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Brown LA, Griffiths JA, Santer P, Jakeman PM, Smith TG. Potential for using simulated altitude as a means of prehabilitation: a physiology study. Anaesthesia 2023; 78:1472-1480. [PMID: 37877784 PMCID: PMC10953332 DOI: 10.1111/anae.16158] [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] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
The current pandemic of surgical complications necessitates urgent and pragmatic innovation to reduce postoperative morbidity and mortality, which are associated with poor pre-operative fitness and anaemia. Exercise prehabilitation is a compelling strategy, but it has proven difficult to establish that it improves outcomes either in isolation or as part of a multimodal approach. Simulated altitude exposure improves performance in athletes and offers a novel potential means of improving cardiorespiratory and metabolic fitness and alleviating anaemia within the prehabilitation window. We aimed to provide an initial physiological foundation for 'altitude prehabilitation' by determining the physiological effects of one week of simulated altitude (FI O2 15%, equivalent to approximately 2438 m (8000 ft)) in older sedentary volunteers. The study used a randomised, double-blind, sham-controlled crossover design. Eight participants spent counterbalanced normoxic and hypoxic weeks in a residential hypoxia facility and underwent repeated cardiopulmonary exercise tests. Mean (SD) age of participants was 64 (7) y and they were unfit, with mean (SD) baseline anaerobic threshold 12 (2) ml.kg-1 .min-1 and mean (SD) peak V̇O2 15 (3) ml.kg-1 .min-1 . Hypoxia was mild (mean (SD) Sp O2 93 (2) %, p < 0.001) and well-tolerated. Despite some indication of greater peak exercise capacity following hypoxia, overall there was no effect of simulated altitude on anaerobic threshold or peak V̇O2 . However, hypoxia induced a substantial increase in mean (SD) haemoglobin of 1.5 (2.7) g.dl-1 (13% increase, p = 0.028). This study has established the concept and feasibility of 'altitude prehabilitation' and demonstrated specific potential for improving haematological fitness. Physiologically, there is value in exploring a possible role for simulated altitude in pre-operative optimisation.
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Affiliation(s)
| | - J. A. Griffiths
- Nuffield Department of AnaesthesiaOxford University Hospitals NHS Foundation TrustOxfordUK
| | - P. Santer
- Department of Anesthesia, Critical Care and Pain MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMAUSA
| | - P. M. Jakeman
- Health Research Institute and Department of Physical Education and Sport SciencesUniversity of LimerickLimerickIreland
| | - T. G. Smith
- Centre for Human and Applied Physiological SciencesKing's College LondonLondonUK
- Department of AnaesthesiaGuy's and St Thomas' NHS Foundation TrustLondonUK
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Rückert A, Ast J, Hasib A, Nasteska D, Viloria K, Broichhagen J, Hodson DJ. Fine-tuned photochromic sulfonylureas for optical control of beta cell Ca 2+ fluxes. Diabet Med 2023; 40:e15220. [PMID: 37669696 PMCID: PMC10947021 DOI: 10.1111/dme.15220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023]
Abstract
We previously developed, synthesized and tested light-activated sulfonylureas for optical control of KATP channels and pancreatic beta cell activity in vitro and in vivo. Such technology relies on installation of azobenzene photoswitches onto the sulfonylurea backbone, affording light-dependent isomerization, alteration in ligand affinity for SUR1 and hence KATP channel conductance. Inspired by molecular dynamics simulations and to further improve photoswitching characteristics, we set out to develop a novel push-pull closed ring azobenzene unit, before installing this on the sulfonylurea glimepiride as a small molecule recipient. Three fine-tuned, light-activated sulfonylureas were synthesized, encompassing azetidine, pyrrolidine and piperidine closed rings. Azetidine-, pyrrolidine- and piperidine-based sulfonylureas all increased beta cell Ca2+ -spiking activity upon continuous blue light illumination, similarly to first generation JB253. Notably, the pyrrolidine-based sulfonylurea showed superior switch OFF performance to JB253. As such, third generation sulfonylureas afford more precise optical control over primary pancreatic beta cells, and showcase the potential of pyrrolidine-azobenzenes as chemical photoswitches across drug classes.
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Affiliation(s)
| | - Julia Ast
- Institute of Metabolism and Systems Research (IMSR), and Centre of Membrane Proteins and Receptors (COMPARE)University of BirminghamBirminghamUK
| | - Annie Hasib
- Institute of Metabolism and Systems Research (IMSR), and Centre of Membrane Proteins and Receptors (COMPARE)University of BirminghamBirminghamUK
| | - Daniela Nasteska
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, Churchill Hospital, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Katrina Viloria
- Institute of Metabolism and Systems Research (IMSR), and Centre of Membrane Proteins and Receptors (COMPARE)University of BirminghamBirminghamUK
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, Churchill Hospital, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | - David J. Hodson
- Institute of Metabolism and Systems Research (IMSR), and Centre of Membrane Proteins and Receptors (COMPARE)University of BirminghamBirminghamUK
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, Churchill Hospital, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
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Bowman P, Patel KA, McDonald TJ, Holst JJ, Hartmann B, Leveridge M, Shields BM, Hammersley S, Spaull SR, Knight BA, Flanagan SE, Shepherd MH, Andrews RC, Hattersley AT. Incretin hormone responses to carbohydrate and protein/fat are preserved in adults with sulfonylurea-treated KCNJ11 neonatal diabetes. J Diabetes Investig 2023; 14:1378-1382. [PMID: 37602910 PMCID: PMC10688132 DOI: 10.1111/jdi.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
The incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are thought to be the main drivers of insulin secretion in individuals with sulfonylurea (SU)-treated KCNJ11 permanent neonatal diabetes. The aim of this study was to assess for the first time the incretin hormone response to carbohydrate and protein/fat in adults with sulfonylurea-treated KCNJ11 permanent neonatal diabetes compared with that of controls without diabetes. Participants were given a breakfast high in carbohydrate and an isocaloric breakfast high in protein/fat on two different mornings. Incremental area under the curve and total area under the curve (0-240 minutes) for total GLP-1 and GIP were compared between groups, using non-parametric statistical methods. Post-meal GLP-1 and GIP secretion were similar in cases and controls, suggesting this process is adenosine triphosphate-sensitive potassium channel-independent. Future research will investigate whether treatments targeting the incretin pathway are effective in individuals with KCNJ11 permanent neonatal diabetes who do not have good glycemic control on sulfonylurea alone.
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Affiliation(s)
- Pamela Bowman
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Kashyap A Patel
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Timothy J McDonald
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Jens J Holst
- Faculty of Health and Medical SciencesUniversity of CopenhagenKobenhavnDenmark
| | - Bolette Hartmann
- Faculty of Health and Medical SciencesUniversity of CopenhagenKobenhavnDenmark
| | - Maria Leveridge
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Beverley M Shields
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
| | - Suzie Hammersley
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Steve R Spaull
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Bridget A Knight
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Sarah E Flanagan
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
| | - Maggie H Shepherd
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Rob C Andrews
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
| | - Andrew T Hattersley
- University of Exeter Medical SchoolExeterUK
- Exeter NIHR Clinical Research FacilityExeterUK
- NIHR Exeter Biomedical Research Centre (BRC)ExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
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Reimann F. Dorothy Hodgkin lecture 2023: The enteroendocrine system-Sensors in your guts. Diabet Med 2023; 40:e15212. [PMID: 37638546 PMCID: PMC10946932 DOI: 10.1111/dme.15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
Glucagon-like peptide-1 (GLP-1)-based medication is now widely employed in the treatment of type 2 diabetes and obesity. Like other gut hormones, GLP-1 is released from eneteroendocrine cells after a meal and in this review, based on the Dorothy Hodgkin lecture delivered during the annual meeting of Diabetes UK in 2023, I argue that there is sufficient spare capacity of GLP-1 and other gut hormone expressing cells that could be recruited therapeutically. Years of research has revealed several receptors expressed in enteroendocrine cells that could be targeted to stimulate hormone release: although from this research it seems unlikely to find agents that selectively boost GLP-1, release of a mixture of hormones might be the more desirable outcome anyway, given the recent promising results of new peptides combining GLP1-receptor with other gut hormone receptor activation. Alternatively, the fact that GLP-1 and peptideYY (PYY) expressing cells are found in greater density in the ileum might be exploited by increasing the delivery of chyme to the distal small intestine.
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Affiliation(s)
- Frank Reimann
- Department of Clinical BiochemistryInstitute of Metabolic Science & MRC Metabolic Diseases Unit, Addenbrooke's Hospital, University of CambridgeCambridgeUK
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Shapey IM, Summers A, O'Sullivan J, Fullwood C, Hanley NA, Casey J, Forbes S, Rosenthal M, Johnson PRV, Choudhary P, Bushnell J, Shaw JAM, Neiman D, Shemer R, Glaser B, Dor Y, Augustine T, Rutter MK, van Dellen D. Beta-cell death and dysfunction drives hyperglycaemia in organ donors. Diabetes Obes Metab 2023; 25:3529-3537. [PMID: 37646197 PMCID: PMC10947469 DOI: 10.1111/dom.15248] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Donor hyperglycaemia following brain death has been attributed to reversible insulin resistance. However, our islet and pancreas transplant data suggest that other mechanisms may be predominant. We aimed to determine the relationships between donor insulin use and markers of beta-cell death and beta-cell function in pancreas donors after brain death. METHODS In pancreas donors after brain death, we compared clinical and biochemical data in 'insulin-treated' and 'not insulin-treated donors' (IT vs. not-IT). We measured plasma glucose, C-peptide and levels of circulating unmethylated insulin gene promoter cell-free DNA (INS-cfDNA) and microRNA-375 (miR-375), as measures of beta-cell death. Relationships between markers of beta-cell death and islet isolation outcomes and post-transplant function were also evaluated. RESULTS Of 92 pancreas donors, 40 (43%) required insulin. Glycaemic control and beta-cell function were significantly poorer in IT donors versus not-IT donors [median (IQR) peak glucose: 8 (7-11) vs. 6 (6-8) mmol/L, p = .016; C-peptide: 3280 (3159-3386) vs. 3195 (2868-3386) pmol/L, p = .046]. IT donors had significantly higher levels of INS-cfDNA [35 (18-52) vs. 30 (8-51) copies/ml, p = .035] and miR-375 [1.050 (0.19-1.95) vs. 0.73 (0.32-1.10) copies/nl, p = .05]. Circulating donor miR-375 was highly predictive of recipient islet graft failure at 3 months [adjusted receiver operator curve (SE) = 0.813 (0.149)]. CONCLUSIONS In pancreas donors, hyperglycaemia requiring IT is strongly associated with beta-cell death. This provides an explanation for the relationship of donor IT with post-transplant beta-cell dysfunction in transplant recipients.
