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Chaves-Filho AB, Peixoto AS, Castro É, Oliveira TE, Perandini LA, Moreira RJ, da Silva RP, da Silva BP, Moretti EH, Steiner AA, Miyamoto S, Yoshinaga MY, Festuccia WT. Futile cycle of β-oxidation and de novo lipogenesis are associated with essential fatty acids depletion in lipoatrophy. Biochim Biophys Acta Mol Cell Biol Lipids 2023; 1868:159264. [PMID: 36535597 DOI: 10.1016/j.bbalip.2022.159264] [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] [Received: 06/16/2022] [Revised: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Total absence of adipose tissue (lipoatrophy) is associated with the development of severe metabolic disorders including hepatomegaly and fatty liver. Here, we sought to investigate the impact of severe lipoatrophy induced by deletion of peroxisome proliferator-activated receptor gamma (PPARγ) exclusively in adipocytes on lipid metabolism in mice. Untargeted lipidomics of plasma, gastrocnemius and liver uncovered a systemic depletion of the essential linoleic (LA) and α-linolenic (ALA) fatty acids from several lipid classes (storage lipids, glycerophospholipids, free fatty acids) in lipoatrophic mice. Our data revealed that such essential fatty acid depletion was linked to increased: 1) capacity for liver mitochondrial fatty acid β-oxidation (FAO), 2) citrate synthase activity and coenzyme Q content in the liver, 3) whole-body oxygen consumption and reduced respiratory exchange rate in the dark period, and 4) de novo lipogenesis and carbon flux in the TCA cycle. The key role of de novo lipogenesis in hepatic steatosis was evidenced by an accumulation of stearic, oleic, sapienic and mead acids in liver. Our results thus indicate that the simultaneous activation of the antagonic processes FAO and de novo lipogenesis in liver may create a futile metabolic cycle leading to a preferential depletion of LA and ALA. Noteworthy, this previously unrecognized cycle may also explain the increased energy expenditure displayed by lipoatrophic mice, adding a new piece to the metabolic regulation puzzle in lipoatrophies.
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Affiliation(s)
- Adriano B Chaves-Filho
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 748, São Paulo 05508900, Brazil; Department of Biochemistry, Institute of Chemistry, University of São Paulo, Av. Prof Lineu Prestes 1524, São Paulo 05508000, Brazil.
| | - Albert S Peixoto
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 748, São Paulo 05508900, Brazil
| | - Érique Castro
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 748, São Paulo 05508900, Brazil
| | - Tiago E Oliveira
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 748, São Paulo 05508900, Brazil
| | - Luiz A Perandini
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 748, São Paulo 05508900, Brazil
| | - Rafael J Moreira
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 748, São Paulo 05508900, Brazil
| | - Railmara P da Silva
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, Av. Prof Lineu Prestes 1524, São Paulo 05508000, Brazil
| | - Beatriz P da Silva
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, Av. Prof Lineu Prestes 1524, São Paulo 05508000, Brazil
| | - Eduardo H Moretti
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 1524, São Paulo 05508000, Brazil
| | - Alexandre A Steiner
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 1524, São Paulo 05508000, Brazil
| | - Sayuri Miyamoto
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, Av. Prof Lineu Prestes 1524, São Paulo 05508000, Brazil
| | - Marcos Y Yoshinaga
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, Av. Prof Lineu Prestes 1524, São Paulo 05508000, Brazil.
| | - William T Festuccia
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Prof Lineu Prestes 748, São Paulo 05508900, Brazil.
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Mashiko T, Tsukada K, Takada H, Wu SH, Kanayama K, Asahi R, Mori M, Kurisaki A, Oka S, Yoshimura K. Genetic and cytometric analyses of subcutaneous adipose tissue in patients with hemophilia and HIV-associated lipodystrophy. AIDS Res Ther 2022; 19:14. [PMID: 35246167 PMCID: PMC8895510 DOI: 10.1186/s12981-022-00432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background The authors recently performed plastic surgeries for a small number of patients with hemophilia, HIV infection, and morphologic evidence of lipodystrophy. Because the pathophysiological mechanism of HIV-associated lipodystrophy remains to be elucidated, we analyzed subcutaneous adipose tissues from the patients. Methods All six patients had previously been treated with older nucleoside analogue reverse-transcriptase inhibitors (NRTIs; stavudine, didanosine or zidovudine). Abdominal and inguinal subcutaneous fat samples were obtained from the HIV+ patients with hemophilia and HIV− healthy volunteers (n = 6 per group), and analyzed via DNA microarray, real-time PCR, flow cytometry and immunohistochemistry. Results The time from initial NRTI treatment to collecting samples were 21.7 years in average. Cytometric analysis revealed infiltration of inflammatory M1 macrophages into HIV-infected adipose tissue and depletion of adipose-derived stem cells, possibly due to exhaustion following sustained adipocyte death. Genetic analysis revealed that adipose tissue from HIV+ group had increased immune activation, mitochondrial toxicity, chronic inflammation, progressive fibrosis and adipocyte dysfunction (e.g. insulin resistance, inhibited adipocyte differentiation and accelerated apoptosis). Of note, both triglyceride synthesis and lipolysis were inhibited in adipose tissue from patients with HIV. Conclusions Our findings provide important insights into the pathogenesis of HIV-associated lipodystrophy, suggesting that fat redistribution may critically depend on adipocytes’ sensitivity to drug-induced mitochondrial toxicity, which may lead either to atrophy or metabolic complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-022-00432-9.
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Xatzipsalti M, Alvertis H, Kourousi G, Patouni K, Konstantakopoulos S, Delis D, Vazeou A. Lipoatrophy, a rare complication of diabetes: a single-center experience. Hormones (Athens) 2022; 21:61-69. [PMID: 34671939 DOI: 10.1007/s42000-021-00324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lipoatrophy (LA), a rare skin complication in patients with type 1 diabetes (T1D), has decreased dramatically over the past decades due to the use of human purified insulin preparations. METHODS We collected data from the records of T1D patients with LA. Types of insulin and insulin regimen, presence of eosinophilia, anti-insulin (IAA), anti-GAD, anti-IA2 autoantibodies, other autoimmune disorders, site of atrophy and its relationship to catheter, HbA1c at LA onset and after resolution, and different treatment modalities (i.e., change of insulin type or site, sodium cromoglycate (SCG) cream, cortisone cream or percutaneous injections, and laser treatment) were recorded. RESULTS Thirteen out of 1200 T1D subjects (1%) presented with LA. The majority were on insulin pump using rapid-acting analogs. Twelve out of 13 patients had changed the type of insulin, and most of them had switched injection sites. Ten out of 13 patients used SCG cream and 7/10 showed complete/partial improvement. One patient used dexamethasone injection with improvement. Five patients showed self-improvement. In 3/7 patients who were receiving SCG, treatment was combined with change of insulin type (glulisine); however, in 1/3, the result should be attributed to concomitant laser treatment. In 4/7 patients, there was a clear, beneficial effect of SCG. In 1/4 with partial resolution of LA, laser treatment was used after SCG, which further improved the result. CONCLUSIONS LA is a rare skin complication seen even today with the use of insulin analogs. SCG alone or combined with change of insulin type seems to be the most effective treatment. Laser treatment is a promising new therapy.
