1
|
Magré J, Prieur X. Seipin Deficiency as a Model of Severe Adipocyte Dysfunction: Lessons from Rodent Models and Teaching for Human Disease. Int J Mol Sci 2022; 23:740. [PMID: 35054926 PMCID: PMC8775404 DOI: 10.3390/ijms23020740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 02/05/2023] Open
Abstract
Obesity prevalence is increasing worldwide, leading to cardiometabolic morbidities. Adipocyte dysfunction, impairing white adipose tissue (WAT) expandability and metabolic flexibility, is central in the development of obesity-related metabolic complications. Rare syndromes of lipodystrophy characterized by an extreme paucity of functional adipose tissue should be considered as primary adipocyte dysfunction diseases. Berardinelli-Seip congenital lipodystrophy (BSCL) is the most severe form with a near absence of WAT associated with cardiometabolic complications such as insulin resistance, liver steatosis, dyslipidemia, and cardiomyopathy. Twenty years ago, mutations in the BSCL2 gene have been identified as the cause of BSCL in human. BSCL2 encodes seipin, an endoplasmic reticulum (ER) anchored protein whose function was unknown back then. Studies of seipin knockout mice or rats demonstrated how seipin deficiency leads to severe lipodystrophy and to cardiometabolic complications. At the cellular levels, seipin is organized in multimers that are particularly enriched at ER/lipid droplet and ER/mitochondria contact sites. Seipin deficiency impairs both adipocyte differentiation and mature adipocyte maintenance. Experiments using adipose tissue transplantation in seipin knockout mice and tissue-specific deletion of seipin have provided a large body of evidence that liver steatosis, cardiomyopathy, and renal injury, classical diabetic complications, are all consequences of lipodystrophy. Rare adipocyte dysfunctions such as in BSCL are the key paradigm to unravel the pathways that control adipocyte homeostasis. The knowledge gathered through the study of these pathologies may bring new strategies to maintain and improve adipose tissue expandability.
Collapse
Affiliation(s)
| | - Xavier Prieur
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, L’institut du Thorax, Université de Nantes, F-44000 Nantes, France;
| |
Collapse
|
2
|
Abstract
Diabetes mellitus is a significant worldwide health concern and cutaneous manifestations are common. This review describes characteristic skin findings of diabetes, general skin findings related to diabetes, and findings related to diabetes treatment with a focus on clinical presentation, diagnosis, pathophysiology, epidemiology, and treatment. As the prevalence of diabetes continues to rise, cutaneous manifestations of diabetes mellitus likely will be encountered more frequently by physicians in all disciplines including dermatologists and primary care physicians. Accordingly, knowledge regarding the prevention, diagnosis, and management of cutaneous manifestations is an important aspect in the care of patients with diabetes.
Collapse
Affiliation(s)
- Alex Hines
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
3
|
Adachi M, Muroya K, Hanakawa J, Asakura Y. Metreleptin worked in a diabetic woman with a history of hematopoietic stem cell transplantation (HSCT) during infancy: further support for the concept of 'HSCT-associated lipodystrophy'. Endocr J 2021; 68:399-407. [PMID: 33229817 DOI: 10.1507/endocrj.ej20-0325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 17-year-old woman with a history of childhood leukemia and hematopoietic stem cell transplantation (HSCT), preceded by total body irradiation, developed diabetes, dyslipidemia, fatty liver, and marked insulin resistance. Based on Dunnigan phenotype, HSCT-associated lipodystrophy was suspected. Because of rapid deterioration of diabetes control, metreleptin was introduced at 23 years of age upon receipt of her caregiver's documented consent. This trial was initially planned as a prospective 18 month-long study, with regular assessments of the patient's physical activity, food intake, and body composition analysis. However, because an abrupt and transient attenuation of the metreleptin effect occurred 16 months after the treatment initiation, the entire course of 28 months is reported here. Over the period, her HbA1c decreased from 10.9% to 6.7% despite no significant increase of physical activity and with a stable food intake. Decreased levels of triglyceride and non-HDL cholesterol were found. Her liver function improved, indicating the amelioration of fatty liver. In addition, a 25% reduction in the subcutaneous fat area at umbilical level was found, accompanied by a decrease in fat percentage of both total-body and trunk. The formation of neutralizing antibodies to metreleptin may be responsible for the transient loss of efficacy, considering a sudden elevation in her serum leptin level. In conclusion, metreleptin is useful for the management of HSCT-associated lipodystrophy, supporting the concept that adipose tissue dysfunction is responsible for diverse post-HSCT metabolic aberrations.
Collapse
Affiliation(s)
- Masanori Adachi
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama 232-8555, Japan
| | - Koji Muroya
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama 232-8555, Japan
| | - Junko Hanakawa
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama 232-8555, Japan
| | - Yumi Asakura
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama 232-8555, Japan
| |
Collapse
|
4
|
Bini S, D’Erasmo L, Di Costanzo A, Minicocci I, Pecce V, Arca M. The Interplay between Angiopoietin-Like Proteins and Adipose Tissue: Another Piece of the Relationship between Adiposopathy and Cardiometabolic Diseases? Int J Mol Sci 2021; 22:ijms22020742. [PMID: 33451033 PMCID: PMC7828552 DOI: 10.3390/ijms22020742] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 12/15/2022] Open
Abstract
Angiopoietin-like proteins, namely ANGPTL3-4-8, are known as regulators of lipid metabolism. However, recent evidence points towards their involvement in the regulation of adipose tissue function. Alteration of adipose tissue functions (also called adiposopathy) is considered the main inducer of metabolic syndrome (MS) and its related complications. In this review, we intended to analyze available evidence derived from experimental and human investigations highlighting the contribution of ANGPTLs in the regulation of adipocyte metabolism, as well as their potential role in common cardiometabolic alterations associated with adiposopathy. We finally propose a model of ANGPTLs-based adipose tissue dysfunction, possibly linking abnormalities in the angiopoietins to the induction of adiposopathy and its related disorders.
Collapse
|
5
|
Nagayama A, Ashida K, Watanabe M, Moritaka K, Sonezaki A, Kitajima Y, Takahashi H, Yoshinobu S, Iwata S, Yasuda J, Hasuzawa N, Ozono S, Motomura S, Nomura M. Case Report: Metreleptin and SGLT2 Inhibitor Combination Therapy Is Effective for Acquired Incomplete Lipodystrophy. Front Endocrinol (Lausanne) 2021; 12:690996. [PMID: 34135866 PMCID: PMC8201990 DOI: 10.3389/fendo.2021.690996] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/13/2021] [Indexed: 12/30/2022] Open
Abstract
Childhood cancer survivors (CCSs) who have undergone bone marrow transplantation with systemic chemotherapy and whole-body irradiation often experience impaired glucose tolerance with marked insulin resistance. Incomplete acquired diabetic lipodystrophy should be considered as a late complication of bone marrow transplantation. A 24-year-old Japanese female patient with incomplete acquired lipodystrophy, a CCS of acute lymphocytic leukemia at the age of 3 years, was treated for diabetes mellitus and dyslipidemia at our hospital. Administration of multiple daily insulin injections (70 units/day), and oral administration of 500 mg/day metformin, 15 mg/day pioglitazone, and 200 mg/day bezafibrate had proven ineffective for her metabolic disorders. Subcutaneous administration of metreleptin improved her insulin resistance and hypertriglyceridemia within a month; however, it failed to maintain adequate plasma glucose levels in the long term. When oral administration of 10 mg/day empagliflozin was added to the metreleptin supplementation, her HbA1c value (National Glycohemoglobin Standardization Program) improved from 11% to 8%, which was maintained for an additional 18 months. This is the first case report of incomplete lipodystrophy that shows efficacy of a combination therapy with metreleptin and a sodium glucose cotransporter 2 (SGLT2) inhibitor for the treatment of diabetes and dyslipidemia. An SGLT2 inhibitor attenuates hyperglycemia through urinary glucose excretion and has been suggested to enhance lipid catabolism in the extra-adipose tissues, especially in the liver and skeletal muscles. Furthermore, metreleptin supplementation could enhance the action of the SGLT2 inhibitor by promoting satiety and lipolysis through the central nervous system. Combination therapy with metreleptin and an SGLT2 inhibitor was suggested to recover the volume of adipose tissue, possibly through improvement of insulin resistance in the adipose tissue. This report highlights the pathophysiological mechanism of an SGLT2 inhibitor in the improvement of glucose metabolism in non-healthy lean CCSs with insulin resistance. Administration of SGLT2 inhibitor, along with metreleptin supplementation, could be a good alternative therapy for diabetic lipodystrophy observed in CCSs.
Collapse
Affiliation(s)
- Ayako Nagayama
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
- *Correspondence: Kenji Ashida,
| | - Miki Watanabe
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kanoko Moritaka
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Aya Sonezaki
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | - Hirokazu Takahashi
- Division of Hepatology, Diabetes Mellitus, and Endocrinology, Department of Internal Medicine, Saga University, Saga, Japan
| | - Satoko Yoshinobu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Shimpei Iwata
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Junichi Yasuda
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Nao Hasuzawa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Shuichi Ozono
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Seiichi Motomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| |
Collapse
|
6
|
Zammouri J, Vatier C, Capel E, Auclair M, Storey-London C, Bismuth E, Mosbah H, Donadille B, Janmaat S, Fève B, Jéru I, Vigouroux C. Molecular and Cellular Bases of Lipodystrophy Syndromes. Front Endocrinol (Lausanne) 2021; 12:803189. [PMID: 35046902 PMCID: PMC8763341 DOI: 10.3389/fendo.2021.803189] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022] Open
Abstract
Lipodystrophy syndromes are rare diseases originating from a generalized or partial loss of adipose tissue. Adipose tissue dysfunction results from heterogeneous genetic or acquired causes, but leads to similar metabolic complications with insulin resistance, diabetes, hypertriglyceridemia, nonalcoholic fatty liver disease, dysfunctions of the gonadotropic axis and endocrine defects of adipose tissue with leptin and adiponectin deficiency. Diagnosis, based on clinical and metabolic investigations, and on genetic analyses, is of major importance to adapt medical care and genetic counseling. Molecular and cellular bases of these syndromes involve, among others, altered adipocyte differentiation, structure and/or regulation of the adipocyte lipid droplet, and/or premature cellular senescence. Lipodystrophy syndromes frequently present as systemic diseases with multi-tissue involvement. After an update on the main molecular bases and clinical forms of lipodystrophy, we will focus on topics that have recently emerged in the field. We will discuss the links between lipodystrophy and premature ageing and/or immuno-inflammatory aggressions of adipose tissue, as well as the relationships between lipomatosis and lipodystrophy. Finally, the indications of substitutive therapy with metreleptin, an analog of leptin, which is approved in Europe and USA, will be discussed.