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Affiliation(s)
- Iestyn M. Shapey
- Faculty of Medicine, Biology and HealthUniversity of ManchesterManchesterUK
- Department of Renal and Pancreatic TransplantationManchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research CentreManchesterUK
| | - Angela Summers
- Faculty of Medicine, Biology and HealthUniversity of ManchesterManchesterUK
- Department of Renal and Pancreatic TransplantationManchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research CentreManchesterUK
| | - James O'Sullivan
- Manchester Centre for Genomic MedicineManchester University NHS Foundation TrustManchesterUK
| | - Catherine Fullwood
- Faculty of Medicine, Biology and HealthUniversity of ManchesterManchesterUK
- Department of Research and Innovation (medical statistics)Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| | - Neil A. Hanley
- Faculty of Medicine, Biology and HealthUniversity of ManchesterManchesterUK
| | - John Casey
- Transplant Unit, Royal Infirmary of EdinburghEdinburghUK
| | - Shareen Forbes
- Transplant Unit, Royal Infirmary of EdinburghEdinburghUK
- Endocrinology Unit, University of EdinburghEdinburghUK
| | | | - Paul R. V. Johnson
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordOxfordUK
| | | | | | | | - Daniel Neiman
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel‐CanadaThe Hebrew University‐Hadassah Medical SchoolJerusalemIsrael
| | - Ruth Shemer
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel‐CanadaThe Hebrew University‐Hadassah Medical SchoolJerusalemIsrael
| | - Benjamin Glaser
- Department of Endocrinology and Metabolism, Hadassah Medical Center and Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Yuval Dor
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel‐CanadaThe Hebrew University‐Hadassah Medical SchoolJerusalemIsrael
| | - Titus Augustine
- Faculty of Medicine, Biology and HealthUniversity of ManchesterManchesterUK
- Department of Renal and Pancreatic TransplantationManchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research CentreManchesterUK
| | - Martin K. Rutter
- Faculty of Medicine, Biology and HealthUniversity of ManchesterManchesterUK
- Diabetes, Endocrinology and Metabolism CentreManchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| | - David van Dellen
- Faculty of Medicine, Biology and HealthUniversity of ManchesterManchesterUK
- Department of Renal and Pancreatic TransplantationManchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research CentreManchesterUK
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Irshad Z, Lund J, Sillars A, Løvsletten NG, Gharanei S, Salt IP, Freeman DJ, Gill JMR, Thoresen GH, Rustan AC, Zammit VA. The roles of DGAT1 and DGAT2 in human myotubes are dependent on donor patho-physiological background. FASEB J 2023; 37:e23209. [PMID: 37779421 PMCID: PMC10947296 DOI: 10.1096/fj.202300960rr] [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: 05/11/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
The roles of DGAT1 and DGAT2 in lipid metabolism and insulin responsiveness of human skeletal muscle were studied using cryosections and myotubes prepared from muscle biopsies from control, athlete, and impaired glucose regulation (IGR) cohorts of men. The previously observed increases in intramuscular triacylglycerol (IMTG) in athletes and IGR were shown to be related to an increase in lipid droplet (LD) area in type I fibers in athletes but, conversely, in type II fibers in IGR subjects. Specific inhibition of both diacylglycerol acyltransferase (DGAT) 1 and 2 decreased fatty acid (FA) uptake by myotubes, whereas only DGAT2 inhibition also decreased fatty acid oxidation. Fatty acid uptake in myotubes was negatively correlated with the lactate thresholds of the respective donors. DGAT2 inhibition lowered acetate uptake and oxidation in myotubes from all cohorts whereas DGAT1 inhibition had no effect. A positive correlation between acetate oxidation in myotubes and resting metabolic rate (RMR) from fatty acid oxidation in vivo was observed. Myotubes from athletes and IGR had higher rates of de novo lipogenesis from acetate that were normalized by DGAT2 inhibition. Moreover, DGAT2 inhibition in myotubes also resulted in increased insulin-induced Akt phosphorylation. The differential effects of DGAT1 and DGAT2 inhibition suggest that the specialized role of DGAT2 in esterifying nascent diacylglycerols and de novo synthesized FA is associated with synthesis of a pool of triacylglycerol, which upon hydrolysis results in effectors that promote mitochondrial fatty acid oxidation but decrease insulin signaling in skeletal muscle cells.
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Affiliation(s)
- Zehra Irshad
- Translational and Experimental Medicine, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Jenny Lund
- Section for Pharmacology and Pharmaceutical Biosciences, Department of PharmacyUniversity of OsloOsloNorway
| | - Anne Sillars
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Nils Gunnar Løvsletten
- Section for Pharmacology and Pharmaceutical Biosciences, Department of PharmacyUniversity of OsloOsloNorway
| | - Seley Gharanei
- Translational and Experimental Medicine, Warwick Medical SchoolUniversity of WarwickCoventryUK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM)University Hospitals Coventry and Warwickshire NHS TrustCoventryUK
| | - Ian P. Salt
- School of Molecular Biosciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Dilys J. Freeman
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Jason M. R. Gill
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - G. Hege Thoresen
- Section for Pharmacology and Pharmaceutical Biosciences, Department of PharmacyUniversity of OsloOsloNorway
- Department of Pharmacology, Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Arild C. Rustan
- Section for Pharmacology and Pharmaceutical Biosciences, Department of PharmacyUniversity of OsloOsloNorway
| | - Victor A. Zammit
- Translational and Experimental Medicine, Warwick Medical SchoolUniversity of WarwickCoventryUK
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Shah DS, Nisr RB, Krasteva‐Christ G, Hundal HS. Caveolin-3 loss linked with the P104L LGMD-1C mutation modulates skeletal muscle mTORC1 signalling and cholesterol homeostasis. J Cachexia Sarcopenia Muscle 2023; 14:2310-2326. [PMID: 37671684 PMCID: PMC10570080 DOI: 10.1002/jcsm.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Caveolins are the principal structural components of plasma membrane caveolae. Dominant pathogenic mutations in the muscle-specific caveolin-3 (Cav3) gene isoform, such as the limb girdle muscular dystrophy type 1C (LGMD-1C) P104L mutation, result in dramatic loss of the Cav3 protein and pathophysiological muscle weakness/wasting. We hypothesize that such muscle degeneration may be linked to disturbances in signalling events that impact protein turnover. Herein, we report studies assessing the effects of Cav3 deficiency on mammalian or mechanistic target of rapamycin complex 1 (mTORC1) signalling in skeletal muscle cells. METHODS L6 myoblasts were stably transfected with Cav3P104L or expression of native Cav3 was abolished by CRISPR/Cas9 genome editing (Cav3 knockout [Cav3KO]) prior to performing subcellular fractionation and immunoblotting, analysis of real-time mitochondrial respiration or fixed cell immunocytochemistry. Skeletal muscle from wild-type and Cav3-/- mice was processed for immunoblot analysis of downstream mTORC1 substrate phosphorylation. RESULTS Cav3 was detected in lysosomal-enriched membranes isolated from L6 myoblasts and observed by confocal microscopy to co-localize with lysosomal-specific markers. Cav3P104L expression, which results in significant (~95%) loss of native Cav3, or CRISPR/Cas9-mediated Cav3KO, reduced amino acid-dependent mTORC1 activation. The decline in mTORC1-directed signalling was detected by immunoblot analysis of L6 muscle cells and gastrocnemius Cav3-/- mouse muscle as judged by reduced phosphorylation of mTORC1 substrates that play key roles in the initiation of protein synthesis (4EBP1S65 and S6K1T389 ). S6K1T389 and 4EBP1S65 phosphorylation reduced by over 75% and 80% in Cav3KO muscle cells and by over 90% and 30% in Cav3-/- mouse skeletal muscle, respectively. The reduction in protein synthetic capacity in L6 muscle cells was confirmed by analysis of puromycylated peptides using the SUnSET assay. Cav3 loss was also associated with a 26% increase in lysosomal cholesterol, and pharmacological manipulation of lysosomal cholesterol was effective in replicating the reduction in mTORC1 activity observed in Cav3KO cells. Notably, re-expression of Cav3 in Cav3KO myoblasts normalized lysosomal cholesterol content, which coincided with a recovery in protein translation and an associated increase in mTORC1-directed phosphorylation of downstream targets. CONCLUSIONS Our findings indicate that Cav3 can localize on lysosomal membranes and is a novel regulator of mTORC1 signalling in muscle. Cav3 deficiency associated with the Cav3P104L mutation impairs mTORC1 activation and protein synthetic capacity in skeletal muscle cells, which may be linked to disturbances in lysosomal cholesterol trafficking and contribute to the pathology of LGMD-1C.
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Affiliation(s)
- Dinesh S. Shah
- Division of Cell Signalling and Immunology, Sir James Black Centre, School of Life SciencesUniversity of DundeeDundeeDD1 5EHUK
| | - Raid B. Nisr
- Division of Cell Signalling and Immunology, Sir James Black Centre, School of Life SciencesUniversity of DundeeDundeeDD1 5EHUK
| | | | - Harinder S. Hundal
- Division of Cell Signalling and Immunology, Sir James Black Centre, School of Life SciencesUniversity of DundeeDundeeDD1 5EHUK
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Bond Z, Malik S, Bashir A, Stocker R, Buckingham J, Speight J, Shaw JAM. Validation of Igls Criteria for Islet Transplant Functional Status Using Person-Reported Outcome Measures in a Cross-Sectional Study. Transpl Int 2023; 36:11659. [PMID: 37822448 PMCID: PMC10563803 DOI: 10.3389/ti.2023.11659] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
Associations between islet graft function and well-being in islet transplant recipients requiring exogenous insulin remain unclear. This cross-sectional analysis compared person-reported outcome measures in 15 adults with type 1 diabetes whose islet transplants were classified according to Igls criteria as "Good" (n = 5), "Marginal" (n = 4) and "Failed" (n = 6) graft function. At a mean of 6.2 years post-first islet transplant, 90% reduction in severe hypoglycaemia was maintained in all groups, with HbA1c (mean ± SD mmol/mol) 49 ± 4 in recipients with "Good" function; 56 ± 5 ("Marginal"); and 69 ± 25 ("Failed"). Self-reported impaired awareness of hypoglycaemia persisted in all groups but those with "Good" function were more likely to experience symptoms during hypoglycaemia. "Marginal" function was associated with greater fear of hypoglycaemia (HFS-II score: "Marginal": 113 [95, 119]; "Failed": 63 [42, 93] (p = 0.082); "Good": 33 [29, 61]) and severe anxiety (GAD7: "Marginal"): 21 [17, 21]; "Failed": 6 [6, 6] "Good": 6 [3, 11]; (p = 0.079)), diabetes distress and low mood. Despite clear evidence of ongoing clinical benefit, Igls criteria 'Marginal' function is associated with sub-optimal well-being, including greater fear of hypoglycaemia and severe anxiety. This study provides person-reported validation that "Good" and "Marginal" graft function are differentiated by general and diabetes-specific subjective well-being, suggesting those with "Marginal" function may benefit from further intervention, including re-transplantation.