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Affiliation(s)
- Maria Xatzipsalti
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece.
| | | | - Giannoula Kourousi
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Konstantina Patouni
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | | | - Dimitris Delis
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
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Kim J, Song SY, Lee SG, Choi S, Lee YI, Choi JY, Lee JH. Treatment of Human Immunodeficiency Virus-Associated Facial Lipoatrophy With Hyaluronic Acid Filler Mixed With Micronized Cross-Linked Acellular Dermal Matrix. J Korean Med Sci 2022; 37:e37. [PMID: 35132843 PMCID: PMC8822113 DOI: 10.3346/jkms.2022.37.e37] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated facial lipoatrophy (FLA) is a stigmatizing side effect associated with the use of highly active antiretroviral therapy. We sought to evaluate the safety and efficacy of the hyaluronic acid filler mixed with micronized cross-linked acellular dermal matrix (HA/MADM) in HIV-associated FLA. METHODS We conducted an open-label safety and efficacy study in patients with HIV-associated FLA. Fourteen patients received single injection of the HA/MADM, and 13 patients completed the 24-week follow-up evaluation. Treatment efficacy, safety, and patient and physician satisfaction were evaluated. Repeated measure analysis of variance with post-hoc analysis with the Wilcoxon signed rank test was performed to compare and incorporate parameters at each time point. RESULTS All 13 patients maintained a significant improvement of the Carruthers Lipoatrophy Severity Scale grade throughout the study period, along with improvement of the depressed volume due to lipoatrophy measured using a three-dimensional camera system. More than 80% of patients and physicians were satisfied with the treatment, and no treatment-related adverse events were reported, except for one case of transient subcutaneous nodule formation. CONCLUSION Our study findings suggest that injectable HA/MADM is a potentially effective and safe treatment option for treating HIV-positive patients with FLA.
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Affiliation(s)
- Jemin Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Yong Song
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Gyu Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sooyeon Choi
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young In Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Ju Hee Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Wu Y, Lou X. Multifocal lipoatrophy secondary to insulin injection in a patient with type 2 diabetes, hepatitis B virus infection, and liver cirrhosis. J Int Med Res 2021; 49:300060521990237. [PMID: 33682487 PMCID: PMC7944535 DOI: 10.1177/0300060521990237] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lipoatrophy secondary to insulin injection is a rare complication of insulin use. Localized lipoatrophy is recognized by a loss of subcutaneous fat caused by insulin injection. We report the case of a 69-year-old non-obese female patient with type 2 diabetes mellitus, decompensated liver cirrhosis, and hepatitis B virus (HBV) infection who developed multifocal lipoatrophy during the administration of human insulin and an insulin analog.
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Affiliation(s)
- Yuedan Wu
- Department of Endocrinology, Dongyang People's Hospital, Jinhua City, Zhejiang, China
| | - Xiaojia Lou
- Department of Endocrinology, Dongyang People's Hospital, Jinhua City, Zhejiang, China
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Anyanwu EG, Onuchukwu CL. Does plantar lipoatrophy affect dynamic balance in HIV infected persons? Gait Posture 2021; 86:101-105. [PMID: 33711612 DOI: 10.1016/j.gaitpost.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 02/07/2021] [Accepted: 02/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic inflammation in HIV infection and antiretroviral therapy have been shown to cause balance disorders due to neuromusculoskeletal damage, sensorimotor deficits, failure of foot mechanoreceptors and/or plantar lipoatrophy. However, despite evidence of plantar lipoatrophy in HIV patients, there is a dearth of information on how this relates to walking balance. This study sought to investigate how plantar fat thickness affects dynamic balance in HIV infected persons. RESEARCH QUESTION Can plantar lipoatrophy significantly affect walking balance in HIV infected persons? METHODS This is a cross sectional study of 367 persons (106 HIV seronegative control subjects, 211 HIV seropositive subjects on antiretroviral therapy (HIV_ART) and 50 HIV ART naïve subjects (HIV_NonART)). Plantar fat thickness (PFT) was measured using diagnostic ultrasound. Subjects were asked to walk at 5 self-selected speeds, from very slow to very fast on a level 15-meter walkway. Average number of steps and time taken to complete the study distance were obtained, used to calculate gait parameters and plot the velocity field diagram for gait analysis. RESULTS Findings from this study showed significant reduction in plantar fat thickness, velocity of travel, stride frequency and a significant increase in stride and double support duration (p < 0.01) in HIV-seropositive individuals compared to healthy controls but none were observed between HIV_ART and NonART groups. CONCLUSION HIV infection significantly affects dynamic balance and increases the risk of falls, fracture and mobility impairment in this patient population. SIGNIFICANCE This study will help clinicians to recognize plantar lipoatrophy as a significant cause of gait pathology in HIV infected persons and thus, make targeted interventions to minimize deformity and impairment, promote functional independence and improve quality of life.
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Affiliation(s)
- Emeka G Anyanwu
- Department of Anatomy, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Chioma L Onuchukwu
- Department of Physiotherapy, Enugu State University Teaching Hospital Park Lane, Enugu, Enugu State, Nigeria.
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Birnbaum A, Yoon MY, Struhl S. Serial saline solution injections for the treatment of lipoatrophy and depigmentation after corticosteroid injection for medial epicondylitis. JSES Int 2020; 4:1002-5. [PMID: 33345247 DOI: 10.1016/j.jseint.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Yamamoto A, Kikuchi Y, Kusakabe T, Takano H, Sakurai K, Furui S, Oba H. Imaging spectrum of abnormal subcutaneous and visceral fat distribution. Insights Imaging 2020; 11:24. [PMID: 32056035 PMCID: PMC7018866 DOI: 10.1186/s13244-019-0833-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
Adipose tissue plays multiple and complex roles not only in mechanical cushioning and energy storage but also as an important secretory organ that regulates energy balance and homeostasis multilaterally. Fat tissue is categorized into subcutaneous fat tissue (SCAT) or visceral fat tissue (VSA) depending on its distribution, with the two having different metabolic functions. Near-total lack of fat in congenital/acquired generalized lipodystrophy, cachexia, or any other severe malnutrition condition induces severe multi-organ dysfunction due to lack of production of leptin and other adipokines. Increased visceral fat tissue secondary to obesity, hypercortisolism, or multiple symmetric lipomatosis raises the risk of insulin resistance, cardiac complications, and airway or spinal canal stenosis, although the fat distribution pattern differs in each condition. Partial abnormal fat distribution conditions such as HIV/HAART therapy-associated lipodystrophy, familial partial lipodystrophies, and acquired partial lipodystrophy frequently show a mixture of lipoatrophy and lipohypertrophy with metabolic dysfunction. Characteristic imaging features in conditions with local abnormal fat distribution can provide information about a patient’s co-existent/unrecognized disease(s), past medical history, or lifestyle. Knowledge of characteristic abnormal fat distribution patterns can contribute to proper and timely therapeutic decision-making and patient education.
