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1.
Diabetes Obes Metab ; 19(5): 729-733, 2017 05.
Article in English | MEDLINE | ID: mdl-27891769

ABSTRACT

In view of the known vasodilatory effects of glucagon-like peptide-1 and exenatide, we investigated the effects of exenatide on vasoactive factors. We analysed blood samples and mononuclear cells (MNCs) from a previous study, collected after a single dose and 12 weeks of exenatide or placebo treatment in a series of 24 patients with type 2 diabetes mellitus. After exenatide treatment, plasma concentrations of atrial natriuretic peptide, cyclic guanyl monophosphate (cGMP) and cyclic adenyl monophosphate increased significantly at 12 weeks. Plasma cGMP and adenylate cyclase expression in MNCs increased significantly after a single dose. Angiotensinogen concentration fell significantly 2 hours after a single dose and at 12 weeks, while renin and angiotensin II levels fell significantly only after a single dose and not after 12 weeks of treatment. Exenatide also suppressed the plasma concentration of transforming growth factor-ß and the expression of P311 in MNCs at 12 weeks. Thus, exenatide induces an increase in a series of vasodilators, while suppressing the renin-angiotensin system. These changes may contribute to the overall vasodilatory effect of exenatide.


Subject(s)
Antihypertensive Agents/therapeutic use , Atrial Natriuretic Factor/agonists , Gene Expression Regulation/drug effects , Glucagon-Like Peptide 1/agonists , Leukocytes, Mononuclear/drug effects , Nerve Tissue Proteins/antagonists & inhibitors , Oncogene Proteins/antagonists & inhibitors , Peptides/therapeutic use , Venoms/therapeutic use , Adenylyl Cyclases/chemistry , Adenylyl Cyclases/genetics , Adenylyl Cyclases/metabolism , Angiotensinogen/antagonists & inhibitors , Angiotensinogen/blood , Anti-Obesity Agents/therapeutic use , Atrial Natriuretic Factor/blood , Blood Pressure/drug effects , Cyclic AMP/agonists , Cyclic AMP/blood , Cyclic GMP/agonists , Cyclic GMP/blood , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/immunology , Diabetes Mellitus, Type 2/metabolism , Exenatide , Glucagon-Like Peptide 1/metabolism , Humans , Hypoglycemic Agents/therapeutic use , Leukocytes, Mononuclear/immunology , Leukocytes, Mononuclear/metabolism , Nerve Tissue Proteins/genetics , Nerve Tissue Proteins/metabolism , Obesity/blood , Obesity/drug therapy , Obesity/immunology , Obesity/metabolism , Oncogene Proteins/genetics , Oncogene Proteins/metabolism , Renin-Angiotensin System/drug effects , Reproducibility of Results , Single-Blind Method , Transforming Growth Factor beta/antagonists & inhibitors , Transforming Growth Factor beta/blood
2.
Diabetes Obes Metab ; 19(9): 1306-1311, 2017 09.
Article in English | MEDLINE | ID: mdl-28304146

ABSTRACT

In view of the occurrence of diabetic ketoacidosis associated with the use of sodium-glucose transport protein-2 inhibitors in patients with type 1 diabetes (T1DM) and the relative absence of this complication in patients treated with liraglutide in spite of reductions in insulin doses, we investigated the effect of liraglutide on ketogenesis. Twenty-six patients with inadequately controlled T1DM were randomly divided into 2 groups of 13 patients each. After an overnight fast, patients were injected, subcutaneously, with either liraglutide 1.8 mg or with placebo. They were maintained on their basal insulin infusion and were followed up in our clinical research unit for 5 hours. The patients injected with placebo maintained their glucose and glucagon concentrations without an increase, but there was a significant increase in free fatty acids (FFA), acetoacetate and ß-hydoxybutyrate concentrations. In contrast, liraglutide significantly reduced the increase in FFA, and totally prevented the increase in acetoacetate and ß-hydroxybutyrate concentrations while suppressing glucagon and ghrelin concentrations. Thus, a single dose of liraglutide is acutely inhibitory to ketogenesis.


Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Glucagon-Like Peptide-1 Receptor/agonists , Glucagon/antagonists & inhibitors , Hypoglycemic Agents/therapeutic use , Ketone Bodies/antagonists & inhibitors , Lipolysis/drug effects , Liraglutide/therapeutic use , Adult , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/metabolism , Double-Blind Method , Drug Resistance , Drug Therapy, Combination , Fatty Acids, Nonesterified/antagonists & inhibitors , Fatty Acids, Nonesterified/blood , Female , Ghrelin/antagonists & inhibitors , Ghrelin/blood , Glucagon/blood , Glucagon-Like Peptide-1 Receptor/metabolism , Humans , Hypoglycemic Agents/administration & dosage , Injections, Subcutaneous , Insulin/administration & dosage , Insulin/therapeutic use , Insulin Infusion Systems , Ketone Bodies/biosynthesis , Ketone Bodies/blood , Liraglutide/administration & dosage , Male , Middle Aged
3.
Clin Endocrinol (Oxf) ; 85(5): 772-780, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27292585

