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Bahrami-Nejad Z, Zhang ZB, Tholen S, Sharma S, Rabiee A, Zhao ML, Kraemer FB, Teruel MN. Early enforcement of cell identity by a functional component of the terminally differentiated state. PLoS Biol 2022; 20:e3001900. [PMID: 36469503 PMCID: PMC9721491 DOI: 10.1371/journal.pbio.3001900] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
How progenitor cells can attain a distinct differentiated cell identity is a challenging problem given the fluctuating signaling environment in which cells exist and that critical transcription factors are often not unique to a differentiation process. Here, we test the hypothesis that a unique differentiated cell identity can result from a core component of the differentiated state doubling up as a signaling protein that also drives differentiation. Using live single-cell imaging in the adipocyte differentiation system, we show that progenitor fat cells (preadipocytes) can only commit to terminally differentiate after up-regulating FABP4, a lipid buffer that is highly enriched in mature adipocytes. Upon induction of adipogenesis in mouse preadipocyte cells, we show that after a long delay, cells first abruptly start to engage a positive feedback between CEBPA and PPARG before then engaging, after a second delay, a positive feedback between FABP4 and PPARG. These sequential positive feedbacks both need to engage in order to drive PPARG levels past the threshold for irreversible differentiation. In the last step before commitment, PPARG transcriptionally increases FABP4 expression while fatty acid-loaded FABP4 increases PPARG activity. Together, our study suggests a control principle for robust cell identity whereby a core component of the differentiated state also promotes differentiation from its own progenitor state.
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Affiliation(s)
- Zahra Bahrami-Nejad
- Department of Chemical and Systems Biology, Stanford University, Stanford, California, United States of America
| | - Zhi-Bo Zhang
- Department of Chemical and Systems Biology, Stanford University, Stanford, California, United States of America
- Department of Biochemistry and the Drukier Institute for Children’s Health, Weill Cornell Medical College of Cornell University, New York, New York, United States of America
| | - Stefan Tholen
- Department of Chemical and Systems Biology, Stanford University, Stanford, California, United States of America
| | - Sanjeev Sharma
- Department of Biochemistry and the Drukier Institute for Children’s Health, Weill Cornell Medical College of Cornell University, New York, New York, United States of America
| | - Atefeh Rabiee
- Department of Chemical and Systems Biology, Stanford University, Stanford, California, United States of America
- Department of Physiology and Pharmacology, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, California, United States of America
| | - Michael L. Zhao
- Department of Chemical and Systems Biology, Stanford University, Stanford, California, United States of America
| | - Fredric B. Kraemer
- Department of Medicine/Division of Endocrinology, Stanford University, Stanford, California, United States of America
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Mary N. Teruel
- Department of Chemical and Systems Biology, Stanford University, Stanford, California, United States of America
- Department of Biochemistry and the Drukier Institute for Children’s Health, Weill Cornell Medical College of Cornell University, New York, New York, United States of America
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, United States of America
- Weill Center for Metabolic Health, Division of Endocrinology, Diabetes & Metabolism, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, United States of America
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Gardner CD, Landry MJ, Perelman D, Petlura C, Durand LR, Aronica L, Crimarco A, Cunanan KM, Chang A, Dant CC, Robinson JL, Kim SH. Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin in individuals with prediabetes and type 2 diabetes mellitus: The interventional Keto-Med randomized crossover trial. Am J Clin Nutr 2022; 116:640-652. [PMID: 35641199 PMCID: PMC9437985 DOI: 10.1093/ajcn/nqac154] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/09/2022] [Accepted: 05/25/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Consensus has not been reached on what constitutes an optimal diet in individuals with prediabetes and type 2 diabetes mellitus (T2DM), especially between low-carbohydrate options. OBJECTIVES We compared 2 low-carbohydrate diets with 3 key similarities (incorporating nonstarchy vegetables and avoiding added sugars and