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Affiliation(s)
- Asako Yamamoto
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8606, Japan.
| | - Yoshinao Kikuchi
- Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8606, Japan
| | - Toru Kusakabe
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Hideyuki Takano
- Department of Radiology, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba-shi, Chiba, 260-8717, Japan
| | - Keita Sakurai
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8606, Japan
| | - Shigeru Furui
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8606, Japan
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8606, Japan
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Tao C, Wang Y, Zhao Y, Pan J, Fan Y, Liang X, Cao C, Zhao J, Petris MJ, Li K, Wang Y. Adipocyte-specific disruption of ATPase copper transporting α in mice accelerates lipoatrophy. Diabetologia 2019; 62:2340-2353. [PMID: 31396659 DOI: 10.1007/s00125-019-4966-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/26/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS ATPase copper transporting α (ATP7A), also known as Menkes disease protein, is a P-type ATPase that transports copper across cell membranes. The critical role of ATP7A-mediated copper homeostasis has been well recognised in various organs, such as the intestine, macrophages and the nervous system. However, the importance of adipocyte ATP7A-mediated copper homeostasis on fat metabolism is not well understood. Here, we sought to reveal the contribution of adipose ATP7A to whole-body fat metabolism in mice. METHODS We generated adipocyte-specific Atp7a-knockout (ASKO) mice using the Cre/loxP system, with Cre expression driven by the adiponectin promoter. ASKO mice and littermate control mice were aged on a chow diet or fed with a high-fat diet (HFD); body weight, fat mass, and glucose and insulin metabolism were analysed. Histological analysis, transmission electron microscopy and RNA-sequencing (RNA-Seq) analysis of white adipose tissue (WAT) were used to understand the physiological and molecular changes associated with loss of copper homeostasis in adipocytes. RESULTS Significantly increased copper concentrations were observed in adipose tissues of ASKO mice compared with control mice. Aged or HFD-fed ASKO mice manifested a lipoatrophic phenotype characterised by a progressive generalised loss of WAT. Dysfunction of adipose tissues in these ASKO mice was confirmed by decreased levels of both serum leptin and adiponectin and increased levels of triacylglycerol and insulin. Systemic metabolism was also impaired in these mice, as evidenced by a pronounced glucose intolerance, insulin resistance and hepatic steatosis. Moreover, we demonstrate a significant induction of lipolysis and DNA-damage signalling pathways in gonadal WAT from aged and HFD-fed ASKO mice. In vitro studies suggest that copper overload is responsible for increased lipolysis and DNA damage. CONCLUSIONS/INTERPRETATION Our results show a previously unappreciated role of adipocyte Atp7a in the regulation of ageing-related metabolic disease and identify new metallophysiologies in whole-body fat metabolism. DATA AVAILABILITY The datasets generated during the current study are available in the Genome Sequence Archive in BIG Data Center, Beijing Institute of Genomics (BIG), Chinese Academy of Sciences, under accession number CRA001769 (http://bigd.big.ac.cn/gsa).
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Affiliation(s)
- Cong Tao
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, People's Republic of China, 100193
| | - Yajun Wang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, People's Republic of China, 100193
| | - Ying Zhao
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, People's Republic of China, 100193
| | - Jianfei Pan
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, People's Republic of China, 100193
| | - Yiping Fan
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, People's Republic of China, 100193
| | - Xiaojuan Liang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, People's Republic of China, 100193
| | - Chunwei Cao
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Jianguo Zhao
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Michael J Petris
- Department of Biochemistry, University of Missouri, Columbia, MO, USA
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
- The Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| | - Kui Li
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, People's Republic of China, 100193
| | - Yanfang Wang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, People's Republic of China, 100193.
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He G, Yan Z, Sun L, Lv Y, Guo W, Gang X, Wang G. Diabetes mellitus coexisted with progeria: a case report of atypical Werner syndrome with novel LMNA mutations and literature review. Endocr J 2019; 66:961-969. [PMID: 31270292 DOI: 10.1507/endocrj.ej19-0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Werner syndrome (WS) is a rare, adult-onset progeroid syndrome. Classic WS is caused by WRN mutation and partial atypical WS (AWS) is caused by LMNA mutation. A 19-year-old female patient with irregular menstruation and hyperglycemia was admitted. Physical examination revealed characteristic faces of progeria, graying and thinning of the hair scalp, thinner and atrophic skin over the hands and feet, as well as lipoatrophy of the extremities, undeveloped breasts at Tanner stage 3, and short stature. The patient also suffered from severe insulin-resistant diabetes mellitus, hyperlipidemia, fatty liver, and polycystic ovarian morphology. Possible WS was considered and both WRN and LMNA genes were analyzed. A novel missense mutation p.L140Q (c.419T>A) in the LMNA gene was identified and confirmed the diagnosis of AWS. Her father was a carrier of the same mutation. We carried out therapy for lowering blood glucose and lipid and improving insulin resistance, et al. The fasting glucose, postprandial glucose and triglyceride level was improved after treatment for 9 days. Literature review of AWS was performed to identify characteristics of the disease. Diabetes mellitus is one of the clinical manifestations of WS and attention must give to the differential diagnosis. Gene analysis is critical in the diagnosis of WS. According to the literature, classic and atypical WS differ in incidence, pathogenic gene, and clinical manifestations. Characteristic dermatological pathology may be significantly more important for the initial identification of AWS. Early detection, appropriate treatments, and regular follow-up may improve prognosis and survival of WS patients.
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Affiliation(s)
- Guangyu He
- The First Hospital of Jilin University, Changchun Jilin, 130021, China
| | - Zi Yan
- The First Hospital of Jilin University, Changchun Jilin, 130021, China
| | - Lin Sun
- The First Hospital of Jilin University, Changchun Jilin, 130021, China
| | - You Lv
- The First Hospital of Jilin University, Changchun Jilin, 130021, China
| | - Weiying Guo
- The First Hospital of Jilin University, Changchun Jilin, 130021, China
| | - Xiaokun Gang
- The First Hospital of Jilin University, Changchun Jilin, 130021, China
| | - Guixia Wang
- The First Hospital of Jilin University, Changchun Jilin, 130021, China
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Willcocks RJ, Forbes SC, Walter GA, Vandenborne K. Magnetic resonance imaging characteristics of injection site reactions after long-term subcutaneous delivery of drisapersen. Eur J Pediatr 2019; 178:777-778. [PMID: 30790036 PMCID: PMC6530557 DOI: 10.1007/s00431-019-03349-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/12/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Rebecca J Willcocks
- Department of Physical Therapy, University of Florida, 1225 Center Drive, Gainesville, FL, USA.
