A system model of the effects of exercise on plasma Interleukin-6 dynamics in healthy individuals: Role of skeletal muscle and adipose tissue

Interleukin-6 (IL-6) has been recently shown to play a central role in glucose homeostasis, since it stimulates the production and secretion of Glucagon-like Peptide-1 (GLP-1) from intestinal L-cells and pancreas, leading to an enhanced insulin response. In resting conditions, IL-6 is mainly produced by the adipose tissue whereas, during exercise, skeletal muscle contractions stimulate a marked IL-6 secretion as well. Available mathematical models describing the effects of exercise on glucose homeostasis, however, do not account for this IL-6 contribution. This study aimed at developing and validating a system model of exercise’s effects on plasma IL-6 dynamics in healthy humans, combining the contributions of both adipose tissue and skeletal muscle. A two-compartment description was adopted to model plasma IL-6 changes in response to oxygen uptake’s variation during an exercise bout. The free parameters of the model were estimated by means of a cross-validation procedure performed on four different datasets. A low coefficient of variation (<10%) was found for each parameter and the physiologically meaningful parameters were all consistent with literature data. Moreover, plasma IL-6 dynamics during exercise and post-exercise were consistent with literature data from exercise protocols differing in intensity, duration and modality. The model successfully emulated the physiological effects of exercise on plasma IL-6 levels and provided a reliable description of the role of skeletal muscle and adipose tissue on the dynamics of plasma IL-6. The system model here proposed is suitable to simulate IL-6 response to different exercise modalities. Its future integration with existing models of GLP-1-induced insulin secretion might provide a more reliable description of exercise’s effects on glucose homeostasis and hence support the definition of more tailored interventions for the treatment of type 2 diabetes

Mathematical Model of Glucagon Kinetics for the Assessment of Insulin-Mediated Glucagon Inhibition During an Oral Glucose Tolerance Test

none6siGlucagon is secreted from the pancreatic alpha cells and plays an important role in the maintenance of glucose homeostasis, by interacting with insulin. The plasma glucose levels determine whether glucagon secretion or insulin secretion is activated or inhibited. Despite its relevance, some aspects of glucagon secretion and kinetics remain unclear. To gain insight into this, we aimed to develop a mathematical model of the glucagon kinetics during an oral glucose tolerance test, which is sufficiently simple to be used in the clinical practice. The proposed model included two first-order differential equations -one describing glucagon and the other describing C-peptide in a compartment remote from plasma - and yielded a parameter of possible clinical relevance (i.e., SGLUCA(t), glucagon-inhibition sensitivity to glucose-induced insulin secretion). Model was validated on mean glucagon data derived from the scientific literature, yielding values for SGLUCA(t) ranging from -15.03 to 2.75 (ng of glucagon·nmol of C-peptide-1). A further validation on a total of 100 virtual subjects provided reliable results (mean residuals between -1.5 and 1.5 ng·L-1) and a negative significant linear correlation (r = -0.74, p < 0.0001, 95% CI: -0.82 - -0.64) between SGLUCA(t) and the ratio between the areas under the curve of suprabasal remote C-peptide and glucagon. Model reliability was also proven by the ability to capture different patterns in glucagon kinetics. In conclusion, the proposed model reliably reproduces glucagon kinetics and is characterized by sufficient simplicity to be possibly used in the clinical practice, for the estimation in the single individual of some glucagon-related parameters.openMorettini, Micaela; Burattini, Laura; Göbl, Christian; Pacini, Giovanni; Ahrén, Bo; Tura, AndreaMorettini, Micaela; Burattini, Laura; Göbl, Christian; Pacini, Giovanni; Ahrén, Bo; Tura, Andre

A model of beta-cell response to GLP-1 to quantify incretin effect in healthy and prediabetic subjects

