and Hormone diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - Mads Svart
- Department and laboratories of Diabetes and Hormone diseases, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Jens Frederik Rehfeld
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences and Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences and Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Johannsen
- Department of Forensic Medicine, Aarhus University, Aarhus C, Denmark
| | - Niels Møller
- Department and laboratories of Diabetes and Hormone diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Jessen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
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Jensen NJ, Nilsson M, Ingerslev JS, Olsen DA, Fenger M, Svart M, Møller N, Zander M, Miskowiak KW, Rungby J. Effects of β-hydroxybutyrate on cognition in patients with type 2 diabetes. Eur J Endocrinol 2020; 182:233-242. [PMID: 31821157 DOI: 10.1530/eje-19-0710] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/09/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive impairment in type 2 diabetes is associated with cerebral glucose hypometabolism. Providing a glucose substitute such as ketone bodies might restore metabolic balance in glucose-compromised neurones and improve cognitive performance. We aimed to investigate if β-hydroxybutyrate (ketone body) infusion acutely affects cognitive performance, measured by a neuropsychological test battery, in patients with type 2 diabetes. DESIGN Randomised, placebo-controlled, double-blind cross-over trial. METHODS Eighteen patients with type 2 diabetes received i.v. ketone body (β-hydroxybutyrate) and placebo (saline) infusion in a randomised order on two separate occasions. On both days of examination, blood glucose was clamped at 7.5 mmol/L and a neuropsychological test battery was used to assess global cognitive performance (primary outcome) and specialized cognitive measures of verbal memory, working memory, executive function, psychomotor speed, and sustained attention. RESULTS During neurocognitive testing, β-hydroxybutyrate concentrations were 2.4 vs 0.1 mmol/L. Working memory assessed by Wechsler Adult Intelligence Scale letter-number-sequencing significantly improved by 1.6 points (95% CI: 0.7, 2.4; non-adjusted P < 0.001) corresponding to a 17% increase in performance during ketone infusion compared to placebo. There was no change for global cognitive performance or any other cognitive measure after adjusting for multiple comparisons. Blood concentrations of β-hydroxybutyrate and glycaemic status did not associate with test performance; however, insulin resistance measured by HOMA was related to improved working memory performance during ketone infusion (β = 4%; 95% CI: 1.1, 7.7; P = 0.012). CONCLUSIONS Ketone infusion specifically improved working memory performance in patients with type 2 diabetes in the absence of changes in global cognition.
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Affiliation(s)
| | - Malin Nilsson
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Dorte Aalund Olsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Mogens Fenger
- Department of Clinical Biochemistry, Hvidovre University Hospital, Hvidovre, Denmark
| | - Mads Svart
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Møller
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Zander
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Jørgen Rungby
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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7
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Andersen PE, Svart M. [Acute renal failure in a healthy 19-year-old woman after intake of 7 g of paracetamol]. Ugeskr Laeger 2019; 181:V10180742. [PMID: 31124443] [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: 06/09/2023]
Abstract
In this case report, a 19-year-old woman was admitted with delayed acute renal failure due to a paracetamol intake of 7 g. No liver damage was present, and the renal function recovered spontaneously after a few weeks. Paracetamol is the most common cause of medical induced overdose or death. It is well known, that poisoning from paracetamol may cause liver damage, but the risk of renal toxicity is known to a lesser extent. Acute renal failure due to paracetamol overdose may easily be missed due to the delayed manifestation.