| | - Sean C Forbes
- Department of Physical Therapy, University of Florida, 1225 Center Drive, Gainesville, FL, USA
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, 1345 Center Drive, Gainesville, FL, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, 1225 Center Drive, Gainesville, FL, USA
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Shibata Y, Nakatsuka A, Eguchi J, Miyamoto S, Masuda Y, Awazawa M, Takaki A, Yoshida R, Yagi T, Wada J. Acquired partial lipoatrophy as graft-versus-host disease and treatment with metreleptin: two case reports. J Med Case Rep 2018; 12:368. [PMID: 30545408 PMCID: PMC6293520 DOI: 10.1186/s13256-018-1901-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/29/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction Acquired partial lipoatrophy has been reported after bone marrow transplantation during childhood; however, no adult cases have previously been reported. We herein report two adult cases of acquired partial lipoatrophy after transplantation. Case presentation A 28-year-old Japanese woman developed diabetic ketoacidosis and received insulin therapy after bone marrow transplantation. She manifested partial lipoatrophy of the extremities, prominent insulin resistance, hyperglycemia, hypertriglyceridemia, and fatty liver. A 40-year-old Japanese woman underwent liver transplantation from a living donor for alcoholic liver disease after abstinence from alcohol. She newly developed non-alcoholic steatohepatitis and diabetes. Non-alcoholic steatohepatitis progressed to liver failure, and a second liver transplantation from a brain-dead donor was performed at 42 years of age. She demonstrated loss of subdermal fat of the upper and lower extremities, prominent insulin resistance, hyperglycemia, and hypertriglyceridemia. In both cases, the injection of recombinant methionyl human leptin reversed all of the metabolic abnormalities. Conclusions Acquired partial lipoatrophy after transplantation is a manifestation of chronic graft-versus-host disease in adults. This entity is associated with diabetes with prominent insulin resistance and severe hypertriglycemia and can be successfully treated with metreleptin for the long term.
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Affiliation(s)
- Yusuke Shibata
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Atsuko Nakatsuka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Jun Eguchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Satoshi Miyamoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yukari Masuda
- Department of Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Motoharu Awazawa
- Department of Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Ryuichi Yoshida
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Takahito Yagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
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13
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Cames C, Pascal L, Ba A, Mbodj H, Ouattara B, Diallo NF, Msellati P, Mbaye N, Sy Signate H, Blanche S, Diack A. Low prevalence of lipodystrophy in HIV-infected Senegalese children on long-term antiretroviral treatment: the ANRS 12279 MAGGSEN Pediatric Cohort Study. BMC Infect Dis 2018; 18:374. [PMID: 30081838 PMCID: PMC6090843 DOI: 10.1186/s12879-018-3282-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 07/30/2018] [Indexed: 12/02/2022] Open
Abstract
Background The long-term benefits of antiretroviral treatment (ART) are associated with metabolic complications, especially lipodystrophy, which has been well described among HIV-infected adults and children on ART in developed settings. Specifically, stavudine, and to a lesser extent zidovudine and protease inhibitors (PI), have been consistently implicated in the development of lipodystrophy. In 2006, following advice from the WHO, Senegal began phasing out stavudine from first-line ART. The objectives of this cross-sectional analysis are to assess and identify risk factors affecting the prevalence of lipodystrophy in Senegalese children and adolescents on long-term ART participating in a cohort study. Methods Lipodystrophy was clinically assessed in two- to 18-year-old children on ART for at least six months and with no concurrent severe acute malnutrition. Risk factors for lipodystrophy were identified using stepwise multivariable logistic regression. Explanatory variables included clinical and personal data, immunovirologic status, and therapeutic history. Results Overall, 254 children were assessed for lipodystrophy. The median age was 10.9 years (IQR: 8.1–14.2) and the median duration on ART was 54 months (32–84). Only 18% had been previously treated with stavudine, with a median treatment duration of 8 months (5–25). Ongoing treatment included 76% of children receiving zidovudine (median duration of 48 months (26–74)) and 27% receiving PI (lopinavir/ritonavir; median duration of 49 months (23–59)). Mild signs of lipodystrophy were observed in 33 children (13%): 28 with lipoatrophy, 4 with lipohypertrophy and one with combined type. Boys were more likely to present with lipoatrophy than girls (aOR: 4.3, 95% CI: 1.6–11.7). Children previously treated with stavudine for ≥1 year had a greater risk for lipoatrophy than those never exposed (3.8, 1.0–14.0), although the association was weak. There was no association between lipodystrophy and age or current or cumulative treatment with lopinavir/ritonavir or zidovudine. Conclusions We report low prevalence of mild lipodystrophy in children and adolescents on long-term ART receiving a stavudine-sparing regimen. These findings are reassuring for clinicians in low-income settings where zidovudine is massively prescribed and lopinavir/ritonavir is the only widely available PI. Trial registration ClinicalTrials.gov identifier: NCT01771562 (registration date: 01/18/2013).
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Affiliation(s)
- Cecile Cames
- Institut de Recherche pour le Développement (IRD), UMI233 IRD, INSERM U1175, Université de Montpellier, 911, avenue Agropolis, BP 64501, 34394, Montpellier cedex 5, France.
| | - Lea Pascal
- Institut de Recherche pour le Développement (IRD), UMI233 IRD, INSERM U1175, Université de Montpellier, 911, avenue Agropolis, BP 64501, 34394, Montpellier cedex 5, France
| | - Aissatou Ba
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | - Hélène Mbodj
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | - Baly Ouattara
- Synergie Pour l'Enfance, Centre Hospitalier Roi Baudouin, Guediawaye, Sénégal
| | | | - Philippe Msellati
- Institut de Recherche pour le Développement (IRD), UMI233 IRD, INSERM U1175, Université de Montpellier, 911, avenue Agropolis, BP 64501, 34394, Montpellier cedex 5, France
| | - Ngagne Mbaye
- Synergie Pour l'Enfance, Centre Hospitalier Roi Baudouin, Guediawaye, Sénégal
| | - Haby Sy Signate
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | | | - Aminata Diack
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
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14
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Dos Santos AP, Navarro AM, Schwingel A, Alves TC, Abdalla PP, Venturini ACR, de Santana RC, Machado DRL. Lipodystrophy diagnosis in people living with HIV/AIDS: prediction and validation of sex-specific anthropometric models. BMC Public Health 2018; 18:806. [PMID: 29945584 PMCID: PMC6020387 DOI: 10.1186/s12889-018-5707-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/13/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Body composition alterations, or lipodystrophy, can lead to serious health problems in people living with HIV/AIDS (PLWHA). The objectives of this study are to predict and validate sex-specific anthropometric predictive models for the diagnosis of lipodystrophy in PLWHA. METHODS A cross-sectional design was employed to recruit 106 PLWHA (men = 65 and women = 41) in Brazil during 2013-2014. They were evaluated using dual-energy X-ray absorptiometry, and 19 regions of body perimeters and 6 skinfold thicknesses were taken. Sex-specific predictive models for lipodystrophy diagnosis were developed through stepwise linear regression analysis. Cross-validations using predicted residual error sum of squares was performed to validate each predictive model. RESULTS Results support the use of anthropometry for the diagnosis of lipodystrophy in men and women living with HIV/AIDS. A high power of determination with a small degree of error was observed for lipodystrophy diagnosis for men in model six (r2 = 0.77, SEE = 0.14, r2PRESS = 0.73, SEE PRESS = 0.15), that included ratio of skinfold thickness of subscapular to medial calf, skinfold thickness of thigh, body circumference of waist, formal education years, time of diagnosis to HIV months, and type of combined antiretroviral therapy (cART) (with protease inhibitor "WI/PI = 1" or without protease inhibitor "WO/PI = 0"); and model five for women (r2 = 0.78, SEE = 0.11, r2PRESS = 0.71, SEE PRESS = 0.12), that included skinfold thickness of thigh, skinfold thickness of subscapular, time of exposure to cART months, body circumference of chest, and race (Asian) ("Yes" for Asian race = 1; "No" = 0). CONCLUSIONS The proposed anthropometric models advance the field of public health by facilitating early diagnosis and better management of lipodystrophy, a serious adverse health effect experienced by PLWHA.