Glucose regulation, in healthy subjects, relies on a complex control system that keeps blood glucose level within a narrow range around its basal value. Impairment of the glucose regulatory system is the cause of several metabolic derangements, including diabetes, which is characterized by chronic hyperglycemia which leads to severe micro and macro-vascular complications. Diabetes is generally classified into two categories, type 1 and type 2 diabetes. Both arise from complex interactions between genes and the environment, and are characterized by an absolute deficiency of insulin production (type 1) or a relative deficiency of the pancreas to produce insulin in amounts sufficient to meet the body needs (type 2). The prevalence of diabetes is increasing dramatically in populations of the world, and its global incidence has been increasing steadily in the past several years. Traditional medications for type 2 diabetes, including insulin, sulfonylureas, glitinides, acarbose, metformin, and thiazolidinediones, lower blood glucose through diverse mechanisms of action. However, many of the oral hypoglycemic agents lose their efficacy over time, resulting in progressive deterioration in β-cell function and loss of glycemic control due to progressive loss of β-cell mass. Consequently, there is an increasing interest in developing therapeutic agents that preserve or restore functional β-cells mass such as the incretin hormone Glucagon-Like Peptide-1 (GLP-1). It not only acutely lowers blood glucose by promoting insulin secretion and inhibiting glucagon release, but also engages signaling pathways in the islet β-cells that leads to stimulation of β-cells proliferation and neo-genesis and inhibition of β-cell apoptosis. Impairment of insulin secretion and glucagon suppression suggests that decreased β-cells responsiveness to GLP-1 is part of the pathogenesis of type 2 diabetes. Thus the ability to measure the effect of GLP-1 on insulin secretion can be useful to understand the pathogenesis of type 2 diabetes. Moreover it can be employed to optimized GLP-1 based therapy by determining those individuals who may benefit more from such therapy. However, a mechanistic model enabling direct quantitation of pancreatic response to GLP-1 has never been developed. In this contribution a mathematical model which describes the mechanism of GLP-1 action on insulin secretion is proposed. It provides a direct measure of the β-cells responsivity indexes to glucose and GLP-1. Three databases were used to develop, test and validate the model. Data of 88 healthy individuals, who underwent a hyperglycemic clamp with a concomitant GLP-1 intravenous infusion, were used for model formulation. A set of models of increasing complexity describing GLP-1 action on insulin secretion were tested. All models share the common assumption that insulin secretion is made up of two components, one proportional to glucose rate of change through dynamic responsivity, Φd, and one proportional to glucose through static responsivity, Φs, but differ in the modality of GLP-1 control on β-cells. For each model potentiation index П was derived representing the percent increase in secretion due to 1 pmol/l of circulating GLP-1. All the models fit the data well, as confirmed by the run test, which supported randomness of residuals in 70% of the subjects and provide precise estimate of model parameters. Model selection was tackled using standard criteria (e.g. ability to describe the data, precision of parameter estimates, model parsimony, residual independence). The most parsimonious model in most subjects assumes that above-basal insulin secretion depends linearly on GLP-1 concentration and its rate of change. However, the hyperglycemic clamp with concomitant intravenous infusion of GLP-1, is not physiological and easy to perfume in large scale studies. Thus data of 22 impairing fasting glucose (IFG) subjects, studied twice with a mixed meal, were used to test the model performance in a more physiological condition. We found that during an oral test, a simpler model is sufficient to describe the data. Validation of the model was performed using both simulations and real data of 10 healthy subjects studied with an OGTT and matched intravenous glucose challenge (I-IVG). The protocol allows to calculate a model-independent index (PI) from the comparison of insulin secretion rate estimated in these two occasions. The comparison between model-derived Π and incretin potentiation index PI shows that they are very similar (П = 6.55, CV = 65%; PI = 6.15 % per pmol/l). In addition in silico validation proved the ability of the model to single out the effect of GLP-1 on insulin secretion since it correctly estimated П in the 93 ± 1% of the simulations