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Affiliation(s)
- Zoe Bond
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Saffron Malik
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayat Bashir
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rachel Stocker
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jocelyn Buckingham
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jane Speight
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, VIC, Australia
| | - James A. M. Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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9
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Karwen T, Kolczynska‐Matysiak K, Gross C, Löffler MC, Friedrich M, Loza‐Valdes A, Schmitz W, Wit M, Dziaczkowski F, Belykh A, Trujillo‐Viera J, El‐Merahbi R, Deppermann C, Nawaz S, Hastoy B, Demczuk A, Erk M, Wieckowski MR, Rorsman P, Heinze KG, Stegner D, Nieswandt B, Sumara G. Platelet-derived lipids promote insulin secretion of pancreatic β cells. EMBO Mol Med 2023; 15:e16858. [PMID: 37490001 PMCID: PMC10493578 DOI: 10.15252/emmm.202216858] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
Hyperreactive platelets are commonly observed in diabetic patients indicating a potential link between glucose homeostasis and platelet reactivity. This raises the possibility that platelets may play a role in the regulation of metabolism. Pancreatic β cells are the central regulators of systemic glucose homeostasis. Here, we show that factor(s) derived from β cells stimulate platelet activity and platelets selectively localize to the vascular endothelium of pancreatic islets. Both depletion of platelets and ablation of major platelet adhesion or activation pathways consistently resulted in impaired glucose tolerance and decreased circulating insulin levels. Furthermore, we found platelet-derived lipid classes to promote insulin secretion and identified 20-Hydroxyeicosatetraenoic acid (20-HETE) as the main factor promoting β cells function. Finally, we demonstrate that the levels of platelet-derived 20-HETE decline with age and that this parallels with reduced impact of platelets on β cell function. Our findings identify an unexpected function of platelets in the regulation of insulin secretion and glucose metabolism, which promotes metabolic fitness in young individuals.
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Affiliation(s)
- Till Karwen
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | | | - Carina Gross
- Institute of Experimental Biomedicine IUniversity Hospital WürzburgWürzburgGermany
| | - Mona C Löffler
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Mike Friedrich
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Angel Loza‐Valdes
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Werner Schmitz
- Theodor Boveri Institute, BiocenterUniversity of WürzburgWürzburgGermany
| | - Magdalena Wit
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Filip Dziaczkowski
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Andrei Belykh
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Jonathan Trujillo‐Viera
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Rabih El‐Merahbi
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Carsten Deppermann
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
- Center for Thrombosis and HemostasisUniversity Medical Center of the Johannes Gutenberg‐UniversityMainzGermany
| | - Sameena Nawaz
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill HospitalOxfordUK
| | - Benoit Hastoy
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill HospitalOxfordUK
| | - Agnieszka Demczuk
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Manuela Erk
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Mariusz R Wieckowski
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Patrik Rorsman
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill HospitalOxfordUK
- Department of Physiology, Institute of Neuroscience and PhysiologyUniversity of GöteborgGöteborgSweden
- Oxford National Institute for Health Research, Biomedical Research CentreChurchill HospitalOxfordUK
| | - Katrin G Heinze
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - David Stegner
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
- Institute of Experimental Biomedicine IUniversity Hospital WürzburgWürzburgGermany
| | - Bernhard Nieswandt
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
- Institute of Experimental Biomedicine IUniversity Hospital WürzburgWürzburgGermany
| | - Grzegorz Sumara
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
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10
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Firth G, Georgiadou E, Griffiths A, Amrahli M, Kim J, Yu Z, Hu M, Stewart TJ, Leclerc I, Okamoto H, Gomez D, Blower PJ, Rutter GA. Impact of an SLC30A8 loss-of-function variant on the pancreatic distribution of zinc and manganese: laser ablation-ICP-MS and positron emission tomography studies in mice. Front Endocrinol (Lausanne) 2023; 14:1171933. [PMID: 37396167 PMCID: PMC10313231 DOI: 10.3389/fendo.2023.1171933] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Common variants in the SLC30A8 gene, encoding the secretory granule zinc transporter ZnT8 (expressed largely in pancreatic islet alpha and beta cells), are associated with altered risk of type 2 diabetes. Unexpectedly, rare loss-of-function (LoF) variants in the gene, described in heterozygous individuals only, are protective against the disease, even though knockout of the homologous SLC30A8 gene in mice leads to unchanged or impaired glucose tolerance. Here, we aimed to determine how one or two copies of the mutant R138X allele in the mouse SLC30A8 gene impacts the homeostasis of zinc at a whole-body (using non-invasive 62Zn PET imaging to assess the acute dynamics of zinc handling) and tissue/cell level [using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) to map the long-term distribution of zinc and manganese in the pancreas]. Methods Following intravenous administration of [62Zn]Zn-citrate (~7 MBq, 150 μl) in wild-type (WT), heterozygous (R138X+/-), and homozygous (R138X+/+) mutant mice (14-15 weeks old, n = 4 per genotype), zinc dynamics were measured over 60 min using PET. Histological, islet hormone immunohistochemistry, and elemental analysis with LA-ICP-MS (Zn, Mn, P) were performed on sequential pancreas sections. Bulk Zn and Mn concentration in the pancreas was determined by solution ICP-MS. Results Our findings reveal that whereas uptake into organs, assessed using PET imaging of 62Zn, is largely unaffected by the R138X variant, mice homozygous of the mutant allele show a substantial lowering (to 40% of WT) of total islet zinc, as anticipated. In contrast, mice heterozygous for this allele, thus mimicking human carriers of LoF alleles, show markedly increased endocrine and exocrine zinc content (1.6-fold increase for both compared to WT), as measured by LA-ICP-MS. Both endocrine and exocrine manganese contents were also sharply increased in R138X+/- mice, with smaller increases observed in R138X+/+ mice. Discussion These data challenge the view that zinc depletion from the beta cell is the likely underlying driver for protection from type 2 diabetes development in carriers of LoF alleles. Instead, they suggest that heterozygous LoF may paradoxically increase pancreatic β-cell zinc and manganese content and impact the levels of these metals in the exocrine pancreas to improve insulin secretion.
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Affiliation(s)
- George Firth
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Eleni Georgiadou
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
| | | | - Maral Amrahli
- London Metallomics Facility, King’s College London, London, United Kingdom
| | - Jana Kim
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Zilin Yu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Ming Hu
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
| | | | - Isabelle Leclerc
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
- Centre hospitalier de l’Université de Montréal (CHUM) Research Center and Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Haruka Okamoto
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, United States
| | - Daniel Gomez
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, United States
| | - Philip J. Blower
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Guy A. Rutter
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
- Centre hospitalier de l’Université de Montréal (CHUM) Research Center and Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Lee Kong Chian School of Medicine, Nanyang Technological, University, Singapore, Singapore
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11
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Soukup T, Winters D, Chua K, Rowland P, Moneke J, Skolarus TA, Bharathan R, Harling L, Bali A, Asher V, Gandamihardja T, Sevdalis N, Green JSA, Lamb BW. Evaluation of changes to work patterns in multidisciplinary cancer team meetings due to the COVID-19 pandemic: A national mixed-method survey study. Cancer Med 2023; 12:8729-8741. [PMID: 36647755 PMCID: PMC10134365 DOI: 10.1002/cam4.5608] [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: 10/20/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND It is not well understood the overall changes that multidisciplinary teams (MDTs) have had to make in response to the COVID-19 pandemic, nor the impact that such changes, in addition to the other challenges faced by MDTs, have had on decision-making, communication, or participation in the context of MDT meetings specifically. METHODS This was a mixed method, prospective cross-sectional survey study taking place in the United Kingdom between September 2020 and August 2021. RESULTS The participants were 423 MDT members. Qualitative findings revealed hybrid working and possibility of virtual attendance as the change introduced because of COVID-19 that MDTs would like to maintain. However, IT-related issues, slower meetings, longer lists and delays were identified as common with improving of the IT infrastructure necessary going forward. In contrast, virtual meetings and increased attendance/availability of clinicians were highlighted as the positive outcomes resulting from the change. Quantitative findings showed significant improvement from before COVID-19 for MDT meeting organisation and logistics (M = 45, SD = 20) compared to the access (M = 50, SD = 12, t(390) = 5.028, p = 0.001), case discussions (M = 50, SD = 14, t(373) = -5.104, p = 0.001), and patient representation (M = 50, SD = 12, t(382) = -4.537, p = 0.001) at MDT meetings. DISCUSSION Our study explored the perception of change since COVID-19 among cancer MDTs using mixed methods. While hybrid working was preferred, challenges exist. Significant improvements in the meeting organisation and logistics were reported. Although we found no significant perceived worsening across the four domains investigated, there was an indication in this direction for the case discussions warranting further 'live' assessments of MDT meetings.
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Affiliation(s)
- Tayana Soukup
- Institute of Psychiatry, Psychology, and Neuroscience, Health Service and Population Research DepartmentKing's College LondonLondonUK
| | | | - Kia‐Chong Chua
- Institute of Psychiatry, Psychology, and Neuroscience, Health Service and Population Research DepartmentKing's College LondonLondonUK
| | - Philip Rowland
- Department of UrologyCambridge University Hospital NHS TrustLondonUK
| | - Jacqueline Moneke
- Department of UrologyCambridge University Hospital NHS TrustLondonUK
| | - Ted A. Skolarus
- Dow Division of Health Services Research, Department of UrologyUniversity of Michigan, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | | | - Leanne Harling
- Department of Surgery and CancerImperial College LondonLondonUK
- School of Cancer and Pharmaceutical ScienceKings College LondonLondonUK
| | - Anish Bali
- Gynaecology Cancer CentreUniversity Hospitals of Derby & BurtonDerbyUK
| | - Viren Asher
- Gynaecology Cancer CentreUniversity Hospitals of Derby & BurtonDerbyUK
| | | | - Nick Sevdalis
- Institute of Psychiatry, Psychology, and Neuroscience, Health Service and Population Research DepartmentKing's College LondonLondonUK
| | | | - Benjamin W. Lamb
- Department of UrologyBarts Health NHS TrustLondonUK
- Bart’s Cancer InstituteQueen Mary University of LondonLondonUK
- Department of UrologyUniversity London College HospitalsLondonUK
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12
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Perera LA, Hattersley AT, Harding HP, Wakeling MN, Flanagan SE, Mohsina I, Raza J, Gardham A, Ron D, De Franco E. Infancy-onset diabetes caused by de-regulated AMPylation of the human endoplasmic reticulum chaperone BiP. EMBO Mol Med 2023; 15:e16491. [PMID: 36704923 PMCID: PMC9994480 DOI: 10.15252/emmm.202216491] [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: 06/24/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/28/2023] Open
Abstract
Dysfunction of the endoplasmic reticulum (ER) in insulin-producing beta cells results in cell loss and diabetes mellitus. Here we report on five individuals from three different consanguineous families with infancy-onset diabetes mellitus and severe neurodevelopmental delay caused by a homozygous p.(Arg371Ser) mutation in FICD. The FICD gene encodes a bifunctional Fic domain-containing enzyme that regulates the ER Hsp70 chaperone, BiP, via catalysis of two antagonistic reactions: inhibitory AMPylation and stimulatory deAMPylation of BiP. Arg371 is a conserved residue in the Fic domain active site. The FICDR371S mutation partially compromises BiP AMPylation in vitro but eliminates all detectable deAMPylation activity. Overexpression of FICDR371S or knock-in of the mutation at the FICD locus of stressed CHO cells results in inappropriately elevated levels of AMPylated BiP and compromised secretion. These findings, guided by human genetics, highlight the destructive consequences of de-regulated BiP AMPylation and raise the prospect of tuning FICD's antagonistic activities towards therapeutic ends.