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Affiliation(s)
- André P Dos Santos
- Interunit Nursing Doctoral Program, College of Nursing of the University of Sao Paulo, Avenida dos Bandeirantes, Campus Universitario, 3900, Ribeirao Preto, SP, 14040-902, Brazil. .,Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, USA.
| | - Anderson M Navarro
- Department of Clinical Medicine, Faculty of Medicine at the University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Andiara Schwingel
- Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, USA
| | - Thiago C Alves
- Interunit Nursing Doctoral Program, College of Nursing of the University of Sao Paulo, Avenida dos Bandeirantes, Campus Universitario, 3900, Ribeirao Preto, SP, 14040-902, Brazil
| | - Pedro P Abdalla
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Ana Claudia R Venturini
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Rodrigo C de Santana
- Department of Clinical Medicine, Faculty of Medicine at the University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Dalmo R L Machado
- Interunit Nursing Doctoral Program, College of Nursing of the University of Sao Paulo, Avenida dos Bandeirantes, Campus Universitario, 3900, Ribeirao Preto, SP, 14040-902, Brazil.,School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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15
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Venkatraman C, Subramanian S, Abraham DS, Vellaichamy K. Unilateral Limb Thinning -Thinking Out of the Box. Ann Indian Acad Neurol 2018; 21:74-76. [PMID: 29720803 PMCID: PMC5909151 DOI: 10.4103/aian.aian_416_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report an unusual presentation in a 9-year-old girl with unilateral circumferential thinning of the entire right upper limb without any other neurological deficit, with normal nerve conduction and electromyography initially thought of as a neurodegenerative disorder based on clinical presentation. Magnetic resonance imaging of the upper limb showed partial lipoatrophy with normal glucose metabolism and lipid profile and negativity for HIV and autoimmune disease (panniculitis) with no family history of similar disorder. Remember to think out of box before labeling neurodegenerative disease.
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Affiliation(s)
- Chandramouleeswaran Venkatraman
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India,Address for correspondence: Prof. Chandramouleeswaran Venkatraman, Institute of Neurology, Madras Medical College, Government Rajiv Gandhi General Hospital, Chennai - 600 003, Tamil Nadu, India. E-mail:
| | - Shubha Subramanian
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | - Kannan Vellaichamy
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
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16
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Alencastro PR, Barcellos NT, Wolff FH, Ikeda MLR, Schuelter-Trevisol F, Brandão ABM, Fuchs SC. People living with HIV on ART have accurate perception of lipodystrophy signs: a cross-sectional study. BMC Res Notes 2017; 10:40. [PMID: 28086977 PMCID: PMC5234247 DOI: 10.1186/s13104-017-2377-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/06/2017] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence of lipodystrophy ranges from 31 to 65%, depending on the criteria adopted for diagnosis. The usual methods applied in the diagnosis vary from self-perception, medical examination, skinfolds measurements, or even imaging assessment for confirmation of fat distribution changes. Although several methods have been developed, there is no gold standard for characterization of LA and LH, or mixed forms. This study aimed to compare self-reported signs of lipodystrophy with objective measures by skinfolds and circumferences, and to evaluate the prevalence of lipoatrophy (LA) and lipohypertrophy (LH) among subjects living with HIV/AIDS on ART. Methods A cross-sectional study enrolled participants living with HIV/AIDS receiving ART, aged 18 years or older from an outpatient health care center, in Southern Brazil. Self-reported body fat enlargement in the abdomen, chest or breasts, and dorsocervical fat pad were used to determine LH, while LA was identified by self-reported fat wasting of the face, neck, legs, arms or buttocks. Measurements were obtained with a scientific caliper for infraorbital, buccal, and submandibular skinfolds, and using an inelastic tape to measure circumferences of waist, hip, neck, and arm. LH and LA were established by the presence of at least one self-reported sign. Results Comparisons of self-reported signs with objective measurements for men and women were carried out in 815 participants on ART, out of 1240 participants with HIV infection. Self-report of decreased facial fat and sunken cheeks was associated with lower infraorbital, buccal, and submandibular skinfolds. Participants who reported buffalo hump had, on average, greater neck circumference, as well as those who have increased waist circumference also reported abdominal enlargement, but no buttock wasting. Men were most commonly affected by lipoatrophy (73 vs. 53%; P < 0.001), and women by lipohypertrophy (79 vs. 56%; P < 0.001). Conclusion In conclusion, self-reported signs of lipodystrophy and lipoatrophy are prevalent, differ by gender, and are associated with objective measurements in people living with HIV/AIDS.
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Affiliation(s)
- Paulo R Alencastro
- Hospital Sanatório Partenon, State Department of Health, Rio Grande do Sul. Av. Bento Gonçalves, 3722, Porto Alegre, RS, 90650-001, Brazil.,Post-graduate Program of Collective Health, Universidade do Vale do Rio dos Sinos, Av. Unisinos, 950, São Leopoldo, RS, 93022-750, Brazil
| | - Nemora T Barcellos
- Post-graduate Program of Collective Health, Universidade do Vale do Rio dos Sinos, Av. Unisinos, 950, São Leopoldo, RS, 93022-750, Brazil
| | - Fernando H Wolff
- Postgraduate Studies Program in Sciences in Gastroenterology and Hepatology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, Porto Alegre, RS, 90035-003, Brazil
| | - Maria Letícia R Ikeda
- Post-graduate Program of Collective Health, Universidade do Vale do Rio dos Sinos, Av. Unisinos, 950, São Leopoldo, RS, 93022-750, Brazil.,Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, Porto Alegre, RS, 90035-003, Brazil
| | - Fabiana Schuelter-Trevisol
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, Porto Alegre, RS, 90035-003, Brazil
| | - Ajácio B M Brandão
- Post Graduate Studies Program in Medicine-Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Sandra C Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, Porto Alegre, RS, 90035-003, Brazil. .,Division of Cardiology, Centro de Pesquisa Clínica, 5º andar, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcellos, 2350, Porto Alegre, RS, 90035-903, Brazil.
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17
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Gentile S, Strollo F, Ceriello A. Lipodystrophy in Insulin-Treated Subjects and Other Injection-Site Skin Reactions: Are We Sure Everything is Clear? Diabetes Ther 2016; 7:401-9. [PMID: 27456528 PMCID: PMC5014793 DOI: 10.1007/s13300-016-0187-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Indexed: 01/06/2023] Open
Abstract
Physicians and patients have long been aware of skin lesions at the sites of insulin injections, referred to as lipodystrophy that can present as lipoatrophy (LA) or lipohypertrophy (LH). However, the reported prevalence of these different skin lesions varies widely, emphasizing the need for a correct identification method. In this short review we discuss LA and LH and also take into account other skin lesions, such as bruising, as well as different needle injuries, including those associated with the subcutaneous injection of pegvisomant (a drug aimed at counteracting the high levels of growth hormone associated with acromegaly), long-acting exenatide (a glucagon-like peptide-1 receptor agonist), and anti-tumor necrosis factor-alpha biologic agents (used against Crohn's disease). In these latter cases specific studies are warranted to understand the pathophysiological background and possible prevention. However, the most common lesion is still insulin injection site-related LD, so a strong effort has to be made to avoid the confusion generated by previously misleading classifications which were barely able to reliably distinguish between LA and LH.
