Exogenous H2S initiating Nrf2/GPx4/GSH pathway through promoting Syvn1-Keap1 interaction in diabetic hearts.

Excessive ROS accumulation contributes to cardiac injury in type 2 diabetes mellitus. Hydrogen sulfide (H2S) is a vital endogenous gasotransmitter to alleviate cardiac damage in diabetic cardiomyopathy (DCM). However, the underlying mechanisms remain unclear. In this study, we investigated the effects of NaHS administration in db/db mice via intraperitoneal injection for 20 weeks and the treatment of high glucose (HG), palmitate (PA) and NaHS in HL-1 cardiomyocytes for 48 h, respectively. H2S levels were decreased in hearts of db/db mice and HL-1 cardiomyocytes exposed to HG and PA, which were restored by NaHS. Exogenous H2S activated the nuclear factor erythroid 2-related factor 2 (Nrf2)/glutathione peroxidase 4 (GPx4)/glutathione (GSH) pathway, suppressed ferroptosis and mitigated mitochondrial apoptosis in db/db mice. However, these effects were abrogated after Nrf2 knockdown. NaHS treatment elevated the ubiquitination level of Kelch-like ECH-associated protein (Keap1) by preserving its E3 ligase synoviolin (Syvn1), resulting in Nrf2 nuclear translocation. H2S facilitated the sulfhydration of Syvn1-cys115 site, a post-translational modification. Transfecting Syvn1 C115A in cardiomyocytes exposed to HG and PA partially attenuated the effects of NaHS on Nrf2 and cell death. Our findings suggest that exogenous H2S regulates Nrf2/GPx4/GSH pathway by promoting the Syvn1-Keap1 interaction to reduce ferroptosis and mitochondrial apoptosis in DCM.

Identification of key genes, biological functions, and pathways of empagliflozin by network pharmacology and its significance in the treatment of type 2 diabetes mellitus.

Background: To explore the key genes, biological functions, and pathways of empagliflozin in the treatment of type 2 diabetes mellitus (T2DM) through network pharmacology. Methods: The TCMSP (a traditional Chinese medicine system pharmacology database and analysis platform) was used to screen empagliflozin's active components and targets. The target genes of T2DM were screened according to the GeneCards and OMIM databases, and a Venn diagram was constructed to obtain the target for T2DM treatment. Cytoscape 3.7.2 software was adopted to construct the drug-component-target-disease network. Functional annotation of Gene Ontology (GO) and enrichment analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were performed using R software. Results: Target genes with a probability >0 were selected, among which Compound 012, Compound 060, Compound 093, Compound 111, and Compound 119 Swiss Target Prediction suggested that no similar active substances or predictable target genes were found. A "compound-target gene-disease" network was constructed, in which SLC5A2, SLC5A1, SLC5A4, SLC5A11, ADK, and ADORA2A were the core genes of T2DM. The key factors of the GO summary map included chemical reaction, membrane organelle, protein binding, and so on. The KEGG pathway summary map included the AMPK pathway, insulin resistance, the MAPK pathway, longevity-related pathway regulation, and so on. The top 10 pathways were endocrine resistance, the NF-κB signaling pathway, the HIF-1 signaling pathway, apoptosis, cell senescence, the Ras signaling pathway, the MAPK signaling pathway, the FoxO signaling pathway, the P13K-Akt signaling pathway, and the p53 signaling pathway. The binding of active compounds to key proteins was verified based on the Swiss Dock database, and the molecular docking of 193 bioactive compounds was finally verified. Among them, SLC5A2, SLC5A1, LDHA, KLK1, KLF5, and GSTP1 had better binding to the protein molecules. Conclusions: Empagliflozin may regulate the targets of SLC5A2, SLC5A1, LDHA, KLK1, KLF5, and GSTP1. There are numerous ways of treating T2DM with empagliflozin, including by regulating apoptosis, cell aging, as well as the NF-κB, HIF-1HIF-1, Ras, MAPK, FoxO, P13K-Akt, and p53 pathways.

Metabolomics study on liver of db/db mice treated with curcumin using UPLC-Q-TOF-MS.