Tyypin 2 diabeteksen ja siihen liittyvien ominaisuuksien periytyvyys

Disturbances in insulin sensitivity and insulin secretion precede the manifestation of type 2 diabetes. Both genes and environment contribute to the diabetes risk. Heritability indicates the proportion to which genotype determines the variability of a trait, such as for example blood glucose concentration. The current work was done for the Hjelt institute and for the Finnish institute of Molecular Medicine (FiMM) in the University of Helsinki. Heritability of insulin sensitivity, insulin secretion and traits associated with type 2 diabetes were estimated by means of twin and family studies. The twins belonged to the Finnish Twin Cohort Study of the University of Helsinki and the families participated in the Botnia study, a project on type 2 diabetes genetics. The collecting of the material was made between the years 1992 - 2004. Insulin sensitivity was measured by means of hyperinsulinaemic euglycaemic clamp technique. Insulin secretion was measured both via oral (OGTT) and intravenous (IVGTT) glucose tolerance tests. The heritability of body mass index (BMI) and type 2 diabetes were estimated in a follow-up study of twins. Furthermore, heritability estimates of several glucose metabolism and insulin sensitivity related traits were obtained by examining Botnia study families where at least two family members had type 2 diabetes. Altogether 66 monozygotic (MZ) and 85 dizygotic (DZ) twin pairs underwent OGTT. A subset of the pairs participated also in IVGTT- and clamp studies. The follow-up study was based on information that was received from 10400 twin pairs during a maximum of 28 years of follow-up. From the Botnia-study, 5810 adults from 942 families were chosen: 1707 of them had type 2 diabetes. The average family size was 6,17. On the basis of the metabolic studies, it was concluded that the genotype determines the insulin secretion's early phase, which begins immediately after the ingestion or infusion of glucose. The heritability of this trait varied between 55% and 76%. The majority of variation in insulin sensitivity, instead, seemed to be due to non-hereditary factors, as the heritability of insulin sensitivity was only 37%. In the follow-up study, 6.3% of male and 5.1% of female twins got type 2 diabetes. BMI calculated on the basis of the data recorded at the start of the follow-up, predicted future diabetes well. On average, the hazard ratio for type 2 diabetes was 1,22 per each BMI unit and the risk began to increase already from the BMI-value of 20kg/m2. The hazard ratios for type 2 diabetes in normal weight, overweight, obese and morbidly obese twins were 0.59, 2.96, 6.80 and 13.64, respectively. When BMI and type 2 diabetes were modelled together, the heritability of BMI in men was 75%, and 71% in women. Correspondingly, the heritability of type 2 diabetes was 73% in men and 64% in women, respectively. The genetic factors influencing BMI explained only 16% of the risk for type 2 diabetes among men and 21% of the risk among women. In the Botnia study, the highest heritability estimate for type 2 diabetes, 69%, was observed among individuals aged 35 to 60 years. The heritability of the early phase of insulin secretion varied between 41% (all subjects) and 50% (non-diabetic subjects). The heritability of insulin sensitivity was the same as among twins, from 37% to 40%. Among diabetes-related traits, the highest heritability estimates were obtained for lean body mass (53% to 65%), serum HDL cholesterol concentration (52% to 61%) and suppression of free fatty acids during OGTT (63% to 76%). The variation of all insulin sensitivity and insulin secretion -related traits were smaller within than between families. It is stated as a summary of this doctoral thesis that the risk for type 2 diabetes seems to be an inherited trait. A relatively small share in this risk, on the other hand, seems to be due to genes which influence BMI. Finally, the early phase of the pancreatic insulin secretion appears to be an aspect of metabolism that encompasses promising phenotypes for genomic studies.Häiriöt sokeriaineenvaihdunnan insuliiniherkkyydessä ja insuliininerityksessä edeltävät tyypin 2 diabeteksen puhkeamista. Sekä