Pub Date : 2015-11-03DOI: 10.33590/emjdiabet/10311827
E. Green
Immunobiological interventions are proving to be an exciting new area for mobilising the immune response towards certain tumours. In contrast, classical immunotherapeutic interventions aimed at dampening the autoimmune response to host tissue have been less successful; this is particularly evident for Type 1 diabetes (T1D). In part, the failure to control autoimmunity in T1D relates to the complexity of the immune response to β cells. To resolve this dilemma, immunologists are turning to immunobiological agents that were initially deemed too high risk for therapeutic use due to their potential to inadvertently promote autoimmunity or induce deleterious side effects. Two of these immunobiological mediators under consideration are transforming growth factor β (TGFβ) and tolerogenic dendritic cells (DCs), both of which have shown robust control of the anti-islet response in animal models of T1D, the latter also recently documented to be acceptable for trialling in patients with T1D. In this review, both the challenges of translating immunobiological therapies discovered in animal models of T1D to man and the potential of TGFβ and tolerogenic DCs in the T1D setting will be discussed.
{"title":"Transforming Growth Factor Beta-Based Therapies, a Potential Modulator of the Immune Response in Type 1 Diabetes?","authors":"E. Green","doi":"10.33590/emjdiabet/10311827","DOIUrl":"https://doi.org/10.33590/emjdiabet/10311827","url":null,"abstract":"Immunobiological interventions are proving to be an exciting new area for mobilising the immune response towards certain tumours. In contrast, classical immunotherapeutic interventions aimed at dampening the autoimmune response to host tissue have been less successful; this is particularly evident for Type 1 diabetes (T1D). In part, the failure to control autoimmunity in T1D relates to the complexity of the immune response to β cells. To resolve this dilemma, immunologists are turning to immunobiological agents that were initially deemed too high risk for therapeutic use due to their potential to inadvertently promote autoimmunity or induce deleterious side effects. Two of these immunobiological mediators under consideration are transforming growth factor β (TGFβ) and tolerogenic dendritic cells (DCs), both of which have shown robust control of the anti-islet response in animal models of T1D, the latter also recently documented to be acceptable for trialling in patients with T1D. In this review, both the challenges of translating immunobiological therapies discovered in animal models of T1D to man and the potential of TGFβ and tolerogenic DCs in the T1D setting will be discussed.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134547628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-03DOI: 10.33590/emjdiabet/10310044
M. Vogel, E. Blaak, G. Goossens
The obesity epidemic calls for novel strategies to prevent and treat obesity and its comorbidities. Several studies have indicated that the amount of oxygen to which tissues are exposed may substantially impact cardiometabolic health. Interestingly, living at high altitude (hypobaric hypoxia) seems to be associated with improved glucose homeostasis and a decreased prevalence of Type 2 diabetes. Furthermore, normobaric hypoxia exposure has been shown to exert beneficial effects on glucose homeostasis and insulin sensitivity in rodents and humans. This may, at least in part, be explained by altered adipose tissue and skeletal muscle oxygen tension. In contrast, patients with obstructive sleep apnoea syndrome, which is characterised by episodes of severe intermittent hypoxia due to periodic collapse of the upper airway during sleep, show impairments in glucose homeostasis and are at increased cardiovascular risk. These discrepancies may be explained by the severity, duration, and pattern (number of cycles) of hypoxic episodes, but underlying mechanisms have not yet been studied in detail. The purpose of this review is to provide an overview of available studies on the link between oxygen tension, inflammation, and glucose homeostasis. Detailed studies to elucidate the effects of moderate hypoxia exposure on wholebody and tissue-specific insulin sensitivity in humans are clearly warranted.