A metabolomics method based on ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) was applied to study the metabolic changes of liver in db/db mice administered with curcumin. After one week of acclimating to feeding, 20 db/db mice were randomly divided into two groups: curcumin non-treatment group and curcumin treatment group. After eight weeks of treatment, plasma and liver were collected for biochemical analysis and metabolomics analysis, as well as liver oxidative stress and histopathology examination. Serum biochemical indicators such as blood glucose, triglycerides, fasting insulin, and aspartate aminotransferase decreased significantly in the curcumin treatment group compared to the curcumin non-treatment group, whereas hepatic pathological levels and antioxidation levels improved. There were several different potential biomarkers in two groups, including sphingomyelin (SM) (d18:0/20:0), eicosapentaenoic acid (EPA), docosapentaenoic acid (22n-6) (DPAn-6), arachidonic acid (AA), dihomo-gamma- linolenic acid (DGLA), leukotriene C4 (LTC4), lysophosphatidylethanolamine (LysoPE) (16:1(9Z)/0:0), LysoPE (18:1(9Z)/0:0), LysoPE (0:0/18:0), LysoPE (0:0/20:1(11Z)), LysoPE (20:1(11Z)/0:0), 3-sulfinoalanine, alpha-tocotrienol (α-T3) and pantetheine 4'-phosphate (4'-PP). The mechanism might be related to biosynthesis of unsaturated fatty acids, arachidonic acid metabolism, phospholipid metabolism, and taurine and hypotaurine metabolism. The effects of curcumin on type 2 diabetes mellitus (T2DM) include antioxidant, delaying development of T2DM, preventing ß-cell death, decreasing insulin resistance, alleviating hepatic damage, and improving metabolic disturbances. Our results provide novel insights and ideas for prevention and treatment of curcumin on T2DM and its complications.

Continuous glucose monitoring in diabetes patients with chronic kidney disease on dialysis: a meta-analysis.

INTRODUCTION: This review investigates the effectiveness of continuous glucose monitoring (CGM) in diabetes patients who were on routine dialysis. EVIDENCE ACQUISITION: Literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate: 1) correlations of CGM with other indicators including glycated hemoglobin A1c (HbA1c), glycated albumin and mean amplitude of glucose excursions (MAGE); 2) mean differences (MDs) in CGM and MAGE values between dialysis and off-dialysis days or during vs before dialysis. EVIDENCE SYNTHESIS: There was a good correlation between CGM and self-monitoring of blood glucose values (r=0.837 [95% CI: 0.67, 0.92]). Correlation coefficient between CGM and HbA1c was 0.523 (95% CI: 0.422, 0.604) in diabetes patients on dialysis and 0.592 (95% CI: 0.354, 0.757) in diabetes patients without renal failure. Correlation coefficient between CGM and glycated albumin in diabetes patients on dialysis was 0.544 (95% CI: 0.254, 0.744). Average CGM and MAGE values on dialysis day were not significantly different from those of off-dialysis day in diabetes patients (MDs: -0.40 mmol/L [95% CI: -1.06, 0.26]; P=0.23; and MAGE 0.50 mmol/L [95% CI: -0.01, 1.00]; P=0.05). Compared to pre-dialysis values, average CGM and MAGE values were significantly lower during dialysis in diabetes patients (MDs: -2.11 mmol/L [95% CI: -3.25, -0.97]; P=0.0003 and MAGE -2.24 mmol/L [95% CI: -3.99, -0.50]; P=0.01). CONCLUSIONS: CGM is an efficient method of glycemic monitoring in diabetes patients on dialysis. CGM had similar correlations with HbA1c and glycated albumin.

Comparison of Clinical Efficacy and Safety of Metformin Sustained-Release Tablet (II) (Dulening) and Metformin Tablet (Glucophage) in Treatment of Type 2 Diabetes Mellitus.