Collapse
Affiliation(s)
- Jamila Zammouri
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
| | - Camille Vatier
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
- Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - Emilie Capel
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
| | - Martine Auclair
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
| | - Caroline Storey-London
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Pediatric Endocrinology Department, National Competence Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - Elise Bismuth
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Pediatric Endocrinology Department, National Competence Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - Héléna Mosbah
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
- Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - Bruno Donadille
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
- Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - Sonja Janmaat
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
- Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - Bruno Fève
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
- Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - Isabelle Jéru
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
- Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
- Genetics Department, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Paris, France
| | - Corinne Vigouroux
- Sorbonne University, Inserm UMR_S 938, Saint-Antoine Research Centre, Cardiometabolism and Nutrition University Hospital Institute (ICAN), Paris, France
- Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
- Genetics Department, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
7
|
D’Apice MR, De Dominicis A, Murdocca M, Amati F, Botta A, Sangiuolo F, Lattanzi G, Federici M, Novelli G. Cutaneous and metabolic defects associated with nuclear abnormalities in a transgenic mouse model expressing R527H lamin A mutation causing mandibuloacral dysplasia type A (MADA) syndrome. Acta Myol 2020; 39:320-335. [PMID: 33458588 PMCID: PMC7783430 DOI: 10.36185/2532-1900-036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
LMNA gene encodes for lamin A/C, attractive proteins linked to nuclear structure and functions. When mutated, it causes different rare diseases called laminopathies. In particular, an Arginine change in Histidine in position 527 (p.Arg527His) falling in the C-terminal domain of lamin A precursor form (prelamin A) causes mandibuloacral dysplasia Type A (MADA), a segmental progeroid syndrome characterized by skin, bone and metabolic anomalies. The well-characterized cellular models made difficult to assess the tissue-specific functions of 527His prelamin A. Here, we describe the generation and characterization of a MADA transgenic mouse overexpressing 527His LMNA gene, encoding mutated prelamin A. Bodyweight is slightly affected, while no difference in lifespan was observed in transgenic animals. Mild metabolic anomalies and thinning and loss of hairs from the back were the other observed phenotypic MADA manifestations. Histological analysis of tissues relevant for MADA syndrome revealed slight increase in adipose tissue inflammatory cells and a reduction of hypodermis due to a loss of subcutaneous adipose tissue. At cellular levels, transgenic cutaneous fibroblasts displayed nuclear envelope aberrations, presence of prelamin A, proliferation, and senescence rate defects. Gene transcriptional pattern was found differentially modulated between transgenic and wildtype animals, too. In conclusion, the presence of 527His Prelamin A accumulation is further linked to the appearance of mild progeroid features and metabolic disorder without lifespan reduction.
Collapse
Affiliation(s)
| | | | - Michela Murdocca
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesca Amati
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Annalisa Botta
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Federica Sangiuolo
- Laboratory of Medical Genetics, Tor Vergata Hospital, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Giovanna Lattanzi
- Center for Atherosclerosis, School of Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Massimo Federici
- Center for Atherosclerosis, School of Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Giuseppe Novelli
- Laboratory of Medical Genetics, Tor Vergata Hospital, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Neuromed IRCCS Institute, Pozzilli (IS), Italy
- School of Medicine, University of Nevada, Reno, NV, USA
| |
Collapse
|
8
|
Wabitsch M, V Schnurbein J. [Recognize rare diseases by the adipose tissue : Lipodystrophy-actually simple but nevertheless often overlooked]. Internist (Berl) 2020; 61:1063-1075. [PMID: 32930809 DOI: 10.1007/s00108-020-00864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lipodystrophy (LD) syndromes are a group of rare and heterogeneous diseases characterized by a congenital deficiency or acquired loss of adipose tissue. Due to the resulting disorder of metabolism, sometimes severe sequelae can develop, such as hypertriglyceridemia, marked insulin resistance and early manifestation of type 2 diabetes, recurrent pancreatitis, fatty liver disease and liver fibrosis. Lipodystrophies are clinically recognizable due to the complete lack of subcutaneous adipose tissue or a conspicuous pattern of the distribution of body fat. Acanthosis nigricans in slimly built persons, a high fasting triglyceride level and elevated concentrations of liver enzymes as well as a positive history of pancreatitis can be indications of LD.
Collapse
Affiliation(s)
- M Wabitsch
- Zentrum für Seltene Endokrine Erkrankungen (ZSEE), Sektion Pädiatrische Endokrinologie und Diabetologie, Universitätsklinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland.
| | - J V Schnurbein
- Zentrum für Seltene Endokrine Erkrankungen (ZSEE), Sektion Pädiatrische Endokrinologie und Diabetologie, Universitätsklinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland
| |
Collapse
|
9
|
Borghi F, Silva C, da Silva PC, Ferrucci DL, Morais CL, Conceição-Vertamatti AG, Carvalho HF, Fonseca MDC, Vieira AS, Grassi-Kassisse DM. The influence of hypertensive environment on adipose tissue remodeling measured by fluorescence lifetime imaging in spontaneously hypertensive rats. Mol Cell Endocrinol 2020; 506:110758. [PMID: 32057944 DOI: 10.1016/j.mce.2020.110758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 12/20/2022]
Abstract
There is a lack of information correlating low adiposity with hypertension experienced by Spontaneous Hypertensive Rats (SHR) or overweight and normotension in Wistar-Kyoto (WKY). We aimed to investigate this lipodystrophy phenomenon by measuring fluorescence lifetime (FLIM), optical redox ratio (ORR), serum levels of hypothalamic-pituitary-adrenal (HPA) and/or hypothalamic-pituitary-thyroid (HPT) hormones axes between Wistar, WKY and SHR before and after establishment of hypertension. Under high blood pressure, we evaluated serum adipokines. Brown adipose tissue was characterized as lower ORR and shorter FLIM compared to white adipose tissue. HPT axis showed a crucial role in the SHR adipose tissue configuration by attenuating whitening. The increased adiposity in WKY may act as a preventive agent for hypertension, since SHR, with low adiposity, establishes the disease. The hypertensive environment can highlight key adipokines that may result in new therapeutic approaches to the treatment of adiposity dysfunctions and hypertension.
Collapse
Affiliation(s)
- Filipy Borghi
- LABEEST, Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil
| | - Carolina Silva
- LABEEST, Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil
| | - Priscila Cristina da Silva
- LABEEST, Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil
| | - Danilo Lopes Ferrucci
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil
| | - Camila Lidiane Morais
- LABEEST, Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil
| | - Ana Gabriela Conceição-Vertamatti
- LABEEST, Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil
| | - Hernandes Faustino Carvalho
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil
| | - Matheus de Castro Fonseca
- Brazilian Biosciences National Laboratory (LNBio), Brazilian Center for Research in Energy and Materials (CNPEM), 13083-970, Campinas, Sao Paulo, Brazil
| | - André Schwambach Vieira
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil
| | - Dora Maria Grassi-Kassisse
- LABEEST, Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, UNICAMP, 13083-862, Campinas, SP, Brazil.
| |
Collapse
|
10
|
Affiliation(s)
- Philippe Oriot
- Philippe Oriot, MD, Mouscron Hospital
Centre, 49, Avenue de Fécamp, Mouscron 7700, Belgium.
| | - Michel P. Hermans
- Cliniques Universitaires Saint-Luc,
Service d’endocrinologie et Nutrition, Brussels, Belgium
| |
Collapse
|
11
|
Gentile S, Strollo F, Della Corte T, Marino G, Guarino G. Insulin related lipodystrophic lesions and hypoglycemia: Double standards? Diabetes Metab Syndr 2018; 12:813-818. [PMID: 29703450 DOI: 10.1016/j.dsx.2018.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
Lipohypertophy (LH) is the most common skin complication of incorrect injection technique which does not only represent an aesthetic defect but also severely disrupts insulin pharmacokinetics/pharmacodynamics. As a consequence of that, hormone release is delayed and unexplained/unpredictable hypoglycemia occurs, both deteriorating metabolic control while negatively affecting adherence to treatment and quality of life. The economic burden due to unwanted intra-LH injections is accounted for by inappropriately high insulin requirements, increased emergency-related hospitalizations, and loss of work days. Greater attention has to be paid by diabetes care teams to education programs with periodic refreshers to achieve better metabolic control and reduce the economic burden of diabetes.
Collapse
Affiliation(s)
- Sandro Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples Italy; Coordinator of the Study Group on Injection Technique of AMD (Medical Association of Diabetology), Italy.
| | - Felice Strollo
- Endocrinology and Diabetes, San Raffaele Termini Institute, Rome, Italy
| | - Teresa Della Corte
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples Italy
| | - Giuseppina Guarino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples Italy
| |
Collapse
|
12
|
Halpern B, Nery M, Pereira MAA. Case Report of Acquired Generalized Lipodystrophy Associated With Common Variable Immunodeficiency. J Clin Endocrinol Metab 2018; 103:2807-2810. [PMID: 29846625 DOI: 10.1210/jc.2018-00494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/23/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Acquired generalized lipodystrophy (AGL), a rare disorder characterized by loss of subcutaneous adipose tissue, is estimated to occur in association with autoimmune diseases in ~25% of the cases. Common variable immunodeficiency (CVI) is a condition known for its strong association with autoimmune diseases often occurring with negative autoantibodies. To the best of our knowledge, we describe the first known case of AGL in a patient with CVI. CASE DESCRIPTION A 24-year-old man was referred to our center with hyperglycemia, hypertriglyceridemia, hepatomegaly, and a clear pattern of generalized fat loss. AGL had been diagnosed on the basis of the clinical and laboratory findings. Because of the presence of associated hypogammaglobulinemia, a diagnosis of CVI was subsequently established. CONCLUSIONS We propose that AGL be added to the list of possible diseases associated with CVI and, owing to the similar clinical presentation with type 1 diabetes mellitus, be included in the differential diagnosis of this condition, which is present in 1.5% of patients with CVI.