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Affiliation(s)
- Luke A Perera
- Cambridge Institute for Medical ResearchUniversity of CambridgeCambridgeUK
- Present address:
The Francis Crick InstituteLondonUK
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and HealthUniversity of ExeterExeterUK
| | - Heather P Harding
- Cambridge Institute for Medical ResearchUniversity of CambridgeCambridgeUK
| | - Matthew N Wakeling
- Institute of Biomedical and Clinical Science, College of Medicine and HealthUniversity of ExeterExeterUK
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, College of Medicine and HealthUniversity of ExeterExeterUK
| | - Ibrahim Mohsina
- Department of Endocrine and DiabetesNational Institute of Child HealthKarachiPakistan
| | - Jamal Raza
- Department of Endocrine and DiabetesNational Institute of Child HealthKarachiPakistan
| | | | - David Ron
- Cambridge Institute for Medical ResearchUniversity of CambridgeCambridgeUK
| | - Elisa De Franco
- Institute of Biomedical and Clinical Science, College of Medicine and HealthUniversity of ExeterExeterUK
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13
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Jones NK, Costello HM, Monaghan MT, Stewart K, Binnie D, Marks J, Bailey MA, Culshaw GJ. Sodium-glucose cotransporter 2 inhibition does not improve the acute pressure natriuresis response in rats with type 1 diabetes. Exp Physiol 2023; 108:480-490. [PMID: 36644793 PMCID: PMC10103849 DOI: 10.1113/ep090849] [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: 09/26/2022] [Accepted: 12/19/2022] [Indexed: 01/17/2023]
Abstract
NEW FINDINGS What is the central question of this study? Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce cardiovascular risk in patients with both diabetic and non-diabetic kidney disease: can SGLT2 inhibition improve renal pressure natriuresis (PN), an important mechanism for long-term blood pressure control, which is impaired in type 1 diabetes mellitus (T1DM)? What is the main finding and its importance? The SGLT2 inhibitor dapagliflozin did not enhance the acute in vivo PN response in either healthy or T1DM Sprague-Dawley rats. The data suggest that the mechanism underpinning the clinical benefits of SGLT2 inhibitors on health is unlikely to be due to an enhanced natriuretic response to increased blood pressure. ABSTRACT Type 1 diabetes mellitus (T1DM) leads to serious complications including premature cardiovascular and kidney disease. Hypertension contributes importantly to these adverse outcomes. The renal pressure natriuresis (PN) response, a key regulator of blood pressure (BP), is impaired in rats with T1DM as tubular sodium reabsorption fails to down-regulate with increasing BP. We hypothesised that sodium-glucose cotransporter 2 (SGLT2) inhibitors, which reduce cardiovascular risk in kidney disease, would augment the PN response in T1DM rats. Non-diabetic or T1DM (35-50 mg/kg streptozotocin i.p.) adult male Sprague-Dawley rats were anaesthetised (thiopental 50 mg/kg i.p.) and randomised to receive either dapagliflozin (1 mg/kg i.v.) or vehicle. Baseline sodium excretion was measured and then BP was increased by sequential arterial ligations to induce the PN response. In non-diabetic animals, the natriuretic and diuretic responses to increasing BP were not augmented by dapagliflozin. Dapagliflozin induced glycosuria, but this was not influenced by BP. In T1DM rats the PN response was impaired. Dapagliflozin again increased urinary glucose excretion but did not enhance PN. Inhibition of SGLT2 does not enhance the PN response in rats, either with or without T1DM. SGLT2 makes only a minor contribution to tubular sodium reabsorption and does not contribute to the impaired PN response in T1DM.
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Affiliation(s)
- Natalie K. Jones
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Hannah M. Costello
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | | | - Kevin Stewart
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - David Binnie
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Joanne Marks
- Department of NeurosciencePhysiology and Pharmacology, Royal Free CampusUniversity College LondonLondonUK
| | - Matthew A. Bailey
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Geoffrey J. Culshaw
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
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14
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Hayes BL, Vabistsevits M, Martin RM, Lawlor DA, Richmond RC, Robinson T. Establishing causal relationships between sleep and adiposity traits using Mendelian randomization. Obesity (Silver Spring) 2023; 31:861-870. [PMID: 36790827 PMCID: PMC10946465 DOI: 10.1002/oby.23668] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The aim of this study was to systematically evaluate the direction of any potential causal effect between sleep and adiposity traits. METHODS Two-sample Mendelian randomization was used to assess the association of genetically predicted sleep traits with adiposity and vice versa. Using data from UK Biobank and 23andMe, the sleep traits explored were morning preference (chronotype; N = 697,828), insomnia (N = 1,331,010), sleep duration (N = 446,118), napping (N = 452,633), and daytime sleepiness (N = 452,071). Using data from the Genetic Investigation of ANthropometric Traits (GIANT) and Early Growth Genetics (EGG) consortia, the adiposity traits explored were adult BMI, hip circumference (HC), waist circumference (WC), waist-hip ratio (WHR; N = 322,154), and childhood BMI (N = 35,668). RESULTS This study found evidence that insomnia symptoms increased mean WC, BMI, and WHR (difference in means, WC = 0.39 SD [95% CI: 0.13-0.64], BMI = 0.47 SD [95% CI: 0.22-0.73], and WHR = 0.34 SD [95% CI: 0.16-0.52]). Napping increased mean WHR (0.23 SD [95% CI: 0.08-0.39]). Higher HC, WC, and adult BMI increased odds of daytime sleepiness (HC = 0.02 SD [95% CI: 0.01-0.04], WC = 0.04 SD [95% CI: 0.01-0.06], and BMI 0.02 SD [95% CI: 0.00-0.04]). This study also found that higher mean childhood BMI resulted in lower odds of napping (-0.01 SD [95% CI: 0.02-0.00]). CONCLUSIONS The effects of insomnia on adiposity and of adiposity on daytime sleepiness suggest that poor sleep and weight gain may contribute to a feedback loop that could be detrimental to overall health.
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Affiliation(s)
- Bryony L. Hayes
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Marina Vabistsevits
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Richard M. Martin
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Bristol Biomedical Research CentreUniversity Hospitals Bristol and Weston National Health Services Foundation Trust and the University of BristolBristolUK
| | - Deborah A. Lawlor
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Bristol Biomedical Research CentreUniversity Hospitals Bristol and Weston National Health Services Foundation Trust and the University of BristolBristolUK
| | - Rebecca C. Richmond
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Timothy Robinson
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Bristol Cancer InstituteUniversity Hospitals Bristol and Weston National Health Services Foundation TrustBristolUK
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15
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Mustafa OG, Haq M, Dashora U, Castro E, Dhatariya KK. Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group. Diabet Med 2023; 40:e15005. [PMID: 36370077 PMCID: PMC10107355 DOI: 10.1111/dme.15005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
Hyperosmolar Hyperglycaemic State (HHS) is a medical emergency associated with high mortality. It occurs less frequently than diabetic ketoacidosis (DKA), affects those with pre-existing/new type 2 diabetes mellitus and increasingly affecting children/younger adults. Mixed DKA/HHS may occur. The JBDS HHS care pathway consists of 3 themes (clinical assessment and monitoring, interventions, assessments and prevention of harm) and 5 phases of therapy (0-60 min, 1-6, 6-12, 12-24 and 24-72 h). Clinical features of HHS include marked hypovolaemia, osmolality ≥320 mOsm/kg using [(2×Na+ ) + glucose+urea], marked hyperglycaemia ≥30 mmol/L, without significant ketonaemia (≤3.0 mmol/L), without significant acidosis (pH >7.3) and bicarbonate ≥15 mmol/L. Aims of the therapy are to improve clinical status/replace fluid losses by 24 h, gradual decline in osmolality (3.0-8.0 mOsm/kg/h to minimise the risk of neurological complications), blood glucose 10-15 mmol/L in the first 24 h, prevent hypoglycaemia/hypokalaemia and prevent harm (VTE, osmotic demyelination, fluid overload, foot ulceration). Underlying precipitants must be identified and treated. Interventions include: (1) intravenous (IV) 0.9% sodium chloride to restore circulating volume (fluid losses 100-220 ml/kg, caution in elderly), (2) fixed rate intravenous insulin infusion (FRIII) should be commenced once osmolality stops falling with fluid replacement unless there is ketonaemia (FRIII should be commenced at the same time as IV fluids). (3) glucose infusion (5% or 10%) should be started once glucose <14 mmol/L and (4) potassium replacement according to potassium levels. HHS resolution criteria are: osmolality <300 mOsm/kg, hypovolaemia corrected (urine output ≥0.5 ml/kg/h), cognitive status returned to pre-morbid state and blood glucose <15 mmol/L.