ABSTRACT

CONTEXT: As the syndrome of hypogonadotropic hypogonadism (HH) is associated with anaemia and the administration of testosterone restores haematocrit to normal, we investigated the potential underlying mechanisms. DESIGN: Randomized, double-blind, placebo-controlled trial. METHODS: We measured basal serum concentrations of erythropoietin, iron, iron binding capacity, transferrin (saturated and unsaturated), ferritin and hepcidin and the expression of ferroportin and transferrin receptor (TR) in peripheral blood mononuclear cells (MNC) of 94 men with type 2 diabetes. Forty-four men had HH (defined as subnormal free testosterone along with low or normal LH concentrations) while 50 were eugonadal. Men with HH were randomized to testosterone or placebo treatment every 2 weeks for 15 weeks. Blood samples were collected at baseline, 3 and 15 weeks after starting treatment. Twenty men in testosterone group and 14 men in placebo group completed the study. RESULTS: Haematocrit levels were lower in men with HH (41·1 ± 3·9% vs 43·8 ± 3·4%, P = 0·001). There were no differences in plasma concentrations of hepcidin, ferritin, erythropoietin, transferrin or iron, or in the expression of ferroportin or TR in MNC among HH and eugonadal men. Haematocrit increased to 45·3 ± 4·5%, hepcidin decreased by 28 ± 7% and erythropoietin increased by 21 ± 7% after testosterone therapy (P < 0·05). There was no significant change in ferritin concentrations, but transferrin concentration increased while transferrin saturation and iron concentrations decreased (P < 0·05). Ferroportin and TR mRNA expression in MNC increased by 70 ± 13% and 43 ± 10%, respectively (P < 0·01), after testosterone therapy. CONCLUSIONS: The increase in haematocrit following testosterone therapy is associated with an increase in erythropoietin, the suppression of hepcidin, and an increase in the expression of ferroportin and TR.


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Ferritins/drug effects , Hepcidins/drug effects , Hypogonadism/drug therapy , Iron/metabolism , Testosterone/pharmacology , Adult , Aged , Cation Transport Proteins/biosynthesis , Cation Transport Proteins/blood , Diabetes Mellitus, Type 2/blood , Double-Blind Method , Erythropoietin/blood , Ferritins/blood , Hematocrit , Hepcidins/blood , Humans , Hypogonadism/blood , Iron/blood , Leukocytes, Mononuclear/metabolism , Male , Middle Aged , Receptors, Transferrin/biosynthesis , Receptors, Transferrin/blood
4.
Am J Physiol Endocrinol Metab ; 308(3): E185-91, 2015 Feb 01.
Article in English | MEDLINE | ID: mdl-25406260

ABSTRACT

This study was conducted to investigate whether a high-fat/high-carbohydrate (HFHC) meal induces an increase in plasma concentrations of glucagon, dipeptidyl peptidase-IV (DPP-IV), and CD26 expression in mononuclear cells (MNC) while reducing insulin, C-peptide, proinsulin, GIP, and GLP-1 concentrations. Ten healthy normal subjects were given either a 910-calorie HFHC meal or an American Heart Association (AHA) meal rich in fruit and fiber during the first visit and the other meal during the second visit in crossover design. Blood samples were collected at baseline and at 15, 30, 45, 60, 75, 90, 120, 180, and 300 min following the meal. There was a significantly greater increase in glucose concentrations and lower increase in postprandial insulin, C-peptide, and proinsulin concentrations and lower insulin/glucose ratios following the HFHC meal. HFHC meal intake induced marked increases in plasma glucagon and DPP-IV concentrations and an increase in CD26 mRNA expression in MNC compared with the AHA meal. In addition, the HFHC meal induced a reduction in GIP and peak GLP-1 secretion compared with the AHA meal. This was associated with a significantly greater increase in oxidative stress and proinflammatory mediators including, ROS generation, TNFα, and IL-1ß mRNA expression and plasma concentrations of TBARS, FFA, and LPS. We conclude that the proinflammatory HFHC meals result in lower insulin, C-peptide, proinsulin, and GIP secretion in association with higher plasma glucagon and DPP-IV concentrations and CD26 expression in MNC compared with the AHA meal.


Subject(s)
Diet, High-Fat , Dietary Fiber/administration & dosage , Fruit , Glucagon/blood , Incretins/blood , Insulin/metabolism , Adult , Dietary Fats/administration & dosage , Down-Regulation/drug effects , Female , Humans , Insulin/blood , Insulin Secretion , Male , Meals , Middle Aged , Up-Regulation/drug effects , Young Adult
5.
J Clin Endocrinol Metab ; 105(4)2020 04 01.
Article in English | MEDLINE | ID: mdl-31858126

ABSTRACT

CONTEXT: Adenosine 5'-monophosphate-activated protein kinase-α (AMPKα) is a mediator of exercise-induced glucose uptake in skeletal muscle. OBJECTIVE: We evaluated whether AMPKα expression and phosphorylation are reduced in skeletal muscle and adipose tissue of patients with hypogonadotropic hypogonadism (HH), and whether testosterone replacement therapy results in restoration of the expression and phosphorylation of AMPKα. DESIGN: This is a secondary analysis of a previously completed trial that showed an insulin-sensitizing effect of testosterone therapy in men with type 2 diabetes and HH. SETTING: Clinical research center at university. PATIENTS: Thirty-two men with HH and 32 eugonadal men were compared at baseline. INTERVENTIONS: Men with HH were treated with intramuscular injections of testosterone or placebo every 2 weeks for 22 weeks. Quadriceps muscle biopsies and subcutaneous abdominal fat biopsies were obtained before and after 4-hour euglycemic hyperinsulinemic clamp, prior to and after testosterone or placebo therapy. OUTCOME MEASURES AND RESULTS: mRNA expression of AMPKα in hypogonadal men was lower by 37% in adipose tissue and 29% in skeletal muscle, respectively, compared with levels in eugonadal men, while phosphorylated AMPKα was lower by 22% and 28%, respectively. Following testosterone replacement, the expression of AMPKα did not alter in the fasting state but increased markedly by 41% and 46% in adipose tissue and muscle, respectively, after the clamp. In contrast, phosphorylated AMPKα increased by 69% in muscle after testosterone therapy but did not change following the clamp. CONCLUSIONS: Testosterone modulates the expression of AMPKα and phosphorylated AMPKα. These effects may contribute to the improved insulin sensitivity following testosterone therapy.


