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‣ β-Cell Mass and Type 1 Diabetes: Going, Going, Gone?

Akirav, Eitan; Kushner, Jake A.; Herold, Kevan C.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Publicado em /11/2008 Português
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OBJECTIVE— β-Cell regeneration is a fundamental but elusive goal for type 1 diabetes research. Our objective is to review newer human and animal studies of β-cell destruction and regeneration and consider the implications for treatment of type 1 diabetes.

‣ Brave New Worlds: How Virtual Environments Can Augment Traditional Care in the Management of Diabetes

Watson, Alice J.; Grant, Richard W.; Bello, Heather; Hoch, Daniel B.
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em /07/2008 Português
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New technologies, such as online networking tools, offer innovative ways to engage patients in their diabetes care. Second Life (SL) is one such virtual world that allows patients to interact in a 3D environment with peers and healthcare providers. This article presents a framework that demonstrates how applications within SL can be constructed to meet the needs of patients with diabetes, allowing them to attend group visits, learn more about lifestyle changes, and foster a sense of support and emotional well-being. This experiential approach to education may prove more engaging, and therefore successful, than existing strategies. Addressing concerns relating to privacy and liability is a necessary first step to engage providers in this new approach to patient care.

‣ Definition of Information Technology Architectures for Continuous Data Management and Medical Device Integration in Diabetes

Hernando, M. Elena; Pascual, Mario; Salvador, Carlos H.; García-Sáez, Gema; Rodríguez-Herrero, Agustín; Martínez-Sarriegui, Iñaki; Gómez, Enrique J.
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em /09/2008 Português
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The growing availability of continuous data from medical devices in diabetes management makes it crucial to define novel information technology architectures for efficient data storage, data transmission, and data visualization. The new paradigm of care demands the sharing of information in interoperable systems as the only way to support patient care in a continuum of care scenario. The technological platforms should support all the services required by the actors involved in the care process, located in different scenarios and managing diverse information for different purposes. This article presents basic criteria for defining flexible and adaptive architectures that are capable of interoperating with external systems, and integrating medical devices and decision support tools to extract all the relevant knowledge to support diabetes care.

‣ The Business of Intensive Insulin Therapy for Type 2 Diabetes Patients: Where It All Began for Me

Norton, Evan
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em /11/2009 Português
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Ideally, it would be easy for physicians with Diabetes Control and Complications Trial data in hand to convince type 2 diabetes mellitus (T2DM) patients on insulin to move toward intensive insulin therapy (IIT), but in actuality, patient compliance remains a significant issue. One of the statistics that best illustrates this point is that 89% of T2DM patients on insulin do not inject themselves outside of the home (according to the National Health and Nutrition Examination Survey). The market has responded to poor compliance by developing insulin pens and different insulin formulations to improve compliance. But the fact remains that most T2DM patients on insulin are out of control. I would suggest that, in addition to better education, an opportunity exists for a medical device approach to better facilitate an easy-to-use, discreet approach to moving from conventional to IIT.

‣ Impact of Epidemic Rates of Diabetes on the Chinese Blood Glucose Testing Market

Hu, Jamie; Zhang, Xian-En
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em 01/09/2011 Português
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China has become the country with the largest diabetes mellitus population in the world since the 1990s. About 100 million diabetes cases have been diagnosed since 2008. Handheld blood glucose meters and test strips are urgently needed for daily patient measurement. The glucose monitor with a screen-printed carbon-based glucose electrode has been in commercial production since 1994. Since then, approximately 20 companies have been involved in manufacturing and marketing meters and test strips in China. The current market and production volume and updates on technology issues are discussed in this article.