Objectives: This study investigated the clinical efficacy and safety of metformin hydrochloride sustained-release (SR) tablet (II) produced by Dulening and the original metformin hydrochloride tablet produced by Glucophage in the treatment of type 2 diabetes mellitus (T2DM). Methods: This randomized, open and parallel controlled clinical trial consecutively recruited a total of 886 patients with T2DM in 40 clinical centers between May 2016 and December 2018. These patients were randomly assigned to the Dulening group (n=446), in which patients were treated with Dulening metformin SR tablets, and the Glucophage group (n=440), in which patients were treated with Glucophage metformin tablets, for 16 weeks. The changes in the levels of glycated hemoglobin (HbAc1) and fasting blood glucose (FBG) as well as weight loss were compared between these two groups. Also, the overall incidence of adverse drug reactions (ADRs) and the incidence of ADR of the gastrointestinal system observed in patients of these two groups were also compared. Results: There were no significant differences in demographic and basal clinical characteristics between these two groups. The Dulening and Glucophage groups showed comparable levels of decrease in HbA1c levels, FBG and weight loss after 12-week treatment (all p>0.05). The Dulening group had a significantly lower overall incidence of ADRs as well as gastrointestinal ADR than the Glucophage group. Conclusions: Metformin SR tablets (II) and the original metformin tablets exhibit similar therapeutic efficacy in the treatment of T2DM, but metformin SR tablets (II) has the significantly lower incidence of ADRs than the original metformin tablets.

Effect of Baseline Characteristics on Hypoglycaemia Risk with Insulin Glargine 100 U/mL: Post Hoc Analysis of the BEYOND 7 Study.

INTRODUCTION: BEYOND 7 demonstrated that a higher starting dose (0.3 U/kg) of insulin glargine 100 U/mL (Gla-100) is as safe as the standard starting dose (0.2 U/kg) in Chinese individuals with type 2 diabetes who had uncontrolled hyperglycaemia despite receiving oral antihyperglycaemic drugs. This post hoc analysis determined the effect of baseline characteristics on hypoglycaemia risk in these individuals. METHODS: Participants from BEYOND 7 were assessed based on their age at baseline (< 60 vs. ≥ 60 years), duration of diabetes (< 10 vs. ≥ 10 years), glycated haemoglobin (HbA1c; < 9 vs. ≥ 9%) and fasting plasma glucose level (FPG; < 11 vs. ≥ 11 mmol/L). Endpoints included the proportion of participants with overall confirmed (≤ 3.9 mmol/L) and symptomatic hypoglycaemia, as well as the proportion of participants who achieved an HbA1c < 7% without hypoglycaemia, the time to first achievement of fasting blood glucose (FBG) < 7 mmol/L and the change in HbA1c from baseline between the two treatment arms in each of these subgroups. RESULTS: The proportion of participants with overall confirmed (6.1-16.7%) or symptomatic hypoglycaemia (5.7-18.4%) or the proportion who achieved HbA1c < 7.0% without hypoglycaemia (23.6-47.4%) was similar between the two treatment arms in all subgroups, with the exception of participants with a baseline duration of diabetes ≥ 10 years who experienced more symptomatic hypoglycaemia if initiating Gla-100 at a dose of 0.3 versus 0.2 U/kg. Participants aged < 60 years with an HbA1c < 9% or ≥ 9% or a duration of diabetes of 2-10 years achieved an FBG < 7.0 mmol/L in a significantly shorter time with Gla-100 starting dose of 0.3 U/kg versus 0.2 U/kg (all p < 0.001). No significant differences were seen among the subgroups in terms of change from baseline in HbA1c. CONCLUSIONS: Baseline age, duration of diabetes, HbA1c level and FPG level do not affect the risk of hypoglycaemia with a higher starting dose of Gla-100 versus its standard starting dose. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02836704.

Exenatide Attenuates Non-Alcoholic Steatohepatitis by Inhibiting the Pyroptosis Signaling Pathway.