Subject(s)
AMP-Activated Protein Kinases/metabolism , Diabetes Mellitus, Type 2/physiopathology , Hormone Replacement Therapy/methods , Hypogonadism/drug therapy , Testosterone/pharmacology , Adult , Aged , Biomarkers/analysis , Follow-Up Studies , Humans , Hypogonadism/enzymology , Hypogonadism/epidemiology , Male , Middle Aged , Phosphorylation , Prognosis , United States/epidemiology
6.
J Endocr Soc ; 3(8): 1617-1630, 2019 Aug 01.
Article in English | MEDLINE | ID: mdl-31403089

ABSTRACT

CONTEXT: One-third of men with type 2 diabetes have subnormal free testosterone concentrations. We evaluated the following: (i) whether bone mineral density (BMD) and bone strength are affected by gonadal status in type 2 diabetes and (ii) the effect of testosterone replacement on markers of osteoblast and osteoclast activity. DESIGN: This is a secondary analysis of a previously completed, randomized, placebo-controlled trial. Ninety-four men with type 2 diabetes were recruited; 44 had subnormal free testosterone concentrations. Men with subnormal free testosterone concentrations were randomized to receive intramuscular injections of testosterone or placebo every 2 weeks for 22 weeks. Dual energy X-ray absorptiometry scans were performed at baseline and at 23 weeks. RESULTS: Men with subnormal free testosterone had similar BMD compared with men with normal free testosterone. However, bone strength indices were lower in men with subnormal free testosterone. BMD was related to free estradiol concentrations (r = 0.37, P = 0.004 at hip), whereas bone strength was related to free testosterone concentrations (r = 0.41, P < 0.001). Testosterone replacement increased osteocalcin concentrations [mean change (95% CI), 3.52 (0.45, 6.59), P = 0.008]. C-Terminal telopeptide (CTx) concentrations also increased at 15 weeks but reverted to baseline following that. There were no changes in other bone turnover markers or BMD. CONCLUSION: We conclude that testosterone replacement resulted in an increase in osteocalcin and a transient increase in CTx, indicating an increase in osteoblastic activity and transient increase in bone breakdown. Therefore, a major action of testosterone is to increase bone turnover in men with type 2 diabetes.

7.
J Clin Endocrinol Metab ; 104(6): 2094-2102, 2019 06 01.
Article in English | MEDLINE | ID: mdl-30629183

ABSTRACT

CONTEXT: Fibroblast growth factor (FGF)2 is an important stimulatory modulator of satellite cells in skeletal muscle. Satellite cells play a cardinal role in muscle growth and repair. OBJECTIVE: We evaluated whether skeletal muscle expression of FGF2 and muscle growth and differentiation factors are reduced in patients with hypogonadotropic hypogonadism (HH) and whether testosterone replacement therapy results in their restoration. DESIGN: This is a secondary analysis of a previously completed trial of testosterone replacement in men with type 2 diabetes and HH. SETTING: Clinical Research Center at a university. PATIENTS: Twenty-two men with HH and 20 eugonadal men were compared at baseline. INTERVENTIONS: Twelve men with HH were treated with intramuscular injections of 250 mg testosterone every 2 weeks for 22 weeks, and 10 men received placebo injections. Quadriceps muscle biopsies and blood samples were obtained before and after testosterone therapy. OUTCOME MEASURES AND RESULTS: The expression of FGF2 and FGF receptor (FGFR)2 in skeletal muscle of men with HH was significantly lower than that in eugonadal men by 57% and 39%, respectively (P < 0.05). After 22 weeks of testosterone, the expression of FGF2 increased, whereas that of myogenic regulatory factor (MRF)4 and myostatin decreased significantly. There was no change in expression of FGFR2, myogenin, or myogenic differentiation protein in the skeletal muscle. Plasma FGF2 and IGF-1 concentrations increased after testosterone therapy. CONCLUSIONS: These data show that testosterone is a major modulator of FGF2, MRF4, and myostatin expression in skeletal muscle. These effects may contribute to the increase in muscle mass after testosterone therapy.


Subject(s)
Fibroblast Growth Factor 2/blood , Hypogonadism/drug therapy , Muscle, Skeletal/drug effects , Myogenic Regulatory Factors/genetics , Myostatin/blood , Testosterone/pharmacology , Adult , Aged , Fibroblast Growth Factor 2/genetics , Humans , Hypogonadism/physiopathology , Insulin-Like Growth Factor I/analysis , Male , Middle Aged , Muscle, Skeletal/growth & development , Muscle, Skeletal/metabolism , Receptor, Fibroblast Growth Factor, Type 2/genetics
8.
Eur J Endocrinol ; 181(6): K55-K59, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31618707

ABSTRACT

AIMS: Insulin has anabolic effects on skeletal muscle. However, there is limited understanding of the molecular mechanisms underlying this effect in humans. We evaluated whether the skeletal muscle expression of satellite cell activator fibroblast growth factor 2 (FGF2) and muscle growth and differentiation factors are modulated acutely by insulin during euglycemic-hyperinsulinemic clamp (EHC). DESIGN AND METHODS: This is a secondary investigation and analysis of samples obtained from a previously completed trial investigating the effect of testosterone replacement in males with hypogonadotropic hypogonadism and type 2 diabetes. Twenty men with type 2 diabetes underwent quadriceps muscle biopsies before and after 4 h of EHC. RESULTS: The infusion of insulin during EHC raised the expression of myogenic growth factors, myogenin (by 72 ± 20%) and myogenin differentiation protein (MyoD; by 81 ± 22%). Insulin reduced the expression of muscle hypertrophy suppressor, myogenic regulatory factor 4 (MRF4) by 34 ± 14%. In addition, there was an increase in expression of FGF receptor 2, but not FGF2, following EHC. The expression of myostatin did not change. CONCLUSIONS: Insulin has an acute potent effect on expression of genes that can stimulate muscle differentiation and growth.


