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Jürgensen C, Eckart M, Haberbosch L, Tacke F, Sandforth A, Birkenfeld AL, Overkamp D, Daniels M, Mogl M, Goretzki P, Strasburger C, Mai K, Spranger J, Jumpertz von Schwartzenberg R. Endoscopic ultrasound-guided ethanol ablation versus surgical resection of insulinomas. Ultraschall Med 2024. [PMID: 37931914 DOI: 10.1055/a-2204-5814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE Insulinoma is a rare tumor of the pancreas that can lead to hypoglycemia. To date, the standard therapy is surgical resection. After the first case report of successful endoscopic ultrasound-guided (EUS) ethanol injection 16 years ago, the need for establishing an alternative treatment method remains unchanged given the high morbidity rates of surgery and its unsuitability in some patients. MATERIALS AND METHODS Here, we provide retrospective data from 33 insulinoma patients that were treated at our center between 2010 and 2021. Of these, 9 patients were treated with EUS-guided ethanol injection and 24 underwent pancreatic surgery. RESULTS The ethanol group was older (ethanol: mean ± SE 67.8±11.2 years vs. surgery: 52.3±15.7, p=0.014) with a higher Charlson Comorbidity Index (3.0 (1.0;4.0) vs. 1.0 (0.0;2.0), p=0.008). The lowest glucose values were similar between groups before (ethanol: 2.09±0.17 mmol/l vs. surgery: 1.81±0.08, p=0.158) and after (4.95±0.74 vs. 5.41±0.28, p=0.581) the respective treatments. Complications occurred more frequently in the surgery group (11 % vs. 54 %, p=0.026). One patient after prior partial pancreatectomy died postoperatively. The hospitalization time was significantly shorter in the ethanol group (4.78±0.78 days vs. 19.88±4.07, p<0.001). CONCLUSION EUS-guided ethanol injection can be similarly effective for the treatment of hyperinsulinemic hypoglycemia compared with pancreatic surgery but seems to be associated with less severe complications. This implies the need for prospective randomized trials in insulinoma patients with a low risk for malignancy.
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Affiliation(s)
- Christian Jürgensen
- Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany
| | - Marius Eckart
- Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany
| | - Linus Haberbosch
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany
| | - Arvid Sandforth
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
| | - Andreas L Birkenfeld
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
| | - Dietrich Overkamp
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Martin Daniels
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
| | - Martina Mogl
- Department of Surgery, Charité University Medicine, Berlin, Germany
| | - Peter Goretzki
- Department of Surgery, Charité University Medicine, Berlin, Germany
| | - Christian Strasburger
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
- Berlin Institute of Health at Charite, Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
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Sandforth A, von Schwartzenberg RJ, Arreola EV, Hanson RL, Sancar G, Katzenstein S, Lange K, Preißl H, Dreher SI, Weigert C, Wagner R, Kantartzis K, Machann J, Schick F, Lehmann R, Peter A, Katsouli N, Ntziachristos V, Dannecker C, Fritsche L, Perakakis N, Heni M, Nawroth PP, Kopf S, Pfeiffer AFH, Kabisch S, Stumvoll M, Schwarz PEH, Hauner H, Lechner A, Seissler J, Yurchenko I, Icks A, Solimena M, Häring HU, Szendroedi J, Schürmann A, de Angelis MH, Blüher M, Roden M, Bornstein SR, Stefan N, Fritsche A, Birkenfeld AL. Mechanisms of weight loss-induced remission in people with prediabetes: a post-hoc analysis of the randomised, controlled, multicentre Prediabetes Lifestyle Intervention Study (PLIS). Lancet Diabetes Endocrinol 2023; 11:798-810. [PMID: 37769677 DOI: 10.1016/s2213-8587(23)00235-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Remission of type 2 diabetes can occur as a result of weight loss and is characterised by liver fat and pancreas fat reduction and recovered insulin secretion. In this analysis, we aimed to investigate the mechanisms of weight loss- induced remission in people with prediabetes. METHODS In this prespecified post-hoc analysis, weight loss-induced resolution of prediabetes in the randomised, controlled, multicentre Prediabetes Lifestyle Intervention Study (PLIS) was assessed, and the results were validated against participants from the Diabetes Prevention Program (DPP) study. For PLIS, between March 1, 2012, and Aug 31, 2016, participants were recruited from eight clinical study centres (including seven university hospitals) in Germany and randomly assigned to receive either a control intervention, a standard lifestyle intervention (ie, DPP-based intervention), or an intensified lifestyle intervention for 12 months. For DPP, participants were recruited from 23 clinical study centres in the USA between July 31, 1996, and May 18, 1999, and randomly assigned to receive either a standard lifestyle intervention, metformin, or placebo. In both PLIS and DPP, only participants who were randomly assigned to receive lifestyle intervention or placebo and who lost at least 5% of their bodyweight were included in this analysis. Responders were defined as people who returned to normal fasting plasma glucose (FPG; <5·6 mmol/L), normal glucose tolerance (<7·8 mmol/L), and HbA1c less than 39 mmol/mol after 12 months of lifestyle intervention or placebo or control intervention. Non-responders were defined as people who had FPG, 2 h glucose, or HbA1c more than these thresholds. The main outcomes for this analysis were insulin sensitivity, insulin secretion, visceral adipose tissue (VAT), and intrahepatic lipid content (IHL) and were evaluated via linear mixed models. FINDINGS Of 1160 participants recruited to PLIS, 298 (25·7%) had weight loss of 5% or more of their bodyweight at baseline. 128 (43%) of 298 participants were responders and 170 (57%) were non-responders. Responders were younger than non-responders (mean age 55·6 years [SD 9·9] vs 60·4 years [8·6]; p<0·0001). The DPP validation cohort included 683 participants who lost at least 5% of their bodyweight at baseline. Of these, 132 (19%) were responders and 551 (81%) were non-responders. In PLIS, BMI reduction was similar between responders and non-responders (responders mean at baseline 32·4 kg/m2 [SD 5·6] to mean at 12 months 29·0 kg/m2 [4·9] vs non-responders 32·1 kg/m2 [5·9] to 29·2 kg/m2 [5·4]; p=0·86). However, whole-body insulin sensitivity increased more in responders than in non-responders (mean at baseline 291 mL/[min × m2], SD 60 to mean at 12 months 378 mL/[min × m2], 56 vs 278 mL/[min × m2], 62, to 323 mL/[min × m2], 66; p<0·0001), whereas insulin secretion did not differ within groups over time or between groups (responders mean at baseline 175 pmol/mmol [SD 64] to mean at 12 months 163·7 pmol/mmol [60·6] vs non-responders 158·0 pmol/mmol [55·6] to 154·1 pmol/mmol [56·2]; p=0·46). IHL decreased in both groups, without a difference between groups (responders mean at baseline 10·1% [SD 8·7] to mean at 12 months 3·5% [3·9] vs