perimä (geneettiset tekijät) että elintavat vaikuttavat diabetesriskiin. Periytyvyys eli heritabiliteetti ilmaisee, paljonko perimä määrää mitattavan ominaisuuden kuten esimerkiksi verensokerin vaihtelua. Helsingin yliopiston lääketieteellisen tiedekunnan alaisessa, Hjelt-instituutille ja Suomen molekyylilääketieteen instituutille (FiMM) tehdyssä väitöstutkimuksessa selvitettiin sokeriaineenaihdunnan, insuliininerityksen ja diabetesriskin periytyvyyttä kaksos- ja perhetutkimuksen keinoin. Kaksoset kuuluivat Helsingin yliopiston Kaksostutkimukseen, joka vuonna 2014 täyttää 40 vuotta. Perheaineisto koottiin suomalaisesta Botnia-tutkimuksesta, joka on maailman huomattavimpia tyypin 2 diabeteksen perimää selvittäviä projekteja. Aineiston kokoaminen ja seuranta tehtiin vuosien 1992 - 2004 aikana. Tutkimuksessa määritettiin insuliiniherkkyys clamp-tekniikan avulla: tutkittavan henkilön veren insuliinitaso nostettiin keinotekoisesti halutulle tasolle ja katsottiin, kuinka paljon sokeriliuosta on annettava laskimoon estämään insuliinin aikaansaama verensokerin lasku. Insuliinineritys mitattiin sekä tavallista (oraalista, OGTT) että laskimonsisäistä (IVGTT) sokerirasitusta käyttäen. Tyypin 2 diabeteksen ja kehon painoindeksin (BMI) periytyvyys selvitettiin pitkässä seurantatutkimuksessa. Lisäksi useille sokeriaineenvaihduntaan ja insuliiniherkkyyteen liittyville piirteille määritettiin periytyvyys tutkimalla Botnia-tutkimukseen osallistuneita perheitä, joissa vähintään kahdella perheenjäsenellä on tyypin 2 diabetes. Kaikkian 66 identtiselle ja 85 epäidenttiselle kaksosparille tehtiin OGTT ja osalle lisäksi sekä IVGTT että clamp. Seurantatutkimus perustui 10400 kaksosparista saatuihin tietoihin. Pisin seuranta-aika oli 28 vuotta. Botnia-tutkimuksesta valittiin 942 perhettä, joihin kuului 5810 aikuista. Heistä 1707:llä oli tyypin 2 diabetes. Keskimääräinen perhekoko oli 6,17. Kaksosille tehtyjen aineenvaihduntatutkimusten perusteella ilmeni, että perimä määrää vahvasti erityisesti insuliininerityksen varhaista vaihetta, joka alkaa välittömästi sokerin nauttimisen tai laskimoon annostelun jälkeen. Tämän ominaisuuden periytyvyys vaihteli 55 ja 76% välillä. Valtaosa insuliiniherkkyyden vaihtelusta sen sijaan näytti johtuvan ei-perinnöllisistä syistä ja insuliiniherkkyyden periytyvyydeksi saatiin vain 37%. Seurantatutkimuksessa 6,3% mies- ja 5,1% naiskaksosista sairastui tyypin 2 diabetekseen. Seurannan alussa kerättyjen tietojen perusteella laskettu painoindeksi ennusti tulevaa diabetesta erittäin hyvin. Keskimäärin riskisuhde oli 1,22 jokaista nousevaa BMI-yksikköä kohti. Diabetesriski alkoi lisääntyä jo BMI-arvosta 20 kg/m2 lähtien. Normaalipainoisten, ylipainoisten, lihavien ja sairaalloisen lihavien riskisuhteet olivat 0,59, 2,96, 6,80 ja 13,64. Kun sekä BMI että tyypin 2 diabetes huomioitiin yhtä aikaa, saatiin BMI:n periytyvyydeksi 75% miehillä ja 71% naisilla. Vastaavasti tyypin 2 diabeteksen periytyvyydeksi saatiin miehillä 73% ja naisilla 64%. Painoindeksin perintötekijät selittivät vain 16% miesten ja 21% naisten riskistä sairastua tyypin 2 diabetekseen. Botniatutkimuksessa tyypin 2 diabeteksen periytyvyys oli suurimmillaan 69 prosenttia, 35 - 60 -vuotiaiden keskuudessa. Insuliininerityksen varhaisen vaiheen periytyvyys vaihteli 41% (kaikki tutkittavat) ja 50% (tutkittavat, joilla ei diabetesta) välillä. Insuliiniherkkyyden periytyvyys oli sama kuin kaksostutkimuksessa, 37-40%. Diabetekseen liittyvistä aineenvaihdunnan ominaisuuksista korkein periytyvyys saatiin kehon rasvattomalle massalle (53-65%), seerumin HDL-kolesteroli-pitoisuudelle (52-61%) ja OGTT:n aikaiselle vapaiden rasvahappojen pitoisuuden laskulle (63-76%). Kaikkien insuliiniherkkyyteen ja insuliinineritykseen liittyvien ominaisuuksien vaihtelu perheiden sisällä oli pienempää kuin perheiden välillä. Väitöstutkimuksen yhteenvetona todetaan, että riski sairastua tyypin 2 diabetekseen on periytyvä. Painoindeksiin vaikuttavilla geeneillä on merkittävä, kenties tähän asti oletettua pienempi osuus tässä riskissä. Lisäksi todetaan, että insuliininerityksen varhainen vaihe kannattaa huomioida haettaessa tyypin 2 diabetekselle altistavia perintötekijöitä esimerkiksi koko genomin laajuisissa assosiaatiotutukimuksissa