Background/Aims: Exenatide is a glucagon-like polypeptide-1 analog, whose main clinical use is to treat type 2 diabetes. However, the mechanism of exenatide in mitigating non-alcoholic steatohepatitis (NASH) remains unclear. This study aimed to investigate the in vitro and in vivo effect of exenatide on NASH. Methods: Leptin receptor-deficient C57BL/KsJ- db/db male mice were fed with methionine-choline-deficient (MCD) diet for 4 weeks to induce NASH, while oleic acid/LPS-treated HepG2 cells were used as an in vitro cell model. Exenatide (20 µg/kg/day, subcutaneous) and specific exenatide inhibitors (20 µg/kg/day, intraperitoneal) were used to determine the effects of exenatide on NASH. Results: Exenatide treatment inhibited the pyroptosis signaling pathway to attenuate NASH. Conclusion: To the best of our knowledge, this report provides the first evidence showing that exenatide attenuated NASH by inhibiting the pyroptosis signaling pathway. Exenatide thus has important pathophysiological functions in NASH and may represent a useful new therapeutic target.

Associations Between Thyroid Hormones Within the Euthyroid Range and Indices of Obesity in Obese Chinese Women of Reproductive Age.

Background: A number of researches have reported that thyroid hormones are associated with obesity. However, the relationship of serum levels of thyroid hormones in the normal range with obesity and parameters of obesity in women of childbearing age remains controversial. The purpose of this study was to examine serum levels of thyroid hormones within the normal range in obese Chinese women of reproductive age and to investigate the relationship between concentration of thyroid hormones and indices of obesity, including body mass index (BMI), waist-to-hip ratio (WHR), insulin resistance, blood glucose, blood lipids, and blood pressure. Methods: One hundred fifty-one obese women of reproductive age and 160 nonobese women of reproductive age were enrolled in this study. Serum levels of thyroid-stimulating hormone (TSH) of all subjects were within the normal reference range (0.35-4.94 mIU/L). The serum levels of free triiodothyronine (FT3), free thyroxine (FT4), and TSH, height, body weight, BMI, waist and hip circumferences, WHR, fasting blood glucose (FBG), fasting insulin (FI), homeostasis model assessment of insulin resistance (HOMA-IR), total triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured in all subjects. Quantile regression analysis was used to analyze the associations of serum levels of FT3, FT4, and TSH with values of BMI, WHR, FBG, FI, HOMA-IR, TG, TC, LDL-C, HDL-C, SBP, and DBP. Results: In the group of obese women, serum levels of FT4 were lower (P < 0.001) and serum levels of TSH were higher (P < 0.001) compared with nonobese controls. After adjusting for covariables, quantile regression analysis showed that serum levels of FT4 were inversely associated with BMI values between the quantile levels of 0.29 and 0.60 of BMI (i.e., BMI level of 22.49 and 28.31 kg/m2, respectively). Meanwhile, we found that serum levels of TSH positively correlated with BMI values after the quantile level of 0.51 (i.e., BMI level of 27.06 kg/m2), positively associated with TC after the quantile level of 0.6 (i.e., TC level of 4.86 mM), and positively associated with LDL-C after the quantile level of 0.39 (i.e., LDL level of 1.96 mM). No significant associations were found between serum levels of thyroid hormones and values of WHR, FBG, FI, HOMA-IR, TG, HDL-C, SBP, and DBP. Conclusions: FT4 and TSH play an important role in regulating the weight in women with normal thyroid function during their reproductive years. Women with decreased serum FT4 or increased serum TSH levels have a higher risk of developing obesity. Besides, TSH has a significant influence on metabolism of blood lipids. Women with higher serum levels of TSH have a higher risk of incidence of lipid metabolism disorders.

Measurement of hydroxyproline in collagen with three different methods.

Determination of the 4-hydroxy-l-proline (hydroxyproline) concentration may provide useful information for the diagnosis and prognosis of diseases caused by disorders of collagen metabolism. The objective of the present study was to apply liquid chromatography-mass spectrometry (LC-MS) to assess the hydroxyproline concentration. The hydroxyproline concentration in lung and liver tissues measured by LC-MS was compared with values obtained by a colorimetric method, as well as a fluorescence method using high-performance liquid chromatography (HPLC) from previous studies by our group. The determination of the hydroxyproline concentration by LC-MS was improved as compared with that using the colorimetric and HPLC methods, due to its simplicity, high sensitivity (pg level) and short separation time. These results suggested that utilizing the LC-MS method for measuring the hydroxyproline concentration would be advantageous for the diagnosis of diseases associated with abnormalities of collagen metabolism.