Collapse
Affiliation(s)
- Bruno Halpern
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcia Nery
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Adelaide Albergaria Pereira
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
13
|
Coelho AR, Moreira FA, Santos AC, Silva-Pinto A, Sarmento A, Carvalho D, Freitas P. Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test - which method to choose for the diagnosis? BMC Infect Dis 2018; 18:309. [PMID: 29980190 PMCID: PMC6035413 DOI: 10.1186/s12879-018-3221-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antiretroviral therapy dramatically reduced HIV-related morbidity and mortality, prolonging the lifespan of HIV-infected patients. Greater duration of infection and exposure to antiretroviral therapy makes these patients susceptible to traditional cardio-metabolic risk factors and pathologies. The optimal diagnostic protocol for Diabetes Mellitus in these patients is still controversial. Haemoglobin A1c (HbA1c) has been shown to underestimate glycaemia levels and the oral glucose tolerance test (OGTT) has been shown to reveal cases of glucose metabolism disturbances in patients with normal fasting glucose. Thus, this study aimed to determine the prevalence of prediabetes and diabetes in a population of HIV-infected patients undergoing combined antiretroviral therapy, using three different diagnostic methods (fasting glucose, OGTT and HbA1c), to determine the agreement between the different methods and the characteristics associated with each one. METHODS This study analyzed 220 HIV-infected patients on antiretroviral therapy. Patient characteristics were collected using a standardized protocol. Disturbances of glucose homeostasis were defined by the ADA 2017 criteria. Patients were characterized according to the presence or absence of clinical lipodystrophy, and distributed into four different categories, according to the presence, or absence of either clinical lipoatrophy, or abdominal prominence. Insulin resistance was assessed by HOMA-IR and QUICKI indexes. Agreement between the diagnostic methods was assessed by Cohen's kappa coefficient. RESULTS There were no patients diagnosed with diabetes with HbA1c. 5.9% prevalence was obtained when OGTT was used, and 3.2% prevalence when fasting glucose was used. Prediabetes had a prevalence of 14.1% when using HbA1c, 24.1% when using OGTT, and 20% when using fasting glucose. In all three methods, glucose homeostasis disturbances were associated with older age and higher resistance to insulin. Regarding other characteristics, associations varied between the three methods. The agreement between them was fair, or slight. CONCLUSIONS We observed that HbA1c was the method that diagnosed the least amount of cases and that OGTT was the one that diagnosed the most cases. Accordingly, our results indicate that HbA1c underestimated glycaemia levels in this population and that the use of OGTT might allow an earlier diagnosis of glucose homeostasis disturbances, potentially making it possible to avoid severe complications of DM.
Collapse
Affiliation(s)
- Ana Rita Coelho
- Medical Student. Faculty of Medicine, University of Porto. Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Flávia Andreia Moreira
- Medical Student. Faculty of Medicine, University of Porto. Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
- Renal, Urological and Infectious Diseases Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
- Renal, Urological and Infectious Diseases Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Davide Carvalho
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, and Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Paula Freitas
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, and Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| |
Collapse
|
14
|
Bonato L, Taleb N, Gingras V, Messier V, Gobeil F, Ménard J, Ardilouze JL, Rabasa-Lhoret R. Duration of Catheter Use in Patients with Diabetes Using Continuous Subcutaneous Insulin Infusion: A Review. Diabetes Technol Ther 2018; 20:506-515. [PMID: 29958025 DOI: 10.1089/dia.2018.0110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Increasing proportions of patients with diabetes use continuous subcutaneous insulin infusion (CSII) therapy mostly due to its clinical efficacy and flexibility for insulin dosing and adjustments. Some challenges are nevertheless associated with this technology. A key and underlooked component of CSII technical difficulties is the subcutaneous catheter used to infuse insulin. Several adverse events (AEs) have been experienced by patients in relation to catheters, such as blockage, kinking, and insertion site reactions, including irritation, infections, lipohypertrophies etc., all of which could compromise the metabolic control. With the objective of minimizing these AEs, recommendations for changing catheters every 2-3 days have historically been provided by manufacturers based on reports derived from small studies and anecdotal data. The aim of this review was to provide an updated analysis of current recommendations and patients' practices in relation to frequency of catheter change. Our main findings are: (1) adequately designed and powered studies investigating optimal catheter wearing time are still lacking; (2) increasing catheter wearing time is generally associated with increased frequency of catheter AEs; (3) however, interpatient variability is large, with some individuals needing to change their catheters every 2-3 days, whereas others probably being able to keep them in place for longer periods without problems. Further research is thus warranted to provide more solid and evidence-based recommendations while exploring personalized approaches at the same time. Increasing catheter wear life without significant side effects is an important goal to simplify CSII therapy and reduce its associated costs and burdens.
Collapse
Affiliation(s)
- Lisa Bonato
- 1 Research Platform on obesity, metabolism and diabetes, Institut de Recherches Cliniques de Montréal (IRCM) , Montréal, Québec, Canada
| | - Nadine Taleb
- 1 Research Platform on obesity, metabolism and diabetes, Institut de Recherches Cliniques de Montréal (IRCM) , Montréal, Québec, Canada
- 2 Department of Biomedical Sciences, Faculty of Medecine, Université de Montréal , Édouard-Montpetit, Montréal, Québec, Canada
| | - Véronique Gingras
- 1 Research Platform on obesity, metabolism and diabetes, Institut de Recherches Cliniques de Montréal (IRCM) , Montréal, Québec, Canada
- 3 Department of Nutrition, Faculty of Medecine, Université de Montréal , Chemin de la Côte-Sainte-Catherine, Montréal, Québec, Canada
| | - Virginie Messier
- 1 Research Platform on obesity, metabolism and diabetes, Institut de Recherches Cliniques de Montréal (IRCM) , Montréal, Québec, Canada
| | - Fernand Gobeil
- 4 Department of Pharmacology and Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Québec, Canada
- 5 Diabetes, obesity and cardiovscular complications axis, Research Center of the Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke, Québec, Canada
| | - Julie Ménard
- 5 Diabetes, obesity and cardiovscular complications axis, Research Center of the Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke, Québec, Canada
| | - Jean-Luc Ardilouze
- 5 Diabetes, obesity and cardiovscular complications axis, Research Center of the Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke, Québec, Canada
- 6 Endocrine Division, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Québec, Canada
| | - Rémi Rabasa-Lhoret
- 1 Research Platform on obesity, metabolism and diabetes, Institut de Recherches Cliniques de Montréal (IRCM) , Montréal, Québec, Canada
- 3 Department of Nutrition, Faculty of Medecine, Université de Montréal , Chemin de la Côte-Sainte-Catherine, Montréal, Québec, Canada
- 7 Montréal Diabetes Research Center , Saint-Denis Montréal, Québec, Canada
| |
Collapse
|
15
|
Abstract
BACKGROUND Lipohypertrophy (LH) at insulin injection sites is a common but preventable complication in type 1 diabetes mellitus (T1DM). We evaluated the prevalence, contributing risk factors, and consequences of LH, specifically the glycemic variability (GV) among T1DM patients. METHODS This is a cross-sectional study conducted at a tertiary care center in India, wherein 139 subjects with T1DM were randomly selected and evaluated for the presence of LH through visual and palpation examinations. Demography, anthropometry, and injecting practices were evaluated using a validated questionnaire and their effect on LH was determined. Subsequently, the effect of LH on GV and unexplained hypoglycemia (UH) was studied. Mean glucose, mean amplitude of glycemic excursions (MAGEs), and continuous overlapping net glycemic action (CONGA) were assessed in a subset of patients who injected insulin alternately in LH and non-LH sites. RESULTS The overall prevalence of LH was 69.8%, and was significantly higher in adults than in children (P = 0.038). Improper rotation of sites (P < 0.0001) and insulin syringe reusage for more than five times (P = 0.009) significantly increase the risk of LH. The presence of LH has a significant effect on GV and UH with adjusted odds ratios of 17.65 (P < 0.0001) and 28.02 (P < 0.0001), respectively. Ambulatory glucose monitoring on a subset of patients confirmed that the mean glucose, MAGE, and CONGA were higher when subjects injected insulin at LH sites than at non-LH sites. CONCLUSIONS Improper rotation of sites and reuse of needles are the leading causes of LH in Indian T1DM patients, which, in turn, significantly increases the risk of GV and UH.
Collapse
Affiliation(s)
- Sunil S Gupta
- 1 Department of Diabetology, Sunil's Diabetes Care n' Research Centre , Nagpur, India
| | - Kavita S Gupta
- 2 Research Scholar, Rashtrasant Tukdoji Maharaj Nagpur University, MS, India and Department of Dietetics and Diabetes Education, Sunil's Diabetes Care n' Research Centre Pvt. Ltd. , Nagpur, India
| | - Sachin S Gathe
- 3 Department of Clinical Research and Epidemiology, Sunil's Diabetes Care n' Research Centre Pvt. Ltd. , Nagpur, India
| | | | - Shlok S Gupta
- 5 Student, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur; Maharashtra University of Health Sciences (Nashik), India
| |
Collapse
|
16
|
Beires MT, Silva-Pinto A, Santos AC, Madureira AJ, Pereira J, Carvalho D, Sarmento A, Freitas P. Visceral adipose tissue and carotid intima-media thickness in HIV-infected patients undergoing cART: a prospective cohort study. BMC Infect Dis 2018; 18:32. [PMID: 29325542 PMCID: PMC5765644 DOI: 10.1186/s12879-017-2884-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Combined antiretroviral therapy (cART) in HIV-infected patients has been associated with lipodystrophy, metabolic abnormalities, and an increased risk of cardiovascular disease. Ultrasound measures of carotid artery intima-media thickness (cIMT) have been used as a valid measure of subclinical atherosclerosis and as a tool to predict the risk of cardiovascular events. Our aim was to evaluate the progression of cIMT in HIV-infected patients subjected to cART, with and without lipodystrophy, over a one-year period. METHODS We performed a one-year prospective cohort study to compare changes in cIMT, metabolic and inflammation markers in HIV-infected patients undergoing cART. Body composition was assessed by dual-energy X-ray absorptiometry (DXA) and abdominal computed tomography (CT). Levels of blood pressure, lipids and inflammatory markers were evaluated, as well as ultrasound measures of cIMT. Lipodystrophy defined by Fat Mass Ratio (L-FMR) is measured as the ratio of the percentage of trunk fat mass to the percentage of lower limb fat mass by DXA. Categorical variables were compared, using the chi-square or Fisher's exact test. Wilcoxon ranks tests and the McNemar chi-square tests were used to compare results of selected variables, from the first to the second year of evaluation. Means of cIMT, adjusted for age, glucose, triglycerides levels, systolic blood pressure (SBP), and waist to hip ratio were calculated, using generalised linear models for repeated measures. RESULTS L-FMR was present in 44.3% of patients, and the mean of cIMT increased significantly in this group [0.82 (0.26) vs 0.92 (0.33); p = 0.037], as well as in patients without lipodystrophy [0.73 (0.20) vs 0.84 (0.30); p = 0.012]. In the overall sample, the progression of cIMT was statistically significant after the adjustment for age, glucose, triglycerides, and SBP, but the significance of the progression ceased after the adjustment for waist/hip ratio [0.770 (0.737-0.803) vs 0.874 (0.815-0.933); p = 0.514]. CONCLUSIONS Carotid IMT progressed significantly in both groups of this HIV-infected cohort, however no association between the progression of cIMT and the presence of lipodystrophy defined by FMR was found. Visceral adipose tissue had an impact on the increment of cIMT, both in patients with, and without lipodystrophy defined by FMR.