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8
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Svart M, Rittig N, Møller N, Møller HJ, Gronbaek H. Soluble CD163 correlates with lipid metabolic adaptations in type 1 diabetes patients during ketoacidosis. J Diabetes Investig 2019; 10:67-72. [PMID: 29802679 PMCID: PMC6319477 DOI: 10.1111/jdi.12869] [Citation(s) in RCA: 4] [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: 12/11/2017] [Revised: 04/08/2018] [Accepted: 05/18/2018] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) is associated with inflammation and increased lipolysis. The macrophage activation marker, soluble CD163 (sCD163), is associated with obesity, non-alcoholic fatty liver disease and type 2 diabetes. We aimed to investigate whether sCD163 correlates with key elements of lipolysis in type 1 diabetes patients during mild DKA. MATERIALS AND METHODS We investigated nine patients with type 1 diabetes twice during: (i) euglycemic control conditions and a bolus of saline; and (ii) hyperglycemic ketotic conditions induced by lipopolysaccharide administration combined with insulin deprivation. Blood samples, indirect calorimetry, palmitate tracer and adipose tissue biopsies were used to investigate lipid metabolism. RESULTS We observed a significant increase in plasma sCD163 levels after lipopolysaccharide exposure (P < 0.001). Concentrations of sCD163 were positively correlated with plasma concentrations of free fatty acids, palmitate rate of appearance and lipid oxidation rates, and negatively correlated to the expression of G0/G1 switch 2 gene messenger ribonucleic acid content in adipose tissue (P < 0.01 for all). Furthermore, sCD163 levels correlated positively with plasma peak concentrations of cortisol, glucagon, tumor necrosis factor-α, interleukin-6 and interleukin-10 (P < 0.01 for all). Data on lipolysis and inflammation have previously been published. CONCLUSIONS Macrophage activation assessed by sCD163 might play an important role in DKA, as it correlates strongly with important components of lipid metabolism including free fatty acids, palmitate, lipid oxidation, G0/G1 switch 2 gene and pro-inflammatory cytokines during initial steps of DKA. These results are novel and add important knowledge to the field of DKA.
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Affiliation(s)
- Mads Svart
- Department of Internal Medicine and Endocrinology (MEA) and Medical Research LaboratoryAarhus University HospitalAarhus CDenmark
| | - Nikolaj Rittig
- Department of Internal Medicine and Endocrinology (MEA) and Medical Research LaboratoryAarhus University HospitalAarhus CDenmark
| | - Niels Møller
- Department of Internal Medicine and Endocrinology (MEA) and Medical Research LaboratoryAarhus University HospitalAarhus CDenmark
| | - Holger J Møller
- Department of Clinical BiochemistryAarhus University HospitalAarhus NDenmark
| | - Henning Gronbaek
- Department of Hepatology and GastroenterologyAarhus UniversityAarhus CDenmark
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9
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Lauritsen KM, Søndergaard E, Svart M, Møller N, Gormsen LC. Ketone Body Infusion Increases Circulating Erythropoietin and Bone Marrow Glucose Uptake. Diabetes Care 2018; 41:e152-e154. [PMID: 30327354 DOI: 10.2337/dc18-1421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/04/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Katrine M Lauritsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Esben Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Danish Diabetes Academy, Odense University Hospital, Odense, Denmark.,Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Mads Svart
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Niels Møller
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Lars C Gormsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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10
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Dollerup OL, Christensen B, Svart M, Schmidt MS, Sulek K, Ringgaard S, Stødkilde-Jørgensen H, Møller N, Brenner C, Treebak JT, Jessen N. A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects. Am J Clin Nutr 2018; 108:343-353. [PMID: 29992272 DOI: 10.1093/ajcn/nqy132] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/17/2018] [Indexed: 12/13/2022] Open
Abstract
Background Animal studies suggest a positive role for nicotinamide riboside (NR) on insulin sensitivity and hepatic steatosis in models of obesity and type 2 diabetes. NR, an NAD+ precursor, is a member of the vitamin B-3 family now available as an over-the-counter supplement. Although data from preclinical trials appear consistent, potential effects and safety need to be evaluated in human clinical trials. Objective The aim of this study was to test the safety of dietary NR supplementation over a 12-wk period and potential to improve insulin sensitivity and other metabolic parameters in obese, insulin-resistant men. Design In an investigator-initiated randomized, placebo-controlled, double-blinded, and parallel-group designed clinical trial, forty healthy, sedentary men with a body mass index (BMI) > 30 kg/m2, age-range 40-70 y were randomly assigned to 12 wk of NR (1000 mg twice daily) or placebo. We determined the effects of NR supplementation on insulin sensitivity by a hyperinsulinemic euglycemic clamp and substrate metabolism by indirect calorimetry and labeled substrates of tritiated glucose and palmitate. Body composition and fat mass distribution were determined by whole-body dual-energy X-ray absorptiometry (DXA) and MRI scans, and measurements of intrahepatic lipid content were obtained by MR spectroscopy. Results Insulin sensitivity, endogenous glucose production, and glucose disposal and oxidation were not improved by NR supplementation. Similarly, NR supplementation had no effect on resting energy expenditure, lipolysis, oxidation of lipids, or body composition. No serious adverse events due to NR supplementation were observed and safety blood tests were normal. Conclusion 12 wk of NR supplementation in doses of 2000 mg/d appears safe, but does not improve insulin sensitivity and whole-body glucose metabolism in obese, insulin-resistant men. This trial was registered at clinicaltrials.gov as NCT02303483.