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/metabolism , Insulin/therapeutic use , Muscle, Skeletal/drug effects , Muscle, Skeletal/metabolism , Absorptiometry, Photon , Adult , Aged , Cell Differentiation/drug effects , Glucose Clamp Technique , Humans , Hypogonadism/drug therapy , Hypogonadism/metabolism , Male , Middle Aged , Myogenic Regulatory Factors/metabolism , Receptors, Fibroblast Growth Factor/metabolism , Reverse Transcriptase Polymerase Chain Reaction
9.
Case Rep Endocrinol ; 2018: 8270936, 2018.
Article in English | MEDLINE | ID: mdl-30356346

ABSTRACT

We report the case of a 54-year-old Caucasian female who presented with a two-year history of persistent hypocalcemia requiring multiple hospitalizations. Her medical history was significant for HIV diagnosed four years ago. She denied any history of prior neck surgery or radiation. Her vital signs were stable with an unremarkable physical exam. Pertinent medications included calcium carbonate, vitamin D3, calcitriol, efavirenz, emtricitabine, tenofovir disoproxil, hydrochlorothiazide, and inhaled budesonide/formoterol. Laboratory testing showed total calcium of 5.7 mg/dL (normal range: 8.4-10.2 mg/dL), ionized calcium of 2.7 mg/dL (normal range: 4.5-5.5 mg/dL), serum phosphate of 6.3 mg/dL (normal range: 2.7-4.5 mg/dL), and intact PTH of 7.6 pg/mL (normal range: 15-65 pg/mL). She was diagnosed with primary hypoparathyroidism. Anti-calcium-sensing receptor antibodies and NALP5 antibodies were tested and found to be negative. During subsequent clinic visits, doses of calcium supplements and calcitriol were titrated. Last corrected serum calcium level was 9.18 mg/dL. She was subsequently lost to follow-up. This case gives insight into severe symptomatic hypocalcemia from primary hypoparathyroidism attributed to HIV infection. We suggest that calcium levels should be closely monitored in patients with HIV infection.

10.
Eur J Endocrinol ; 178(3): 277-283, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29339527

ABSTRACT

AIMS: One-third of males with type 2 diabetes (T2DM) have hypogonadism, characterized by low total and free testosterone concentrations. We hypothesized that this condition is associated with a compensatory increase in the expression of androgen receptors (AR) and that testosterone replacement reverses these changes. We also measured estrogen receptor and aromatase expression. MATERIALS AND METHODS: This is a randomized double-blind placebo-controlled trial. Thirty-two hypogonadal and 32 eugonadal men with T2DM were recruited. Hypogonadal men were randomized to receive intramuscular testosterone or saline every 2 weeks for 22 weeks. We measured AR, ERα and aromatase expression in peripheral blood mononuclear cells (MNC), adipose tissue and skeletal muscle in hypogonadal and eugonadal males with T2DM at baseline and after 22 weeks of treatment in those with hypogonadism. RESULTS: The mRNA expression of AR, ERα (ESR1) and aromatase in adipose tissue from hypogonadal men was significantly lower as compared to eugonadal men, and it increased significantly to levels comparable to those in eugonadal patients with T2DM following testosterone treatment. AR mRNA expression was also significantly lower in MNC from hypogonadal patients compared to eugonadal T2DM patients. Testosterone administration in hypogonadal patients also restored AR mRNA and nuclear extract protein levels from MNC to that in eugonadal patients. In the skeletal muscle, AR mRNA and protein expression are lower in men with hypogonadism. Testosterone treatment restored AR expression levels to that comparable to levels in eugonadal men. CONCLUSIONS: We conclude that, contrary to our hypothesis, the expression of AR, ERα and aromatase is significantly diminished in hypogonadal men as compared to eugonadal men with type 2 diabetes. Following testosterone replacement, there is a reversal of these deficits.


Subject(s)
Androgens/therapeutic use , Aromatase/genetics , Diabetes Mellitus, Type 2/metabolism , Estrogen Receptor alpha/genetics , Hypogonadism/drug therapy , Leukocytes, Mononuclear/metabolism , Receptors, Androgen/genetics , Testosterone/therapeutic use , Adult , Aged , Aromatase/metabolism , Blotting, Western , Diabetes Mellitus, Type 2/complications , Double-Blind Method , Estrogen Receptor alpha/metabolism , Humans , Hypogonadism/complications , Hypogonadism/genetics , Hypogonadism/metabolism , Male , Middle Aged , RNA, Messenger/metabolism , Real-Time Polymerase Chain Reaction , Receptors, Androgen/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Subcutaneous Fat/metabolism
11.
J Clin Endocrinol Metab ; 103(3): 1180-1187, 2018 03 01.
Article in English | MEDLINE | ID: mdl-29346597

ABSTRACT

Purpose: We previously demonstrated the anti-inflammatory and antioxidant effects of exenatide. We now hypothesized that exenatide also increases the plasma concentration of interleukin-1 receptor antagonist (IL-1RA), an endogenous anti-inflammatory protein, and modulates the nuclear factor erythroid 2‒related factor‒Kelchlike ECH-associated protein 1‒antioxidant response element (Nrf-2‒Keap-1‒ARE) system to induce key antioxidant enzymes to suppress inflammatory and oxidative stress. Methods: Twenty-four patients with obesity and type 2 diabetes receiving combined oral and insulin therapy were randomly assigned to receive either exenatide 10 µg or placebo twice a day for 12 weeks. Results: Exenatide increased IL-1RA concentration by 61% (from 318 ± 53 to 456 ± 88 pg/mL; P < 0.05). Exenatide treatment also suppressed Keap-1 protein (P < 0.05) and increased messenger RNA expression of NQO-1, glutathione S-transferase PI, heme oxygenase-1, and p21 and increased NAD(P)H dehydrogenase [quinone] 1 protein (P < 0.05) in mononuclear cells. Conclusions: Because IL-1RA protects, maintains, and stimulates ß-cell function in humans and Nrf-2‒Keap-1‒ARE protects ß cells in animals with experimental diabetes, these actions of exenatide may contribute to a potential protective effect on ß cells in diabetes.