‣ Sugar, Uric Acid, and the Etiology of Diabetes and Obesity

Johnson, Richard J.; Nakagawa, Takahiko; Sanchez-Lozada, L. Gabriela; Shafiu, Mohamed; Sundaram, Shikha; Le, Myphuong; Ishimoto, Takuji; Sautin, Yuri Y.; Lanaspa, Miguel A.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Português
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The intake of added sugars, such as from table sugar (sucrose) and high-fructose corn syrup has increased dramatically in the last hundred years and correlates closely with the rise in obesity, metabolic syndrome, and diabetes. Fructose is a major component of added sugars and is distinct from other sugars in its ability to cause intracellular ATP depletion, nucleotide turnover, and the generation of uric acid. In this article, we revisit the hypothesis that it is this unique aspect of fructose metabolism that accounts for why fructose intake increases the risk for metabolic syndrome. Recent studies show that fructose-induced uric acid generation causes mitochondrial oxidative stress that stimulates fat accumulation independent of excessive caloric intake. These studies challenge the long-standing dogma that “a calorie is just a calorie” and suggest that the metabolic effects of food may matter as much as its energy content. The discovery that fructose-mediated generation of uric acid may have a causal role in diabetes and obesity provides new insights into pathogenesis and therapies for this important disease.

‣ Endothelial-Podocyte Crosstalk: The Missing Link Between Endothelial Dysfunction and Albuminuria in Diabetes

Siddiqi, Ferhan S.; Advani, Andrew
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Português
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Although diabetes is the most common cause of end-stage renal disease (ESRD) worldwide, most people with diabetic nephropathy will never develop ESRD but will instead die of cardiovascular (CV) disease (CVD). The first evidence of kidney injury in diabetes is often microalbuminuria, itself also an independent risk marker for CVD. Although the two processes are closely associated, the recent failure of antialbuminuric therapies to affect CV outcomes has encouraged a reconsideration of how albuminuria may occur in diabetes and how increased urinary albumin excretion may be indicative of CV risk. The relationship between CVD and urinary albumin content (even within the normal range) is widely considered to reflect the common underlying pathology of endothelial dysfunction. At the same time, recent years have witnessed a growing appreciation that diabetic albuminuria commonly arises from damage to glomerular podocytes, specialized epithelial cells acting as the final barrier to macromolecular flow into the urinary filtrate. These superficially discordant paradigms can be assimilated by the emerging concept of endothelial-podocyte crosstalk across the glomerular filtration barrier, whereby the actions of one type of cell may profoundly influence the function of the other. The bidirectional nature of this paracrine network is illustrated by the actions of the vascular endothelial growth factor-A (VEGF-A)/VEGF receptor-2 and activated protein C systems...

‣ Diabetes Technology, Innovation, and the U.S. Health Insurance System

Quinn, Bruce
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em 01/09/2013 Português
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The flow of funds in the U.S. health care system is crucial both for the provision of services to patients and to encourage innovation that enables long-term improvement of health services. Rising concern about health care costs often includes concerns about inappropriate adoption of costly or unnecessary technology. Many innovations in diabetes technology may involve personal technology, which does not qualify under existing health insurance categories such as “durable medical equipment” or under a currently defined telehealth technology. In such cases, the diabetes technology industry may be developing types of technology that are so innovative they do not have clearly established payment mechanisms in the existing U.S. fee for service health care reimbursement system. This article describes key features of the U.S. health care payment system relevant to developers of new diabetes technologies.

‣ Diabetes Device Reimbursement in the EU-5

Attorney, Elmar Schäfer; Schnell, Gerald; Bobáková, Tamara
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em 01/07/2013 Português
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The reimbursement landscape for new and innovative diabetes devices in Europe is very heterogeneous and nontransparent, with each country employing different mechanisms, pathways, and requirements. This article provides an overview of how diabetes device reimbursement works in the outpatient setting in the five major European Union markets (France, Germany, Italy, Spain, and the United Kingdom; the EU-5). It will be of particular interest to manufacturers of innovative devices. Markets are first categorized as either a centralized or a regionalized reimbursement decision-making system, and implications for device reimbursement are explored. In the second part, specific requirements and success factors for wide reimbursement in the EU-5 are analyzed in detail. Gaining early acceptance by the main influencers (key opinion leaders and payers) is the first step. Equally important is the provision of convincing evidence, be this clinical, health–economic (cost-effectiveness), or a demonstration of cost savings (budget impact). In some countries, local usage data may be a requirement as well. Lastly, as payers’ willingness to pay stems directly from their perceived value of a device, a key success factor and a necessary precondition for manufacturers is to set the right price.