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Affiliation(s)
- Sandro Gentile
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Felice Strollo
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
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Abstract
Lipoatrophy is characterized by inflammation and tissue loss in fatty tissue. This disease may be congenital or acquired, primary or secondary. Secondary lipoatrophy develops with infections, collagen tissue diseases, tumors and drug injections. In this report, we present the case of a 14-year-old female patient who developed lipoatrophy following intramuscular steroid injection to both buttocks.
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Affiliation(s)
- Osman Tanrıkulu
- Department of Dermatology, Harran University School of Medicine, Şanliurfa, Turkey
| | - Yavuz Yesilova
- Dermatology Clinic, Health Sciences University, Training and Research Hospital, Van, Turkey
| | - Mustafa Aksoy
- Department of Dermatology, Harran University School of Medicine, Şanliurfa, Turkey
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19
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Chakraborty PP, Biswas SN. Distant site lipoatrophy: a rare complication of subcutaneous insulin therapy. Postgrad Med J 2015; 92:57-8. [PMID: 26561591 DOI: 10.1136/postgradmedj-2015-133639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/20/2015] [Indexed: 11/03/2022]
Affiliation(s)
| | - Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
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20
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Saberi S, Esfandiari NH, MacEachern MP, Tan MH. Detemir plus aspart and glulisine induced lipoatrophy: 2015 literature review and report of a new case. Clin Diabetes Endocrinol 2015; 1:10. [PMID: 28702229 PMCID: PMC5471683 DOI: 10.1186/s40842-015-0013-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the first and only literature review, conducted in 2009, of human insulin analog- induced lipoatrophy, there were 12 published cases, including 1 with aspart, 1 with detemir, 1 with NovoMix 30 and none with detemir plus aspart. It is perceived that insulin analog induced-lipoatrophy is increasing. We conducted a 2015 literature review of published reports of lipoatrophy induced by aspart, detemir, detemir plus aspart, and NovoMix30. We also report a new case of detemir plus aspart and glulisine induced lipoatrophy. METHODS Our focused literature searches (limited to 1995-2014) in PubMed, Embase, and Web of Science, using a combination of insulin analog and lipoatrophy terminology, was conducted in early January 2015. RESULTS From the 520 unique citations there were 33 (from 13 papers and 9 abstracts) lipoatrophy cases induced by detemir (n = 5), aspart (n = 21), detemir plus aspart (n = 4) and NovoMix 30 (n = 3), representing 30 new cases since 2009. Many of these reported cases were females (76 %), had type 1 diabetes mellitus (T1DM) (94 %) and were in young persons (61 %). A 41-year-old T1DM woman developed lipoatrophy on her upper thighs, arms and abdomen 14 months after injecting detemir plus aspart at the same sites. Later on, after a year on continuous subcutaneous insulin infusion (CSII) using aspart and then glulisine, she developed lipoatrophy at the infusion sites. When CSII insulin was switched to lispro she did not develop lipoatrophy after 10 months. Meanwhile, the original lipoatrophy sites significantly improved. CONCLUSIONS Our literature review uncovered 30 new published cases of aspart, detemir, aspart plus detemir and NovoMix 30-induced lipoatrophy since 2009. The largest increase in cases was in aspart- induced lipoatrophy. Recent surveys showed most rapid acting insulin analog-induced lipoatrophy were associated with CSII. In our review of the reported cases, 85.7 % cases of aspart-induced lipoatrophy were associated with CSII. As in previous reports, we showed lipoatrophy was more common in females, T1DM and young persons. Our patient may be the 5th published case of detemir plus aspart-induced lipoatrophy and possibly the first case report of glulisine induced lipoatrophy. She believed both detemir plus aspart and glulisine induced the lipoatrophy.
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Affiliation(s)
- Sima Saberi
- Ann Arbor Endocrinology and Diabetes, PC, Ypsilanti, Michigan USA
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Lobby C, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106 USA
| | - Mark P MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan USA
| | - Meng H Tan
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Lobby C, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106 USA
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21
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Abrahams Z, Dave JA, Maartens G, Levitt NS. Changes in blood pressure, glucose levels, insulin secretion and anthropometry after long term exposure to antiretroviral therapy in South African women. AIDS Res Ther 2015; 12:24. [PMID: 26251665 PMCID: PMC4526419 DOI: 10.1186/s12981-015-0065-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/28/2015] [Indexed: 12/27/2022] Open
Abstract
Background A number of metabolic abnormalities, such as dysglycaemia, insulin resistance, lipodystrophy and dyslipidaemia, are associated with the use of antiretroviral drugs. We aimed to assess the effects of long-term antiretroviral exposure on blood pressure, glycaemia, insulin secretion and anthropometric measures in black South African women. Methods A convenience sample of HIV-infected women on first-line ART for a median of 16 months at baseline, had the following evaluations twice, at baseline and after approximately 5 years: anthropometry, including skin fold thicknesses, blood pressure, oral glucose test, and insulin. Insulin sensitivity and secretion (HOMA-IR, IGI and DIo) were estimated. Results At baseline more than half the 103 women were using stavudine and efavirenz. The median interval between baseline and follow-up evaluation was 66 months. Weight, waist circumference, and waist-hip ratio increased over time, while limb skinfold thickness decreased over time. Systolic and diastolic blood pressure increased significantly and the proportion of participants with hypertension increased from 3.9 to 15.5% (p < 0.001). There were increases from baseline in plasma glucose concentrations at 30 and 120 min; insulin concentrations at 0 and 30 min; and IGI and DIo. The proportion of participants with diabetes increased from 1 to 7.5% (p = 0.070). Conclusion In black South African women with long-term exposure to ART, increases in hypertension and possibly diabetes were observed. Participants experienced an increase in central fat and a decrease in peripheral fat distribution. Early identification and management of these metabolic changes are important, especially in a region with the highest HIV-infected population in the world.