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/pharmacology , Interleukin 1 Receptor Antagonist Protein/blood , Obesity/drug therapy , Peptides/pharmacology , Venoms/pharmacology , Antioxidant Response Elements/drug effects , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/etiology , Drug Therapy, Combination , Enzyme Induction/drug effects , Exenatide , Female , Glutathione S-Transferase pi/biosynthesis , Heme Oxygenase-1/biosynthesis , Humans , Insulin/pharmacology , Insulin-Secreting Cells/drug effects , Kelch-Like ECH-Associated Protein 1/drug effects , Male , Middle Aged , NAD(P)H Dehydrogenase (Quinone)/biosynthesis , NF-E2-Related Factor 2/drug effects , Obesity/blood , Obesity/complications
12.
Thyroid ; 17(11): 1137-42, 2007 Nov.
Article in English | MEDLINE | ID: mdl-17887931

ABSTRACT

OBJECTIVES: To estimate the prevalence of the association between thyroid disease and idiopathic thrombocytopenia (ITP), and to examine the effect of treatment of the thyroid condition on platelet count. DESIGN: Retrospective cohort study performed in a tertiary care center setting. All patients who were diagnosed with ITP by a single provider at the Cleveland Clinic Hematology/Oncology Department between 1988 and 2005 were included. MAIN OUTCOME: Among the 98 patients, thyroid function tests were available in 80 patients. Of these, 16 (20%) had abnormal thyroid function: 6 had hyperthyroidism and 10 had hypothyroidism. The median interval from the onset of the thyroid or hematological condition (whichever came first) was 84 months (range: 25-612). The autoimmune nature of the thyroid disease was proven in 12 cases (75%). Three patients showed a transient increase in the platelet count after restoring the euthyroid state; however, durable improvement of thrombocytopenia was not encountered. CONCLUSIONS: The prevalence of hypothyroidism in patients with ITP is higher than in the general population. Based on this observation, routine assessment of thyroid function should be done in patients with ITP. The long-term course of ITP was not influenced by the treatment of the thyroid condition.


Subject(s)
Thrombocytopenia/etiology , Thyroid Diseases/complications , Adult , Aged , Child , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Thrombocytopenia/blood , Thyroid Diseases/therapy
13.
J Clin Endocrinol Metab ; 102(3): 858-869, 2017 Mar 01.
Article in English | MEDLINE | ID: mdl-27906549

ABSTRACT

Background: Fiber intake is associated with a reduction in the occurrence of cardiovascular events and diabetes. Objective: To investigate whether the addition of fiber to a high-fat, high-calorie (HFHC) meal prevents proinflammatory changes induced by the HFHC meal. Design: Ten normal fasting subjects consumed an HFHC meal with or without an additional 30 g of insoluble dietary fiber on 2 separate visits. Blood samples were collected over 5 hours, and mononuclear cells (MNCs) were isolated. Results: Fiber addition to the HFHC meal significantly lowered glucose excursion in the first 90 minutes and increased insulin and C-peptide secretion throughout the 5-hour follow-up period compared with the meal alone. The HFHC meal induced increases in lipopolysaccharide (LPS) concentrations, MNC reactive oxygen species generation, and the expression of interleukin (IL)-1ß, tumor necrosis factor α (TNF-α), Toll-like receptor (TLR)-4, and CD14. The addition of fiber prevented an increase in LPS and significantly reduced the increases in ROS generation and the expression of IL-1ß, TNF-α, TLR-4, and CD14. In addition, the meal increased Suppressor of cytokine signaling (SOCS)-3 and protein tyrosine phosphatase 1B (PTP-1B) messenger RNA and protein levels, which were inhibited when fiber was added. Conclusions: The addition of fiber to a proinflammatory HFHC meal had beneficial anti-inflammatory and metabolic effects. Thus, the fiber content of the American Heart Association meal may contribute to its noninflammatory nature. If these actions of dietary fiber are sustained following long-term intake, they may contribute to fiber's known benefits in the prevention of insulin resistance, type 2 diabetes, and atherosclerosis.


Subject(s)
Blood Glucose/drug effects , Diet, High-Fat , Dietary Fiber/pharmacology , Energy Intake , Leukocytes, Mononuclear/drug effects , Meals , Postprandial Period/drug effects , Reactive Oxygen Species/metabolism , Adult , Blood Glucose/metabolism , C-Peptide/drug effects , C-Peptide/metabolism , Female , Humans , Insulin/metabolism , Insulin Resistance , Interleukin-1beta/drug effects , Interleukin-1beta/immunology , Leukocytes, Mononuclear/immunology , Lipopolysaccharide Receptors/drug effects , Lipopolysaccharide Receptors/immunology , Lipopolysaccharides/metabolism , Male , Middle Aged , Postprandial Period/immunology , Postprandial Period/physiology , Protein Tyrosine Phosphatase, Non-Receptor Type 1/drug effects , Protein Tyrosine Phosphatase, Non-Receptor Type 1/genetics , RNA, Messenger/drug effects , RNA, Messenger/metabolism , Suppressor of Cytokine Signaling 3 Protein/drug effects , Suppressor of Cytokine Signaling 3 Protein/genetics , Toll-Like Receptor 4/drug effects , Toll-Like Receptor 4/immunology , Tumor Necrosis Factor-alpha/drug effects , Tumor Necrosis Factor-alpha/immunology , Young Adult
14.
Atherosclerosis ; 263: 278-286, 2017 08.
Article in English | MEDLINE | ID: mdl-28711708