‣ Activation of GPR40 as a Therapeutic Target for the Treatment of Type 2 Diabetes

Burant, Charles F.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Português
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The stimulation of insulin secretion by glucose can be modulated by multiple nutritive, hormonal, and pharmacological inputs. Fatty acids potentiate insulin secretion through the generation of intracellular signaling molecules and through the activation of cell surface receptors. The G-protein–coupled receptor 40 (GPR40), also known as free fatty acid receptor 1 (we will use GPR40 in this review), has emerged as an important component in the fatty acid augmentation of insulin secretion. By signaling predominantly through Gαq/11, GPR40 increases intracellular calcium and activates phospholipases to generate diacylglycerols resulting in increased insulin secretion. Synthetic small-molecule agonists of GPR40 enhance insulin secretion in a glucose-dependent manner in vitro and in vivo with a mechanism similar to that found with fatty acids. GPR40 agonists have shown efficacy in increasing insulin secretion and lowering blood glucose in rodent models of type 2 diabetes. Recent phase I and phase II clinical trials in humans have shown that the GPR40 agonist TAK-875 reduces fasting and postprandial blood glucose and lowers HbA1c with efficacy equal to that of the sulfonylurea glimepiride without inducing hypoglycemia or evidence of tachyphylaxis. These data suggest that targeting the GPR40 receptor can be a viable therapeutic option for the treatment of type 2 diabetes.

‣ Retinoid Metabolism and Diabetes Mellitus

Rhee, Eun-Jung; Plutzky, Jorge
Fonte: Korean Diabetes Association Publicador: Korean Diabetes Association
Tipo: Artigo de Revista Científica
Português
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Retinoid acid is a metabolite of vitamin A and functions as an important factor in cell survival, differentiation and death. Most previous studies on retinoid metabolism have focused on its association with cancer, hematologic and dermatologic disorders. Given the special concern over the recent increase in the prevalence of diabetes worldwide, the role of retinoid metabolism on glucose metabolism and insulin resistance in the human body is of marked importance. Therefore, in this issue, we review the literature on the association of retinoid metabolism with glucose tolerance, with regard to insulin secretion, pancreatic autoimmunity, insulin sensitivity and lipid metabolism. Further, we tried to assess the possibility of using retinoids as a novel therapeutic strategy for diabetes.

‣ Association between rotavirus infection and pancreatic islet autoimmunity in children at risk of developing type 1 diabetes

Honeyman, B.; Coulson, B.; Stone, N.; Gellert, S.; Goldwater, P.; Steele, C.; Couper, J.; Tait, B.; Coleman, P.; Harrison, L.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2000 Português
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Pancreatic islet autoimmunity leading to type 1 diabetes could be triggered by viruses in genetically susceptible individuals. Rotavirus (RV), the most common cause of childhood gastroenteritis, contains peptide sequences highly similar to T-cell epitopes in the islet autoantigens GAD and tyrosine phosphatase IA-2 (IA-2), suggesting T-cells to RV could trigger islet autoimmunity by molecular mimicry. We therefore sought an association between RV infection and islet autoantibody markers in children at risk for diabetes who were followed from birth. There was a specific and highly significant association between RV seroconversion and increases in any of these antibodies: 86% of antibodies to IA-2, 62% to insulin, and 50% to GAD first appeared or increased with increases in RV IgG or IgA. RV infection may therefore trigger or exacerbate islet autoimmunity in genetically susceptible children.

‣ Effect of Energy Restriction, Weight Loss, and Diet Composition on Plasma Lipids and Glucose in Patients With Type 2 Diabetes