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Affiliation(s)
- Ole L Dollerup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Integrative Physiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Medical Research Laboratory, Department of Clinical Medicine
| | - Britt Christensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Integrative Physiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Medical Research Laboratory, Department of Clinical Medicine
| | - Mads Svart
- Medical Research Laboratory, Department of Clinical Medicine
| | - Mark S Schmidt
- Department of Biochemistry, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Karolina Sulek
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Integrative Physiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Niels Møller
- Medical Research Laboratory, Department of Clinical Medicine.,Department of Endocrinology
| | - Charles Brenner
- Department of Biochemistry, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Jonas T Treebak
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Integrative Physiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Jessen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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11
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Svart M, Gormsen LC, Hansen J, Zeidler D, Gejl M, Vang K, Aanerud J, Moeller N. Regional cerebral effects of ketone body infusion with 3-hydroxybutyrate in humans: Reduced glucose uptake, unchanged oxygen consumption and increased blood flow by positron emission tomography. A randomized, controlled trial. PLoS One 2018; 13:e0190556. [PMID: 29489818 PMCID: PMC5830038 DOI: 10.1371/journal.pone.0190556] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 06/22/2017] [Accepted: 12/16/2017] [Indexed: 01/24/2023] Open
Abstract
Ketone bodies are neuroprotective in neurological disorders such as epilepsy. We randomly studied nine healthy human subjects twice—with and without continuous infusion of 3-hydroxybutyrate–to define potential underlying mechanisms, assessed regionally (parietal, occipital, temporal, cortical grey, and frontal) by PET scan. During 3-hydroxybutyrate infusions concentrations increased to 5.5±0.4 mmol/l and cerebral glucose utilisation decreased 14%, oxygen consumption remained unchanged, and cerebral blood flow increased 30%. We conclude that acute 3-hydroxybutyrate infusion reduces cerebral glucose uptake and increases cerebral blood flow in all measured brain regions, without detectable effects on cerebral oxygen uptake though oxygen extraction decreased. Increased oxygen supply concomitant with unchanged oxygen utilisation may contribute to the neuroprotective effects of ketone bodies.
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Affiliation(s)
- Mads Svart
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Lars C. Gormsen
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Hansen
- Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dora Zeidler
- Centre of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Gejl
- Institute of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Kim Vang
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Joel Aanerud
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Moeller
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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12
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Rittig N, Svart M, Jessen N, Møller N, Møller HJ, Grønbæk H. Macrophage activation marker sCD163 correlates with accelerated lipolysis following LPS exposure: a human-randomised clinical trial. Endocr Connect 2018; 7:107-114. [PMID: 29295869 PMCID: PMC5754508 DOI: 10.1530/ec-17-0296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Macrophage activation determined by levels of soluble sCD163 is associated with obesity, insulin resistance, diabetes mellitus type 2 (DM2) and non-alcoholic fatty liver disease (NAFLD). This suggests that macrophage activation is involved in the pathogenesis of conditions is characterised by adaptions in the lipid metabolism. Since sCD163 is shed to serum by inflammatory signals including lipopolysaccharides (LPS, endotoxin), we investigated sCD163 and correlations with lipid metabolism following LPS exposure. METHODS Eight healthy male subjects were investigated on two separate occasions: (i) following an LPS exposure and (ii) following saline exposure. Each study day consisted of a four-hour non-insulin-stimulated period followed by a two-hour hyperinsulinemic euglycemic clamp period. A 3H-palmitate tracer was used to calculate the rate of appearance (Rapalmitate). Blood samples were consecutively obtained throughout each study day. Abdominal subcutaneous adipose tissue was obtained for western blotting. RESULTS We observed a significant two-fold increase in plasma sCD163 levels following LPS exposure (P < 0.001), and sCD163 concentrations correlated positively with the plasma concentration of free fatty acids, Rapalmitate, lipid oxidation rates and phosphorylation of the hormone-sensitive lipase at serine 660 in adipose tissue (P < 0.05, all). Furthermore, sCD163 concentrations correlated positively with plasma concentrations of cortisol, glucagon, tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 (P < 0.05, all). CONCLUSION We observed a strong correlation between sCD163 and stimulation of lipolysis and fat oxidation following LPS exposure. These findings support preexisting theory that inflammation and macrophage activation play a significant role in lipid metabolic adaptions under conditions such as obesity, DM2 and NAFLD.