ABSTRACT

BACKGROUND AND AIMS: Inflammation and postprandial lipemia are associated with increased cardiovascular disease. We investigated whether ezetimibe and simvastatin combination, a lipid lowering combination of simvastatin and ezetimibe, exerts an anti-inflammatory effect in the fasting state and after dairy cream intake. METHODS: Twenty obese patients were randomized to either ezetimibe and simvastatin combination or placebo treatment for 6 weeks. All patients were asked to ingest 33 ml of dairy cream (300 Calories) at the beginning and at the end of intervention. Fasting and post-cream blood samples were obtained. RESULTS: At 0 week, ingestion of cream induced significant increases in MNC expression of IL-1ß (105 ± 18%), TNFα (97 ± 12%), CD68 (48 ± 8%), CD16 (141 ± 39%), MMP-9 (122 ± 31%), PECAM (66 ± 10%), TLR-4 (84 ± 11%) and TLR-2 (67 ± 9%) and in endotoxin (LPS) concentrations (49 ± 7%) (p < 0.05). Ezetimibe and simvastatin combination treatment lowered fasting total cholesterol, LDLc and Lp(a) concentrations and Apo B/A1 ratio and suppressed the MNC expression of IL-1ß and CD68 (by 21 ± 7 and 24 ± 10, p < 0.05) and the concentrations of LPS, CRP, FFA and IL-18 by 24 ± 7%, 32 ± 11%, 19 ± 8% 15 ± 4%, respectively, (p < 0.05). Cream-induced increases in the expression of IL-1ß, CD68, CD16, MMP-9, TNFα and PECAM were reduced in the ezetimibe and simvastatin combination group by 74 ± 15%, 68 ± 13%, 57 ± 13%, 64 ± 16%, 67 ± 14% and 45 ± 9%, respectively, while those of LPS and MMP-9 concentrations were reduced by 53 ± 9% and 38 ± 8%, respectively, compared to the increases at week 0 (p < 0.05). There was a suppression of TLR-2 and TLR-4 expression by 21 ± 8% and 18 ± 7%, respectively, compared to 0-h baseline, after cream intake following ezetimibe and simvastatin combination treatment. CONCLUSIONS: Ezetimibe and simvastatin combination exerts a profound anti-inflammatory effect both in the fasting state and acutely after the ingestion of saturated fat.


Subject(s)
Anticholesteremic Agents/therapeutic use , Dairy Products/adverse effects , Ezetimibe, Simvastatin Drug Combination/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hyperlipidemias/prevention & control , Inflammation/prevention & control , Obesity/drug therapy , Adult , Anticholesteremic Agents/adverse effects , Biomarkers/blood , Double-Blind Method , Ezetimibe, Simvastatin Drug Combination/adverse effects , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Hyperlipidemias/blood , Hyperlipidemias/diagnosis , Hyperlipidemias/etiology , Inflammation/blood , Inflammation/diagnosis , Inflammation/etiology , Inflammation Mediators/blood , Lipids/blood , Male , Middle Aged , New York , Obesity/blood , Obesity/diagnosis , Postprandial Period , Prospective Studies , Time Factors , Treatment Outcome
15.
Diabetes Care ; 39(6): 1027-35, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27208343

ABSTRACT

OBJECTIVE: To investigate whether addition of three different doses of liraglutide to insulin in patients with type 1 diabetes (T1D) results in significant reduction in glycemia, body weight, and insulin dose. RESEARCH DESIGN AND METHODS: We randomized 72 patients (placebo = 18, liraglutide = 54) with T1D to receive placebo and 0.6, 1.2, and 1.8 mg liraglutide daily for 12 weeks. RESULTS: In the 1.2-mg and 1.8-mg groups, the mean weekly reduction in average blood glucose was -0.55 ± 0.11 mmol/L (10 ± 2 mg/dL) and -0.55 ± 0.05 mmol/L (10 ± 1 mg/dL), respectively (P < 0.0001), while it remained unchanged in the 0.6-mg and placebo groups. In the 1.2-mg group, HbA1c fell significantly (-0.78 ± 15%, -8.5 ± 1.6 mmol/mol, P < 0.01), while it did not in the 1.8-mg group (-0.42 ± 0.15%, -4.6 ± 1.6 mmol/mol, P = 0.39) and 0.6-mg group (-0.26 ± 0.17%, -2.8 ± 1.9 mmol/mol, P = 0.81) vs. the placebo group (-0.3 ± 0.15%, -3.3 ± 1.6 mmol/mol). Glycemic variability was reduced by 5 ± 1% (P < 0.01) in the 1.2-mg group only. Total daily insulin dose fell significantly only in the 1.2-mg and 1.8-mg groups (P < 0.05). There was a 5 ± 1 kg weight loss in the two higher-dose groups (P < 0.05) and by 2.7 ± 0.6 kg (P < 0.01) in the 0.6-mg group vs. none in the placebo group. In the 1.2- and 1.8-mg groups, postprandial plasma glucagon concentration fell by 72 ± 12% and 47 ± 12%, respectively (P < 0.05). Liraglutide led to higher gastrointestinal adverse events (P < 0.05) and ≤1% increases (not significant) in percent time spent in hypoglycemia (<55 mg/dL, 3.05 mmol/L). CONCLUSIONS: Addition of 1.2 mg and 1.8 mg liraglutide to insulin over a 12-week period in overweight and obese patients with T1D results in modest reductions of weekly mean glucose levels with significant weight loss, small insulin dose reductions, and frequent gastrointestinal side effects. These findings do not justify the use of liraglutide in all patients with T1D.


Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Liraglutide/therapeutic use , Adult , Blood Glucose/metabolism , Body Weight , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/metabolism , Double-Blind Method , Drug Therapy, Combination , Female , Glucagon/metabolism , Humans , Hypoglycemia/chemically induced , Male , Middle Aged , Obesity/complications , Overweight/complications , Postprandial Period , Time Factors , Treatment Outcome
16.
Diabetes Care ; 39(1): 82-91, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26622051

ABSTRACT

OBJECTIVE: One-third of men with type 2 diabetes have hypogonadotropic hypogonadism (HH). We conducted a randomized placebo-controlled trial to evaluate the effect of testosterone replacement on insulin resistance in men with type 2 diabetes and HH. RESEARCH DESIGN AND METHODS: A total of 94 men with type 2 diabetes were recruited into the study; 50 men were eugonadal, while 44 men had HH. Insulin sensitivity was calculated from the glucose infusion rate (GIR) during hyperinsulinemic-euglycemic clamp. Lean body mass and fat mass were measured by DEXA and MRI. Subcutaneous fat samples were taken to assess insulin signaling genes. Men with HH were randomized to receive intramuscular testosterone (250 mg) or placebo (1 mL saline) every 2 weeks for 24 weeks. RESULTS: Men with HH had higher subcutaneous and visceral fat mass than eugonadal men. GIR was 36% lower in men with HH. GIR increased by 32% after 24 weeks of testosterone therapy but did not change after placebo (P = 0.03 for comparison). There was a decrease in subcutaneous fat mass (-3.3 kg) and increase in lean mass (3.4 kg) after testosterone treatment (P < 0.01) compared with placebo. Visceral and hepatic fat did not change. The expression of insulin signaling genes (IR-ß, IRS-1, AKT-2, and GLUT4) in adipose tissue was significantly lower in men with HH and was upregulated after testosterone treatment. Testosterone treatment also caused a significant fall in circulating concentrations of free fatty acids, C-reactive protein, interleukin-1ß, tumor necrosis factor-α, and leptin (P < 0.05 for all). CONCLUSIONS: Testosterone treatment in men with type 2 diabetes and HH increases insulin sensitivity, increases lean mass, and decreases subcutaneous fat.


Subject(s)
Diabetes Mellitus, Type 2/complications , Hormone Replacement Therapy , Hypogonadism/drug therapy , Inflammation/blood , Insulin Resistance , Testosterone/therapeutic use , Adult , Body Composition , C-Reactive Protein/metabolism , Fatty Acids, Nonesterified/blood , Humans , Hypogonadism/complications , Insulin/therapeutic use , Interleukin-1beta/blood , Intra-Abdominal Fat/metabolism , Leptin/blood , Male , Middle Aged , Subcutaneous Fat/metabolism , Tumor Necrosis Factor-alpha/blood
17.
J Clin Endocrinol Metab ; 101(9): 3506-15, 2016 09.
Article in English | MEDLINE | ID: mdl-27490915

ABSTRACT

CONTEXT: It is imperative that novel approaches to treatment of type 1 diabetes (T1D) are devised. OBJECTIVE: The objective of the study was to investigate whether addition of dapagliflozin to insulin and liraglutide results in a significant reduction in glycemia and body weight. DESIGN: This was a randomized clinical trial. SETTING: The study was conducted at a single academic medical center. PARTICIPANTS: Participants included T1D patients on liraglutide therapy for at least last 6 months. INTERVENTION: Thirty T1D patients were randomized (in 2:1 ratio) to receive either dapagliflozin 10 mg or placebo daily for 12 weeks. MAIN OUTCOME MEASURE: Change in mean glycated hemoglobin after 12 weeks of dapagliflozin when compared with placebo was measured. RESULTS: In the dapagliflozin group, glycated hemoglobin fell by 0.66% ± 0.08% from 7.8% ± 0.21% (P < .01 vs placebo), whereas it did not change significantly in the placebo group from 7.40% ± 0.20% to 7.30% ± 0.20%. The body weight fell by1.9 ± 0.54kg (P < .05 vs placebo). There was no additional hypoglycemia (blood glucose < 3.88 mmol/L; P = .52 vs placebo). In the dapagliflozin group, there were significant increases in the plasma concentrations of glucagon by 35% ± 13% (P < .05), hormone-sensitive lipase by 29% ± 11% (P < .05), free fatty acids by 74% ± 32% (P < .05), acetoacetate by 67% ± 34% (P < .05), and ß-hydroxybutyrate by 254% ± 81% (P < .05). Urinary ketone levels also increased significantly (P < .05). None of these changes was observed in the placebo group. Two patients in the dapagliflozin group developed diabetic ketoacidosis. CONCLUSIONS: Addition of dapagliflozin to insulin and liraglutide in patients with T1D results in a significant improvement in glycemia and weight loss while increasing ketosis. If it is decided to use this approach, then it must be used only by a knowledgeable patient along with an endocrinologist who is well versed with it.


Subject(s)
Benzhydryl Compounds/therapeutic use , Biomarkers/analysis , Diabetes Mellitus, Type 1/drug therapy , Glucosides/therapeutic use , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Liraglutide/therapeutic use , Adolescent , Adult , Aged , Blood Glucose/analysis , Diabetes Mellitus, Type 1/metabolism , Double-Blind Method , Drug Therapy, Combination , Female , Follow-Up Studies , Glycated Hemoglobin/analysis , Humans , Male , Middle Aged , Prognosis , Young Adult
18.
J Diabetes Res ; 2015: 202406, 2015.
Article in English | MEDLINE | ID: mdl-25642424

ABSTRACT

BACKGROUND AND HYPOTHESIS: Following our recent demonstration that the chronic inflammatory and insulin resistant state of obesity is associated with an increase in the expression of mediators known to contribute to the pathogenesis of asthma and that weight loss after gastric bypass surgery results in the reduction of these genes, we have now hypothesized that insulin suppresses the cellular expression and plasma concentrations of these mediators. METHODS: The expression of IL-4, LIGHT, LTBR, ADAM-33, and TSLP in MNC and plasma concentrations of LIGHT, TGF-ß1, MMP-9, MCP-1, TSLP, and NOM in obese patients with T2DM were measured before, during, and after the infusion of a low dose (2 U/h) infusion of insulin for 4 hours. The patients were also infused with dextrose or saline for 4 hours on two separate visits and served as controls. Results. Following insulin infusion, the mRNA expression of IL-4, ADAM-33, LIGHT, and LTBR mRNA expression fell significantly (P < 0.05 for all). There was also a concomitant reduction in plasma NOM, LIGHT, TGF-ß1, MCP-1, and MMP-9 concentrations. CONCLUSIONS: Insulin suppresses the expression of these genes and mediators related to asthma and may, therefore, have a potential role in the treatment of asthma.