{"title":"Moderate Hypoxia Exposure: A Novel Strategy to Improve Glucose Metabolism in Humans?","authors":"M. Vogel, E. Blaak, G. Goossens","doi":"10.33590/emjdiabet/10310044","DOIUrl":"https://doi.org/10.33590/emjdiabet/10310044","url":null,"abstract":"The obesity epidemic calls for novel strategies to prevent and treat obesity and its comorbidities. Several studies have indicated that the amount of oxygen to which tissues are exposed may substantially impact cardiometabolic health. Interestingly, living at high altitude (hypobaric hypoxia) seems to be associated with improved glucose homeostasis and a decreased prevalence of Type 2 diabetes. Furthermore, normobaric hypoxia exposure has been shown to exert beneficial effects on glucose homeostasis and insulin sensitivity in rodents and humans. This may, at least in part, be explained by altered adipose tissue and skeletal muscle oxygen tension. In contrast, patients with obstructive sleep apnoea syndrome, which is characterised by episodes of severe intermittent hypoxia due to periodic collapse of the upper airway during sleep, show impairments in glucose homeostasis and are at increased cardiovascular risk. These discrepancies may be explained by the severity, duration, and pattern (number of cycles) of hypoxic episodes, but underlying mechanisms have not yet been studied in detail. The purpose of this review is to provide an overview of available studies on the link between oxygen tension, inflammation, and glucose homeostasis. Detailed studies to elucidate the effects of moderate hypoxia exposure on wholebody and tissue-specific insulin sensitivity in humans are clearly warranted.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121122250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-01DOI: 10.33590/emjdiabet/10312637
D. Yabe, H. Kuwata, M. Iwasaki, Y. Seino
Type 2 diabetes mellitus (T2D) is one of the most serious global health problems. This is partly a result of its drastic increase in East Asia, which now comprises more than a quarter of the global diabetes population. Ethnicity and lifestyle factors are two determinants in the aetiology of T2D, and changes such as increased animal fat intake and decreased physical activity link readily to T2D in East Asians, which is characterised primarily by β-cell dysfunction that is evident immediately after ingestion of glucose or a meal, and less adiposity compared with T2D in Caucasians. These pathophysiological differences have an important impact on therapeutic approaches. Incretin-based therapies, such as dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), have become widely available for the management of T2D. Incretins, glucose-dependent insulinotropic polypeptide, and glucagon-like peptide-1 are secreted from the gut in response to the ingestion of various nutrients, including carbohydrates, proteins, and fats, and enhance insulin secretion via a glucose-dependent pathway to exert their glucose-lowering effects. Recent meta-analyses of clinical trials of DPP-4i and GLP-1RA found the drugs to be more effective in East Asians, most likely due to amelioration of the primary β-cell dysfunction by increased stimulation through incretin activity. In addition, our finding that the glycosylated haemoglobin-lowering effects of DPP-4i are enhanced by fish intake, and possibly worsened by animal fat intake, suggests that dietary habits such as eating more fish and less meat can affect the secretion of incretins, and supports the greater efficacy of incretin-based therapies in East Asians.
{"title":"Why Are Incretin-Based Therapies More Efficient in East Asians? Perspectives from the Pathophysiology of Type 2 Diabetes and East Asian Dietary Habits","authors":"D. Yabe, H. Kuwata, M. Iwasaki, Y. Seino","doi":"10.33590/emjdiabet/10312637","DOIUrl":"https://doi.org/10.33590/emjdiabet/10312637","url":null,"abstract":"Type 2 diabetes mellitus (T2D) is one of the most serious global health problems. This is partly a result of its drastic increase in East Asia, which now comprises more than a quarter of the global diabetes population. Ethnicity and lifestyle factors are two determinants in the aetiology of T2D, and changes such as increased animal fat intake and decreased physical activity link readily to T2D in East Asians, which is characterised primarily by β-cell dysfunction that is evident immediately after ingestion of glucose or a meal, and less adiposity compared with T2D in Caucasians. These pathophysiological differences have an important impact on therapeutic approaches. Incretin-based therapies, such as dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), have become widely available for the management of T2D. Incretins, glucose-dependent insulinotropic polypeptide, and glucagon-like peptide-1 are secreted from the gut in response to the ingestion of various nutrients, including carbohydrates, proteins, and fats, and enhance insulin secretion via a glucose-dependent pathway to exert their glucose-lowering effects. Recent meta-analyses of clinical trials of DPP-4i and GLP-1RA found the drugs to be more effective in East Asians, most likely due to amelioration of the primary β-cell dysfunction by increased stimulation through incretin activity. In addition, our finding that the glycosylated haemoglobin-lowering effects of DPP-4i are enhanced by fish intake, and possibly worsened by animal fat intake, suggests that dietary habits such as eating more fish and less meat can affect the secretion of incretins, and supports the greater efficacy of incretin-based therapies in East Asians.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116483720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-31DOI: 10.33590/emjdiabet/10311312
B. Turgut Ozturk
Diabetic macular oedema (DMO) presents an enormous rise in the last decades with an increasing number of diabetic patients. It has a negative impact on the health-related quality of life beside the related visual loss. Additionally, it incurs more health centre visits, higher health costs, and lower working performance. Therefore, early diagnosis and preventive measures gain more and more importance in the management of DMO. Risk factors for DMO can be divided into systemic and ocular risk factors. The leading systemic risk factors include age, type and duration of diabetes, insulin use, and glucose regulation. Hypertension, nephropathy, hyperlipidaemia, anaemia, cardiovascular disease, smoking, and amputation are other risk factors reported. In addition, susceptibility in cases with endothelial nitric oxide synthase polymorphism and vascular endothelial growth factor C634-G polymorphism has been reported. The severity of diabetic retinopathy, microaneurysm turnover, cataract surgery, incomplete vitreous detachment, and peripheral retinal ischaemia are among ocular risk factors. Though avoiding changes in the metabolic memory related to hyperglycaemia in the early period seems to be the most efficient treatment, nowadays close follow-up of patients with high risk and effort to control the modifiable risk factors seems to be the ideal treatment.