Collapse
Affiliation(s)
- Maria Teresa Beires
- Faculty of Medicine, University of Porto. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
- Renal, Urological and Infectious Diseases Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - António José Madureira
- Radiology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal
| | - Jorge Pereira
- Nuclear Medicine Department, Hospital de São João, Porto, Portugal
| | - Davide Carvalho
- Endocrinology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
- Renal, Urological and Infectious Diseases Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Paula Freitas
- Endocrinology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal
| |
Collapse
|
17
|
Abstract
AIMS Lipohypertrophy (LH) represents the most common skin-related complication associated with insulin therapy. Our aim is to estimate the prevalence of LH among insulin-treated patients, to identify its association with errors in insulin injection technique and storage, and the correlation between LH, risk of hypoglycemia, and glycemic control. METHODS Consecutive patients with T1DM or T2DM, attending a diabetes clinic for a routine visit, were administered an anonymous questionnaire investigating the modalities of insulin injection, the correct use of pen device, insulin storage, and reported frequency of hypoglycemic episodes. The presence of LH was assessed by inspection and palpation of injection sites. RESULTS Overall, 352 patients were enrolled (mean age 68 ± 12 years, 43.2% males, 88.9% with T2DM, mean duration of insulin therapy 9.1 ± 8.6 years). The prevalence of LH was 42.9%. At multivariate analysis, the strongest correlates of LH were not spacing injections (OR 20.4; 95% CI 10.5-39.6) and not rotating the site of injection (OR 2.01; 95% CI 1.08-3.75). Increasing doses of insulin and longer duration of insulin therapy also increased the risk of LH. The presence of LH was associated with a 2.7 times higher risk of severe hypoglycemia. Higher daily insulin doses, lack of rotation of injection sites, and keeping insulin in use in the refrigerator were independent correlates of higher HbA1c levels. CONCLUSIONS Insulin injection technique is suboptimal in many patients, highlighting the need for improved patient education. Increasing the awareness of the importance of preventing lipohypertrophy and insulin injection errors represents an important tool to reduce the clinical, social, and economic burden of diabetes.
Collapse
Affiliation(s)
| | - Mario Laudato
- Azienda Sanitaria Locale Caserta, Centro Diabetologico, via Harris, 81100, Caserta, Italy
| | - Maria Barone
- Azienda Sanitaria Locale Caserta, Centro Diabetologico, via Harris, 81100, Caserta, Italy
| | - Franco Crisci
- Università degli Studi Della Campania: L. Vanvitelli. Corso di Laurea in Infermieristica. ASL CE, via Napoli, 81024, Maddaloni, Italy
| | - Bianca Pozzuoli
- Università degli Studi Della Campania: L. Vanvitelli. Corso di Laurea in Infermieristica. ASL CE, via Napoli, 81024, Maddaloni, Italy
| |
Collapse
|
18
|
Ceccarini G, Ferrari F, Santini F. Acquired partial lipodystrophy after bone marrow transplant during childhood: a novel syndrome to be added to the disease classification list. J Endocrinol Invest 2017; 40:1273-1274. [PMID: 28721522 DOI: 10.1007/s40618-017-0731-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 01/31/2023]
Affiliation(s)
- G Ceccarini
- Obesity Center at the Endocrine Unit, University Hospital of Pisa, Pisa, Italy.
| | - F Ferrari
- Obesity Center at the Endocrine Unit, University Hospital of Pisa, Pisa, Italy
| | - F Santini
- Obesity Center at the Endocrine Unit, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
19
|
Campinos C, Le Floch JP, Petit C, Penfornis A, Winiszewski P, Bordier L, Lepage M, Fermon C, Louis J, Almain C, Morel D, Hirsch L, Strauss KW. An Effective Intervention for Diabetic Lipohypertrophy: Results of a Randomized, Controlled, Prospective Multicenter Study in France. Diabetes Technol Ther 2017; 19:623-632. [PMID: 29058477 PMCID: PMC5750448 DOI: 10.1089/dia.2017.0165] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Lipohypertrophy (LH) is highly prevalent and is potentially harmful to insulin-injecting patients. METHODS In this study, we assessed the impact of injection technique (IT) education, including use of a 4-mm pen needle on insulin-treated patients with clinically observed LH in a randomized, controlled, prospective multicenter study in France with follow-up of 6 months. Intensive education and between-visit reinforcement were given to the intervention group. Control patients received similar messages at study outset. RESULTS A total of 123 patients were recruited (age 52.1 ± 15.7 years; men 70.7%; body mass index >30 kg/m2: 34.2%; type 1: 53.7%; years with diabetes mellitus: 18.1 ± 10.5), of which 109 patients were included in the final analysis. The intervention group (n = 53) showed a significant decrease of total daily dose of insulin (average at baseline: 54.1 IU) at 3 months (T-3) and 6 months (T-6), reaching just over 5 IU versus baseline (P = 0.035). Corresponding, although not significant, decreases occurred in controls (n = 56); between-group differences were not significant. There were significant decreases in HbA1c (up to 0.5%) at T-3 and T-6 in both groups, with no significant differences between groups. A significant number of intervention patients improved their IT habits; about half achieved ideal IT habits by T-3 versus a quarter of control patients. By T-6, 2/3 of intervention patients achieved either ideal or acceptable IT habits, while only 1/3 of control patients did. CONCLUSIONS Our intervention was effective in both study arms, however, to a greater degree and more rapidly in the intervention group. Widespread application of this intervention could be highly cost-effective.
Collapse
Affiliation(s)
| | | | - Catherine Petit
- CH Sud Francilien Diabetes Service, Corbeil-Essonnes, France
| | - Alfred Penfornis
- Université Paris Sud Diabetes Service, CH Sud Francilien, Corbeil-Essonnes, France
| | | | - Lyse Bordier
- H.I.A. Begin Diabetes Service, Saint Mande, France
| | - Marie Lepage
- C.H.B. Diabetes Service, Boulogne sur Mer Cedex, France
| | | | | | | | | | | | | |
Collapse
|
20
|
Sahasrabudhe R, Limaye T, Gokhale V. Unusual Presentation of Injection Site Adverse Effect. J Assoc Physicians India 2017; 65:96-97. [PMID: 29322722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Insulin is an integral part of Type 1 diabetes management. Patient education is of utmost importance to ensure proper injection technique for getting appropriate glycaemic control and to avoid injection site adverse effects. Commonest injection site adverse effect is lipodystrophy.1 We present a case where incorrect injection technique led to an unusual presentation of injection site adverse effect, which is resolving after correction of the injection technique.
Collapse
Affiliation(s)
| | | | - Vidya Gokhale
- Diabetes Educator and Medical Social Worker, Diabetes Unit, KEM Hospital, Pune, Maharashtra
| |
Collapse
|
21
|
Lee SY, Lee HY, Song JH, Kim GT, Jeon S, Song YJ, Lee JS, Hur JH, Oh HH, Park SY, Shim SM, Yoo HJ, Lee BC, Jiang XC, Choi CS, Park TS. Adipocyte-Specific Deficiency of De Novo Sphingolipid Biosynthesis Leads to Lipodystrophy and Insulin Resistance. Diabetes 2017; 66:2596-2609. [PMID: 28698261 PMCID: PMC7970771 DOI: 10.2337/db16-1232] [Citation(s) in RCA: 42] [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: 10/12/2016] [Accepted: 06/28/2017] [Indexed: 12/16/2022]
Abstract
Sphingolipids have been implicated in the etiology of chronic metabolic diseases. Here, we investigated whether sphingolipid biosynthesis is associated with the development of adipose tissues and metabolic diseases. SPTLC2, a subunit of serine palmitoyltransferase, was transcriptionally upregulated in the adipose tissues of obese mice and in differentiating adipocytes. Adipocyte-specific SPTLC2-deficient (aSPTLC2 KO) mice had markedly reduced adipose tissue mass. Fatty acids that were destined for the adipose tissue were instead shunted to liver and caused hepatosteatosis. This impaired fat distribution caused systemic insulin resistance and hyperglycemia, indicating severe lipodystrophy. Mechanistically, sphingosine 1-phosphate (S1P) was reduced in the adipose tissues of aSPTLC2 KO mice, and this inhibited adipocyte proliferation and differentiation via the downregulation of S1P receptor 1 and decreased activity of the peroxisome proliferator-activator receptor γ. In addition, downregulation of SREBP (sterol regulatory element-binding protein)-1c prevented adipogenesis of aSPTLC2 KO adipocytes. Collectively, our observations suggest that the tight regulation of de novo sphingolipid biosynthesis and S1P signaling plays an important role in adipogenesis and hepatosteatosis.