refined grains) and 3 key differences (incorporating compared with avoiding legumes, fruits, and whole, intact grains) for their effects on glucose control and cardiometabolic risk factors in individuals with prediabetes and T2DM. METHODS Keto-Med was a randomized, crossover, interventional trial. Forty participants aged ≥18 years with prediabetes or T2DM followed the well-formulated ketogenic diet (WFKD) and the Mediterranean-plus diet (Med-Plus) for 12 weeks each, in random order. The diets shared the 3 key similarities noted above. The Med-Plus incorporated legumes, fruits, and whole, intact grains, while the WFKD avoided them. The primary outcome was the percentage change in glycated hemoglobin (HbA1c) after 12 weeks on each diet. Secondary and exploratory outcomes included percentage changes in body weight, fasting insulin, glucose, and blood lipids; average glucose from continuous glucose monitor (CGM), and nutrient intake. RESULTS The primary analysis was of 33 participants with complete data. The HbA1c values did not differ between diets at 12 weeks. Triglycerides decreased more for the WFKD [percentage changes, -16% (SEM, 4%) compared with -5% (SEM, 6%) for the Med-Plus; P = 0.02] and LDL cholesterol was higher for the WFKD [percentage changes, +10% (SEM, 4%) compared with -5% (SEM, 5%) for the Med-Plus; P = 0.01]. Weight decreased 8% (SEM, 1%) compared with 7% (SEM, 1%) and HDL cholesterol increased 11% (SEM, 2%) compared with 7% (SEM, 3%) for the WFKD compared with the Med-Plus, respectively; however, there was a significant interaction of diet × order for both. Participants had lower intakes of fiber and 3 nutrients on the WFKD compared with the Med-Plus. Twelve-week follow-up data suggest the Med-Plus is more sustainable. CONCLUSIONS HbA1c values were not different between diet phases after 12 weeks, but improved from baseline on both diets, likely due to several shared dietary aspects. The WFKD led to a greater decrease in triglycerides, but also had potential untoward risks from elevated LDL cholesterol and lower nutrient intakes from avoiding legumes, fruits, and whole, intact grains, as well as being less sustainable. This trial was registered at clinicaltrials.gov as NCT03810378.
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Affiliation(s)
- Christopher D Gardner
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Matthew J Landry
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Dalia Perelman
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Christina Petlura
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lindsay R Durand
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lucia Aronica
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Anthony Crimarco
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Kristen M Cunanan
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Annie Chang
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Christopher C Dant
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jennifer L Robinson
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Sun H Kim
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
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Li J, Zaslavsky M, Su Y, Guo J, Sikora MJ, van Unen V, Christophersen A, Chiou SH, Chen L, Li J, Ji X, Wilhelmy J, McSween AM, Palanski BA, Mallajosyula VVA, Bracey NA, Dhondalay GKR, Bhamidipati K, Pai J, Kipp LB, Dunn JE, Hauser SL, Oksenberg JR, Satpathy AT, Robinson WH, Dekker CL, Steinmetz LM, Khosla C, Utz PJ, Sollid LM, Chien YH, Heath JR, Fernandez-Becker NQ, Nadeau KC, Saligrama N, Davis MM. KIR +CD8 + T cells suppress pathogenic T cells and are active in autoimmune diseases and COVID-19. Science 2022; 376:eabi9591. [PMID: 35258337 PMCID: PMC8995031 DOI: 10.1126/science.abi9591] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/12/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
In this work, we find that CD8+ T cells expressing inhibitory killer cell immunoglobulin-like receptors (KIRs) are the human equivalent of Ly49+CD8+ regulatory T cells in mice and are increased in the blood and inflamed tissues of patients with a variety of autoimmune diseases. Moreover, these CD8+ T cells efficiently eliminated pathogenic gliadin-specific CD4+ T cells from the leukocytes of celiac disease patients in vitro. We also find elevated levels of KIR+CD8+ T cells, but not CD4+ regulatory T cells, in COVID-19 patients, correlating with disease severity and vasculitis. Selective ablation of Ly49+CD8+ T cells in virus-infected mice led to autoimmunity after infection. Our results indicate that in both species, these regulatory CD8+ T cells act specifically to suppress pathogenic T cells in autoimmune and infectious diseases.
