Novel Urinary Glycan Biomarkers Predict Cardiovascular Events in Patients With Type 2 Diabetes: A Multicenter Prospective Study With 5-Year Follow Up (U-CARE Study 2).

Background: Although various biomarkers predict cardiovascular event (CVE) in patients with diabetes, the relationship of urinary glycan profile with CVE in patients with diabetes remains unclear. Methods: Among 680 patients with type 2 diabetes, we examined the baseline urinary glycan signals binding to 45 lectins with different specificities. Primary outcome was defined as CVE including cardiovascular disease, stroke, and peripheral arterial disease. Results: During approximately a 5-year follow-up period, 62 patients reached the endpoint. Cox proportional hazards analysis revealed that urinary glycan signals binding to two lectins were significantly associated with the outcome after adjustment for known indicators of CVE and for false discovery rate, as well as increased model fitness. Hazard ratios for these lectins (+1 SD for the glycan index) were UDA (recognizing glycan: mixture of Man5 to Man9): 1.78 (95% CI: 1.24-2.55, P = 0.002) and Calsepa [High-Man (Man2-6)]: 1.56 (1.19-2.04, P = 0.001). Common glycan binding to these lectins was high-mannose type of N-glycans. Moreover, adding glycan index for UDA to a model including known confounders improved the outcome prediction [Difference of Harrel's C-index: 0.028 (95% CI: 0.001-0.055, P = 0.044), net reclassification improvement at 5-year risk increased by 0.368 (0.045-0.692, P = 0.026), and the Akaike information criterion and Bayesian information criterion decreased from 725.7 to 716.5, and 761.8 to 757.2, respectively]. Conclusion: The urinary excretion of high-mannose glycan may be a valuable biomarker for improving prediction of CVE in patients with type 2 diabetes, and provides the rationale to explore the mechanism underlying abnormal N-glycosylation occurring in patients with diabetes at higher risk of CVE. Trial Registration: This study was registered with the University Hospital Medical Information Network on June 26, 2012 (Clinical trial number: UMIN000011525, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000013482).

Identification of Novel Urinary Biomarkers for Predicting Renal Prognosis in Patients With Type 2 Diabetes by Glycan Profiling in a Multicenter Prospective Cohort Study: U-CARE Study 1.

OBJECTIVE: Because quantifying glycans with complex structures is technically challenging, little is known about the association of glycosylation profiles with the renal prognosis in diabetic kidney disease (DKD). RESEARCH DESIGN AND METHODS: In 675 patients with type 2 diabetes, we assessed the baseline urinary glycan signals binding to 45 lectins with different specificities. The end point was a decrease of estimated glomerular filtration rate (eGFR) by ≥30% from baseline or dialysis for end-stage renal disease. RESULTS: During a median follow-up of 4.0 years, 63 patients reached the end point. Cox proportional hazards analysis revealed that urinary levels of glycans binding to six lectins were significantly associated with the outcome after adjustment for known indicators of DKD, although these urinary glycans, except that for DBA, were highly correlated with baseline albuminuria and eGFR. Hazard ratios for these lectins were (+1 SD for the glycan index) as follows: SNA (recognizing glycan Siaα2-6Gal/GalNAc), 1.42 (95% CI 1.14-1.76); RCA120 (Galß4GlcNAc), 1.28 (1.01-1.64); DBA (GalNAcα3GalNAc), 0.80 (0.64-0.997); ABA (Galß3GalNAc), 1.29 (1.02-1.64); Jacalin (Galß3GalNAc), 1.30 (1.02-1.67); and ACA (Galß3GalNAc), 1.32 (1.04-1.67). Adding these glycan indexes to a model containing known indicators of progression improved prediction of the outcome (net reclassification improvement increased by 0.51 [0.22-0.80], relative integrated discrimination improvement increased by 0.18 [0.01-0.35], and the Akaike information criterion decreased from 296 to 287). CONCLUSIONS: The urinary glycan profile identified in this study may be useful for predicting renal prognosis in patients with type 2 diabetes. Additional investigation of glycosylation changes and urinary glycan excretion in DKD is needed.

An empirical test of formal equivalence between Emmert's law and the size-distance invariance hypothesis.

Emmert's law and the size-distance invariance hypothesis have been said to be formally equivalent, provided that Emmert's law means that the perceived size of an afterimage is proportional to the perceived distance of the projected surface of the afterimage. However, there have been very few studies that have attempted to verify this formal equivalence empirically. We measured both the perceived size and distance of afterimages and real objects with the same proximal size. Nineteen participants projected afterimages of 1 deg in visual angle on the wall located at distances of 1 to 23 meters from the participants. They also observed real objects, disc-shaped and made from a sheet of Styrofoam board, with the same proximal size as that of the afterimages, which were located at the same physical distances as those of the wall on which the afterimages were projected. Each participant reproduced the apparent sizes of the afterimages and real objects using the reproduction method and estimated the apparent distances using the magnitude estimation method. When the mean apparent sizes of the afterimages and real objects, represented as a function of apparent distance, were fitted to a linear function, the slopes for the afterimages and real objects did not differ significantly. These results are interpreted as evidence for the formal equivalence of Emmert's law and the size-distance invariance hypothesis.

Verification of Emmert's law in actual and virtual environments.

We examined Emmert's law by measuring the perceived size of an afterimage and the perceived distance of the surface on which the afterimage was projected in actual and virtual environments. The actual environment consisted of a corridor with ample cues as to distance and depth. The virtual environment was made from the CAVE of a virtual reality system. The afterimage, disc-shaped and one degree in diameter, was produced by flashing with an electric photoflash. The observers were asked to estimate the perceived distance to surfaces located at various physical distances (1 to 24 m) by the magnitude estimation method and to estimate the perceived size of the afterimage projected on the surfaces by a matching method. The results show that the perceived size of the afterimage was directly proportional to the perceived distance in both environments; thus, Emmert's law holds in virtual as well as actual environments. We suggest that Emmert's law is a specific case of a functional principle of distance scaling by the visual system.