Collapse
Affiliation(s)
- Su-Yeon Lee
- Department of Life Science, Gachon University, Sungnam, Korea
| | - Hui-Young Lee
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon, Korea
| | - Jae-Hwi Song
- Department of Life Science, Gachon University, Sungnam, Korea
| | - Goon-Tae Kim
- Department of Life Science, Gachon University, Sungnam, Korea
| | - Suwon Jeon
- Department of Life Science, Gachon University, Sungnam, Korea
| | - Yoo-Jeong Song
- Department of Life Science, Gachon University, Sungnam, Korea
| | - Jae Sung Lee
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon, Korea
| | - Jang-Ho Hur
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon, Korea
| | - Hyun Hee Oh
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon, Korea
| | - Shi-Young Park
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon, Korea
| | - Soon-Mi Shim
- Department of Food Science and Technology, Sejong University, Seoul, Korea
| | - Hyun Joo Yoo
- Biomedical Research Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Cheon Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul, Korea
| | - Xian-Cheng Jiang
- Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Cheol Soo Choi
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon, Korea
- Endocrinology, Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Tae-Sik Park
- Department of Life Science, Gachon University, Sungnam, Korea
| |
Collapse
|
22
|
Abstract
Treatment with highly active antiretroviral drugs (HAART) is associated with several endocrine and metabolic comorbidities. Pituitary growth hormone (GH) secretion seems to be altered in human immunodeficiency virus (HIV) infection, and about one-third of patients have biochemical GH deficiency (GHD). We undertake a historical review of the functioning of the GH/insulin-like growth factor-1 (IGF-1) axis in patients with acquired immunodeficiency syndrome, and provide an overview of the main changes of the GH/IGF-1 axis occurring today in patients with HIV. Both spontaneous GH secretion and GH response to provocative stimuli are reduced in patients with HIV infection, especially in those with HIV-related lipodystrophy. The role of fat accumulation on flattened GH secretion is discussed, together with all factors able to potentially interfere with the pituitary secretion of GH. Several factors contribute to the development of GHD, but the pathophysiologic mechanisms involved in the genesis of GHD are complex and not yet fully elucidated owing to the difficulty in separating the effects of HIV infection from those of HAART, comorbidities and body changes. An update on the putative mechanisms involved in the pathogenesis of altered GH secretion in these patients is provided, together with an overview on the therapeutic strategies targeting the GH/IGF-1 axis to counteract fat redistribution associated with HIV-related lipodystrophy. The clinical significance of GHD in the context of HIV infection is discussed. The administration of tesamorelin, a GH releasing hormone analogue, is effective in reducing visceral fat in HIV-infected patients with lipodystrophy. This treatment is promising and safer than treatment with high doses of recombinant human growth hormone, which has several side-effects.
Collapse
Affiliation(s)
- Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy.
| | - Giovanni Guaraldi
- HIV Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences for Adults and Children, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
23
|
Le CN, Hulgan T, Tseng CH, Milne GL, Lake JE. Urine Eicosanoids in the Metabolic Abnormalities, Telmisartan, and HIV Infection (MATH) Trial. PLoS One 2017; 12:e0170515. [PMID: 28118376 PMCID: PMC5261803 DOI: 10.1371/journal.pone.0170515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Arachidonic acid metabolites (eicosanoids) reflect oxidative stress and vascular health and have been associated with anthropometric measures and sex differences in cross-sectional analyses of HIV-infected (HIV+) persons. Telmisartan is an angiotensin receptor blocker and PPAR-γ agonist with potential anti-inflammatory and metabolic benefits. We assessed telmisartan's effects on urine eicosanoids among HIV+ adults with central adiposity on suppressive antiretroviral therapy enrolled in a prospective clinical trial. METHODS Thirty-five HIV+ adults (15 women; 20 men) completed 24 weeks of open-label oral telmisartan 40mg daily. Lumbar computed tomography quantified visceral (VAT) and subcutaneous (SAT) abdominal adipose tissue. Urine F2-isoprostane (F2-IsoP), prostaglandin E2 (PGE-M), prostacyclin (PGI-M), and thromboxane B2 (TxB-M) were quantified at baseline and 24 weeks using gas/liquid chromatography-mass spectroscopy. Mann-Whitney-U tests compared sub-group differences; Spearman's rho assessed correlations between clinical factors and eicosanoid levels. RESULTS Median PGE-M increased on telmisartan (p<0.01), with greater changes in men (+4.1 [p = 0.03] vs. +1.0 ng/mg cr in women; between-group p = 0.25) and participants losing >5% VAT (+3.7 ng/mg cr, p<0.01) and gaining >5% SAT (+1.7 ng/mg cr, p = 0.04). Median baseline F2-IsoP and TxB-M were slightly higher in women (both between-group p = 0.08) and did not change on telmisartan. CONCLUSIONS Urine PGE-M increased with 24 weeks of telmisartan in virally suppressed, HIV+ adults with central adiposity. Associations with favorable fat redistribution suggest increased PGE-M may reflect a beneficial response.
Collapse
Affiliation(s)
- Catherine N. Le
- Vanderbilt University School of Medicine, Department of Medicine, Division of Infectious Disease, Nashville, Tennessee, United States of America
- * E-mail:
| | - Todd Hulgan
- Vanderbilt University School of Medicine, Department of Medicine, Division of Infectious Disease, Nashville, Tennessee, United States of America
| | - Chi-Hong Tseng
- University of California-Los Angeles, Department of Medicine, Division of Infectious Disease, Los Angeles, California, United States of America
| | - Ginger L. Milne
- Vanderbilt University School of Medicine, Department of Medicine, Division of Infectious Disease, Nashville, Tennessee, United States of America
| | - Jordan E. Lake
- University of California-Los Angeles, Department of Medicine, Division of Infectious Disease, Los Angeles, California, United States of America
| |
Collapse
|
24
|
Presta F, Del Giglio M, Girolomoni G. Lipoatrophia semicircularis: a case report and review of the literature. GIORN ITAL DERMAT V 2016; 151:441-444. [PMID: 27348322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The case of a 45 years old woman with lipoatrophia semicircularis is presented showing a typical semicircular depressions of the anterolateral aspects of the thighs. The lesion regressed after avoiding the pressing of the thighs against the desk edge. A PubMed search disclosed 125 cases of lipoatrophia semicircularis reported in details. More then 90% were middle aged women. Repeated external microtraumatisms was the most common cause. The few cases biopsied revealed a localized lipoatrophy. Avoiding microtraumatisms resulted in a complete remission of lipoatrophia semicircularis in most cases.
Collapse
Affiliation(s)
- Fabrizio Presta
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy -
| | | | | |
Collapse
|
25
|
Reyes-Vidal CM, Mojahed H, Shen W, Jin Z, Arias-Mendoza F, Fernandez JC, Gallagher D, Bruce JN, Post KD, Freda PU. Adipose Tissue Redistribution and Ectopic Lipid Deposition in Active Acromegaly and Effects of Surgical Treatment. J Clin Endocrinol Metab 2015; 100:2946-55. [PMID: 26037515 PMCID: PMC4524994 DOI: 10.1210/jc.2015-1917] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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] [Indexed: 12/25/2022]
Abstract
CONTEXT GH and IGF-I have important roles in the maintenance of substrate metabolism and body composition. However, when in excess in acromegaly, the lipolytic and insulin antagonistic effects of GH may alter adipose tissue (AT) deposition. OBJECTIVES The purpose of this study was to examine the effect of surgery for acromegaly on AT distribution and ectopic lipid deposition in liver and muscle. DESIGN This was a prospective study before and up to 2 years after pituitary surgery. SETTING The setting was an academic pituitary center. PATIENTS Participants were 23 patients with newly diagnosed, untreated acromegaly. MAIN OUTCOME MEASURES We determined visceral (VAT), subcutaneous (SAT), and intermuscular adipose tissue (IMAT), and skeletal muscle compartments by total-body magnetic resonance imaging, intrahepatic and intramyocellular lipid by proton magnetic resonance spectroscopy, and serum endocrine, metabolic, and cardiovascular risk markers. RESULTS VAT and SAT masses were lower than predicted in active acromegaly, but increased after surgery in male and female subjects along with lowering of GH, IGF-I, and insulin resistance. VAT and SAT increased to a greater extent in men than in women. Skeletal muscle mass decreased in men. IMAT was higher in active acromegaly and decreased in women after surgery. Intrahepatic lipid increased, but intramyocellular lipid did not change after surgery. CONCLUSIONS Acromegaly may present a unique type of lipodystrophy characterized by reduced storage of AT in central depots and a shift of excess lipid to IMAT. After surgery, this pattern partially reverses, but differentially in men and women. These findings have implications for understanding the role of GH in body composition and metabolic risk in acromegaly and other clinical settings of GH use.
Collapse
Affiliation(s)
- Carlos M Reyes-Vidal
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Hamed Mojahed
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Wei Shen
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Zhezhen Jin
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Fernando Arias-Mendoza
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Jean Carlos Fernandez
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Dympna Gallagher
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Jeffrey N Bruce
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Kalmon D Post
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| | - Pamela U Freda
- Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029
| |
Collapse
|
26
|
Nagesh VS, Kalra S. Type 1 diabetes: Syndromes in resource-challenged settings. J PAK MED ASSOC 2015; 65:681-685. [PMID: 26060173] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Type 1 Diabetes is a complex disorder that is made more complex by the myriad of co-morbid conditions associated with it. Mauriac Syndrome is a well-known but nowadays uncommon condition that presents with growth retardation secondary to poor glycaemic control. Limited Joint Mobility is an often-missed association of diabetes. Its importance lies in the fact that it can cause significant impairment of fine movements in T1DM children. It also indicates poor glycaemic control over a long period of time and can be used as a surrogate marker for development of diabetic microvascular complications. Anaemia in T1DM is protean and can develop due to a combination of nutritional factors, chronic renal disease, coeliac disease and worm infestation. Management is etiological. Vitamin deficiencies are ubiquitous in T1DM and if left untreated, can lead to neurological, haematological and skeletal dysfunction. The best-known co-morbid conditions are the local site reactions clubbed together under the moniker lipodystrophies. These can be either atrophic or hypertrophic and are usually due to repeated injections at the same site, improper technique and needle re-use. Management is often difficult and they are best prevented by appropriate diabetes education and emphasis on proper injection techniques at the time of T1DM diagnosis, with periodic reinforcement. Amyloidosis is a little known condition that shares a lot of features in common with the lipodystrophies and often needs to be differentiated from lipohypertrophy. T1DM is a disease which is often associated with a poor quality of life and these co-morbid conditions also need to be treated for effective general and psychological well-being.