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Affiliation(s)
- Jing Li
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Maxim Zaslavsky
- Program in Computer Science, Stanford University, Stanford, CA, USA
| | - Yapeng Su
- Institute for Systems Biology, Seattle, WA, USA
| | - Jing Guo
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael J. Sikora
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vincent van Unen
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Asbjørn Christophersen
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, University of Oslo, Oslo, Norway
| | - Shin-Heng Chiou
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Liang Chen
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Jiefu Li
- The Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Xuhuai Ji
- Human Immune Monitoring Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie Wilhelmy
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Alana M. McSween
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Nathan A. Bracey
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Gopal Krishna R. Dhondalay
- Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Kartik Bhamidipati
- Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Joy Pai
- Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lucas B. Kipp
- Division of Neuroimmunology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey E. Dunn
- Division of Neuroimmunology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen L. Hauser
- Department of Neurology and UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Jorge R. Oksenberg
- Department of Neurology and UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ansuman T. Satpathy
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - William H. Robinson
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Cornelia L. Dekker
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Lars M. Steinmetz
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Genome Technology Center, Stanford University, Palo Alto, CA, USA
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany
| | - Chaitan Khosla
- Department of Chemistry, Stanford University, Stanford, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
- Stanford ChEM-H, Stanford University, Stanford, CA, USA
| | - Paul J. Utz
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ludvig M. Sollid
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Yueh-Hsiu Chien
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - James R. Heath
- Institute for Systems Biology, Seattle, WA, USA
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Kari C. Nadeau
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Naresha Saligrama
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark M. Davis
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- The Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
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Prahalad P, Ding VY, Zaharieva DP, Addala A, Johari R, Scheinker D, Desai M, Hood K, Maahs DM. Teamwork, Targets, Technology, and Tight Control in Newly Diagnosed Type 1 Diabetes: the Pilot 4T Study. J Clin Endocrinol Metab 2022; 107:998-1008. [PMID: 34850024 PMCID: PMC8947228 DOI: 10.1210/clinem/dgab859] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [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: 08/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Youth with type 1 diabetes (T1D) do not meet glycated hemoglobin A1c (HbA1c) targets. OBJECTIVE This work aimed to assess HbA1c outcomes in children with new-onset T1D enrolled in the Teamwork, Targets, Technology and Tight Control (4T) Study. METHODS HbA1c levels were compared between the 4T and historical cohorts. HbA1c differences between cohorts were estimated using locally estimated scatter plot smoothing (LOESS). The change from nadir HbA1c (month 4) to 12 months post diagnosis was estimated by cohort using a piecewise mixed-effects regression model accounting for age at diagnosis, sex, ethnicity, and insurance type. We recruited 135 youth with newly diagnosed T1D at Stanford Children's Health. Starting July 2018, all youth within the first month of T1D diagnosis were offered continuous glucose monitoring (CGM) initiation and remote CGM data review was added in March 2019. The main outcomes measure was HbA1c. RESULTS HbA1c at 6, 9, and 12 months post diagnosis was lower in the 4T cohort than in the historic cohort (-0.54% to -0.52%, and -0.58%, respectively). Within the 4T cohort, HbA1c at 6, 9, and 12 months post diagnosis was lower in those patients with remote monitoring than those without (-0.14%, -0.18% to -0.14%, respectively). Multivariable regression analysis showed that the 4T cohort experienced a significantly lower increase in HbA1c between months 4 and 12 (P < .001). CONCLUSION A technology-enabled, team-based approach to intensified new-onset education involving target setting, CGM initiation, and remote data review statistically significantly decreased HbA1c in youth with T1D 12 months post diagnosis.
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Affiliation(s)
- Priya Prahalad
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California 94304, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California 94304, USA
- Correspondence: Priya Prahalad, MD, PhD, Department of Pediatrics, Division of Pediatric Endocrinology, Center for Academic Medicine, 453 Quarry Rd, Palo Alto, CA 94304, USA.