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Kumar NS, Shashibhushan J, Malappa, Venugopal K, Vishwanatha H, Menon M. Lipodystrophy in Human Immunodeficiency Virus (HIV) Patients on Highly Active Antiretroviral Therapy (HAART). J Clin Diagn Res 2015; 9:OC05-8. [PMID: 26393154 DOI: 10.7860/jcdr/2015/12979.6183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/14/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND In recent years, abnormal lipid deposition (both lipoatrophy and fat redistribution) and its related complications have changed from an anecdotal issue into a major problem for HIV (Human Immunodeficiency Virus) infected patients on HAART (Highly Active Anti-Retroviral Therapy). Lipoatrophy and fat redistribution are potentially stigmatizing complications of HAART and leads to poor adherence among patients. Hence we conducted this study to determine the pattern and to assess various risk factors for maldeposition of lipids in HIV patients. MATERIALS AND METHODS A cross-sectional case series study was conducted in ART PLUS centre, Bellary over a period of 8 months from January to August 2014 in HIV patients on ART to determine risk factors associated with and epidemiological pattern of fat redistribution or atrophy. RESULTS A total of 50 patients with LD {lipodystrophy} (26 with fat redestribution and 24 with lipoatrophy {LA} were diagnosed in this period. Most of them belonged to younger age and was commonly seen in females (76%). Patients with LA had a significantly lower BMI (18.73 ± 7.4), {the p-value being 0.19} compared to LH group (21.54 ± 7.62). The duration of disease was comparable among both groups (6.96 years in LH and 5.79 years in LA group) {p-value is 0.29}. There was a relatively good immunity among these patients with mean CD4 count was 509.23 in LH and 545.91 in LA group {single CD4 count was taken and the p-value was 0.001}. Most of the patients were in TLN (Tenofovir, Lamivudine, Nevirapine) regimen (58%).The duration that patient was on ART before commencement of study varied from patient to patient, but the mean duration was approximately five years in fat redistribution group and 4.5 years in LA group. There were no derangements in lipid and sugar levels among them. CONCLUSION This study shows the need to identify and impact of LD with respect to treatment adherence in young patients especially female patients. Early community based screening for LD by social workers and targeted annual screening might help early detection and awareness about LD. Also adopting the least toxic regimen is one of the main aspects of LD management.
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Affiliation(s)
- N Sunil Kumar
- Post Graduate, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - J Shashibhushan
- Professor, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - Malappa
- Post Graduate, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - K Venugopal
- Post Graduate, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - Huggi Vishwanatha
- Assistant Professor, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - Mahesh Menon
- Post Graduate, Department of General Medicine, Vijayanagara Institute of Medical Sciences, Bellary, Karanataka, India
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Verolet CM, Delhumeau-Cartier C, Sartori M, Toma S, Zawadynski S, Becker M, Bernasconi E, Trellu LT, Calmy A. Lipodystrophy among HIV-infected patients: a cross-sectional study on impact on quality of life and mental health disorders. AIDS Res Ther 2015; 12:21. [PMID: 26097493 PMCID: PMC4475332 DOI: 10.1186/s12981-015-0061-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 06/08/2015] [Indexed: 11/13/2022] Open
Abstract
Background Lipodystrophy (LD) is a frequent adverse event of combination antiretroviral therapy (ART) and occurs mainly in patients exposed to first-generation antiretroviral drugs. The aim of this study was to explore and measure the interaction between LD, mental health, and quality of life of human immunodeficiency virus (HIV) positive individuals seen in a metabolic clinic. Methods We conducted a single-site cross-sectional study including all HIV-infected patients attending the LIPO group and metabolism day clinic at the University Hospitals of Geneva, Switzerland between January 31, 2008 and November 28, 2013. Data on LD were prospectively collected using the HIV Outpatient Study (HOPS) score, the Lipodystrophy Case Definition (LDCD), ART regimens, anthropometric measures, imaging, and standardized questionnaires. Quality of life was evaluated using a visual analog scale of 0–100. Depression and anxiety were assessed using the Beck Depression Inventory and the State Trait Anxiety Inventory scales, respectively. Results One hundred ninety-four patients (54.6% male; 45.4% female; median age, 50 years) on successful ART (median CD4 cell count, 569.0 cells/mm3; median viral load, 20 copies/mL) were evaluated. Among these, 62.7, 63.5 and 35.5% of patients reported at least one body site affected by fat hypertrophy, atrophy or both, respectively. Using the LDCD score conservative definition, including imaging and biological values, 57.8% were diagnosed with LD. Of these, 39.7% suffered from severe/very severe LD. Depression was reported by 35.6% of individuals; 51.9% had anxiety symptoms and 49.5% reported poor quality of life (defined as being inferior to 50% on a scale from 0 to 100%). LD (odds ratio (OR = 5.22, 95% confidence interval (CI) 1.07–25.37, p-value: 0.040), depression (OR = 4.67, 95% CI 1.08–20.31, p-value 0.040), and anxiety (OR = 7.83, 95% CI 1.91–32.03, p-value 0.004) all affected significantly the quality of life. Conclusions LD, depression and anxiety were frequent features among HIV-infected individuals seen in the metabolic clinic and significantly impacted on their quality of life. Electronic supplementary material The online version of this article (doi:10.1186/s12981-015-0061-z) contains supplementary material, which is available to authorized users.
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Abrahams Z, Dave JA, Maartens G, Lesosky M, Levitt NS. The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings. AIDS Res Ther 2014; 11:26. [PMID: 25143778 PMCID: PMC4138415 DOI: 10.1186/1742-6405-11-26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly associated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only recently been phased out and AZT is still widely being used. Several case definitions have been developed to diagnose lipodystrophy, but none of them are generalizable to sub-Saharan Africa where black women have less visceral adipose tissue and more subcutaneous adipose tissue than white women. We aimed to develop a simple, objective measure to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and dual-energy X-ray absorptiometry (DXA) -derived variables. Methods DXA and anthropometric measures were obtained in a cross sectional sample of black HIV-infected South African men (n = 116) and women (n = 434) on ART. Self-reported information on fat gain or fat loss was collected using a standard questionnaire. Receiver operating characteristic (ROC) curves were used to describe the performance of anthropometric and DXA-derived variables using patient reported lipoatrophy and lipohypertrophy as the reference standard. Results Lipoatrophy and lipohypertrophy were more common in women (25% and 33% respectively) than in men (10% and 13% respectively). There were insufficient numbers of men with DXA scans for meaningful analysis. The best predictors of lipoatrophy in women were the anthropometric variables tricep (AUC = 0.725) and thigh skinfold (AUC =0.720) thicknesses; and the DXA-derived variables percentage lower limb fat (AUC = 0.705) and percentage lower limb fat/height (AUC = 0.713). The best predictors of lipohypertrophy in women were the anthropometric variable waist/hip ratio (AUC = 0.645) and the DXA-derived variable percentage trunk fat/percentage limb fat (AUC = 0.647). Conclusions We were able to develop simple, anthropometric measures for defining lipoatrophy and lipohypertrophy, using a sample of black HIV-infected South African women with DXA scans. This is of particular relevance in resource limited settings, where health professionals need simple and inexpensive methods of diagnosing patients with lipoatrophy and lipohypertrophy.
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Abstract
INTRODUCTION Parry-Romberg syndrome (PRS) is a progressive, irreversible disorder characterized by facial lipoatrophy. The patients' physical and psychological well-being is highly affected. The choice of graft for correction of PRS is dictated by numerous factors. This qualitative study aims to present the patients choice of graft for PRS. MATERIALS AND METHODS Reports of experience of patients surgically treated for PRS in the period of 2000-2011 are presented. RESULT A total of 36 patients who had undergone the PRS treatment with fat grafts fulfilled the criteria and were included for the study. Of them 17 (47.2%) were males and 19 (52.8%) were females. For these patients, grafts were obtained from the abdomen in 22 (61.1%) and 14 (38.9%) from the gluteal region. Female PRS patients preferred to have the scar in their gluteal region rather than abdominal region. Similarly, in their immediate postoperative period, most of the patients were apprehensive about the over correction but where satisfied with the long term results of the surgery. DISCUSSION Female PRS patients whose donor site was gluteal region had better perception than those with abdominal grafting. Similarly in immediate postoperative period, they felt that their outcome was not satisfactory. The morphology and metabolic activity of gluteal adipocytes are unique and probably accounts for the better survival rates.