Heilbronn, L.; Noakes, M.; Clifton, P.
Fonte: AMER DIABETES ASSOC Publicador: AMER DIABETES ASSOC
Tipo: Artigo de Revista Científica
Publicado em //1999 Português
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OBJECTIVE: To determine the optimal diet for improving glucose and lipid profiles in obese patients with type 2 diabetes during moderate energy restriction. RESEARCH DESIGN AND METHODS: A total of 35 free-living obese patients with type 2 diabetes were assigned to one of three 1,600 kcal/day diets for 12 weeks. The diets were high carbohydrate (10% fat, 4% saturated), high monounsaturated fat (MUFA) (32% fat, 7% saturated), or high saturated fat (SFA) (32% fat, 17% saturated). RESULTS: Diet composition did not affect the magnitude of weight loss, with subjects losing an average of 6.6 +/- 0.9 kg. Energy restriction and weight loss resulted in reductions in fasting plasma glucose (-14%), insulin (-27%), GHb (-14%), and systolic (-7%) and diastolic blood pressure (-10%) levels and the glucose response area (-17%) independent of diet composition. Diet composition did affect the lipoprotein profile. LDL was 10% and 17% lower with the high-carbohydrate and high-MUFA diets, respectively, whereas no change was observed with the high-SFA diet (P < 0.001 for effect of diet). HDL was transiently reduced on the high-carbohydrate diet at weeks 1, 4, and 8, whereas higher fat consumption maintained these levels. The total cholesterol:HDL ratio...

‣ Glycemia and its relationship to outcomes in the metformin in Gestational Diabetes Trial

Rowan, J.; Gao, W.; Hague, W.; McIntyre, H.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
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OBJECTIVE: To determine how glucose control in women with GDM treated with metformin and/or insulin influenced pregnancy outcomes. RESEARCH DESIGN AND METHODS: Women randomly assigned to metformin or insulin treatment in the Metformin in Gestational Diabetes (MiG) trial had baseline glucose tolerance test (OGTT) results and A1C documented, together with all capillary glucose measurements during treatment. In the 724 women who had glucose data for analysis, tertiles of baseline glucose values and A1C and of mean capillary glucose values during treatment were calculated. The relationships between maternal factors, glucose values, and outcomes (including a composite of neonatal complications, preeclampsia, and large-for-gestational-age [LGA] and small-for-gestational-age infants) were examined with bivariable and multivariate models. RESULTS: Baseline OGTT did not predict outcomes, but A1C predicted LGA infants (P = 0.003). During treatment, fasting capillary glucose predicted neonatal complications (P < 0.001) and postprandial glucose predicted preeclampsia (P = 0.016) and LGA infants (P = 0.001). Obesity did not influence outcomes, and there was no interaction between glycemic control, randomized treatment, or maternal BMI in predicting outcomes. The lowest risk of complications was seen when fasting capillary glucose was <4.9 mmol/l (mean +/- SD 4.6 +/- 0.3 mmol/l) compared with 4.9-5.3 mmol/l or higher and when 2-h postprandial glucose was 5.9-6.4 mmol/l (6.2 +/- 0.2 mmol/l) or lower. CONCLUSIONS: Glucose control in women with gestational diabetes mellitus treated with metformin and/or insulin is strongly related to outcomes. Obesity is not related to outcomes in this group. Targets for fasting and postprandial capillary glucose may need to be lower than currently recommended.; Janet A. Rowan...

‣ Effects of a protein preload on gastric emptying, glycemia, and gut hormones after a carbohydrate meal in diet-controlled Type 2 diabetes

Ma, J.; Stevens, J.; Maddox, A.; Wishart, J.; Jones, K.; Clifton, P.; Horowitz, M.; Rayner, C.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
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OBJECTIVE: We evaluated whether a whey preload could slow gastric emptying, stimulate incretin hormones, and attenuate postprandial glycemia in type 2 diabetes. RESEARCH DESIGN AND METHODS: Eight type 2 diabetic patients ingested 350 ml beef soup 30 min before a potato meal; 55 g whey was added to either the soup (whey preload) or potato (whey in meal) or no whey was given. RESULTS: Gastric emptying was slowest after the whey preload (P < 0.0005). The incremental area under the blood glucose curve was less after the whey preload and whey in meal than after no whey (P < 0.005). Plasma glucose-dependent insulinotropic polypeptide, insulin, and cholecystokinin concentrations were higher on both whey days than after no whey, whereas glucagon-like peptide 1 was greatest after the whey preload (P < 0.05). CONCLUSIONS: Whey protein consumed before a carbohydrate meal can stimulate insulin and incretin hormone secretion and slow gastric emptying, leading to marked reduction in postprandial glycemia in type 2 diabetes.; Jing Ma, Julie E. Stevens, Kimberly Cukier, Anne F. Maddox, Judith M. Wishart, Karen L. Jones, Peter M. Clifton, Michael Horowitz, and Christopher K. Rayner