| | - Victoria Y Ding
- Department of Medicine, Division of Biomedical Informatics Research, Stanford University, Stanford, California 94304, USA
| | - Dessi P Zaharieva
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California 94304, USA
| | - Ananta Addala
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California 94304, USA
| | - Ramesh Johari
- Stanford Diabetes Research Center, Stanford University, Stanford, California 94304, USA
- Department of Management Science and Engineering, Stanford University, Stanford, California 94304, USA
| | - David Scheinker
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California 94304, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California 94304, USA
- Department of Management Science and Engineering, Stanford University, Stanford, California 94304, USA
- Clinical Excellence Research Center, Stanford University, Stanford, California 94304, USA
| | - Manisha Desai
- Department of Medicine, Division of Biomedical Informatics Research, Stanford University, Stanford, California 94304, USA
| | - Korey Hood
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California 94304, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California 94304, USA
| | - David M Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California 94304, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California 94304, USA
- Department of Health Research and Policy (Epidemiology) Stanford University, Stanford, California 94304, USA
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Chang KR, Tsao DD, Bennett C, Wang E, Floyd JF, Tay ASY, Greenwald E, Kim ES, Griffin C, Morse E, Chisholm T, Rankin AE, Baena-Lopez LA, Lantz N, Fox E, Kockel L, Kim SK, Park S. Transgenic Drosophila lines for LexA-dependent gene and growth regulation. G3 (Bethesda) 2022; 12:jkac018. [PMID: 35100369 PMCID: PMC8895989 DOI: 10.1093/g3journal/jkac018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/05/2022] [Indexed: 11/12/2022]
Abstract
Conditional expression of short hairpin RNAs with binary genetic systems is an indispensable tool for studying gene function. Addressing mechanisms underlying cell-cell communication in vivo benefits from simultaneous use of 2 independent gene expression systems. To complement the abundance of existing Gal4/UAS-based resources in Drosophila, we and others have developed LexA/LexAop-based genetic tools. Here, we describe experimental and pedagogical advances that promote the efficient conversion of Drosophila Gal4 lines to LexA lines, and the generation of LexAop-short hairpin RNA lines to suppress gene function. We developed a CRISPR/Cas9-based knock-in system to replace Gal4 coding sequences with LexA, and a LexAop-based short hairpin RNA expression vector to achieve short hairpin RNA-mediated gene silencing. We demonstrate the use of these approaches to achieve targeted genetic loss-of-function in multiple tissues. We also detail our development of secondary school curricula that enable students to create transgenic flies, thereby magnifying the production of well-characterized LexA/LexAop lines for the scientific community. The genetic tools and teaching methods presented here provide LexA/LexAop resources that complement existing resources to study intercellular communication coordinating metazoan physiology and development.
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Affiliation(s)
- Kathleen R Chang
- Stanford University, Stanford, CA 94305, USA
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Deborah D Tsao
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Celine Bennett
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Elaine Wang
- The Lawrenceville School, Lawrenceville, NJ 08648, USA
| | - Jax F Floyd
- The Lawrenceville School, Lawrenceville, NJ 08648, USA
| | | | - Emily Greenwald
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ella S Kim
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | | | | | - Nicole Lantz
- The Lawrenceville School, Lawrenceville, NJ 08648, USA
| | - Elizabeth Fox
- The Lawrenceville School, Lawrenceville, NJ 08648, USA
| | - Lutz Kockel
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Seung K Kim
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Departments of Medicine and of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Diabetes Research Center, Stanford, CA 94305, USA
| | - Sangbin Park
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Lewis M, Mathur MB, VanderWeele TJ, Frank MC. The puzzling relationship between multi-laboratory replications and meta-analyses of the published literature. R Soc Open Sci 2022; 9:211499. [PMID: 35223059 PMCID: PMC8864345 DOI: 10.1098/rsos.211499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/10/2022] [Indexed: 05/03/2023]
Abstract
What is the best way to estimate the size of important effects? Should we aggregate across disparate findings using statistical meta-analysis, or instead run large, multi-laboratory replications (MLR)? A recent paper by Kvarven, Strømland and Johannesson (Kvarven et al. 2020 Nat. Hum. Behav. 4, 423-434. (doi:10.1038/s41562-019-0787-z)) compared effect size estimates derived from these two different methods for 15 different psychological phenomena. The authors reported that, for the same phenomenon, the meta-analytic estimate tended to be about three times larger than the MLR estimate. These results are a specific example of a broader question: What is the relationship between meta-analysis and MLR estimates? Kvarven et al. suggested that their results undermine the value of meta-analysis. By contrast, we argue that both meta-analysis and MLR are informative, and that the discrepancy between the two estimates that they observed is in fact still largely unexplained. Informed by re-analyses of Kvarven et al.'s data and by other empirical evidence, we discuss possible sources of this discrepancy and argue that understanding the relationship between estimates obtained from these two methods is an important puzzle for future meta-scientific research.