Collapse
Affiliation(s)
- V Sri Nagesh
- Department of Endocrinology, CARE Hospital, Hyderabad, India
| | - Sanjay Kalra
- Department of Endocrinology, BRIDE Hospital, Karnal, India
| |
Collapse
|
27
|
Mancini T, Secchiaroli G. Threats to identity: lipodystrophy and identity changes in people with HIV/AIDS (PWA). Acta Biomed 2015; 86 Suppl 1:29-39. [PMID: 25835763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM PWA today have to face new problems associated with their disease state. One of these is tied to bodily changes that are related to HAART (lipodystrophy syndrome, LDS). Applying the Identity Process Theory (Breakwell, 1986), this research aimed to study the impact that LDS body changes may have on the identity of PWA. METHOD One hundred and eight patients (79 M and 29 F, ranging from 35 to 75 years old) at a North Italian clinic completed a questionnaire composed of scales measuring the perception of threats to the identity of PWA, physicians' and patients' assessment of LDS, time from diagnosis, disclosure and perceived social support. RESULTS Results showed that lipodystrophy changes represent a new aspect of the disease that PWA need to handle in terms of identity: the changes resulted in 'loss of the self' and constituted a particular threat to the dimension of personal identity whereby bodily changes called more into question the principles of self-esteem and distinctness. LDS, however, lead to a multiple identity threat that is aggravated by patients' perception of the severity of their bodily changes and by the perception of a lack of friendship and social support. CONCLUSIONS The study highlights how complex, cyclical and dynamic are the effects that HIV status can have on the sick person: they are no longer only clinical, but also psychological and psychosocial.
Collapse
Affiliation(s)
- Tiziana Mancini
- Department of Arts and Literature, History and Social Studies, Parma University, Italy.
| | | |
Collapse
|
28
|
Affiliation(s)
- Kagan Gungor
- Endocrinology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ozge Telci Caklili
- Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Aytekin Oguz
- Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
29
|
Abstract
INTRODUCTION Lipodystrophy is a frequent and disfiguring adverse effect of antiretroviral therapy (ART) in patients with HIV. It affects the quality of life of the patient and adherence to treatment, and generates new needs for comprehensive healthcare services. The aim of this study will be to conduct a systematic review of the literature from observational studies and describe lipodystrophy among patients with HIV infection during current or previous use of ART. METHODS AND ANALYSIS A systematic review of observational studies published in MEDLINE, CINAHL, LILACS, EMBASE and International Pharmaceutical Abstracts will be carried out. Citations of included studies will be checked to identify additional studies not identified in the electronic searches. It will include any observational study that considered lipodystrophy as the primary or secondary outcome and that had enrolled adolescent and adult patients with HIV infection who were on current or previous ART for at least 6 months. Data extraction and analysis will be performed independently by two reviewers. The extracted data will be discussed, decisions documented and, where necessary, the authors of the studies will be contacted for clarification. Measures of frequency, prevalence and incidence of lipodystrophy will be stratified according to definition, method of diagnosis and risk factors of the outcome. ETHICS AND DISSEMINATION Ethics is not required given this is a protocol for a systematic review. The findings of this study will be widely disseminated through peer-reviewed publications and conference presentations. Updates of the review will be conducted to inform and guide healthcare practice. PROTOCOL REGISTRATION PROSPERO-42013005450.
Collapse
Affiliation(s)
- Lorena Gomes Cunha Lana
- Departamento de Farmácia Social, Faculdade de Farmácia, Centro de Estudos do Medicamento (Cemed), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Daniela Rezende Garcia Junqueira
- Departamento de Farmácia Social, Faculdade de Farmácia, Centro de Estudos do Medicamento (Cemed), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade de Sorocaba-Uniso, Sorocaba, São Paulo, Brazil
| | - Edson Perini
- Departamento de Farmácia Social, Faculdade de Farmácia, Centro de Estudos do Medicamento (Cemed), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Cristiane Menezes de Pádua
- Departamento de Farmácia Social, Faculdade de Farmácia, Centro de Estudos do Medicamento (Cemed), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
30
|
Chen XY, Li GM. [Coexistence of growth hormone deficiency and lipodystrophia centrifugalis abdominalis infantilis in a child]. Zhongguo Dang Dai Er Ke Za Zhi 2014; 16:92-93. [PMID: 24461189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Xiao-Yun Chen
- Department of Internal Medicine,Tai'an Central Hospital, Tai'an, Shandong 271000, China
| | | |
Collapse
|
31
|
Senniappan S, Hughes M, Shah P, Shah V, Kaski JP, Brogan P, Hussain K. Pigmentary hypertrichosis and non-autoimmune insulin-dependent diabetes mellitus (PHID) syndrome is associated with severe chronic inflammation and cardiomyopathy, and represents a new monogenic autoinflammatory syndrome. J Pediatr Endocrinol Metab 2013; 26:877-82. [PMID: 23729543 DOI: 10.1515/jpem-2013-0062] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/22/2013] [Indexed: 11/15/2022]
Abstract
Mutations in SLC29A3 lead to pigmentary hypertrichosis and non-autoimmune insulin-dependent diabetes mellitus (PHID) and H syndromes, familial Rosai-Dorfman disease, and histiocytosis-lymphadenopathy plus syndrome. We report a new association of PHID syndrome with severe systemic inflammation, scleroderma-like changes, and cardiomyopathy. A 12-year-old girl with PHID syndrome presented with shortness of breath, hepatosplenomegaly, and raised erythrocyte sedimentation rate and C-reactive protein. An echocardiogram showed biventricular myocardial hypertrophy, and cardiac magnetic resonance imaging showed circumferential late gadolinium enhancement of the myocardium. No systemic amyloid deposits were observed on a whole-body serum amyloid P scintigraphy scan. Abdominal ultrasound revealed intra-abdominal fat surrounding the solid organs, suggesting a possibility of evolving lipodystrophy with visceral adiposity. PHID syndrome is a novel monogenic autoinflammatory syndrome (AIS) associated with severe elevation of serum amyloid. Lipodystrophy, cutaneous sclerodermatous changes, and cardiomyopathy were also present in this case. In contrast to other AIS, blockade of interleukin-1 and tumor necrosis-α was ineffective.
Collapse
|
32
|
Su YB, Xie J, Han Y, Qiu ZF, Li YL, Song XJ, Yu W, Li TS. [The influence of long-term nucleotide reverse transcriptase inhibitors on lipids metabolism in HIV/AIDS patients]. Zhonghua Nei Ke Za Zhi 2012; 51:859-862. [PMID: 23291022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the influence of long-term nucleotide reverse transcriptase inhibitors (NRTIs) on lipids metabolism in HIV/AIDS patients and correlating clinical factors. METHODS A total of 118 HIV/AIDS patients were divided into 3 groups: untreated group (40 patients), highly active antiretroviral therapy (HAART) for 1 - 2 years group (37 patients) and HAART over 5 years group (41 patients), with 20 healthy individuals as the control group. Clinical lipodystrophy (LD) was defined as concordance between patient's report of change and physical examination. Fat mass (FM) was measured by dual-energy X-ray absorptiometry (DXA). RESULTS There was no significant difference in the incidence of LD between HAART for 1 - 2 years group and HAART over 5 years group (51.2% vs 40.5%, P = 0.345). The prevalence of LD was 2.4 folds with stavudine (d4T) treatment compared with zidovudine (AZT)-containing regimens (61.6% vs 23.5%, P = 0.001). Based on DXA measurements, FM of total body and limbs were significantly lower in the HAART over 5 years group than that in the control group, the untreated group and the HAART for 1 - 2 years group (P < 0.05). Trunk FM was significantly lower in the HAART over 5 years group than the untreated group and the HAART for 1 - 2 years group (P < 0.05). FM of total body and trunk were significantly lower in patients without LD in the HAART over 5 years group than patients without LD in the HAART for 1 - 2 years group (P < 0.05). FM was correlated positively with body weight and BMI. Limbs FM was correlated negatively with peripheral blood triglyceride concentration. CONCLUSIONS HIV/AIDS patients with NRTIs therapy have high prevalence of LD, which mainly occurs 1 - 2 years after therapy, and increases with d4T treatment compared with AZT-containing regimens. There was no significant difference in the incidence of LD between the HAART for 1 - 2 years group and the HAART over 5 years group. FM was significantly decreased after long-term HAART in the patients with or without LD. DXA can evaluate LD objectively and guide further clinical treatment.
Collapse
Affiliation(s)
- Yuan-bo Su
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Berry J. The mirror has two faces: a personal account of using facial filler for lipoatrophy. Posit Aware 2012; 24:41-43. [PMID: 23088016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
34
|
Hawilo A, Mebazaa A, Trojjet S, Zribi H, Cheikh Rouhou R, Zaraa I, Azzouz H, El Euch D, Ben Osman A, Zitouna M, Mokni M. [Acquired unilateral facial lipoatrophy: presentation suggestive of lupus panniculitis]. Tunis Med 2012; 90:499-501. [PMID: 22693101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
35
|
Wiwanitkit V. Polymorphisms in candidate genes and lipodystrophy and dyslipidemia. AIDS Res Hum Retroviruses 2012; 28:531. [PMID: 22176158 DOI: 10.1089/aid.2011.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
36
|
Kanazawa N. Nakajo-Nishimura syndrome: an autoinflammatory disorder showing pernio-like rashes and progressive partial lipodystrophy. Allergol Int 2012; 61:197-206. [PMID: 22441638 DOI: 10.2332/allergolint.11-rai-0416] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Indexed: 12/28/2022] Open
Abstract
Nakajo-Nishimura syndrome (ORPHA2615; also registered as Nakajo syndrome in OMIM#256040) is a distinct inherited inflammatory and wasting disease, originally reported from Japan. This disease usually begins in early infancy with a pernio-like rash, especially in winter. The patients develop periodic high fever and nodular erythema-like eruptions, and gradually progress lipomuscular atrophy in the upper body, mainly the face and the upper extremities, to show the characteristic thin facial appearance and long clubbed fingers with joint contractures. So far about 30 cases have been reported from Kansai, especially Wakayama and Osaka, Tohoku and Kanto areas. At present, about 10 cases are confirmed to be alive only in the Kansai area, including one infant case in Wakayama. However, more cases are expected to be added in the near future. Although cause of the disease has long been undefined, a homozygous mutation of the PSMB8 gene, which encodes the β5i subunit of immunoproteasome, has been identified to be responsible in 2011. By analyses of the patients-derived cells and tissues, it has been suggested that accumulation of ubiquitinated and oxidated proteins due to immunoproteasome dysfunction causes hyperactivation of p38 mitogen-activated protein kinase and interleukin-6 overproduction. Since similar diseases with PSMB8 mutations have recently been reported from Europe and the United States, it is becoming clear that Nakajo-Nishimura syndrome and related disorders form proteasome disability syndromes, a new category of autoinflammatory diseases distributed globally.