non-responders 10·3% [8·1] to 4·2% [4·2]; p=0·34); however, VAT decreased more in responders than in non-responders (mean at baseline 6·2 L [SD 2·9] to mean at 12 months 4·1 L [2·3] vs 5·7 L [2·3] to 4·5 L [2·2]; p=0·0003). Responders had a 73% lower risk of developing type 2 diabetes than non-responders in the 2 years after the intervention ended. INTERPRETATION By contrast to remission of type 2 diabetes, resolution of prediabetes was characterised by an improvement in insulin sensitivity and reduced VAT. Because return to normal glucose regulation (NGR) prevents development of type 2 diabetes, we propose the concept of remission of prediabetes in analogy to type 2 diabetes. We suggest that remission of prediabetes should be the primary therapeutic aim in individuals with prediabetes. FUNDING German Federal Ministry for Education and Research via the German Center for Diabetes Research; the Ministry of Science, Research and the Arts Baden-Württemberg; the Helmholtz Association and Helmholtz Munich; the Cluster of Excellence Controlling Microbes to Fight Infections; and the German Research Foundation.
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Affiliation(s)
- Arvid Sandforth
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Reiner Jumpertz von Schwartzenberg
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany; Cluster of Excellence Controlling Microbes to Fight Infections, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Elsa Vazquez Arreola
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Gencer Sancar
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Sarah Katzenstein
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Karl Lange
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Hubert Preißl
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Simon I Dreher
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Cora Weigert
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Robert Wagner
- German Center for Diabetes Research, Neuherberg, Germany; Department of Endocrinology and Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Medical Faculty and University Hospital, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kostantinos Kantartzis
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Jürgen Machann
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany; Department of Radiology, Section on Experimental Radiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Fritz Schick
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany; Department of Radiology, Section on Experimental Radiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Rainer Lehmann
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Andreas Peter
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Nikoletta Katsouli
- Central Institute for Translational Cancer Research, Technical University of Munich, Munich, Germany; Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Munich, Germany
| | - Vasilis Ntziachristos
- Central Institute for Translational Cancer Research, Technical University of Munich, Munich, Germany; Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Munich, Germany
| | - Corinna Dannecker
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Louise Fritsche
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Nikolaos Perakakis
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine III, Technical University Dresden, Dresden, Germany
| | - Martin Heni
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Peter Paul Nawroth
- German Center for Diabetes Research, Neuherberg, Germany; Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Stefan Kopf
- German Center for Diabetes Research, Neuherberg, Germany; Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Andreas F H Pfeiffer
- German Center for Diabetes Research, Neuherberg, Germany; Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Kabisch
- German Center for Diabetes Research, Neuherberg, Germany; German Institute of Human Nutrition Potsdam-Rehbrücke, Brandenburg, Germany
| | - Michael Stumvoll
- German Center for Diabetes Research, Neuherberg, Germany; Department of Medicine, Endocrinology and Nephrology, Universität Leipzig, Leipzig, Germany
| | - Peter E H Schwarz
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine III, Technical University Dresden, Dresden, Germany
| | - Hans Hauner
- German Center for Diabetes Research, Neuherberg, Germany; Institute of Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Andreas Lechner
- German Center for Diabetes Research, Neuherberg, Germany; Diabetes Research Group, Medical Department, Ludwig-Maximilians University Munich, Munich, Germany
| | - Jochen Seissler
- German Center for Diabetes Research, Neuherberg, Germany; Diabetes Research Group, Medical Department, Ludwig-Maximilians University Munich, Munich, Germany
| | - Iryna Yurchenko
- German Center for Diabetes Research, Neuherberg, Germany; Medical Faculty and University Hospital, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- German Center for Diabetes Research, Neuherberg, Germany; Institute for Health Services Research and Health Economics, Centre for Health and Society, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michele Solimena
- German Center for Diabetes Research, Neuherberg, Germany; Paul-Langerhans-Institut Dresden, Helmholtz Center Munich, University Clinic Carl Gustav Carus, Dresden, Germany
| | - Hans-Ulrich Häring
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Julia Szendroedi
- German Center for Diabetes Research, Neuherberg, Germany; Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Annette Schürmann
- German Center for Diabetes Research, Neuherberg, Germany; German Institute of Human Nutrition Potsdam-Rehbrücke, Brandenburg, Germany
| | - Martin Hrabé de Angelis
- German Center for Diabetes Research, Neuherberg, Germany; School of Medicine and School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany; Institute of Experimental Genetics, Helmholtz Center Munich, Munich, Germany
| | - Matthias Blüher
- German Center for Diabetes Research, Neuherberg, Germany; Department of Medicine, Endocrinology and Nephrology, Universität Leipzig, Leipzig, Germany
| | - Michael Roden
- German Center for Diabetes Research, Neuherberg, Germany; Department of Endocrinology and Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Medical Faculty and University Hospital, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan R Bornstein
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine III, Technical University Dresden, Dresden, Germany; Department of Diabetes, Life Sciences and Medicine, Cardiovascular Medicine and Sciences, Kings College London, London, UK
| | - Norbert Stefan
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Andreas Fritsche
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Andreas L Birkenfeld
- German Center for Diabetes Research, Neuherberg, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard-Karls University of Tübingen, Tübingen, Germany; Department of Diabetes, Life Sciences and Medicine, Cardiovascular Medicine and Sciences, Kings College London, London, UK.