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Affiliation(s)
- Molly Lewis
- Department of Psychology Carnegie Mellon University, Pittsburgh, PA, USA
| | | | | | - Michael C. Frank
- Department of Psychology Stanford University, Palo Alto, CA, USA
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7
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Lal RA, Moeller HP, Thomson EA, Horton TM, Lee S, Freeman R, Prahalad P, Poon ASY, Annes JP. Novel Pathogenic De Novo INS p.T97P Variant Presenting With Severe Neonatal DKA. Endocrinology 2022; 163:6458485. [PMID: 34888628 PMCID: PMC9017997 DOI: 10.1210/endocr/bqab246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/19/2022]
Abstract
Pathogenic INS gene mutations are causative for mutant INS-gene-induced diabetes of youth (MIDY). We characterize a novel de novo heterozygous INS gene mutation (c.289A>C, p.T97P) that presented in an autoantibody-negative 5-month-old male infant with severe diabetic ketoacidosis. In silico pathogenicity prediction tools provided contradictory interpretations, while structural modeling indicated a deleterious effect on proinsulin folding. Transfection of wildtype and INS p.T97P expression and luciferase reporter constructs demonstrated elevated intracellular mutant proinsulin levels and dramatically impaired proinsulin/insulin and luciferase secretion. Notably, proteasome inhibition partially and selectively rescued INS p.T97P-derived luciferase secretion. Additionally, expression of INS p.T97P caused increased intracellular proinsulin aggregate formation and XBP-1s protein levels, consistent with induction of endoplasmic reticulum stress. We conclude that INS p.T97P is a newly identified pathogenic A-chain variant that is causative for MIDY via disruption of proinsulin folding and processing with induction of the endoplasmic reticulum stress response.
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Affiliation(s)
- Rayhan A Lal
- Division of Endocrinology, Department of Medicine, Stanford University, Stanford, CA, USA
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford, CA, USA
- Correspondence: Rayhan A. Lal, MD, Stanford University Medical Center, Room S025, 300 Pasteur Dr, Stanford, CA, 94305, USA.
| | - Hannah P Moeller
- Stanford Diabetes Research Center, Stanford, CA, USA
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA, USA
| | - Ella A Thomson
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Timothy M Horton
- Division of Endocrinology, Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - Sooyeon Lee
- Division of Endocrinology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Raquel Freeman
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Priya Prahalad
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford, CA, USA
| | - Ada S Y Poon
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Justin P Annes
- Division of Endocrinology, Department of Medicine, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford, CA, USA
- Correspondence: Justin P. Annes, MD PhD, Stanford University, CCSR 2255-A, 1291 Welch Rd, Stanford, CA, 94305, USA.
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8
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Maikawa CL, Chen PC, Vuong ET, Nguyen LT, Mann JL, d'Aquino AI, Lal RA, Maahs DM, Buckingham BA, Appel EA. Ultra-Fast Insulin-Pramlintide Co-Formulation for Improved Glucose Management in Diabetic Rats. Adv Sci (Weinh) 2021; 8:e2101575. [PMID: 34499434 PMCID: PMC8564421 DOI: 10.1002/advs.202101575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/07/2021] [Indexed: 05/04/2023]
Abstract
Dual-hormone replacement therapy with insulin and amylin in patients with type 1 diabetes has the potential to improve glucose management. Unfortunately, currently available formulations require burdensome separate injections at mealtimes and have disparate pharmacokinetics that do not mimic endogenous co-secretion. Here, amphiphilic acrylamide copolymers are used to create a stable co-formulation of monomeric insulin and amylin analogues (lispro and pramlintide) with synchronous pharmacokinetics and ultra-rapid action. The co-formulation is stable for over 16 h under stressed aging conditions, whereas commercial insulin lispro (Humalog) aggregates in 8 h. The faster pharmacokinetics of monomeric insulin in this co-formulation result in increased insulin-pramlintide overlap of 75 ± 6% compared to only 47 ± 7% for separate injections. The co-formulation results in similar delay in gastric emptying compared to pramlintide delivered separately. In a glucose challenge, in rats, the co-formulation reduces deviation from baseline glucose compared to insulin only, or separate insulin and pramlintide administrations. Further, comparison of interspecies pharmacokinetics of monomeric pramlintide suggests that pharmacokinetics observed for the co-formulation will be well preserved in future translation to humans. Together these results suggest that the co-formulation has the potential to improve mealtime glucose management and reduce patient burden in the treatment of diabetes.