Collapse
Affiliation(s)
- Nobuo Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan. nkanazaw@wakayama−med.ac.jp
| |
Collapse
|
37
|
Rubio Fernández D, Rodríguez Del Canto C, Marcos Galán V, Falcón N, Edreira H, Sevane Fernández L, Francoli Martínez P, Sánchez-De la Rosa R. Contribution of endermology to improving indurations and panniculitis/lipoatrophy at glatiramer acetate injection site. Adv Ther 2012; 29:267-75. [PMID: 22382874 DOI: 10.1007/s12325-012-0005-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Endermology is a mechanical massage therapy that enables fat mobilization and body contouring. The authors' aim was to assess the effect of endermology on indurations and panniculitis/lipoatrophy associated with subcutaneous administration of glatiramer acetate in patients with multiple sclerosis (MS). METHODS This was a multicenter pilot experience carried out in patients with MS treated with glatiramer acetate who showed indurations and/ or panniculitis/lipoatrophy at the injection site. Patients underwent endermology and glatiramer acetate treatment according to clinical practice. The primary endpoint was the change in indurations and/or panniculitis/lipoatrophy after 12 endermology sessions. RESULTS Between April and July 2011, a total of 13 evaluable patients were included (mean age, 40.7±3.1 years; female, 100%; white, 100%; mean MS duration, 10.1±2.3 years; previous MS treatment, 46.2%; mean glatiramer acetate treatment duration, 27.3±9.5 months). Eleven patients (84.6%) showed local indurations (mean diameter, 3.4±0.5 cm; mean number, 9.0±1.0) and six patients (46.2%) areas of panniculitis/ lipoatrophy (mean number, 5.0±1.1). After 12 endermology sessions, patients with indurations reported having experienced a reduction in size (10 patients [90.9%]; mean diameter, 0.1±0.05 cm; P<0.001) and number of indurations (nine patients [81.8%]; mean number, 2.3±1.1; P<0.005). These indurations completely disappeared from arms, thighs, buttocks, and abdomen in six (75.0%), six (75.0%), two (50.0%), and three (42.9%) patients, respectively. Three of these patients (27.3%) recovered from all indurations. Although panniculitis/lipoatrophy did not completely disappear, all patients reported improvements. Most patients with indurations (63.6%) felt very satisfied and considered endermology very useful for reducing indurations. All patients with panniculitis/lipoatrophy were satisfied and considered to be endermology useful in improving it. In addition, endermology enabled glatiramer acetate tolerance to be improved in most patients (60.0%). CONCLUSION Endermology may contribute to improving indurations and panniculitis/ lipoatrophy at the site of subcutaneous injection of glatiramer acetate in patients with MS, enabling areas of injection to recover, and treatment tolerance to increase.
Collapse
|
38
|
Abstract
OBJECTIVE Vitamin D deficiency (VDD) is prevalent in HIV, and following antiretroviral therapy (ART), increased rates of lipoatrophy and metabolic abnormalities are described. We investigated the relationships between 25-hydroxyvitamin D [25(OH)D] and other metabolic parameters in a group of HIV patients with and without lipoatrophy to examine whether lipoatrophy could explain the high prevalence of VDD and metabolic abnormalities. BACKGROUND Vitamin D receptors are expressed in adipose tissue implicating vitamin D, through paracrine/autocrine mechanism, in exerting effects on fat metabolism. HIV patients frequently suffer from VDD, and those treated with thymidine analogues frequently suffer from lipoatrophy so we investigated whether lipoatrophy could explain these associations. DESIGN AND PATIENTS Cross-sectional study of HIV-infected male patients (n = 107; 39 with lipoatrophy) from the West Australian cohort with measurements of 25(OH)D, adiponectin, insulin, lipids and leg fat as a percentage of mass. RESULTS Reduced 25(OH)D levels were common and significantly associated with higher serum insulin in the entire cohort (P = 0·006), but there was no difference in 25(OH)D between untreated and antiretroviral-treated patients with or without lipoatrophy. Treated patients with lipoatrophy were more likely to take thymidine analogue therapy, were older and on therapy longer than treated patients without lipoatrophy. Adiponectin levels did not correlate with 25(OH)D, but lipoatrophic-treated patients had lower levels of adiponectin compared with nonlipoatrophic-treated patients. CONCLUSIONS Lower 25(OH)D is associated with higher serum insulin but not lipoatrophy or hypoadiponectinemia in HIV-infected patients. The association between VDD and insulin resistance is likely to be mediated by independent mechanisms.
Collapse
Affiliation(s)
- E Hammond
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia
| | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Stiefelhagen P. [Recurrent hypoglycemia in a patient with type 1 diabetes. A look at the belly solves the puzzle]. MMW Fortschr Med 2011; 153:20. [PMID: 22111165 DOI: 10.1007/bf03369016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
41
|
Kosmiski LA, Sage-El A, Kealey EH, Bessesen DH. Brown fat activity is not apparent in subjects with HIV lipodystrophy and increased resting energy expenditure. Obesity (Silver Spring) 2011; 19:2096-8. [PMID: 21779087 DOI: 10.1038/oby.2011.231] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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] [Indexed: 11/09/2022]
Abstract
The HIV lipodystrophy (LD) syndrome is associated with increased resting energy expenditure (REE), but the basis of this hypermetabolism has not been determined. The objective of this pilot study was to determine if brown fat is activated in subjects with HIV LD and increased REE. In this descriptive study of four subjects with HIV LD and marked hypermetabolism, REE was measured by indirect calorimetry and brown fat activity was determined by (18)F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) combined with anatomic computed tomography (CT). Brown fat activity was not apparent in any subject with HIV LD and resting hypermetabolism. Therefore, brown fat activation is unlikely to be the principal cause of the increased REE associated with the HIV LD syndrome. Evidence of adaptive thermogenesis has been demonstrated in this syndrome, but this study suggests that tissues other than brown adipose tissue (BAT) are responsible. Further understanding of the chronic hypermetabolism associated with HIV LD could provide new insights into the regulation of energy balance.
Collapse
Affiliation(s)
- Lisa A Kosmiski
- Division of Endocrinology, Diabetes and Metabolism, School of Medicine, University of Colorado, Aurora, Colorado, USA.
| | | | | | | |
Collapse
|
42
|
Chatterjee R, Bhattacharya P, Gavrilova O, Glass K, Moitra J, Myakishev M, Pack S, Jou W, Feigenbaum L, Eckhaus M, Vinson C. Suppression of the C/EBP family of transcription factors in adipose tissue causes lipodystrophy. J Mol Endocrinol 2011; 46:175-92. [PMID: 21321096 PMCID: PMC3159190 DOI: 10.1530/jme-10-0172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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] [Indexed: 12/15/2022]
Abstract
Adipose-specific inactivation of both AP-1 and CCAAT-enhancer-binding protein (C/EBP) families of B-ZIP transcription factors in transgenic mice causes severe lipoatrophy. To evaluate whether inactivation of only C/EBP members was critical for lipoatrophy, A-C/EBP, a dominant-negative protein that specifically inhibits the DNA binding of the C/EBP members, was expressed in adipose tissue. For the first 2 weeks after birth, aP2-A-C/EBP mice had no white adipose tissue (WAT), drastically reduced brown adipose tissue (BAT), and exhibited marked hepatic steatosis, hyperinsulinemia, and hyperlipidemia. However, WAT appeared during the third week, coinciding with significantly improved metabolic functioning. In adults, BAT remained reduced, causing cold intolerance. At 30 weeks, the aP2-A-C/EBP mice had only 35% reduced WAT, with clear morphological signs of lipodystrophy in subcutaneous fat. Circulating leptin and adiponectin levels were less than the wild-type levels, and these mice exhibited impaired triglyceride clearance. Insulin resistance, glucose intolerance, and reduced free fatty acid release in response to β3-adrenergic agonist suggest improper functioning of the residual WAT. Gene expression analysis of inguinal WAT identified reduced mRNA levels of several enzymes involved in fatty acid synthesis and glucose metabolism that are known C/EBPα transcriptional targets. There were increased levels for genes involved in inflammation and muscle differentiation. However, when dermal fibroblasts from aP2-A-C/EBP mice were differentiated into adipocytes in tissue culture, muscle markers were elevated more than the inflammatory markers. These results demonstrate that the C/EBP family is essential for adipose tissue development during the early postnatal period, the regulation of glucose and lipid homeostasis in adults, and the suppression of the muscle lineage.