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Sbierski-Kind J, Grenkowitz S, Schlickeiser S, Sandforth A, Friedrich M, Kunkel D, Glauben R, Brachs S, Mai K, Thürmer A, Radonić A, Drechsel O, Turnbaugh PJ, Bisanz JE, Volk HD, Spranger J, von Schwartzenberg RJ. Effects of caloric restriction on the gut microbiome are linked with immune senescence. Microbiome 2022; 10:57. [PMID: 35379337 PMCID: PMC8978410 DOI: 10.1186/s40168-022-01249-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/07/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND Caloric restriction can delay the development of metabolic diseases ranging from insulin resistance to type 2 diabetes and is linked to both changes in the composition and metabolic function of the gut microbiota and immunological consequences. However, the interaction between dietary intake, the microbiome, and the immune system remains poorly described. RESULTS We transplanted the gut microbiota from an obese female before (AdLib) and after (CalRes) an 8-week very-low-calorie diet (800 kcal/day) into germ-free mice. We used 16S rRNA sequencing to evaluate taxa with differential abundance between the AdLib- and CalRes-microbiota recipients and single-cell multidimensional mass cytometry to define immune signatures in murine colon, liver, and spleen. Recipients of the CalRes sample exhibited overall higher alpha diversity and restructuring of the gut microbiota with decreased abundance of several microbial taxa (e.g., Clostridium ramosum, Hungatella hathewayi, Alistipi obesi). Transplantation of CalRes-microbiota into mice decreased their body fat accumulation and improved glucose tolerance compared to AdLib-microbiota recipients. Finally, the CalRes-associated microbiota reduced the levels of intestinal effector memory CD8+ T cells, intestinal memory B cells, and hepatic effector memory CD4+ and CD8+ T cells. CONCLUSION Caloric restriction shapes the gut microbiome which can improve metabolic health and may induce a shift towards the naïve T and B cell compartment and, thus, delay immune senescence. Understanding the role of the gut microbiome as mediator of beneficial effects of low calorie diets on inflammation and metabolism may enhance the development of new therapeutic treatment options for metabolic diseases. TRIAL REGISTRATION NCT01105143 , "Effects of negative energy balance on muscle mass regulation," registered 16 April 2010. Video Abstract.
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Affiliation(s)
- Julia Sbierski-Kind
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Sophia Grenkowitz
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Stephan Schlickeiser
- BIH Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Arvid Sandforth
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Marie Friedrich
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Désirée Kunkel
- Berlin Institute of Health (BIH), Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Flow & Mass Cytometry Core Facility, Berlin, Germany
| | - Rainer Glauben
- Medical Department for Gastroenterology, Infectious Diseases and Rheumatology, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Brachs
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | | | | | | | - Peter J Turnbaugh
- Department of Microbiology & Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Jordan E Bisanz
- Department of Microbiology & Immunology, University of California San Francisco, San Francisco, CA, USA
- Department for Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA, USA
| | - Hans-Dieter Volk
- Berlin Institute of Health (BIH), Berlin, Germany
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
| | - Reiner Jumpertz von Schwartzenberg
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Cluster of Excellence EXC 2124 Controlling Microbes to Fight Infections, University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
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Haberbosch L, Maurer L, Sandforth A, Wernicke C, Spranger J, Mai K, Jumpertz von Schwartzenberg R. Spironolactone is associated with reduced mitotane levels in adrenocortical carcinoma patients. Endocr Relat Cancer 2022; 29:121-128. [PMID: 35014973 DOI: 10.1530/erc-21-0202] [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: 12/17/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a poor prognosis. Mitotane, a derivative of the pesticide dichlorodiphenyltrichloroethane, has been used successfully as first line chemotherapy since the 1960s, if maintained within a narrow therapeutic window. Spironolactone (SPL) is frequently used to treat glucocorticoid excess-associated adverse effects such as severe hypokalemia. Although data of a previous case report indicate a link, valid data regarding SPL use and mitotane plasma concentrations in a human cohort are lacking.This retrospective analysis includes data from 54 mitotane-receiving ACC patients (14 co-administered with SPL) treated between January 2005 and April 2020 (20 male, mean age 54.1 ± 2.2 years). All available mitotane concentrations, treatment doses, tumor stage and evidence of hormone activity were collected. Primary outcomes included mitotane levels and concentration/dose ratios as well as time-in-range (TR) in patients with and without additional SPL treatment. The SPL group was characterized by higher glucocorticoid secretion. Other features such as tumor stage, size and anthropometrics were similar between groups. Interestingly, the SPL group had significantly lower mitotane levels despite higher doses. Mitotane TR was significantly reduced in the SPL group, as was time-in-range to progression. These data provide first evidence in a human cohort for potential SPL-mitotane interactions (beyond mentioned case report), which affect dose response and may modulate treatment outcomes. This should caution clinicians to carefully adjust mitotane doses during SPL treatment in ACC patients or choose alternative therapeutic options.