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Affiliation(s)
- Omar G. Mustafa
- Department of diabetesKing's College Hospital NHS Foundation TrustLondonUK
- King's College LondonLondonUK
| | - Masud Haq
- Maidstone and Tunbridge Wells NHS TrustTunbridge WellsUK
| | - Umesh Dashora
- Conquest Hospital, Easdt Sussex Healthcare NHS TrustThe Ridge St Leonards on SeaUK
| | - Erwin Castro
- Conquest Hospital, Easdt Sussex Healthcare NHS TrustThe Ridge St Leonards on SeaUK
| | - Ketan K. Dhatariya
- Elsie Bertram Diabetes CentreNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
- Norwich Medicine SchoolUniversity of East AngliaNorwichUK
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16
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Robinson LA, Collins ACZ, Murphy RA, Davies JC, Allsopp LP. Diversity and prevalence of type VI secretion system effectors in clinical Pseudomonas aeruginosa isolates. Front Microbiol 2023; 13:1042505. [PMID: 36687572 PMCID: PMC9846239 DOI: 10.3389/fmicb.2022.1042505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/23/2022] [Indexed: 01/06/2023] Open
Abstract
Pseudomonas aeruginosa is an opportunistic pathogen and a major driver of morbidity and mortality in people with Cystic Fibrosis (CF). The Type VI secretion system (T6SS) is a molecular nanomachine that translocates effectors across the bacterial membrane into target cells or the extracellular environment enabling intermicrobial interaction. P. aeruginosa encodes three T6SS clusters, the H1-, H2- and H3-T6SS, and numerous orphan islands. Genetic diversity of T6SS-associated effectors in P. aeruginosa has been noted in reference strains but has yet to be explored in clinical isolates. Here, we perform a comprehensive bioinformatic analysis of the pangenome and T6SS effector genes in 52 high-quality clinical P. aeruginosa genomes isolated from CF patients and housed in the Personalised Approach to P. aeruginosa strain repository. We confirm that the clinical CF isolate pangenome is open and principally made up of accessory and unique genes that may provide strain-specific advantages. We observed genetic variability in some effector/immunity encoding genes and show that several well-characterised vgrG and PAAR islands are absent from numerous isolates. Our analysis shows clear evidence of disruption to T6SS genomic loci through transposon, prophage, and mobile genetic element insertions. We identified an orphan vgrG island in P. aeruginosa strain PAK and five clinical isolates using in silico analysis which we denote vgrG7, predicting a gene within this cluster to encode a Tle2 lipase family effector. Close comparison of T6SS loci in clinical isolates compared to reference P. aeruginosa strain PAO1 revealed the presence of genes encoding eight new T6SS effectors with the following putative functions: cytidine deaminase, lipase, metallopeptidase, NADase, and pyocin. Finally, the prevalence of characterised and putative T6SS effectors were assessed in 532 publicly available P. aeruginosa genomes, which suggests the existence of accessory effectors. Our in silico study of the P. aeruginosa T6SS exposes a level of genetic diversity at T6SS genomic loci not seen to date within P. aeruginosa, particularly in CF isolates. As understanding the effector repertoire is key to identifying the targets of T6SSs and its efficacy, this comprehensive analysis provides a path for future experimental characterisation of these mediators of intermicrobial competition and host manipulation.
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Affiliation(s)
- Luca A. Robinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alice C. Z. Collins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ronan A. Murphy
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jane C. Davies
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Luke P. Allsopp
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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17
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Grace SL, Mortimer GL, Kozhakhmetova A, Leveret J, Newton R, Reimand K, Shield JPH, Uibo R, Williams AJK, Gillespie KM. Increased levels of anti-BSA antibodies in children with Down syndrome. Front Endocrinol (Lausanne) 2023; 14:1056925. [PMID: 36817608 PMCID: PMC9935828 DOI: 10.3389/fendo.2023.1056925] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Autoimmune diabetes occurs more often in the first 2 years of life in children with Down syndrome (DS) compared with the general population. We previously observed increased frequencies of islet autoantibodies, including insulin autoantibodies (IAA), in children with DS. Assays for IAA using 125I-labelled insulin require competition to overcome cross reactivity with antibodies to the cow's milk protein, bovine serum albumin (BSA). 125I-IAA assay results suggested that levels of antibodies to BSA may also be increased in children with DS. The aim of this study therefore was to determine whether the levels of anti-BSA antibodies differed in children with DS compared with controls. METHODS Samples were available from two populations with DS: one from the UK, (UK DS cohort n=106, 58 male, median age 12.5 years) and one from Estonia (Estonian DS cohort: n=121, 65 male, median age 9.75 years). A UK control population was provided by sex and age-matched healthy siblings of probands participating in the Bart's Oxford (BOX) family study of type 1 diabetes. A competitive-displacement radiobinding assay (RBA) and a Dissociation Enhanced Lanthanide Fluoroimmunoassay (DELFIA) were developed to measure and confirm anti-BSA antibody levels. HLA class II genotype was analysed by PCR using sequence specific primers (PCR-SSP). RESULTS Overall, levels of anti-BSA antibodies were increased in those with DS compared with controls (p<0.0001) but this was not HLA associated. CONCLUSION Increased levels of anti-BSA antibodies may reflect a defect in immune maturation or increased gut permeability in children with DS, increasing their risk of developing autoimmunity.
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Affiliation(s)
- Sian L. Grace
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | | | - Jamie Leveret
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard Newton
- Department of Neurology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Koit Reimand
- Department of Immunology, Institute of Bio- and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Julian P. H. Shield
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, United Kingdom
| | - Raivo Uibo
- Department of Immunology, Institute of Bio- and Translational Medicine, University of Tartu, Tartu, Estonia
| | | | - Kathleen M. Gillespie
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- *Correspondence: Kathleen M. Gillespie,
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18
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McLaughlin K, Acreman S, Nawaz S, Cutteridge J, Clark A, Knudsen JG, Denwood G, Spigelman AF, Manning Fox JE, Singh SP, MacDonald PE, Hastoy B, Zhang Q. Loss of tetraspanin-7 expression reduces pancreatic β-cell exocytosis Ca 2+ sensitivity but has limited effect on systemic metabolism. Diabet Med 2022; 39:e14984. [PMID: 36264270 PMCID: PMC9828109 DOI: 10.1111/dme.14984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/12/2022] [Revised: 10/08/2022] [Accepted: 10/18/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Tetraspanin-7 (Tspan7) is an islet autoantigen involved in autoimmune type 1 diabetes and known to regulate β-cell L-type Ca2+ channel activity. However, the role of Tspan7 in pancreatic β-cell function is not yet fully understood. METHODS Histological analyses were conducted using immunostaining. Whole-body metabolism was tested using glucose tolerance test. Islet hormone secretion was quantified using static batch incubation or dynamic perifusion. β-cell transmembrane currents, electrical activity and exocytosis were measured using whole-cell patch-clamping and capacitance measurements. Gene expression was studied using mRNA-sequencing and quantitative PCR. RESULTS Tspan7 is expressed in insulin-containing granules of pancreatic β-cells and glucagon-producing α-cells. Tspan7 knockout mice (Tspan7y/- mouse) exhibit reduced body weight and ad libitum plasma glucose but normal glucose tolerance. Tspan7y/- islets have normal insulin content and glucose- or tolbutamide-stimulated insulin secretion. Depolarisation-triggered Ca2+ current was enhanced in Tspan7y/- β-cells, but β-cell electrical activity and depolarisation-evoked exocytosis were unchanged suggesting that exocytosis was less sensitive to Ca2+ . TSPAN7 knockdown (KD) in human pseudo-islets led to a significant reduction in insulin secretion stimulated by 20 mM K+ . Transcriptomic analyses show that TSPAN7 KD in human pseudo-islets correlated with changes in genes involved in hormone secretion, apoptosis and ER stress. Consistent with rodent β-cells, exocytotic Ca2+ sensitivity was reduced in a human β-cell line (EndoC-βH1) following Tspan7 KD. CONCLUSION Tspan7 is involved in the regulation of Ca2+ -dependent exocytosis in β-cells. Its function is more significant in human β-cells than their rodent counterparts.
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Affiliation(s)
- Kerry McLaughlin
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Churchill HospitalOxfordUK
| | - Samuel Acreman
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Churchill HospitalOxfordUK
- Institute of Neuroscience and Physiology, Department of Physiology, Metabolic Research UnitUniversity of GoteborgGöteborgSweden
| | - Sameena Nawaz
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Churchill HospitalOxfordUK
| | - Joseph Cutteridge
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Churchill HospitalOxfordUK
| | - Anne Clark
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Churchill HospitalOxfordUK
| | - Jakob G. Knudsen
- Section for Cell Biology and Physiology, Department of BiologyUniversity of CopenhagenCopenhagenDenmark
| | - Geoffrey Denwood
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Churchill HospitalOxfordUK
| | - Aliya F. Spigelman
- Alberta Diabetes Institute and Department of PharmacologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Jocelyn E. Manning Fox
- Alberta Diabetes Institute and Department of PharmacologyUniversity of AlbertaEdmontonAlbertaCanada
| | | | - Patrick E. MacDonald
- Alberta Diabetes Institute and Department of PharmacologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Benoit Hastoy
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Churchill HospitalOxfordUK
| | - Quan Zhang
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Churchill HospitalOxfordUK
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19
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McCrimmon RJ. Remembrance of things past: The consequences of recurrent hypoglycaemia in diabetes. Diabet Med 2022; 39:e14973. [PMID: 36251572 PMCID: PMC10015985 DOI: 10.1111/dme.14973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 01/18/2023]
Abstract
AIMS People with type 1 and type 2 diabetes still frequently experience hypoglycaemia, which can be severe, leading to loss of consciousness. This review will examine the cellular consequences of recurrent hypoglycaemia. METHODS This review, based on the Dorothy Hodgkin Lecture given at the Diabetes UK 2022 annual symposium by the author, will discuss our current understanding of the mechanisms by which hypoglycaemia is detected and the consequences of recurrent exposure to hypoglycaemia. RESULTS Glucose-responsive cells found in the periphery as well as multiple areas of the brain are organised in a classical sensori-motor integrative network encompassing peripheral, hindbrain and hypothalamic components. The mechanism used by glucose-responsive neurons to detect hypoglycaemia parallel those of the classical glucose sensor the pancreatic ß-cell, namely in their use of glucokinase, KATP channels and AMP-activated protein kinase. Recurrent exposure to hypoglycaemia results in a series of cellular adaptations that may be designed to increase the resilience of cells to future hypoglycaemia. This review also highlights how hypoglycaemia, as an oxidative stressor, may also exacerbate chronic hyperglycaemia-induced increases in oxidative stress and inflammation, leading to damage to vulnerable brain regions. CONCLUSIONS Impaired awareness of hypoglycaemia follows the adaptation of central glucose-responsive neurons to repeated hypoglycaemia and may represent a form of memory called habituation. In diabetes, recurrent hypoglycaemia may have tissue consequences as a result of a profound disruption in the cellular response to a hypoglycaemic challenge that increases vulnerability to oxidative damage.