Review of methods for detecting glycemic disorders

Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity

Architecture of androgen receptor pathways amplifying glucagon-like peptide-1 insulinotropic action in male pancreatic β cells

Male mice lacking the androgen receptor (AR) in pancreatic β cells exhibit blunted glucose-stimulated insulin secretion (GSIS), leading to hyperglycemia. Testosterone activates an extranuclear AR in β cells to amplify glucagon-like peptide-1 (GLP-1) insulinotropic action. Here, we examined the architecture of AR targets that regulate GLP-1 insulinotropic action in male β cells. Testosterone cooperates with GLP-1 to enhance cAMP production at the plasma membrane and endosomes via: (1) increased mitochondrial production of C

Architecture of androgen receptor pathways amplifying glucagon-like peptide-1 insulinotropic action in male pancreatic β cells

Male mice lacking the androgen receptor (AR) in pancreatic β cells exhibit blunted glucose-stimulated insulin secretion (GSIS), leading to hyperglycemia. Testosterone activates an extranuclear AR in β cells to amplify glucagon-like peptide-1 (GLP-1) insulinotropic action. Here, we examined the architecture of AR targets that regulate GLP-1 insulinotropic action in male β cells. Testosterone cooperates with GLP-1 to enhance cAMP production at the plasma membrane and endosomes via: (1) increased mitochondrial production of CO2, activating the HCO3--sensitive soluble adenylate cyclase; and (2) increased Gαs recruitment to GLP-1 receptor and AR complexes, activating transmembrane adenylate cyclase. Additionally, testosterone enhances GSIS in human islets via a focal adhesion kinase/SRC/phosphatidylinositol 3-kinase/mammalian target of rapamycin complex 2 actin remodeling cascade. We describe the testosterone-stimulated AR interactome, transcriptome, proteome, and metabolome that contribute to these effects. This study identifies AR genomic and non-genomic actions that enhance GLP-1-stimulated insulin exocytosis in male β cells

Insights into the metabolic regulation of insulin secretion using a metabolomics approach

In the post genomic era, metabolomics, as an integrated part of system biology, offers a promising approach to identify biomarkers associated with diseases and hence has been widely used in disease diagnosis, toxicology, plant science, and pharmaceutical and environmental research. Based on the specific study goals, metabolomics involves two major categories: targeted and untargeted. Unlike targeted metabolomics with well-established analysis method, untargeted metabolomics still needs to overcome some technical challenges. This dissertation attempts to address these challenges and to establish a feasible untargeted metabolomics platform from sample preparation to data interpretation and biologically meaningful validation. In this dissertation, gas chromatography-mass spectrometry (GC-MS) was used as the analytical instrument to detect and identify metabolites. This GC-MS based untargeted metabolomics was successfully applied to study four different aspects of glucose-stimulated insulin secretion (GSIS), including the biochemical mechanism underlying insulin secretion, biphasic insulin secretion, time-dependent effects (TDE) of glucose on insulin secretion, as well as the role of alpha-ketoglutarate dependent hydroxylation in regulation of insulin secretion. GSIS was identified by orthogonal partial least squares (OPLS) to be associated with not only glycolysis and tricarboxylic acid cycle (TCA cycle), but also the pentose phosphate pathway (PPP), the sorbitol-aldose reductase pathway as well as aspartate. The characterization of the kinetics of insulin secretion revealed that alpha-ketoglutarate, succinate and hydroxyproline were the metabolites strongly associated with the second phase of biphasic insulin secretion. Study of TDE by using a metabolomics approach showed that the time-dependent inhibition (TDI) of glucose on insulin secretion is mainly regulated by redox state in pancreatic beta cells, since it was suggested to be correlated to the decreased ratio between dihydroxyacetone phosphate (DHAP) and alpha-glycerolphosphate (alpha-GP). This was probably the result of the reduced malate-aspartate shuttle activity and lower lactate output in beta cells. On the other hand, time-dependent potentiation (TDP) might be mediated by succinate-regulated pro-insulin biosynthesis. Finally, alpha-ketoglutarate dependent hydroxylation was found to be a master regulator that controls glucose metabolism as well as glucose derived anaplerosis, a finding which, if true, provides a positive feedback loop for the secretion function of pancreatic beta cells. Overall, this GC-MS based untargeted metabolomics approach was established and then was used to study the mechanism of GSIS. Alpha-ketoglutarate was revealed to be critical to kinetically coupling glucose metabolism to (especially the second phase of) insulin secretion probably via an alpha-ketoglutarate dependent hydroxylation mechanism.1 yea