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Affiliation(s)
- Linus Haberbosch
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lukas Maurer
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Arvid Sandforth
- Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine IV, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Partner of the German Center for Diabetes Research (DZD), Germany
| | - Charlotte Wernicke
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Charité Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Charité Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Division of Diabetology, Endocrinology and Nephrology, Department of Internal Medicine IV, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Partner of the German Center for Diabetes Research (DZD), Germany
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5
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von Schwartzenberg RJ, Bisanz JE, Lyalina S, Spanogiannopoulos P, Ang QY, Cai J, Dickmann S, Friedrich M, Liu SY, Collins SL, Ingebrigtsen D, Miller S, Turnbaugh JA, Patterson AD, Pollard KS, Mai K, Spranger J, Turnbaugh PJ. Caloric restriction disrupts the microbiota and colonization resistance. Nature 2021; 595:272-277. [PMID: 34163067 PMCID: PMC8959578 DOI: 10.1038/s41586-021-03663-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [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] [Received: 11/28/2017] [Accepted: 05/21/2021] [Indexed: 12/14/2022]
Abstract
Diet is a major factor that shapes the gut microbiome1, but the consequences of diet-induced changes in the microbiome for host pathophysiology remain poorly understood. We conducted a randomized human intervention study using a very-low-calorie diet (NCT01105143). Although metabolic health was improved, severe calorie restriction led to a decrease in bacterial abundance and restructuring of the gut microbiome. Transplantation of post-diet microbiota to mice decreased their body weight and adiposity relative to mice that received pre-diet microbiota. Weight loss was associated with impaired nutrient absorption and enrichment in Clostridioides difficile, which was consistent with a decrease in bile acids and was sufficient to replicate metabolic phenotypes in mice in a toxin-dependent manner. These results emphasize the importance of diet-microbiome interactions in modulating host energy balance and the need to understand the role of diet in the interplay between pathogenic and beneficial symbionts.
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Affiliation(s)
- Reiner Jumpertz von Schwartzenberg
- Charité Universitätsmedizin Berlin, Department of Endocrinology and Metabolic Diseases, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Center for Cardiovascular Research (CCR), Berlin, Germany
| | - Jordan E Bisanz
- Department of Microbiology & Immunology, University of California San Francisco, San Francisco, CA, USA
| | | | - Peter Spanogiannopoulos
- Department of Microbiology & Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Qi Yan Ang
- Department of Microbiology & Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Jingwei Cai
- Center for Molecular Toxicology and Carcinogenesis, Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Sophia Dickmann
- Charité Universitätsmedizin Berlin, Department of Endocrinology and Metabolic Diseases, Berlin, Germany
| | - Marie Friedrich
- Charité Universitätsmedizin Berlin, Department of Endocrinology and Metabolic Diseases, Berlin, Germany
| | - Su-Yang Liu
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Stephanie L Collins
- Center for Molecular Toxicology and Carcinogenesis, Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Danielle Ingebrigtsen
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jessie A Turnbaugh
- Department of Microbiology & Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D Patterson
- Center for Molecular Toxicology and Carcinogenesis, Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Katherine S Pollard
- Gladstone Institutes, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
- Institute for Computational Health Sciences, University of California San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Knut Mai
- Charité Universitätsmedizin Berlin, Department of Endocrinology and Metabolic Diseases, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Joachim Spranger
- Charité Universitätsmedizin Berlin, Department of Endocrinology and Metabolic Diseases, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Center for Cardiovascular Research (CCR), Berlin, Germany.
| | - Peter J Turnbaugh
- Department of Microbiology & Immunology, University of California San Francisco, San Francisco, CA, USA.