Collapse
Affiliation(s)
- Raghunath Chatterjee
- Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, University of Maryland, College Park, Maryland
| | - Paramita Bhattacharya
- Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, University of Maryland, College Park, Maryland
| | - Oksana Gavrilova
- Mouse Metabolism Laboratory, NIDDK, NIH, University of Maryland, College Park, Maryland
| | - Kimberly Glass
- Physics Department, University of Maryland, College Park, Maryland
| | - Jaideep Moitra
- Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, University of Maryland, College Park, Maryland
| | - Max Myakishev
- Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, University of Maryland, College Park, Maryland
| | - Stephanie Pack
- Mouse Metabolism Laboratory, NIDDK, NIH, University of Maryland, College Park, Maryland
| | - William Jou
- Mouse Metabolism Laboratory, NIDDK, NIH, University of Maryland, College Park, Maryland
| | - Lionel Feigenbaum
- SAIC Frederick, NCI-Frederick Cancer Research and Development Center, Frederick, Maryland
| | - Michael Eckhaus
- Veterinary Resources Program, Office of Research Services, NIH, Bethesda, Maryland
| | - Charles Vinson
- Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, University of Maryland, College Park, Maryland
- Corresponding author: Building 37, Room 3128, LM, NCI, NIH, Bethesda, Maryland 20892, tel: (301) 496-8753, fax: (301) 496-8419,
| |
Collapse
|
43
|
Dimock D, Thomas V, Cushing A, Purdy JB, Worrell C, Kopp JB, Hazra R, Hadigan C. Longitudinal assessment of metabolic abnormalities in adolescents and young adults with HIV-infection acquired perinatally or in early childhood. Metabolism 2011; 60:874-80. [PMID: 20947103 PMCID: PMC3021796 DOI: 10.1016/j.metabol.2010.08.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [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: 06/30/2010] [Revised: 08/19/2010] [Accepted: 08/19/2010] [Indexed: 12/14/2022]
Abstract
Metabolic complications of HIV pose challenges for health maintenance among young adults who acquired HIV in early childhood. Between July 2004 and July 2009, we evaluated 47 HIV-infected subjects who acquired HIV in early life. Participants completed glucose tolerance testing; insulin, lipid, urine albumin, and creatinine determinations; and dual-energy x-ray absorptiometry scans. Longitudinal data were available for 39 subjects; duration of follow-up was 26.4 ± 16.8 months. At baseline, participants were 17.1 ± 3.9 years old; and duration of antiretroviral therapy was 12.7 ± 3.4 years. CD4 count was 658 ± 374 cells per cubic millimeter, and 55% had undetectable viral load. Impaired glucose tolerance was present in 15%; 33% had insulin resistance (homeostasis model assessment of insulin resistance >4.0). Furthermore, 52% had triglycerides of at least 150 mg/dL, 36% had high-density lipoprotein cholesterol less than 40 mg/dL, 18% had low-density lipoprotein cholesterol of at least 130 mg/dL, and 25% had total cholesterol of at least 200 mg/dL. Microalbuminuria was present in 15% of participants and was inversely correlated with CD4% (P = .001). During follow-up, more than one third remained insulin resistant; lipid parameters tended to improve. There were significant increases in body mass index (P = .0002), percentage leg fat (P = .008), and percentage trunk fat (P = .002). Impaired glucose tolerance, insulin resistance, dyslipidemia, and microalbuminuria are common among young adults with HIV. Long-term exposure to therapy may translate into substantial persistent metabolic risk.
Collapse
Affiliation(s)
- David Dimock
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Vijaya Thomas
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Anna Cushing
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Julia B. Purdy
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
- HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Carol Worrell
- Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Jeffrey B. Kopp
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Rohan Hazra
- HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
- Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Colleen Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| |
Collapse
|
44
|
Abstract
Laminopathies are genetic diseases due to mutations or altered post-translational processing of nuclear envelope/lamina proteins. The majority of laminopathies are caused by mutations in the LMNA gene, encoding lamin A/C, but manifest as diverse pathologies including muscular dystrophy, lipodystrophy, neuropathy, and progeroid syndromes. Lamin-binding proteins implicated in laminopathies include lamin B2, nuclear envelope proteins such as emerin, MAN1, LBR, and nesprins, the nuclear matrix protein matrin 3, the lamina-associated polypeptide, LAP2alpha and the transcriptional regulator FHL1. Thus, the altered functionality of a nuclear proteins network appears to be involved in the onset of laminopathic diseases. The functional interplay among different proteins involved in this network implies signaling partners. The signaling effectors may either modify nuclear envelope proteins and their binding properties, or use nuclear envelope/lamina proteins as platforms to regulate signal transduction. In this review, both aspects of lamin-linked signaling are presented and the major pathways so far implicated in laminopathies are summarized.
Collapse
Affiliation(s)
- Nadir M Maraldi
- Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopedic Institute, Bologna, Italy.
| | | | | | | | | |
Collapse
|
45
|
Peteiro-González D, Fernández-Rodríguez B, Cabezas-Agrícola JM, Araújo-Vilar D. Severe localized lipoatrophy related to therapy with insulin analogs in type 1a diabetes mellitus. Diabetes Res Clin Pract 2011; 91:e61-3. [PMID: 21146887 DOI: 10.1016/j.diabres.2010.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/30/2010] [Accepted: 11/18/2010] [Indexed: 11/20/2022]
Abstract
Insulin analog-related lipoatrophy is a rare complication of this type of treatment. We report a case of severe localized lipoatrophy in different locations in a patient with type 1a diabetes mellitus associated with other autoimmune disease.
Collapse
Affiliation(s)
- Diego Peteiro-González
- Servicio de Endocrinoloxía e Nutrición, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | | | | | | |
Collapse
|
46
|
Kurugöl Z, Ulger Z, Berk O, Tuğral O. Acquired partial lipodystrophy associated with varicella. Turk J Pediatr 2009; 51:617-620. [PMID: 20196400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Acquired partial lipodystrophy (Barraquer-Simons syndrome) is a rare condition with onset in childhood, and it is characterized by progressive loss of subcutaneous fat in a cephalocaudal fashion. Although it is known that acquired partial lipodystrophy usually follows acute febrile illness, it is very rarely reported to occur in association with varicella. In this case report, we present a seven-year-old girl with progressive loss of fat in her face just after varicella who was diagnosed as acquired partial lipodystrophy.
Collapse
Affiliation(s)
- Zafer Kurugöl
- Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey
| | | | | | | |
Collapse
|
47
|
Haddad Filho D, Kafejian-Haddad AP, Alonso N, Perez MDCJ, Castiglione M, Fukutaki MF, Anger M. Lymphoscintigraphic appraisal of the lower limbs after liposuction. Aesthet Surg J 2009; 29:396-9. [PMID: 19825468 DOI: 10.1016/j.asj.2009.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 03/24/2009] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The trauma resulting from liposuction damages the subcutaneous cellular tissue and subsequently the lymphatic structures. In turn, this damage can reduce lymphatic drainage, which may or may not appear clinically as some degree of edema. OBJECTIVE It is possible to evaluate the function of the lymphatic system using lymphoscintigraphy. We conducted a study to evaluate the lymphatic system using this technique both before and after liposuction of the lower limbs. METHODS The study included seven women ranging from 18 to 42 years of age, all of whom were diagnosed with lipodystrophy solely in the lateral and medial regions of the upper third of the thighs. This study was conducted in three stages: preoperative lymphoscintigraphy, liposuction, and postoperative lymphoscintigraphy three months postoperatively. The Wilcoxon signed-rank test was used for the statistical analysis of the results. RESULTS A comparison of values for the average time of the radiopharmaceutical acquisition curve and clearance in the areas of lymphoscintigraphic interest both before and three months after liposuction did not reveal significant results. CONCLUSIONS A comparison of preoperative and postoperative lymphoscintigraphic findings showed no significant damage to the lymphatic system associated with liposuction of the lower limbs.
Collapse
Affiliation(s)
- Douglas Haddad Filho
- Department of Plastic Surgery, Universidade Santo Amaro Medical School, São Paulo 040114-010, Brazil.
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
The development of new drugs to counter human immunodeficiency virus (HIV) infection has led to an increase in lipodystrophic syndrome among HIV-infected individuals receiving combination therapy. Bio-Alcamid(TM) is a recently developed polymeric substance that can be implanted to compensate for adipose effects. We have implanted this substance in 73 patients with up to three years' follow-up. The aesthetic results were deemed excellent by both physicians and patients. No implant dislocation, implant migration, granuloma, allergic reaction or intolerance were recorded.
Collapse
|
49
|
Abstract
The main function of the nuclear lamina, an intermediate filament meshwork lying primarily beneath the inner nuclear membrane, is to provide structural scaffolding for the cell nucleus. However, the lamina also serves other functions, such as having a role in chromatin organization, connecting the nucleus to the cytoplasm, gene transcription, and mitosis. In somatic cells, the main protein constituents of the nuclear lamina are lamins A, C, B1, and B2. Interest in the nuclear lamins increased dramatically in recent years with the realization that mutations in LMNA, the gene encoding lamins A and C, cause a panoply of human diseases ("laminopathies"), including muscular dystrophy, cardiomyopathy, partial lipodystrophy, and progeroid syndromes. Here, we review the laminopathies and the long strange trip from basic cell biology to therapeutic approaches for these diseases.
Collapse
Affiliation(s)
- Howard J. Worman
- Department of Medicine and
Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Department of Medicine and
Department of Human Genetics, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Loren G. Fong
- Department of Medicine and
Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Department of Medicine and
Department of Human Genetics, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Antoine Muchir
- Department of Medicine and
Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Department of Medicine and
Department of Human Genetics, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Stephen G. Young
- Department of Medicine and
Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Department of Medicine and
Department of Human Genetics, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| |
Collapse
|
50
|
Tao MM, Zhang L, Qiu ZF, Xie J, Han Y, Yu W, Li M, Li TS. [Adipokines and highly active antiretroviral therapy related lipodystrophy: clinical study of 52 cases]. Zhonghua Yi Xue Za Zhi 2009; 89:867-871. [PMID: 19671283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the prevalence of glucose and lipid abnormalities in AIDS patients treated with highly active antiretroviral therapy (HAART) and difference thereof between the HIV-lipodystrophy (LD) and non-HIV-LD groups, and to compare the plasma levels of adiponectin (APN) and leptin (LEP) and their relationship to metabolic disturbance and fat redistribution in these 2 groups. METHODS Fifty-two HIV-infected patients were divided into HIV-LD group and non-HIV-LD group according to the patients' reports and doctors' evaluation. Body composition was assessed by whole body dual-energy X-ray absorptiometry. Plasma samples were analyzed for cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), insulin, APN, and LEP. The prevalence of dyslipidemia and hyperinsulinemia, the difference of adipocytokine levels, and the relationship of adiponectin, leptin with lipids, insulin as well as fat mass in different body regions were analyzed between the groups. RESULTS The prevalence rates of hypercholesterolaemia, hypertriglyceridaemia, and low HDL-C level were 17.3%, 50.0%, and 17.3% respectively. The rate of hyperinsulinemia and any kind of dyslipidemia were 25.0% and 59.6%. Compared with non-HIV-LD patients, HIV-LD patients had higher TG level, and lower HDL-C and APN levels. In the HIV-LD group, the APN level was correlated positively with limb/total body fat, but negatively with trunk/total body fat, and was an independent predictor of HDL-C and insulin level. However, LEP was positively correlated with the levels of total body fat, limb fat, and trunk fat in both groups. CONCLUSION The prevalence rates of dyslipidemia and insulin resistance are high in Chinese HIV/AIDS patients receiving HAART, especially in the HIV-LD group. The APN concentration in the HIV-LD patients is closely related to fat redistribution and independently predicts the levels of HDL-C and insulin. LEP can serve as a biomarker of total body fat mass.
Collapse
Affiliation(s)
- Mei-mei Tao
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | | | | | | | | | | | | | | |
Collapse
|