‣ Metformin in gestational diabetes: The Offspring Follow-Up (MiG TOFU): body composition at 2 years of age

Rowan, J.; Rush, E.; Obolonkin, V.; Battin, M.; Wouldes, T.; Hague, W.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
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OBJECTIVE: In women with gestational diabetes mellitus, who were randomized to metformin or insulin treatment, pregnancy outcomes were similar (Metformin in Gestational diabetes [MiG] trial). Metformin crosses the placenta, so it is important to assess potential effects on growth of the children. RESEARCH DESIGN AND METHODS: In Auckland, New Zealand, and Adelaide, Australia, women who had participated in the MiG trial were reviewed when their children were 2 years old. Body composition was measured in 154 and 164 children whose mothers had been randomized to metformin and insulin, respectively. Children were assessed with anthropometry, bioimpedance, and dual energy X-ray absorptiometry (DEXA), using standard methods. RESULTS: The children were similar for baseline maternal characteristics and pregnancy outcomes. In the metformin group, compared with the insulin group, children had larger mid-upper arm circumferences (17.2 6 1.5 vs. 16.7 6 1.5 cm; P = 0.002) and subscapular (6.3 6 1.9 vs. 6.0 6 1.7 mm; P = 0.02) and biceps skinfolds (6.03 6 1.9 vs. 5.6 6 1.7 mm; P = 0.04). Total fat mass and percentage body fat assessed by bioimpedance (n = 221) and DEXA (n = 114) were not different. CONCLUSIONS: Children exposed to metformin had larger measures of subcutaneous fat...

‣ Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype

Appleton, S.; Seaborn, C.; Visvanathan, R.; Hill, C.; Gill, T.; Taylor, A.; Adams, R.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
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OBJECTIVE To determine the correlates of the “metabolically healthy obese” (MHO) phenotype and the longitudinal risks of diabetes and cardiovascular disease (CVD)/stroke associated with this phenotype. RESEARCH DESIGN AND METHODS The North West Adelaide Health Study is a prospective cohort study of 4,056 randomly selected adults aged ≥18 years. Participants free of CVD/stroke and not underweight (n = 3,743) were stratified by BMI categories and metabolic risk, defined as having two or more International Diabetes Federation metabolic syndrome criteria, excluding waist circumference. RESULTS Correlates of the MHO (n = 454 [12.1%]) included smoking, socioeconomic disadvantage, and physical inactivity. Compared with metabolically healthy normal-weight subjects (n = 1,172 [31.3%]), the MHO were more likely to develop metabolic risk (15.5 vs. 33.1%, P < 0.001) and incident diabetes (odds ratio 2.09 [95% CI 0.87–5.03]) but not CVD/stroke (1.16 [0.58–2.29]) during 5.5–10.3 years of follow-up. These risks were not seen in MHO subjects maintaining metabolic health (n = 188 [67%]). Sustained metabolic health in obese participants was associated with age ≤40 years and lower waist circumference. Compared with the metabolically at-risk obese...

‣ Cardiac autonomic dysfunction is associated with high-risk albumin-to-creatinine ratio in young adolescents with type 1 diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)

Cho, Y.H.; Craig, M.E.; Davis, E.A.; Cotterill, A.M.; Couper, J.J.; Cameron, F.J.; Benitez-Aguirre, P.Z.; Dalton, R.N.; Dunger, D.B.; Jones, T.W.; Donaghue, K.C.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Publicado em //2015 Português
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OBJECTIVE: This study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: Adolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10-17 years, mean duration 6.9 years; mean HbA1c 8.4%, 68 mmol/mol) underwent a 10-min continuous electrocardiogram recording for heart rate variability analysis. Time-domain heart rate variability measures included baseline heart rate, SD of the R-R interval (SDNN), and root mean squared difference of successive R-R intervals (RMSSD). Spectral analysis included sympathetic (low-frequency) and parasympathetic (high-frequency) components. Standardized ACR were calculated from six early morning urine collections using an established algorithm, reflecting age, sex, and duration, and stratified into ACR tertiles, where the upper tertile reflects higher nephropathy risk. RESULTS: The upper-tertile ACR group had a faster heart rate (76 vs. 73 bpm; P < 0.01) and less heart rate variability (SDNN 68 vs. 76 ms, P = 0.02; RMSSD 63 vs. 71 ms, P = 0.04). HbA1c was 8.5% (69 mmol/mmol) in the upper tertile vs. 8.3% (67 mmol/mol) in the lower tertiles (P = 0.07). In multivariable analysis...