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6
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Poitou C, Puder L, Dubern B, Krabusch P, Genser L, Wiegand S, Verkindt H, Köhn A, von Schwartzenberg RJ, Flück C, Pattou F, Laville M, Kühnen P, Clément K. Long-term outcomes of bariatric surgery in patients with bi-allelic mutations in the POMC, LEPR, and MC4R genes. Surg Obes Relat Dis 2021; 17:1449-1456. [PMID: 34083135 DOI: 10.1016/j.soard.2021.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gene mutations in the leptin-melanocortin signaling cascade lead to hyperphagia and severe early onset obesity. In most cases, multimodal conservative treatment (increased physical activity, reduced caloric intake) is not successful to stabilize body weight and control hyperphagia. OBJECTIVES To examine bariatric surgery as a therapeutic option for patients with genetic obesity. SETTING Three major academic, specialized medical centers. METHODS In 3 clinical centers, we retrospectively analyzed the outcomes of bariatric surgery performed in 8 patients with monogenic forms of obesity with bi-allelic variants in the genes LEPR (n = 5), POMC (n = 2), and MC4R (n = 1). RESULTS In this group of patients with monogenic obesity, initial bariatric surgery was performed at a median age of 19 years (interquartile range [IQR], 16-23.8 yr). All patients initially experienced weight loss after each bariatric surgery, which was followed by substantial weight regain. In total, bariatric surgery led to a median maximum reduction of body weight of -21.5 kg (IQR, -36.3 to -2.9 kg), median percent excess weight loss (%EWL) of -47.5 %EWL (IQR, -57.6 to -28.9 %EWL). This body weight reduction was followed by median weight regain of 24.1 kg (IQR: 10.0 to 42.0 kg), leading to a final weight change of -24.2 % EWL (IQR: -37.6 to -5.4 %EWL) after a maximum duration of 19 years post surgery. In one patient, bariatric surgery was accompanied by significant complications, including vitamin deficiencies and hernia development. CONCLUSION The indication for bariatric surgery in patients with monogenic obesity based on bi-allelic gene mutations and its benefit/risk balance has to be evaluated very cautiously by specialized centers. Furthermore, to avoid an unsuccessful operation, preoperative genetic testing of patients with a history of early onset obesity might be essential, even more since novel pharmacological treatment options are expected.
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Affiliation(s)
- Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, CRNH Ile de France, F-CRIN/FORCE Network Paris, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France
| | - Lia Puder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany; Department for Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Beatrice Dubern
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France; Pediatric Nutrition and Gastroenterology Department, Assistance Publique-Hôpitaux de Paris, Trousseau Hospital, Paris, France
| | - Philipp Krabusch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany; Department for Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Laurent Genser
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Susanna Wiegand
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Berlin, Germany
| | - Hélène Verkindt
- CHU Lille, Endocrine and Metabolic Surgery, Integrated Center for Obesity, Lille, France
| | - Arvid Köhn
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Berlin, Germany
| | - Christa Flück
- Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics and Department of BioMedical Research, Bern University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - François Pattou
- CHU Lille, Endocrine and Metabolic Surgery, Integrated Center for Obesity, Lille, France; University of Lille, Lille Pasteur Institute, Inserm U1190, European Genomic Institute for Diabetes, Lille, France; F-CRIN/FORCE Network, Pierre Bénite, Lyon, France
| | - Martine Laville
- F-CRIN/FORCE Network, Pierre Bénite, Lyon, France; Département Endocrinologie, Diabète et Nutrition, Hospices Civils de Lyon, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, F-CRIN/FORCE Network, Pierre Bénite, Lyon, France
| | - Peter Kühnen
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany.
| | - Karine Clément
- Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, CRNH Ile de France, F-CRIN/FORCE Network Paris, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France
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7
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Sbierski-Kind J, Mai K, Kath J, Jurisch A, Streitz M, Kuchenbecker L, Babel N, Nienen M, Jürchott K, Spranger L, Jumpertz von Schwartzenberg R, Decker AM, Krüger U, Volk HD, Spranger J. Association between Subcutaneous Adipose Tissue Inflammation, Insulin Resistance, and Calorie Restriction in Obese Females. J Immunol 2020; 205:45-55. [PMID: 32482712 DOI: 10.4049/jimmunol.2000108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/21/2020] [Indexed: 01/30/2023]
Abstract
The worldwide epidemic of overweight and obesity has led to an increase in associated metabolic comorbidities. Obesity induces chronic low-grade inflammation in white adipose tissue (WAT). However, the function and regulation of both innate and adaptive immune cells in human WAT under conditions of obesity and calorie restriction (CR) is not fully understood yet. Using a randomized interventional design, we investigated postmenopausal overweight or obese female subjects who either underwent CR for 3 mo followed by a 4-wk phase of weight maintenance or had to maintain a stable weight over the whole study period. A comprehensive immune phenotyping protocol was conducted using validated multiparameter flow cytometry analysis in blood and s.c. WAT (SAT). The TCR repertoire was analyzed by next-generation sequencing and cytokine levels were determined in SAT. Metabolic parameters were determined by hyperinsulinemic-euglycemic clamp. We found that insulin resistance correlates significantly with a shift toward the memory T cell compartment in SAT. TCR analysis revealed a diverse repertoire in SAT of overweight or obese individuals. Additionally, whereas weight loss improved systemic insulin sensitivity in the intervention group, SAT displayed no significant improvement of inflammatory parameters (cytokine levels and leukocyte subpopulations) compared with the control group. Our data demonstrate the accumulation of effector memory T cells in obese SAT and an association between systemic glucose homeostasis and inflammatory parameters in obese females. The long-standing effect of obesity-induced changes in SAT was demonstrated by preserved immune cell composition after short-term CR-induced weight loss.