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Affiliation(s)
- Rory J. McCrimmon
- Systems Medicine, School of MedicineUniversity of Dundee, Ninewells Hospital and Medical SchoolDundeeUK
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20
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Williams CL, Aitken RJ, Wilson IV, Mortimer GLM, Long AE, Williams AJK, Gillespie KM. The measurement of autoantibodies to insulin informs diagnosis of diabetes in a childhood population negative for other autoantibodies. Diabet Med 2022; 39:e14979. [PMID: 36251483 PMCID: PMC9827938 DOI: 10.1111/dme.14979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/14/2022] [Indexed: 02/06/2023]
Abstract
AIMS Some childhood type 1 diabetes cases are islet autoantibody negative at diagnosis. Potential explanations include misdiagnosis of genetic forms of diabetes or insufficient islet autoantibody testing. Many NHS laboratories offer combinations of three autoantibody markers. We sought to determine the benefit of testing for additional islet autoantibodies, including insulin (IAA) and tetraspanin 7 (TSPAN7A). METHODS Radiobinding assays (RBAs) were used to test for four islet autoantibodies in children with newly diagnosed type 1 diabetes (n = 486; 54.1% male; median age 10.4 years [range 0.7-18.0]; median duration 1 day [range -183 to 14]). Islet autoantibody negative children were tested for TSPAN7A using a luminescence-based test. Where available, islet cell antibody (ICA) and human leucocyte antigen (HLA) data were considered. RESULTS Using three autoantibody markers, 21/486 (4.3%) children were autoantibody negative. Testing for IAA classified a further 9/21 (42.9%) children as autoantibody positive. Of the remaining 12 (2.5%) autoantibody negative children, all were TPAN7A negative, seven were ICA negative and one was positive for the protective variant DQB1*0602. One was subsequently diagnosed with Maturity Onset of Diabetes in the Young, but follow-up was not available in all cases. CONCLUSIONS Using highly sensitive assays, testing for three autoantibodies fails to detect islet autoimmunity in approximately 1/20 children diagnosed with type 1 diabetes. Testing for IAA in children <5 years and GADA in those >10 years was the most effective strategy for detecting islet autoimmunity. The ability to test for all islet autoantibodies should inform clinical decisions and make screening for monogenic diabetes more cost-effective.
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Affiliation(s)
- Claire L. Williams
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Southmead HospitalBristolUK
| | - Rachel J. Aitken
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Southmead HospitalBristolUK
| | - Isabel V. Wilson
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Southmead HospitalBristolUK
| | - Georgina L. M. Mortimer
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Southmead HospitalBristolUK
| | - Anna E. Long
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Southmead HospitalBristolUK
| | - Alistair J. K. Williams
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Southmead HospitalBristolUK
| | | | - Kathleen M. Gillespie
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Southmead HospitalBristolUK
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21
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Williams BM, Cliff CL, Demirel I, Squires PE, Hills CE. Blocking connexin 43 hemichannel-mediated ATP release reduces communication within and between tubular epithelial cells and medullary fibroblasts in a model of diabetic nephropathy. Diabet Med 2022; 39:e14963. [PMID: 36256487 PMCID: PMC9828766 DOI: 10.1111/dme.14963] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Fibrosis of renal tubules is the final common pathway in diabetic nephropathy and develops in the face of tubular injury and fibroblast activation. Aberrant connexin 43 (Cx43) hemichannel activity has been linked to this damage under euglycaemic conditions, however, its role in glycaemic injury is unknown. This study investigated the effect of a Cx43 blocker (Tonabersat) on hemichannel activity and cell-cell interactions within and between tubular epithelial cells and fibroblasts in an in vitro model of diabetic nephropathy. METHODS Human kidney (HK2) proximal tubule epithelial cells and medullary fibroblasts (TK173) were treated in low (5 mM) or high (25 mM) glucose ± transforming growth factor beta-1 (TGFβ1) ± Tonabersat in high glucose. Carboxyfluorescein dye uptake and ATPlite luminescence assessed changes in hemichannel-mediated ATP release, while immunoblotting determined protein expression. Co-incubation with the ATP-diphosphohydrolase apyrase or a P2X7R inhibitor (A438079) assessed ATP-P2X7R signalling. Indirect co-culture with conditioned media from the alternate cell type evaluated paracrine-mediated heterotypic interactions. RESULTS Tonabersat partially negated glucose/TGFβ1-induced increases in Cx43 hemichannel-mediated ATP release and downstream changes in adherens junction and extracellular matrix (ECM) protein expression in HK2 and TK173 cells. Apyrase and A438079 highlighted the role for ATP-P2X7R in driving changes in protein expression in TK173 fibroblasts. Indirect co-culture studies suggest that epithelial cell secretome increases Tonabersat-sensitive hemichannel-mediated dye uptake in fibroblasts and downstream protein expression. CONCLUSION Tonabersat-sensitive hemichannel-mediated ATP release enhances TGFβ1-driven heterotypic cell-cell interaction and favours myofibroblast activation. The data supports the potential benefit of Cx43 inhibition in reducing tubulointerstitial fibrosis in late-stage diabetic nephropathy.
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Affiliation(s)
| | | | - Isak Demirel
- School of Medical SciencesÖrebro UniversityÖrebroSweden
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22
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Halliday A, Long AE, Baum HE, Thomas AC, Shelley KL, Oliver E, Gupta K, Francis O, Williamson MK, Di Bartolo N, Randell MJ, Ben-Khoud Y, Kelland I, Mortimer G, Ball O, Plumptre C, Chandler K, Obst U, Secchi M, Piemonti L, Lampasona V, Smith J, Gregorova M, Knezevic L, Metz J, Barr R, Morales-Aza B, Oliver J, Collingwood L, Hitchings B, Ring S, Wooldridge L, Rivino L, Timpson N, McKernon J, Muir P, Hamilton F, Arnold D, Woolfson DN, Goenka A, Davidson AD, Toye AM, Berger I, Bailey M, Gillespie KM, Williams AJK, Finn A. Development and evaluation of low-volume tests to detect and characterize antibodies to SARS-CoV-2. Front Immunol 2022; 13:968317. [PMID: 36439154 PMCID: PMC9682908 DOI: 10.3389/fimmu.2022.968317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022] Open
Abstract
Low-volume antibody assays can be used to track SARS-CoV-2 infection rates in settings where active testing for virus is limited and remote sampling is optimal. We developed 12 ELISAs detecting total or antibody isotypes to SARS-CoV-2 nucleocapsid, spike protein or its receptor binding domain (RBD), 3 anti-RBD isotype specific luciferase immunoprecipitation system (LIPS) assays and a novel Spike-RBD bridging LIPS total-antibody assay. We utilized pre-pandemic (n=984) and confirmed/suspected recent COVID-19 sera taken pre-vaccination rollout in 2020 (n=269). Assays measuring total antibody discriminated best between pre-pandemic and COVID-19 sera and were selected for diagnostic evaluation. In the blind evaluation, two of these assays (Spike Pan ELISA and Spike-RBD Bridging LIPS assay) demonstrated >97% specificity and >92% sensitivity for samples from COVID-19 patients taken >21 days post symptom onset or PCR test. These assays offered better sensitivity for the detection of COVID-19 cases than a commercial assay which requires 100-fold larger serum volumes. This study demonstrates that low-volume in-house antibody assays can provide good diagnostic performance, and highlights the importance of using well-characterized samples and controls for all stages of assay development and evaluation. These cost-effective assays may be particularly useful for seroprevalence studies in low and middle-income countries.
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Affiliation(s)
- Alice Halliday
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Anna E. Long
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Holly E. Baum
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | - Amy C. Thomas
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kathryn L. Shelley
- School of Chemistry, University of Bristol, Bristol, United Kingdom
- School of Biochemistry, Biomedical Sciences Building, University Walk, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Oliver
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Kapil Gupta
- School of Biochemistry, Biomedical Sciences Building, University Walk, University of Bristol, Bristol, United Kingdom
| | - Ore Francis
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
| | | | - Natalie Di Bartolo
- School of Biochemistry, Biomedical Sciences Building, University Walk, University of Bristol, Bristol, United Kingdom
| | - Matthew J. Randell
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Yassin Ben-Khoud
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ilana Kelland
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Georgina Mortimer
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Olivia Ball
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Charlie Plumptre
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Kyla Chandler
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ulrike Obst
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | - Massimiliano Secchi
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Piemonti
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Lampasona
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Joyce Smith
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Michaela Gregorova
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Lea Knezevic
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
| | - Jane Metz
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
- Department of Paediatric Immunology and Infectious Diseases, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Rachael Barr
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
- Department of Paediatric Immunology and Infectious Diseases, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Begonia Morales-Aza
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Jennifer Oliver
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Collingwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Benjamin Hitchings
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Susan Ring
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit at University of Bristol, Bristol, United Kingdom
| | - Linda Wooldridge
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
| | - Laura Rivino
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Nicholas Timpson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit at University of Bristol, Bristol, United Kingdom
| | - Jorgen McKernon
- National Infection Service, UK Health Security Agency, Southmead Hospital, Bristol, United Kingdom
| | - Peter Muir
- National Infection Service, UK Health Security Agency, Southmead Hospital, Bristol, United Kingdom
| | - Fergus Hamilton
- MRC Integrative Epidemiology Unit at University of Bristol, Bristol, United Kingdom
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Arnold
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Derek N. Woolfson
- School of Chemistry, University of Bristol, Bristol, United Kingdom
- School of Biochemistry, Biomedical Sciences Building, University Walk, University of Bristol, Bristol, United Kingdom
- Bristol BioDesign Institute, University of Bristol, Bristol, United Kingdom
| | - Anu Goenka
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
- Department of Paediatric Immunology and Infectious Diseases, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Andrew D. Davidson
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Ashley M. Toye
- School of Biochemistry, Biomedical Sciences Building, University Walk, University of Bristol, Bristol, United Kingdom
- Bristol BioDesign Institute, University of Bristol, Bristol, United Kingdom
- Bristol Institute of Transfusion Sciences, NHS Blood and Transplant Filton, Bristol, United Kingdom
| | - Imre Berger
- School of Chemistry, University of Bristol, Bristol, United Kingdom
- School of Biochemistry, Biomedical Sciences Building, University Walk, University of Bristol, Bristol, United Kingdom
- Bristol BioDesign Institute, University of Bristol, Bristol, United Kingdom
| | - Mick Bailey
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
| | - Kathleen M. Gillespie
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alistair J. K. Williams
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Adam Finn
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Department of Paediatric Immunology and Infectious Diseases, Bristol Royal Hospital for Children, Bristol, United Kingdom
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Jones B, Burade V, Akalestou E, Manchanda Y, Ramchunder Z, Carrat G, Nguyen‐Tu M, Marchetti P, Piemonti L, Leclerc I, Thennati R, Vilsboll T, Thorens B, Tomas A, Rutter GA. In vivo and in vitro characterization of GL0034, a novel long-acting glucagon-like peptide-1 receptor agonist. Diabetes Obes Metab 2022; 24:2090-2101. [PMID: 35676825 PMCID: PMC9796023 DOI: 10.1111/dom.14794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/20/2022] [Accepted: 06/01/2022] [Indexed: 12/31/2022]
Abstract
AIMS To describe the in vitro characteristics and antidiabetic in vivo efficacy of the novel glucagon-like peptide-1 receptor agonist (GLP-1RA) GL0034. MATERIALS AND METHODS Glucagon-like peptide-1 receptor (GLP-1R) kinetic binding parameters, cyclic adenosine monophosphate (cAMP) signalling, endocytosis and recycling were measured using HEK293 and INS-1832/3 cells expressing human GLP-1R. Insulin secretion was measured in vitro using INS-1832/3 cells, mouse islets and human islets. Chronic administration studies to evaluate weight loss and glycaemic effects were performed in db/db and diet-induced obese mice. RESULTS Compared to the leading GLP-1RA semaglutide, GL0034 showed increased binding affinity and potency-driven bias in favour of cAMP over GLP-1R endocytosis and β-arrestin-2 recruitment. Insulin secretory responses were similar for both ligands. GL0034 (6 nmol/kg) led to at least as much weight loss and lowering of blood glucose as did semaglutide at a higher dose (14 nmol/kg). CONCLUSIONS GL0034 is a G protein-biased agonist that shows powerful antidiabetic effects in mice, and may serve as a promising new GLP-1RA for obese patients with type 2 diabetes.