Subject(s)
Asthma/blood , Diabetes Mellitus, Type 2/blood , Gene Expression Regulation , Inflammation/blood , Insulin/metabolism , Obesity/metabolism , Adult , Blood Glucose/analysis , Body Mass Index , Cross-Over Studies , Diabetes Mellitus, Type 2/complications , Female , Gene Expression , Gene Expression Profiling , Glycated Hemoglobin/metabolism , Humans , Infusions, Intravenous , Insulin/administration & dosage , Insulin Resistance , Luminescence , Male , Middle Aged , Obesity/complications , Reactive Oxygen Species , Weight Loss
19.
Endocr Pract ; 19(6): 963-7, 2013.
Article in English | MEDLINE | ID: mdl-23807520

ABSTRACT

OBJECTIVE: Because approximately 40% of patients with type 1 diabetes have the metabolic syndrome, we tested the hypothesis that addition of liraglutide to insulin in obese patients with type 1 diabetes will result in an improvement in plasma glucose concentrations, a reduction in hemoglobin A1c (HbA1c), a fall in systolic blood pressure, and weight loss. METHODS: This is a retrospective analysis of data obtained from 27 obese patients with type 1 diabetes treated with liraglutide in addition to insulin. Patients were also treated for hypertension. Paired t tests were used to compare the changes in HbA1c, insulin doses, body weight, body mass index, 4-week mean blood glucose concentrations (28-day insulin pump mean blood glucose), blood pressure, and lipid parameters prior to and 180 ± 14 days after liraglutide therapy. RESULTS: Mean glucose concentrations fell from 191 ± 6 to 170 ± 6 mg/dL (P = .002). HbA1c fell from 7.89 ± 0.13% to 7.46 ± 0.13% (P = .001), without an increase in frequency of hypoglycemia. Mean body weight fell from 96.20 ± 3.68 kg to 91.56 ± 3.78 kg (P<.0001). Daily total and bolus doses of insulin fell from 73 ± 6 to 60 ± 4 (P = .008) units and from 40 ± 5 to 29 ± 3 units (P = .011), respectively. Mean systolic blood pressure fell from 130 ± 3 to 120 ± 4 mm Hg (P = .020). CONCLUSION: Addition of liraglutide to insulin in obese patients with type 1 diabetes mellitus leads to improvements in glycemic control and HbA1c and to reductions in insulin dose, systolic blood pressure, and body weight.


Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Glucagon-Like Peptide 1/analogs & derivatives , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Obesity/drug therapy , Blood Glucose/metabolism , Blood Pressure/drug effects , Body Mass Index , Body Weight/drug effects , Diabetes Mellitus, Type 1/complications , Drug Therapy, Combination , Female , Glucagon-Like Peptide 1/therapeutic use , Glycated Hemoglobin/analysis , Humans , Hypoglycemia/drug therapy , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Liraglutide , Male , Middle Aged , Obesity/complications , Retrospective Studies , Weight Loss/drug effects
20.
Endocr Pract ; 18(2): 140-5, 2012.
Article in English | MEDLINE | ID: mdl-21856595

ABSTRACT

OBJECTIVE: To assess whether liraglutide, a glucagon-like peptide-1 receptor agonist, has cardioprotective properties in addition to its glycemic effects. METHODS: We performed a retrospective analysis of medical records of 110 obese patients with type 2 diabetes mellitus treated with liraglutide for at least 6 months between March 2010 and April 2011 at our tertiary care referral center. The variables analyzed were body mass index, hemoglobin A(1c) (A1C), systolic blood pressure (SBP), plasma C-reactive protein (CRP) concentrations, and serum lipids. RESULTS: In our overall study cohort, we noted a reduction in mean weight from 120 ± 5 kg to 115 ± 3 kg and a decrease in mean A1C from 7.8% ± 0.6% to 7.2% ± 0.2%. The mean triglyceride concentration decreased from 173 ± 19 mg/dL to 151 ± 15 mg/dL, the mean SBP was reduced from 132 ± 6 mm Hg to 125 ± 4 mm Hg, and the mean CRP concentration declined from 4.7 ± 0.8 mg/L to 3.2 ± 0.4 mg/L after treatment with liraglutide for a minimal duration of 6 months and a mean duration of 7.5 months (for all the foregoing changes, P<.05). These variables decreased whether these patients were previously treated with orally administered hypoglycemic agents alone or in combination with insulin or exenatide. CONCLUSION: Our findings in a clinical practice show that liraglutide is a potent antidiabetes drug, whether given in combination with orally administered agents or insulin or as a substitution for exenatide. It lowers body weight, A1C levels, SBP, and CRP and triglyceride concentrations.


Subject(s)
Cardiovascular Diseases/prevention & control , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Glucagon-Like Peptide 1/analogs & derivatives , Hypoglycemic Agents/therapeutic use , Receptors, Glucagon/agonists , Body Mass Index , C-Reactive Protein/analysis , Cardiovascular Diseases/complications , Cardiovascular Diseases/epidemiology , Cohort Studies , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/immunology , Drug Therapy, Combination , Glucagon-Like Peptide 1/therapeutic use , Glucagon-Like Peptide-1 Receptor , Glycated Hemoglobin/analysis , Humans , Hyperglycemia/complications , Hyperglycemia/prevention & control , Hypertension/complications , Hypertension/prevention & control , Hypertriglyceridemia/complications , Hypertriglyceridemia/prevention & control , Insulin/therapeutic use , Lipids/blood , Liraglutide , Medical Records , New York/epidemiology , Obesity/complications , Retrospective Studies , Risk Factors , Weight Loss/drug effects
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