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Affiliation(s)
- Julia Sbierski-Kind
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of Endocrinology and Metabolism, Berlin Institute of Health, 10178 Berlin, Germany; .,Berlin Institute of Health, 10178 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Institute for Medical Immunology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Knut Mai
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of Endocrinology and Metabolism, Berlin Institute of Health, 10178 Berlin, Germany.,Berlin Institute of Health, 10178 Berlin, Germany.,Charité - Center for Cardiovascular Research, 10117 Berlin, Germany
| | - Jonas Kath
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of Endocrinology and Metabolism, Berlin Institute of Health, 10178 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Anke Jurisch
- Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Institute for Medical Immunology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Mathias Streitz
- Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Institute for Medical Immunology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Leon Kuchenbecker
- Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Institute for Medical Immunology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Nina Babel
- Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Center for Translational Medicine, Department of Internal Medicine I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, 44625 Bochum, Germany
| | - Mikalai Nienen
- Berlin Institute of Health, 10178 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Center for Translational Medicine, Department of Internal Medicine I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, 44625 Bochum, Germany
| | - Karsten Jürchott
- Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Institute for Medical Immunology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Leonard Spranger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of Endocrinology and Metabolism, Berlin Institute of Health, 10178 Berlin, Germany.,Charité - Center for Cardiovascular Research, 10117 Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of Endocrinology and Metabolism, Berlin Institute of Health, 10178 Berlin, Germany.,Berlin Institute of Health, 10178 Berlin, Germany.,Charité - Center for Cardiovascular Research, 10117 Berlin, Germany.,German Center for Cardiovascular Research, partner site Berlin, 13353 Berlin, Germany; and
| | - Anne-Marie Decker
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of Endocrinology and Metabolism, Berlin Institute of Health, 10178 Berlin, Germany.,Berlin Institute of Health, 10178 Berlin, Germany
| | - Ulrike Krüger
- Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Institute for Medical Immunology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Hans-Dieter Volk
- Berlin Institute of Health Center for Regenerative Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany.,Institute for Medical Immunology, Charité University Medicine Berlin, 10117 Berlin, Germany.,Berlin Center for Advanced Therapies, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Joachim Spranger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of Endocrinology and Metabolism, Berlin Institute of Health, 10178 Berlin, Germany.,Berlin Institute of Health, 10178 Berlin, Germany.,Charité - Center for Cardiovascular Research, 10117 Berlin, Germany.,German Center for Cardiovascular Research, partner site Berlin, 13353 Berlin, Germany; and
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8
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Basolo A, Hohenadel M, Ang QY, Piaggi P, Heinitz S, Walter M, Walter P, Parrington S, Trinidad DD, von Schwartzenberg RJ, Turnbaugh PJ, Krakoff J. Effects of underfeeding and oral vancomycin on gut microbiome and nutrient absorption in humans. Nat Med 2020; 26:589-598. [PMID: 32235930 DOI: 10.1038/s41591-020-0801-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
Direct evidence in humans for the impact of the microbiome on nutrient absorption is lacking. We conducted an extended inpatient study using two interventions that we hypothesized would alter the gut microbiome and nutrient absorption. In each, stool calorie loss, a direct proxy of nutrient absorption, was measured. The first phase was a randomized cross-over dietary intervention in which all participants underwent in random order 3 d of over- and underfeeding. The second was a randomized, double-blind, placebo-controlled pharmacologic intervention using oral vancomycin or matching placebo (NCT02037295). Twenty-seven volunteers (17 men and 10 women, age 35.1 ± 7.3, BMI 32.3 ± 8.0), who were healthy other than having impaired glucose tolerance and obesity, were enrolled and 25 completed the entire trial. The primary endpoints were the effects of dietary and pharmacological intervention on stool calorie loss. We hypothesized that stool calories expressed as percentage of caloric intake would increase with underfeeding compared with overfeeding and increase during oral vancomycin treatment. Both primary endpoints were met. Greater stool calorie loss was observed during underfeeding relative to overfeeding and during vancomycin treatment compared with placebo. Key secondary endpoints were to evaluate the changes in gut microbial community structure as evidenced by amplicon sequencing and metagenomics. We observed only a modest perturbation of gut microbial community structure with under- versus overfeeding but a more widespread change in community structure with reduced diversity with oral vancomycin. Increase in Akkermansia muciniphila was common to both interventions that resulted in greater stool calorie loss. These results indicate that nutrient absorption is sensitive to environmental perturbations and support the translational relevance of preclinical models demonstrating a possible causal role for the gut microbiome in dietary energy harvest.
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Affiliation(s)
- Alessio Basolo
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Phoenix, AZ, USA.
| | - Maximilian Hohenadel
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Phoenix, AZ, USA
| | - Qi Yan Ang
- Department of Microbiology and Immunology, University of California, San Francisco, CA, USA
| | - Paolo Piaggi
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Phoenix, AZ, USA
| | - Sascha Heinitz
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Phoenix, AZ, USA.,Department of Medicine, Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany.,Helmholtz Institute for Metabolic Obesity and Vascular Research (HI-MAG), Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Mary Walter
- Clinical Core Laboratory, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Peter Walter
- Clinical Mass Spectrometry Core, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Shannon Parrington
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Phoenix, AZ, USA
| | - Donovan D Trinidad
- Department of Microbiology and Immunology, University of California, San Francisco, CA, USA
| | | | - Peter J Turnbaugh
- Department of Microbiology and Immunology, University of California, San Francisco, CA, USA. .,Chan Zuckerberg Biohub, San Francisco, CA, USA.
| | - Jonathan Krakoff
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Phoenix, AZ, USA.