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Affiliation(s)
- Ben Jones
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
| | - Vinod Burade
- High Impact Innovations—Sustainable Health SolutionsSun Pharmaceutical Industries LimitedVadodaraIndia
| | - Elina Akalestou
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
| | - Yusman Manchanda
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
| | - Zenouska Ramchunder
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
| | - Gaëlle Carrat
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
| | - Marie‐Sophie Nguyen‐Tu
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, Islet Cell LaboratoryUniversity of PisaPisaItaly
| | - Lorenzo Piemonti
- Diabetes Research InstituteIRCCS Ospedale San RaffaeleMilanItaly
| | - Isabelle Leclerc
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
- CRCHUMUniversity of MontréalMontréalCanada
| | - Rajamannar Thennati
- High Impact Innovations—Sustainable Health SolutionsSun Pharmaceutical Industries LimitedVadodaraIndia
| | - Tina Vilsboll
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark
| | - Bernard Thorens
- Center for Integrative GenomicsUniversity of LausanneLausanneSwitzerland
| | - Alejandra Tomas
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
| | - Guy A. Rutter
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
- CRCHUMUniversity of MontréalMontréalCanada
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
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24
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Liu B, Ruz‐Maldonado I, Toczyska K, Olaniru OE, Zariwala MG, Hopkins D, Zhao M, Persaud SJ. The selective serotonin reuptake inhibitor fluoxetine has direct effects on beta cells, promoting insulin secretion and increasing beta-cell mass. Diabetes Obes Metab 2022; 24:2038-2050. [PMID: 35676820 PMCID: PMC9545812 DOI: 10.1111/dom.14791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/23/2022] [Accepted: 06/06/2022] [Indexed: 12/05/2022]
Abstract
AIM This study investigated whether therapeutically relevant concentrations of fluoxetine, which have been shown to reduce plasma glucose and glycated haemoglobin independent of changes in food intake and body weight, regulate beta-cell function and improve glucose homeostasis. METHODS Cell viability, insulin secretion, beta-cell proliferation and apoptosis were assessed after exposure of MIN6 beta cells or isolated mouse and human islets to 0.1, 1 or 10 μmol/L fluoxetine. The effect of fluoxetine (10 mg/kg body weight) administration on glucose homeostasis and islet function was also examined in ob/ob mice. RESULTS Exposure of MIN6 cells and mouse islets to 0.1 and 1 μmol/L fluoxetine for 72 hours did not compromise cell viability but 10 μmol/L fluoxetine significantly increased Trypan blue uptake. The dose of 1 μmol/L fluoxetine significantly increased beta-cell proliferation and protected islet cells from cytokine-induced apoptosis. In addition, 1 μmol/L fluoxetine induced rapid and reversible potentiation of glucose-stimulated insulin secretion from islets isolated from mice, and from lean and obese human donors. Finally, intraperitoneal administration of fluoxetine to ob/ob mice over 14 days improved glucose tolerance and resulted in significant increases in beta-cell proliferation and enhanced insulin secretory capacity. CONCLUSIONS These data are consistent with a role for fluoxetine in regulating glucose homeostasis through direct effects on beta cells. Fluoxetine thus demonstrates promise as a preferential antidepressant for patients with concomitant occurrence of depression and diabetes.
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Affiliation(s)
- Bo Liu
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Inmaculada Ruz‐Maldonado
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Comparative Medicine and Pathology, Vascular Biology and Therapeutics Program (VBT) Program in Integrative Cell Signaling and Neurobiology of Metabolism (ICSNM)Yale University School of MedicineNew HavenConnecticutUSA
| | - Klaudia Toczyska
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Oladapo E. Olaniru
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | | | - David Hopkins
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Min Zhao
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Shanta J. Persaud
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
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Wylie TAF, Morris A, Robertson E, Middleton A, Newbert C, Andersen B, Maltese G, Stocker R, Weightman A, Sinclair A, Bain SC. Ageing well with diabetes: A workshop to co-design research recommendations for improving the diabetes care of older people. Diabet Med 2022; 39:e14795. [PMID: 35064591 PMCID: PMC9303664 DOI: 10.1111/dme.14795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/18/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify key research questions where answers could improve care for older people living with diabetes (PLWD), and provide detailed recommendations for researchers and research funders on how best to address them. METHODS A series of online research workshops were conducted, bringing together a range of PLWD and an acknowledged group of academic and clinical experts in their diabetes care to identify areas for future research. Throughout the pre-workshop phase, during each workshop, and in manuscript preparation and editing, PLWD played an active and dynamic role in discussions as part of both an iterative and narrative process. RESULTS The following key questions in this field were identified, and research recommendations for each were developed: How can we improve our understanding of the characteristics of older people living with diabetes (PLWD) and their outcomes, and can this deliver better person-centred care? How are services to care for older PLWD currently delivered, both for their diabetes and other conditions? How can we optimise and streamline the process and ensure everyone gets the best care, tailored to their individual needs? What tools might be used to evaluate the level of understanding of diabetes in the older population amongst non-specialist Healthcare Professionals (HCPs)? How can virtual experts or centres most effectively provide access to specialist multi-disciplinary team (MDT) expertise for older PLWD and the HCPs caring for them? Is a combination of exercise and a nutrition-dense, high protein diet effective in the prevention of the adverse effects of type 2 diabetes and deterioration in frailty, and how might this be delivered in a way which is acceptable to people with type 2 diabetes? How might we best use continuous glucose monitoring (CGM) in older people and, for those who require support, how should the data be shared? How can older PLWD be better empowered to manage their diabetes in their own home, particularly when living with additional long-term conditions? What are the benefits of models of peer support for older PLWD, both when living independently and when in care? CONCLUSIONS This paper outlines recommendations supported by PLWD through which new research could improve their diabetes care and calls on the research community and funders to address them in future research programmes and strategies.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppe Maltese
- Epsom and St Helier University Hospitals, and King's CollegeLondonUK
| | - Rachel Stocker
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Andrew Weightman
- Department of MechanicalAerospace and Civil EngineeringThe University of ManchesterManchesterUK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People (fDROP) and King's CollegeLondonUK
| | - Stephen C. Bain
- Diabetes Research UnitSwansea University Medical SchoolSwanseaUK
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26
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O’Donnell NR, Satherley RM, John M, Cooke D, Hale LS, Stewart R, Jones CJ. Development and Theoretical Underpinnings of the PRIORITY Intervention: A Parenting Intervention to Prevent Disordered Eating in Children and Young People With Type 1 Diabetes. Front Clin Diabetes Healthc 2022; 3:822233. [PMID: 36992722 PMCID: PMC10012129 DOI: 10.3389/fcdhc.2022.822233] [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] [Received: 11/25/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022]
Abstract
Children and young people (CYP) with type 1 diabetes (T1D) are twice as likely to develop disordered eating (T1DE) and clinical eating disorders than those without. This has significant implications for physical and mental health, with some eating disorders associated with repeated diabetic ketoacidosis and higher HbA1c levels, both of which are life threatening. There is currently limited psychological support for CYP and families with T1D but increasingly, policy and practice are suggesting disordered eating in T1D may be effectively prevented through psychological intervention. We describe the development and theoretical underpinnings of a preventative psychological intervention for parents of CYP aged 11-14, with T1D. The intervention was informed by psychological theory, notably the Information Motivation Behaviour Skills model and Behaviour Change Technique Taxonomy. The intervention was co-developed with an expert advisory group of clinicians, and families with T1D. The manualised intervention includes two online group workshops, and supplementary online materials. The intervention continues to evolve, and feasibility findings will inform how best to align the intervention with routine care in NHS diabetes teams. Early detection and intervention are crucial in preventing T1DE, and it is hoped that the current intervention can contribute to improving the psychological and physical wellbeing of young people and families managing T1D.
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Affiliation(s)
| | | | - Mary John
- School of Psychology, University of Surrey, Guildford, United Kingdom
- Research and Development Department, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton & Hove, United Kingdom
| | - Debbie Cooke
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Lucy S. Hale
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Rose Stewart
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, United Kingdom
| | - Christina J. Jones
- School of Psychology, University of Surrey, Guildford, United Kingdom
- *Correspondence: Christina J. Jones,
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27
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Forbes S, Flatt AJ, Bennett D, Crookston R, Pimkova M, Birtles L, Pernet A, Wood RC, Burling K, Barker P, Counter C, Lumb A, Choudhary P, Rutter M, Rosenthal M, Sutherland A, Casey J, Johnson P, Shaw JAM. The impact of islet mass, number of transplants, and time between transplants on graft function in a national islet transplant program. Am J Transplant 2022; 22:154-164. [PMID: 34355503 PMCID: PMC9292186 DOI: 10.1111/ajt.16785] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 01/25/2023]
Abstract
The UK islet allotransplant program is nationally funded to deliver one or two transplants over 12 months to individuals with type 1 diabetes and recurrent severe hypoglycemia. Analyses were undertaken 10 years after program inception to evaluate associations between transplanted mass; single versus two transplants; time between two transplants and graft survival (stimulated C-peptide >50 pmol/L) and function. In total, 84 islet transplant recipients were studied. Uninterrupted graft survival over 12 months was attained in 23 (68%) single and 47 (94%) (p = .002) two transplant recipients (separated by [median (IQR)] 6 (3-8) months). 64% recipients of one or two transplants with uninterrupted function at 12 months sustained graft function at 6 years. Total transplanted mass was associated with Mixed Meal Tolerance Test stimulated C-peptide at 12 months (p < .01). Despite 1.9-fold greater transplanted mass in recipients of two versus one islet infusion (12 218 [9291-15 417] vs. 6442 [5156-7639] IEQ/kg; p < .0001), stimulated C-peptide was not significantly higher. Shorter time between transplants was associated with greater insulin dose reduction at 12 months (beta -0.35; p = .02). Graft survival over the first 12 months was greater in recipients of two versus one islet transplant in the UK program, although function at 1 and 6 years was comparable. Minimizing the interval between 2 islet infusions may maximize cumulative impact on graft function.