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Affiliation(s)
- Nikolaj Rittig
- Department of Internal Medicine and Endocrinology (MEA) and Medical Research LaboratoryAarhus University Hospital, Aarhus C, Denmark
| | - Mads Svart
- Department of Internal Medicine and Endocrinology (MEA) and Medical Research LaboratoryAarhus University Hospital, Aarhus C, Denmark
| | - Niels Jessen
- Research Laboratory for Biochemical PathologyInstitute for Clinical Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Niels Møller
- Department of Internal Medicine and Endocrinology (MEA) and Medical Research LaboratoryAarhus University Hospital, Aarhus C, Denmark
| | - Holger J Møller
- Department of Clinical Biochemistry Aarhus University HospitalAarhus C, Denmark
| | - Henning Grønbæk
- Department of Hepatology and GastroenterologyAarhus University Hospital, Aarhus C, Denmark
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13
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Gormsen LC, Svart M, Thomsen HH, Søndergaard E, Vendelbo MH, Christensen N, Tolbod LP, Harms HJ, Nielsen R, Wiggers H, Jessen N, Hansen J, Bøtker HE, Møller N. Ketone Body Infusion With 3-Hydroxybutyrate Reduces Myocardial Glucose Uptake and Increases Blood Flow in Humans: A Positron Emission Tomography Study. J Am Heart Assoc 2017; 6:JAHA.116.005066. [PMID: 28242634 PMCID: PMC5524028 DOI: 10.1161/jaha.116.005066] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [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: 01/16/2023]
Abstract
BACKGROUND High levels of ketone bodies are associated with improved survival as observed with regular exercise, caloric restriction, and-most recently-treatment with sodium-glucose linked transporter 2 inhibitor antidiabetic drugs. In heart failure, indices of ketone body metabolism are upregulated, which may improve energy efficiency and increase blood flow in skeletal muscle and the kidneys. Nevertheless, it is uncertain how ketone bodies affect myocardial glucose uptake and blood flow in humans. Our study was therefore designed to test whether ketone body administration in humans reduces myocardial glucose uptake (MGU) and increases myocardial blood flow. METHODS AND RESULTS Eight healthy subjects, median aged 60 were randomly studied twice: (1) During 390 minutes infusion of Na-3-hydroxybutyrate (KETONE) or (2) during 390 minutes infusion of saline (SALINE), together with a concomitant low-dose hyperinsulinemic-euglycemic clamp to inhibit endogenous ketogenesis. Myocardial blood flow was measured by 15O-H2O positron emission tomography/computed tomography, myocardial fatty acid metabolism by 11C-palmitate positron emission tomography/computed tomography and MGU by 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Similar euglycemia, hyperinsulinemia, and suppressed free fatty acids levels were recorded on both study days; Na-3-hydroxybutyrate infusion increased circulating Na-3-hydroxybutyrate levels from zero to 3.8±0.5 mmol/L. MGU was halved by hyperketonemia (MGU [nmol/g per minute]: 304±97 [SALINE] versus 156±62 [KETONE], P<0.01), whereas no effects were observed on palmitate uptake oxidation or esterification. Hyperketonemia increased heart rate by ≈25% and myocardial blood flow by 75%. CONCLUSIONS Ketone bodies displace MGU and increase myocardial blood flow in healthy humans; these novel observations suggest that ketone bodies are important cardiac fuels and vasodilators, which may have therapeutic potentials.