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9
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Heinitz S, Basolo A, Piaggi P, Piomelli D, Jumpertz von Schwartzenberg R, Krakoff J. Peripheral Endocannabinoids Associated With Energy Expenditure in Native Americans of Southwestern Heritage. J Clin Endocrinol Metab 2018; 103:1077-1087. [PMID: 29300902 PMCID: PMC6276675 DOI: 10.1210/jc.2017-02257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 10/12/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT The endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG), as well as the related acylethanolamide oleoylethanolamide (OEA), have been implicated in energy expenditure (EE) regulation and metabolic diseases. Muscle (fat-free mass) and fat (fat mass) are metabolically active compartments and main determinants of EE. OBJECTIVE To assess whether human muscle, adipose, and plasma endocannabinoids correlate with EE. DESIGN Muscle, adipose, and plasma AEA, 2-AG, and OEA concentrations were measured via liquid chromatography-mass spectrometry. EE was assessed by indirect whole-room calorimetry. SETTING Clinical trial. PARTICIPANTS Obese/overweight Native Americans of full (n = 35) and at least half (n = 21) Southwestern heritage. MAIN OUTCOME MEASURES Twenty-four-hour EE, sleeping EE (SLEEP), resting EE (REE), respiratory quotient (RQ), and macronutrient oxidation. RESULTS In full Natives, muscle AEA concentration correlated with SLEEP (r = -0.65, P = 0.004) and REE (r = -0.53, P = 0.02). Muscle 2-AG was associated with SLEEP (r = -0.75, P = 0.0003). Adipose OEA concentration correlated with RQ (r = -0.47, P = 0.04) and lipid oxidation (r = 0.51, P = 0.03). Plasma OEA concentration was associated with SLEEP (r = -0.52, P = 0.04). After adjustment for major determinants, these lipids explained nearly 20% of the additional variance of the respective measure. Similarly, in Native Americans of at least half Southwestern heritage, investigated lipids correlated with EE measures. CONCLUSION Endocannabinoids in metabolically relevant peripheral tissues explained a large part of EE variation and may be involved in regulating EE. Dysregulation of peripheral endocannabinoids may predispose people to metabolic diseases via an effect on EE and lipid oxidation.
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Affiliation(s)
- Sascha Heinitz
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and
Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases,
Phoenix, Arizona
- Correspondence and Reprint Requests: Sascha Heinitz, MD, Obesity and Diabetes Clinical Research Section, Phoenix
Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive
and Kidney Diseases, 4212 North 16th Street, Phoenix, Arizona 85016. E-mail:
;
| | - Alessio Basolo
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and
Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases,
Phoenix, Arizona
| | - Paolo Piaggi
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and
Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases,
Phoenix, Arizona
| | - Daniele Piomelli
- Department of Pharmacology, University of California Irvine, Irvine,
California
| | - Reiner Jumpertz von Schwartzenberg
- Charité Universitätsmedizin Berlin, Department of Endocrinology and Metabolic
Diseases, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Jonathan Krakoff
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and
Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases,
Phoenix, Arizona
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10
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Prehn K, Jumpertz von Schwartzenberg R, Mai K, Zeitz U, Witte AV, Hampel D, Szela AM, Fabian S, Grittner U, Spranger J, Flöel A. Caloric Restriction in Older Adults-Differential Effects of Weight Loss and Reduced Weight on Brain Structure and Function. Cereb Cortex 2017; 27:1765-1778. [PMID: 26838769 DOI: 10.1093/cercor/bhw008] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Dietary modifications such as caloric restriction (CR) have been suggested as a means to improve memory and prevent age-related decline. However, it is unclear whether those effects remain stable over time or are related specifically to negative energy balance during the weight loss phase of CR. Using a randomized interventional design, we investigated changes in recognition memory and neural correlates in postmenopausal obese women (n = 19): 1) after intense weight loss in the course of a 12-week low-caloric diet (reduced body weight and negative energy balance) and 2) after having sustained the reduced weight over 4 more weeks (reduced body weight, but energy balance equilibrium). Participants were contrasted to a control group (n = 18) instructed not to change dietary habits. In the CR group, we found improved recognition memory, paralleled by increased gray matter volume in inferior frontal gyrus and hippocampus, and augmented hippocampal resting-state functional connectivity to parietal areas. Moreover, effects were specific for transient negative energy balance and could not be detected after subsequent weight maintenance. Our data demonstrate for the first time in humans that beneficial effects of CR on brain structure and function are due to weight loss rather than an overall reduced weight.
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Affiliation(s)
- Kristin Prehn
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Knut Mai
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Zeitz
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Veronica Witte
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Aging and Obesity Group, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Dierk Hampel
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anna-Maria Szela
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sonja Fabian
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Grittner
- Department of Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology, Diabetes and Nutrition, Experimental and Clinical Research Center and Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Agnes Flöel
- Department of Neurology and NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
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11
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Maurer L, Brachs S, Decker AM, Brachs M, Leupelt V, Jumpertz von Schwartzenberg R, Ernert A, Bobbert T, Krude H, Spranger J, Mai K. Weight Loss Partially Restores Glucose-Driven Betatrophin Response in Humans. J Clin Endocrinol Metab 2016; 101:4014-4020. [PMID: 27459526 DOI: 10.1210/jc.2016-1788] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Recently a potential role of betatrophin was shown in the postprandial switch from lipid to glucose metabolism. OBJECTIVE The objective of the study was to analyze whether obesity is associated with altered postprandial betatrophin response and whether this could be restored by weight loss. Design, Setting, Participants, and Intervention: Oral glucose load was performed in 12 lean individuals at baseline as well as in 20 obese subjects before and after a 12-week structured weight-loss program at an endocrinology research center. Euglycemic hyperinsulinemic clamps were performed in the obese cohort. The effect of insulin and different glucose concentrations on betatrophin expression were analyzed in 3T3-L1 adipocytes. MAIN OUTCOME MEASURE Circulating betatrophin levels during a glucose challenge were measured. RESULTS The betatrophin level decreases after an oral glucose intake (P < .001). This correlates with the increase of glucose levels (r = -0.396; P < .05). Hyperinsulinemia results in an increase of betatrophin. In vitro experiments in 3T3-L1 adipocytes confirmed that insulin and low glucose concentration increases betatrophin expression, whereas a further elevation of glucose levels blunts this effect. Obese subjects are characterized by lower fasting betatrophin (600.6 ± 364.4 vs 759.5 ± 197.9 pg/mL; P < .05) and a more pronounced betatrophin suppression during the glucose challenge. The impaired betatrophin response in obese subjects is restored after weight loss and is comparable with lean individuals. CONCLUSIONS Obesity is associated with increased betatrophin suppression after an oral glucose load, which is driven by increased hyperglycemia. Given the metabolic properties of betatrophin, this may indicate that betatrophin is tightly linked to obesity-associated metabolic disturbances. In line with such an assumption, weight loss almost completely eliminated this phenomenon.
