Are There Differences in Gut Microbiome in Patients with Type 2 Diabetes Treated by Metformin or Metformin and Insulin?

Introduction: Recently, gut microbiota has been described as being involved in the health and diseases of the host, and together with diet and drugs may influence metabolic health. Yet, there is still no answer which type of treatment plays the most important role in the interplay of gut microbiota and type of treatment for type 2 diabetes (T2DM). An attempt was made to answer the question of which factors have the most significant impact on the intestinal microbiome in the context of metformin or metformin+insulin use in treatment of the patients with T2DM. Thus the aim of the study was to compare the gut microbiome profiles of patients with T2DM and two of the most traditional treatment methods. Methods: T2DM patients treated by metformin (Met) and metformin+insulin (Met+Ins), with the treatment duration of 5-10 years were enrolled. Biochemically blood glucose and glycated hemoglobin (HbA1c), lipids and kidney function were investigated and the quantitative and qualitative examination of the fecal intestinal flora were performed through the next-generation sequencing. Results: There were no significant differences in the study of the gut microbiome: the dominant bacterial phyla were Firmicutes and Verrucomicrobia, while Bacteroidetes and Proteobacteria shared smaller proportions in both groups. However, the group Met+Ins had worse metabolic control in terms of blood glucose and HbA1c in comparison with the Met group. Conclusion: As there are no differences in gut microbiome in T2DM patients treated with metformin only or metformin plus insulin, adding insulin in the treatment of T2DM may delay late diabetic complications development.

Expression Profiles of Toll-Like Receptors in the Differentiation of an Infection with Borrelia burgdorferi Sensu Lato Spirochetes.

The similarity of Lyme borreliosis to other diseases and its complex pathogenesis present diagnostic and therapeutic difficulties. The changes that occur at the cellular and molecular levels after a Borrelia sp. infection still remain poorly understood. Therefore, the present study focused on the expression of TLR and TLR-signaling genes in human dermal fibroblasts in the differentiation of an infection with Borrelia burgdorferi sensu lato spirochetes. Normal human dermal fibroblasts were cultured with the spirochetes of Borrelia burgdorferi sensu stricto, Borrelia afzelii and Borrelia garinii. Total RNA was extracted from the cells using TRIzol reagent. The analysis of the expression profiles of TLRs and TLR-related genes was performed using commercially available oligonucleotide microarrays of HG-U133A. The GeneSpring 12.0 platform and significance analysis of microarrays were used for the statistical analysis of microarray data. The analyses using the oligonucleotide microarray and QRT-PCR techniques permitted to identify the genes encoding TLR4 and TLR6 as specific for infection with B. afzelii and B. burgdorferi sensu stricto. In turn, TLR3 was only characteristic for an infection with B. burgdorferi sensu stricto. There were no changes in the TLR gene expression after infection with B. garinii. Our findings confirm that Borrelia has a major effect on fibroblast gene expression. Further characterization of changes in gene expression may lead to valuable insights into the role of the toll-like receptor in the pathogenesis of Lyme disease and may provide guidelines for the development of diagnostic markers for an infection with a particular Borrelia genospecies. Moreover, this will help to identify better treatment strategies for Lyme disease.