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Affiliation(s)
- Lars C Gormsen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Svart
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Esben Søndergaard
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel H Vendelbo
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Nana Christensen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Jessen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Hansen
- Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Møller
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
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14
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Svart M, Kampmann U, Voss T, Pedersen SB, Johannsen M, Rittig N, Poulsen PL, Nielsen TS, Jessen N, Møller N. Combined Insulin Deficiency and Endotoxin Exposure Stimulate Lipid Mobilization and Alter Adipose Tissue Signaling in an Experimental Model of Ketoacidosis in Subjects With Type 1 Diabetes: A Randomized Controlled Crossover Trial. Diabetes 2016; 65:1380-6. [PMID: 26884439 DOI: 10.2337/db15-1645] [Citation(s) in RCA: 12] [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] [Received: 12/02/2015] [Accepted: 02/09/2016] [Indexed: 11/13/2022]
Abstract
Most often, diabetic ketoacidosis (DKA) in adults results from insufficient insulin administration and acute infection. DKA is assumed to release proinflammatory cytokines and stress hormones that stimulate lipolysis and ketogenesis. We tested whether this perception of DKA can be reproduced in an experimental human model by using combined insulin deficiency and acute inflammation and tested which intracellular mediators of lipolysis are affected in adipose tissue. Nine subjects with type 1 diabetes were studied twice: 1) insulin-controlled euglycemia and 2) insulin deprivation and endotoxin administration (KET). During KET, serum tumor necrosis factor-α, cortisol, glucagon, and growth hormone levels increased, and free fatty acids and 3-hydroxybutyrate concentrations and the rate of lipolysis rose markedly. Serum bicarbonate and pH decreased. Adipose tissue mRNA contents of comparative gene identification-58 (CGI-58) increased and G0/G1 switch 2 gene (G0S2) mRNA decreased robustly. Neither protein levels of adipose triglyceride lipase (ATGL) nor phosphorylations of hormone-sensitive lipase were altered. The clinical picture of incipient DKA in adults can be reproduced by combined insulin deficiency and endotoxin-induced acute inflammation. The precipitating steps involve the release of proinflammatory cytokines and stress hormones, increased lipolysis, and decreased G0S2 and increased CGI-58 mRNA contents in adipose tissue, compatible with latent ATGL stimulation.
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MESH Headings
- 1-Acylglycerol-3-Phosphate O-Acyltransferase/genetics
- 1-Acylglycerol-3-Phosphate O-Acyltransferase/metabolism
- Adult
- Biopsy
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/metabolism
- Cross-Over Studies
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/pathology
- Diabetic Ketoacidosis/immunology
- Diabetic Ketoacidosis/metabolism
- Diabetic Ketoacidosis/pathology
- Diabetic Ketoacidosis/prevention & control
- Endotoxins/toxicity
- Gene Expression Regulation/drug effects
- Humans
- Hyperglycemia/chemically induced
- Hyperglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/therapeutic use
- Insulin/administration & dosage
- Insulin/therapeutic use
- Insulin, Long-Acting/administration & dosage
- Insulin, Long-Acting/therapeutic use
- Insulin, Short-Acting/administration & dosage
- Insulin, Short-Acting/therapeutic use
- Lipolysis/drug effects
- Male
- Models, Immunological
- Panniculitis/drug therapy
- Panniculitis/immunology
- Panniculitis/metabolism
- Panniculitis/pathology
- Signal Transduction/drug effects
- Subcutaneous Fat, Abdominal/drug effects
- Subcutaneous Fat, Abdominal/immunology
- Subcutaneous Fat, Abdominal/metabolism
- Subcutaneous Fat, Abdominal/pathology
- Young Adult
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Affiliation(s)
- Mads Svart
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ulla Kampmann
- Department of Internal Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Thomas Voss
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Steen B Pedersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mogens Johannsen
- Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Nikolaj Rittig
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Per L Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas S Nielsen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Integrative Physiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Jessen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Møller
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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