‣ Proinsulin-specific, HLA-DQ8, and HLA-DQ8-transdimer-restricted CD4⁺ T cells infiltrate islets in type 1 diabetes; Proinsulin-specific, HLA-DQ8, and HLA-DQ8-transdimer-restricted CD4(+) T cells infiltrate islets in type 1 diabetes

Pathiraja, V.; Kuehlich, J.P.; Campbell, P.D.; Krishnamurthy, B.; Loudovaris, T.; Coates, P.T.H.; Brodnicki, T.C.; O'Connell, P.J.; Kedzierska, K.; Rodda, C.; Bergman, P.; Hill, E.; Purcell, A.W.; Dudek, N.L.; Thomas, H.E.; Kay, T.W.H.; Mannering, S.I.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Publicado em //2015 Português
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Type 1 diabetes (T1D) develops when insulin-secreting β-cells, found in the pancreatic islets of Langerhans, are destroyed by infiltrating T cells. How human T cells recognize β-cell-derived antigens remains unclear. Genetic studies have shown that HLA and insulin alleles are the most strongly associated with risk of T1D. These long-standing observations implicate CD4(+) T-cell responses against (pro)insulin in the pathogenesis of T1D. To dissect the autoimmune T-cell response against human β-cells, we isolated and characterized 53 CD4(+) T-cell clones from within the residual pancreatic islets of a deceased organ donor who had T1D. These 53 clones expressed 47 unique clonotypes, 8 of which encoded proinsulin-specific T-cell receptors. On an individual clone basis, 14 of 53 CD4(+) T-cell clones (26%) recognized 6 distinct but overlapping epitopes in the C-peptide of proinsulin. These clones recognized C-peptide epitopes presented by HLA-DQ8 and, notably, HLA-DQ8 transdimers that form in HLA-DQ2/-DQ8 heterozygous individuals. Responses to these epitopes were detected in the peripheral blood mononuclear cells of some people with recent-onset T1D but not in HLA-matched control subjects. Hence, proinsulin-specific, HLA-DQ8, and HLA-DQ8-transdimer-restricted CD4(+) T cells are strongly implicated in the autoimmune pathogenesis of human T1D.; Vimukthi Pathiraja...

‣ Nuevas perspectivas en la genética de la Diabetes Mellitus tipo 2 y sus complicaciones crónicas

Lobos, S.; Durruty, Pilar; Seelenfreund, H.
Fonte: Sociedad Chilena de Endocrinología y Diabetes Publicador: Sociedad Chilena de Endocrinología y Diabetes
Tipo: Artículo de revista
Português
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This review describes the advances in the knowledge about the genetic aspects of common chronic complications of diabetes with prognostic significance, such as diabetic nephropathy and cardiovascular diseases. It is well known that the genetic factors responsible for chronic complications are different from those that cause Diabetes Mellitus. Until recently, the studies were limited to the analysis of individual genes associated or related to multifactorial diseases. However at the present time the "genome wide associated studies" lead to agreat advance in knowledge. The analysis of genetic variations or polymorphisms allows the understanding of human individuality and the predisposition towards certain diseases. A new research field appeared in 2004, when small messenger RNAs, called microRNA related to Diabetes mellitus and its chronic complications, were identified. The function of these RNAs is to regulate several target genes. These affect insulin secretion and action and genes related to microangiopathic and specific macroangiopahic complications. This new knowledge will identify new genes related to the disease and will allow the development of therapeutic strategies devised according to individual susceptibility towards specific chronic complication.