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Affiliation(s)
- Shareen Forbes
- BHF Centre for Cardiovascular SciencesQueen's Medical Research InstituteUniversity of EdinburghEdinburghUK
- Transplant UnitRoyal Infirmary of EdinburghEdinburghUK
| | - Anneliese J. Flatt
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
- Institute of TransplantationFreeman HospitalNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Denise Bennett
- Institute of TransplantationFreeman HospitalNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Robert Crookston
- Nuffield Department of SurgeryUniversity of OxfordJohn Radcliffe HospitalOxfordUK
| | - Mirka Pimkova
- Institute of Immunity and TransplantationRoyal Free HospitalLondonUK
| | - Linda Birtles
- Diabetes, Endocrinology and Metabolism CentreManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Andrew Pernet
- Department of DiabetesSchool of Life Course SciencesKing's College LondonUK
| | - Ruth C. Wood
- Newcastle Clinical Trials UnitNewcastle UniversityNewcastle upon TyneUK
| | - Keith Burling
- Core Biochemical Assay LaboratoryNIHR Cambridge Biomedical Research CentreCambridgeUK
| | - Peter Barker
- Core Biochemical Assay LaboratoryNIHR Cambridge Biomedical Research CentreCambridgeUK
| | - Claire Counter
- NHS Blood and Transplant, Statistics and Clinical ResearchBristolUK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxfordUK
| | - Pratik Choudhary
- Department of DiabetesSchool of Life Course SciencesKing's College LondonUK
| | - Martin K. Rutter
- Diabetes, Endocrinology and Metabolism CentreManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
- Division of Diabetes, Endocrinology and GastroenterologySchool of Medical SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Miranda Rosenthal
- Institute of Immunity and TransplantationRoyal Free HospitalLondonUK
| | | | - John Casey
- Transplant UnitRoyal Infirmary of EdinburghEdinburghUK
| | - Paul Johnson
- Nuffield Department of SurgeryUniversity of OxfordJohn Radcliffe HospitalOxfordUK
| | - James A. M. Shaw
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
- Institute of TransplantationFreeman HospitalNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
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28
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Michau A, Lafont C, Bargi-Souza P, Kemkem Y, Guillou A, Ravier MA, Bertrand G, Varrault A, Fiordelisio T, Hodson DJ, Mollard P, Schaeffer M. Metabolic Stress Impairs Pericyte Response to Optogenetic Stimulation in Pancreatic Islets. Front Endocrinol (Lausanne) 2022; 13:918733. [PMID: 35813647 PMCID: PMC9259887 DOI: 10.3389/fendo.2022.918733] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Pancreatic islets are highly vascularized micro-organs ensuring whole body glucose homeostasis. Islet vascular cells play an integral part in sustaining adequate insulin release by beta cells. In particular, recent studies have demonstrated that islet pericytes regulate local blood flow velocity and are required for maintenance of beta cell maturity and function. In addition, increased metabolic demand accompanying obesity alters islet pericyte morphology. Here, we sought to explore the effects of metabolic stress on islet pericyte functional response to stimulation in a mouse model of type 2 diabetes, directly in the pancreas in vivo . We found that high fat diet induced islet pericyte hypertrophy without alterations in basal local blood flow. However, optogenetic stimulation of pericyte activity revealed impaired islet vascular responses, despite increased expression of genes encoding proteins directly or indirectly involved in cell contraction. These findings suggest that metabolic stress impinges upon islet pericyte function, which may contribute to beta cell failure during T2D.
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Affiliation(s)
- Aurélien Michau
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Chrystel Lafont
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Paula Bargi-Souza
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
- Department of Physiology and Biophysics of the Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Yasmine Kemkem
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Anne Guillou
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Magalie A. Ravier
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Gyslaine Bertrand
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Annie Varrault
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Tatiana Fiordelisio
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
- Laboratorio de Neuroendocrinología Comparada, Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LaNSBioDyT, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - David J. Hodson
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, Churchill Hospital, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Patrice Mollard
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Marie Schaeffer
- Institute of Functional Genomics, Univ. Montpellier, CNRS, INSERM, Montpellier, France
- Centre de Biologie Structurale, CNRS UMR 5048, INSERM U1054, Univ Montpellier, Montpellier, France
- *Correspondence: Marie Schaeffer,
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30
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Edwards AE, Vathenen R, Henson SM, Finer S, Gunganah K. Acute hyperglycaemic crisis after vaccination against COVID-19: A case series. Diabet Med 2021; 38:e14631. [PMID: 34185927 PMCID: PMC8420566 DOI: 10.1111/dme.14631] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Amy E. Edwards
- Department of Diabetes and EndocrinologyNewham University HospitalBarts Health NHS TrustLondonUK
| | - Ramu Vathenen
- Department of Diabetes and EndocrinologyNewham University HospitalBarts Health NHS TrustLondonUK
| | - Sian M. Henson
- Centre for Translational Medicine and TherapeuticsWilliam Harvey Research Institute, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Sarah Finer
- Department of Diabetes and EndocrinologyNewham University HospitalBarts Health NHS TrustLondonUK
- Institute for Population Health Sciences, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Kirun Gunganah
- Department of Diabetes and EndocrinologyNewham University HospitalBarts Health NHS TrustLondonUK
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31
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Hanna SJ, Tatovic D, Thayer TC, Dayan CM. Insights From Single Cell RNA Sequencing Into the Immunology of Type 1 Diabetes- Cell Phenotypes and Antigen Specificity. Front Immunol 2021; 12:751701. [PMID: 34659258 PMCID: PMC8519581 DOI: 10.3389/fimmu.2021.751701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/14/2021] [Indexed: 01/10/2023] Open
Abstract
In the past few years, huge advances have been made in techniques to analyse cells at an individual level using RNA sequencing, and many of these have precipitated exciting discoveries in the immunology of type 1 diabetes (T1D). This review will cover the first papers to use scRNAseq to characterise human lymphocyte phenotypes in T1D in the peripheral blood, pancreatic lymph nodes and islets. These have revealed specific genes such as IL-32 that are differentially expressed in islet -specific T cells in T1D. scRNAseq has also revealed wider gene expression patterns that are involved in T1D and can predict its development even predating autoantibody production. Single cell sequencing of TCRs has revealed V genes and CDR3 motifs that are commonly used to target islet autoantigens, although truly public TCRs remain elusive. Little is known about BCR repertoires in T1D, but scRNAseq approaches have revealed that insulin binding BCRs commonly use specific J genes, share motifs between donors and frequently demonstrate poly-reactivity. This review will also summarise new developments in scRNAseq technology, the insights they have given into other diseases and how they could be leveraged to advance research in the type 1 diabetes field to identify novel biomarkers and targets for immunotherapy.
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Affiliation(s)
- Stephanie J. Hanna
- Diabetes Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Danijela Tatovic
- Diabetes Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Terri C. Thayer
- Diabetes Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Biological and Chemical Sciences, School of Natural and Social Sciences, Roberts Wesleyan College, Rochester, NY, United States
| | - Colin M. Dayan
- Diabetes Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
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32
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Topriceanu C, Tillin T, Chaturvedi N, Joshi R, Garfield V. The association between plasma metabolites and sleep quality in the Southall and Brent Revisited (SABRE) Study: A cross-sectional analysis. J Sleep Res 2021; 30:e13245. [PMID: 33283399 PMCID: PMC8365718 DOI: 10.1111/jsr.13245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 01/17/2023]
Abstract
We examined the association between plasma metabolites and abnormal sleep patterns using data from the Southall and Brent REvisited (SABRE) cohort. Nuclear magnetic resonance spectroscopy provided 146 circulating plasma metabolites. Sleep questionnaires identified the presence or absence of: difficulty falling asleep, early morning waking, waking up tired, and snoring. Metabolites were compared between the sleep quality categories using the t test, and then filtered using a false discovery rate of 0.05. Generalised linear models with logit-link assessed the associations between filtered metabolites and sleep phenotypes. Adjustment was made for important demographic and health-related covariates. In all, 2,718 participants were included in the analysis. After correcting for multiple testing, three metabolites remained for difficulty falling asleep, 59 for snoring, and none for early morning waking and waking up tired. After adjusting for sex, age, ethnicity and years of education, 1 standard deviation increase in serum histidine and valine associated with lower odds of difficulty falling asleep by 0.89-0.90 (95% confidence intervals [CIs] 0.80-0.99). Branched-chain and aromatic amino acids (odds ratios [ORs] 1.19-1.25, 95% CIs 1.09-1.36) were positively associated with snoring. Total cholesterol in low-density lipoprotein (OR 0.90, 95% CI 0.83-0.97) and high-density lipoprotein (OR 0.88, 95% CI 0.81-0.95) associated with lower odds of snoring. In the fully adjusted model, most associations persisted. To conclude, histidine and valine associated with lower odds of difficulty falling asleep, while docosahexaenoic acid and cholesterol in low-density lipoprotein and high-density lipoprotein subfractions associated with lower odds of snoring. Identified metabolites could provide guidance on the metabolic pathways associated with adverse sleep quality.
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Affiliation(s)
| | - Therese Tillin
- Department of Population Science and Experimental MedicineInstitute of Cardiovascular ScienceUniversity College LondonLondonUK
- MRC Unit for Lifelong Health and AgeingUniversity College LondonLondonUK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental MedicineInstitute of Cardiovascular ScienceUniversity College LondonLondonUK
- MRC Unit for Lifelong Health and AgeingUniversity College LondonLondonUK
| | - Roshni Joshi
- Department of Population Science and Experimental MedicineInstitute of Cardiovascular ScienceUniversity College LondonLondonUK
| | - Victoria Garfield
- Department of Population Science and Experimental MedicineInstitute of Cardiovascular ScienceUniversity College LondonLondonUK
- MRC Unit for Lifelong Health and AgeingUniversity College LondonLondonUK
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