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Affiliation(s)
- S M Balaji
- Director, Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, Tamil Nadu, India
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26
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Kim RJ, Vaghani S, Zifchak LM, Quinn JH, He W, Tebas P, Frank I. In vitro and in vivo effects of IGF-I on adiposity in HIV-associated metabolic disease: a pilot study. Arch Med Res 2013; 44:361-9. [PMID: 23867790 DOI: 10.1016/j.arcmed.2013.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/30/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS We tested the effects of recombinant insulin-like growth factor-I (IGF-I) in an adipocyte model of HIV lipodystrophy and in an open label study on body composition and metabolism in patients with HIV lipodystrophy. METHODS The effects of IGF-I on ritonavir-induced adipocyte cell death were studied in vitro. We assessed lipid accumulation, IGF signaling, apoptosis, and gene expression. We conducted a 24-week open label trial of recombinant IGF-I in ten adults with HIV associated lipoatrophy. Laboratory assessments included glucose, insulin, lipids, and IGF-I. At weeks 0 and 24, body composition studies were performed including skinfold measurement, dual-energy x-ray absorptiometry, and computed tomography of the abdomen and thigh. RESULTS In vitro, ritonavir increased delipidation and apoptosis of adipocytes, whereas co-treatment with IGF-I attenuated the effect. In the clinical study, subcutaneous adipose tissue did not increase in patients after treatment with IGF-I; however, there was a decrease in the proportion of abdominal fat (39.8 ± 7% vs. 34.6 ± 7%, p = 0.007). IGF-I levels increased with treatment (143 ± 28 μg/L at week 0 vs. 453 ± 212 μg/L at week 24, p = 0.002), whereas IGFBP-3 levels declined (3.554 ± 1.146 mg/L vs. 3.235 ± 1.151 mg/L, p = 0.02). Insulin at week 12 decreased significantly (90.1 ± 39.8 pmol/L vs. 33.2 ± 19.6 pmol/L, p = 0.002). There was a nonsignificant decrease in visceral adipose tissue (155.2 ± 68 cm² at week 0 vs. 140.6 ± 70 cm² at week 24, p = 0.08). CONCLUSIONS Use of recombinant IGF-I may lower fasting insulin and abdominal fat in patients with lipoatrophy associated with HIV infection. Further evaluation of this agent for treatment of HIV-associated lipodystrophy may be warranted.
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Affiliation(s)
- Roy J Kim
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
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27
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Lee YB, Kim JE, Park HJ, Cho BK. Two cases of idiopathic localized involutional lipoatrophy. Ann Dermatol 2010; 22:346-8. [PMID: 20711277 DOI: 10.5021/ad.2010.22.3.346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 10/15/2009] [Accepted: 11/20/2009] [Indexed: 11/08/2022] Open
Abstract
Localized involutional lipoatrophy (LIL) is a rare distinctive idiopathic form of localized lipoatrophy. The characteristic features in histopathology of LIL are diminutive fat lobules composed of small adipocyte resembling fetal fat tissue. LIL is not a well-known disorder, there have been only a few reports on LIL in the English literature. We herein report 2 cases of LIL and review the previously published cases.
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Affiliation(s)
- Young Bok Lee
- Department of Dermatology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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28
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Baril JG, Junod P, LeBlanc R, Dion H, Therrien R, Laplante F, Falutz J, Côté P, Hébert MN, Lalonde R, Lapointe N, Lévesque D, Pinault L, Rouleau D, Tremblay C, Trottier B, Trottier S, Tsoukas C, Weiss K. HIV-associated lipodystrophy syndrome: A review of clinical aspects. Can J Infect Dis Med Microbiol 2005; 16:233-43. [PMID: 18159551 PMCID: PMC2095035 DOI: 10.1155/2005/303141] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 03/04/2005] [Indexed: 11/18/2022]
Abstract
Approximately two years after the introduction of highly active antiretroviral therapy for the treatment of HIV infection, body shape changes and metabolic abnormalities were increasingly observed. Initially, these were ascribed to protease inhibitors, but it is now clear that nucleoside reverse transcriptase inhibitors also contribute to lipodystrophy syndrome. The syndrome groups together clinical conditions describing changes in body fat distribution that include lipoatrophy, lipoaccumulation or both. However, there does not appear to be a direct link between lipoatrophy and lipoaccumulation that would support a single mechanism for the redistribution of body fat. Currently, there is no clear definition of lipodystrophy, which explains the difficulty in determining its prevalence and etiology. There are no current guidelines for the treatment of fat distribution abnormalities that occur in the absence of other metabolic complications. The present article reviews the current state of knowledge of the definition, symptoms, risk factors, pathogenesis, diagnosis and treatment of the morphological changes associated with lipodystrophy syndrome.
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Affiliation(s)
- Jean-Guy Baril
- Clinique médicale du Quartier Latin
- Unité hospitalière de recherche, d'enseignement et de soin sur le sida (UHRESS), Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc
- Service de lutte contre les infections transmissibles sexuellement par le sang, ministère de la Santé et des Services sociaux
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Patrice Junod
- Clinique médicale du Quartier Latin
- Unité hospitalière de recherche, d'enseignement et de soin sur le sida (UHRESS), Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Roger LeBlanc
- Clinique Golberg, LeBlanc et Rosengren
- UHRESS, McGill University Health Centre, Royal Victoria Hospital
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Harold Dion
- Clinique médicale L'Actuel
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Rachel Therrien
- UHRESS, CHUM, Hôpital-Dieu de Montréal
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | | | - Julian Falutz
- UHRESS, McGill University Health Centre, Montreal General Hospital
| | - Pierre Côté
- Clinique médicale du Quartier Latin
- Unité hospitalière de recherche, d'enseignement et de soin sur le sida (UHRESS), Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Marie-Nicole Hébert
- Service de lutte contre les infections transmissibles sexuellement par le sang, ministère de la Santé et des Services sociaux
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Richard Lalonde
- UHRESS, McGill University Health Centre, Royal Victoria Hospital
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Normand Lapointe
- UHRESS, Hôpital Sainte-Justine, Centre maternel et infantile sur le sida
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Dominic Lévesque
- Comité des personnes atteintes du VIH du Québec
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Lyse Pinault
- Coalition des organismes communautaires québécois de lutte contre le sida
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Danielle Rouleau
- UHRESS, CHUM, Hôpital Saint-Luc and Hôpital Notre-Dame
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Cécile Tremblay
- UHRESS, CHUM, Hôpital-Dieu de Montréal
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Benoît Trottier
- Unité hospitalière de recherche, d'enseignement et de soin sur le sida (UHRESS), Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc
- Clinique médicale L'Actuel
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Sylvie Trottier
- UHRESS, Centre hospitalier universitaire de Québec
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Chris Tsoukas
- UHRESS, McGill University Health Centre, Montreal General Hospital
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Karl Weiss
- Association des médecins microbiologistes infectiologues du Québec, Hôpital Maisonneuve-Rosemont, Montréal, Québec
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
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