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Affiliation(s)
- Lukas Maurer
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Sebastian Brachs
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Anne-Marie Decker
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Maria Brachs
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Verena Leupelt
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Andrea Ernert
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Thomas Bobbert
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Heiko Krude
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Joachim Spranger
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
| | - Knut Mai
- Medical Clinic of Endocrinology, Diabetes, and Nutrition (L.M., S.B.,A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.) and Department of Pediatric Endocrinology and Diabetology (A.E., H.K.), Charité-Universitaetsmedizin Berlin, 10117 Berlin, Germany, Charité-Center for Cardiovascular Research (L.M., S.B., A.-M.D., M.B., V.L., R.J.v.S., T.B., J.S., K.M.), 10117 Berlin, Germany, and Clinical Research Unit (A.-M.D., K.M.), Berlin Institute of Health 10117 Berlin, Germany; and Experimental and Clinical Research Center (S.B., M.B., R.J.v.S., J.S., K.M.), 13125 Berlin, Germany
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12
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Abstract
Zeevi et al. report that extensive monitoring of a human cohort for variations in dietary intake, lifestyle, host phenotype, and the gut microbiome has enabled the development of a machine-learning algorithm that accurately predicts the individual glycemic response to meals, providing an important first step toward personalized nutrition.
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Affiliation(s)
- Reiner Jumpertz von Schwartzenberg
- University of California, San Francisco, Department of Microbiology and Immunology, G.W. Hooper Research Foundation, 513 Parnassus Avenue, HSE 1001F, San Francisco, CA 94143-0552, USA; Charité Universitätsmedizin Berlin, Department of Endocrinology and Metabolic Diseases, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter J Turnbaugh
- University of California, San Francisco, Department of Microbiology and Immunology, G.W. Hooper Research Foundation, 513 Parnassus Avenue, HSE 1001F, San Francisco, CA 94143-0552, USA.
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13
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Jumpertz von Schwartzenberg R, Elbelt U, Ventz M, Mai K, Kienitz T, Maurer L, Rose T, Rückert JC, Strasburger CJ, Spranger J. Palliative treatment of uncontrollable hypercalcemia due to parathyrotoxicosis: denosumab as rescue therapy. Endocrinol Diabetes Metab Case Rep 2015; 2015:150082. [PMID: 26605043 PMCID: PMC4653612 DOI: 10.1530/edm-15-0082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/29/2015] [Indexed: 11/08/2022] Open
Abstract
Parathyroid carcinoma is a rare disease leading to severe hypercalcemia due to hyperparathyroidism. Surgery is the primary treatment option. A more progressive form of the disease is characterized by parathyrotoxicosis, and subsequent hypercalcemia is the most common cause of death. We report a case presenting with severe hypercalcemia due to parathyrotoxicosis from parathyroid carcinoma treated for the first time using the monoclonal antibody denosumab as a rescue therapy and present long-term follow-up data. The 71-year-old patient presented with severe hypercalcemia due to metastatic parathyroid carcinoma. Despite undergoing treatment with bisphosphonates, cinacalcet hydrochloride, and forced diuresis, the patient`s condition deteriorated rapidly due to resistant hypercalcemia. Surgery performed because of spinal metastasis and forced diuresis lowered calcium levels, albeit they remained in the hypercalcemic range and significantly increased when forced diuresis was stopped. Considering a palliative situation to overcome hypercalcemia, we decided to administer denosumab, a monoclonal antibody that binds to the receptor activator of nuclear factor-kappa B ligand. After a single subcutaneous administration of 60 mg denosumab, calcium levels normalized within one day. Subsequent denosumab injections led to permanent control of serum calcium for more than 2 years despite rising parathyroid hormone levels and repeated surgeries. Together with recent cases in the literature supporting our observation, we believe that denosumab is relevant for future trials and represents an effective tool to control hypercalcemia in patients with advanced stages of parathyroid cancer.
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Affiliation(s)
| | - Ulf Elbelt
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Manfred Ventz
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Knut Mai
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Tina Kienitz
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Lukas Maurer
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Thomas Rose
- Division of Rheumatology and Clinical Immunology, Medical Department, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Jens C Rückert
- Department of General Visceral Vascular and Thoracic Surgery, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Christian J Strasburger
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
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