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Affiliation(s)
- Caitlin L Maikawa
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Peyton C Chen
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Eric T Vuong
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Leslee T Nguyen
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Joseph L Mann
- Department of Materials Science & Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Andrea I d'Aquino
- Department of Materials Science & Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Rayhan A Lal
- Department of Medicine (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
| | - David M Maahs
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
| | - Bruce A Buckingham
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
| | - Eric A Appel
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
- Department of Materials Science & Engineering, Stanford University, Stanford, CA, 94305, USA
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
- ChEM-H Institute, Stanford University, Stanford, CA, 94305, USA
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9
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Addala A, Zaharieva DP, Gu AJ, Prahalad P, Scheinker D, Buckingham B, Hood KK, Maahs DM. Clinically Serious Hypoglycemia Is Rare and Not Associated With Time-in-range in Youth With New-onset Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:3239-3247. [PMID: 34265059 PMCID: PMC8530719 DOI: 10.1210/clinem/dgab522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Early initiation of continuous glucose monitoring (CGM) is advocated for youth with type 1 diabetes (T1D). Data to guide CGM use on time-in-range (TIR), hypoglycemia, and the role of partial clinical remission (PCR) are limited. OBJECTIVE Our aims were to assess whether 1) an association between increased TIR and hypoglycemia exists, and 2) how time in hypoglycemia varies by PCR status. METHODS We analyzed 80 youth who were started on CGM shortly after T1D diagnosis and were followed for up to 1-year post diagnosis. TIR and hypoglycemia rates were determined by CGM data and retrospectively analyzed. PCR was defined as (visit glycated hemoglobin A1c) + (4*units/kg/day) less than 9. RESULTS Youth were started on CGM 8.0 (interquartile range, 6.0-13.0) days post diagnosis. Time spent at less than 70 mg/dL remained low despite changes in TIR (highest TIR 74.6 ± 16.7%, 2.4 ± 2.4% hypoglycemia at 1 month post diagnosis; lowest TIR 61.3 ± 20.3%, 2.1 ± 2.7% hypoglycemia at 12 months post diagnosis). No events of severe hypoglycemia occurred. Hypoglycemia was rare and there was minimal difference for PCR vs non-PCR youth (54-70 mg/dL: 1.8% vs 1.2%, P = .04; < 54mg/dL: 0.3% vs 0.3%, P = .55). Approximately 50% of the time spent in hypoglycemia was in the 65 to 70 mg/dL range. CONCLUSION As TIR gradually decreased over 12 months post diagnosis, hypoglycemia was limited with no episodes of severe hypoglycemia. Hypoglycemia rates did not vary in a clinically meaningful manner by PCR status. With CGM being started earlier, consideration needs to be given to modifying CGM hypoglycemia education, including alarm settings. These data support a trial in the year post diagnosis to determine alarm thresholds for youth who wear CGM.
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Affiliation(s)
- Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Correspondence: Ananta Addala, DO, MPH, Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94305, USA.
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
| | - Angela J Gu
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
| | - Priya Prahalad
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - David Scheinker
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Bruce Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Korey K Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
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10
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Lind L, Zanetti D, Högman M, Sundman L, Ingelsson E. Commonly used clinical chemistry tests as mortality predictors: Results from two large cohort studies. PLoS One 2020; 15:e0241558. [PMID: 33152050 PMCID: PMC7644047 DOI: 10.1371/journal.pone.0241558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/15/2020] [Accepted: 10/18/2020] [Indexed: 12/01/2022] Open
Abstract
Background The normal ranges for clinical chemistry tests are usually defined by cut-offs given by the distribution in healthy individuals. This approach does however not indicate if individuals outside the normal range are more prone to disease. Methods We studied the associations and risk prediction of 11 plasma and serum biomarkers with all-cause mortality in two population-based cohorts: a Swedish cohort (X69) initiated in 1969, and the UK Biobank (UKB) initiated in 2006–2010, with up to 48- and 9-years follow-up, respectively. Results In X69 and in UKB, 18,529 and 425,264 individuals were investigated, respectively. During the follow-up time, 14,475 deaths occurred in X69 and 17,116 in UKB. All evaluated tests were associated with mortality in X69 (P<0.0001, except bilirubin P<0.005). For calcium, blood urea nitrogen, bilirubin, hematocrit, uric acid, and iron, U-shaped associations were seen (P<0.0001). For leukocyte count, gamma-glutamyl transferase, alkaline phosphatases and lactate dehydrogenase, linear positive associations were seen, while for albumin the association was negative. Similar associations were seen in UKB. Addition of all biomarkers to a model with classical risk factors improved mortality prediction (delta C-statistics: +0.009 in X69 and +0.023 in UKB, P<0.00001 in both cohorts). Conclusions Commonly used clinical chemistry tests were associated with all-cause mortality both in the medium- and long-term perspective, and improved mortality prediction beyond classical risk factors. Since both linear and U-shaped relationships were found, we propose to define the normal range of a clinical chemistry test based on its association with mortality, rather than from the distribution.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Daniela Zanetti
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- Stanford Cardiovascular Institute, Stanford, CA, United States of America
- Stanford Diabetes Research Center, Stanford, CA, United States of America
| | - Marieann Högman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Sundman
- Department of Public Health Medicine, County Council of Gävleborg, Gävle, Sweden
| | - Erik Ingelsson
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- Stanford Cardiovascular Institute, Stanford, CA, United States of America
- Stanford Diabetes Research Center, Stanford, CA, United States of America
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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11
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Kim S, Whitener RL, Peiris H, Gu X, Chang CA, Lam JY, Camunas-Soler J, Park I, Bevacqua RJ, Tellez K, Quake SR, Lakey JRT, Bottino R, Ross PJ, Kim SK. Molecular and genetic regulation of pig pancreatic islet cell development. Development 2020; 147:dev186213. [PMID: 32108026 PMCID: PMC7132804 DOI: 10.1242/dev.186213] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Reliance on rodents for understanding pancreatic genetics, development and islet function could limit progress in developing interventions for human diseases such as diabetes mellitus. Similarities of pancreas morphology and function suggest that porcine and human pancreas developmental biology may have useful homologies. However, little is known about pig pancreas development. To fill this knowledge gap, we investigated fetal and neonatal pig pancreas at multiple, crucial developmental stages using modern experimental approaches. Purification of islet β-, α- and δ-cells followed by transcriptome analysis (RNA-seq) and immunohistology identified cell- and stage-specific regulation, and revealed that pig and human islet cells share characteristic features that are not observed in mice. Morphometric analysis also revealed endocrine cell allocation and architectural similarities between pig and human islets. Our analysis unveiled scores of signaling pathways linked to native islet β-cell functional maturation, including evidence of fetal α-cell GLP-1 production and signaling to β-cells. Thus, the findings and resources detailed here show how pig pancreatic islet studies complement other systems for understanding the developmental programs that generate functional islet cells, and that are relevant to human pancreatic diseases.
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Affiliation(s)
- Seokho Kim
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert L Whitener
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Heshan Peiris
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Xueying Gu
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Charles A Chang
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jonathan Y Lam
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Joan Camunas-Soler
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Insung Park
- Department of Animal Science, University of California Davis, Davis, CA 95616, USA
| | - Romina J Bevacqua
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Krissie Tellez
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Stephen R Quake
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Chan Zuckerberg Biohub, San Francisco, CA 94518, USA
| | - Jonathan R T Lakey
- Department of Surgery, University of California at Irvine, Irvine, CA 92868, USA
| | - Rita Bottino
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA 15212, USA
| | - Pablo J Ross
- Department of Animal Science, University of California Davis, Davis, CA 95616, USA
| | - Seung K Kim
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA
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12
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Abstract
Gerald Reaven was often called the "father of insulin resistance." On the 1-year anniversary of his death in 2018, we challenge three myths associated with insulin resistance: metformin improves insulin resistance; measurement of waist circumference predicts insulin resistance better than body mass index; and insulin resistance causes weight gain. In this review, we highlight Reaven's relevant research that helped to dispel these myths associated with insulin resistance.
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Affiliation(s)
- Sun H Kim
- Division of Endocrinology, Gerontology, and Metabolism, Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, USA.
| | - Fahim Abbasi
- Division of Cardiovascular Medicine, Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, USA
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