{"title":"Who Gets Diabetic Macular Oedema; When; and Why? Pathogenesis and Risk Factors","authors":"B. Turgut Ozturk","doi":"10.33590/emjdiabet/10311312","DOIUrl":"https://doi.org/10.33590/emjdiabet/10311312","url":null,"abstract":"Diabetic macular oedema (DMO) presents an enormous rise in the last decades with an increasing number of diabetic patients. It has a negative impact on the health-related quality of life beside the related visual loss. Additionally, it incurs more health centre visits, higher health costs, and lower working performance. Therefore, early diagnosis and preventive measures gain more and more importance in the management of DMO. Risk factors for DMO can be divided into systemic and ocular risk factors. The leading systemic risk factors include age, type and duration of diabetes, insulin use, and glucose regulation. Hypertension, nephropathy, hyperlipidaemia, anaemia, cardiovascular disease, smoking, and amputation are other risk factors reported. In addition, susceptibility in cases with endothelial nitric oxide synthase polymorphism and vascular endothelial growth factor C634-G polymorphism has been reported. The severity of diabetic retinopathy, microaneurysm turnover, cataract surgery, incomplete vitreous detachment, and peripheral retinal ischaemia are among ocular risk factors. Though avoiding changes in the metabolic memory related to hyperglycaemia in the early period seems to be the most efficient treatment, nowadays close follow-up of patients with high risk and effort to control the modifiable risk factors seems to be the ideal treatment.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"160 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124486871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-31DOI: 10.33590/emjdiabet/10312425
J. Ann, V. Antenor-Dorsey, J. Shimony
Individuals with Type 1 diabetes mellitus (T1DM) are required to carefully manage their insulin dosing, dietary intake, and activity levels in order to maintain optimal blood sugar levels. Over time, exposure to hyperglycaemia is known to cause significant damage to the peripheral nervous system, but its impact on the central nervous system has been less well studied. Researchers have begun to explore the cumulative impact of commonly experienced blood glucose fluctuations on brain structure and function in patient populations. To date, these studies have typically used magnetic resonance imaging to measure regional grey and white matter volumes across the brain. However, newer methods, such as diffusion tensor imaging (DTI) can measure the microstructural properties of white matter, which can be more sensitive to neurological effects than standard volumetric measures. Studies are beginning to use DTI to understand the impact of T1DM on white matter structure in the human brain. This work, its implications, future directions, and important caveats, are the focus of this review.
{"title":"Diffusion Tensor Imaging Of the Brain in Type 1 Diabetes","authors":"J. Ann, V. Antenor-Dorsey, J. Shimony","doi":"10.33590/emjdiabet/10312425","DOIUrl":"https://doi.org/10.33590/emjdiabet/10312425","url":null,"abstract":"Individuals with Type 1 diabetes mellitus (T1DM) are required to carefully manage their insulin dosing, dietary intake, and activity levels in order to maintain optimal blood sugar levels. Over time, exposure to hyperglycaemia is known to cause significant damage to the peripheral nervous system, but its impact on the central nervous system has been less well studied. Researchers have begun to explore the cumulative impact of commonly experienced blood glucose fluctuations on brain structure and function in patient populations. To date, these studies have typically used magnetic resonance imaging to measure regional grey and white matter volumes across the brain. However, newer methods, such as diffusion tensor imaging (DTI) can measure the microstructural properties of white matter, which can be more sensitive to neurological effects than standard volumetric measures. Studies are beginning to use DTI to understand the impact of T1DM on white matter structure in the human brain. This work, its implications, future directions, and important caveats, are the focus of this review.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117335254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-31DOI: 10.33590/emjdiabet/10310228
T. Mughal
This Takeda-sponsored European Association for the Study of Diabetes (EASD) symposium addressed the pharmacology, clinical use, and future therapeutic application of dipeptidyl-peptidase-4 (DPP-4) inhibitors. The scientific programme covered the clinical efficacy of DPP-4 inhibitors, their durability in clinical practice, and their use in combination therapy with other antidiabetic drugs. The important issue of the effect of this class of drugs on cardiovascular (CV) outcomes was also explored. The symposium was chaired by Prof Heinz Drexel and included insightful talks from an expert faculty comprising of Profs Jørgen Rungby, Jochen Seufert, and Kausik Ray.
{"title":"Investigating the Different Dimensions of DPP-4 Inhibitors","authors":"T. Mughal","doi":"10.33590/emjdiabet/10310228","DOIUrl":"https://doi.org/10.33590/emjdiabet/10310228","url":null,"abstract":"This Takeda-sponsored European Association for the Study of Diabetes (EASD) symposium addressed the pharmacology, clinical use, and future therapeutic application of dipeptidyl-peptidase-4 (DPP-4) inhibitors. The scientific programme covered the clinical efficacy of DPP-4 inhibitors, their durability in clinical practice, and their use in combination therapy with other antidiabetic drugs. The important issue of the effect of this class of drugs on cardiovascular (CV) outcomes was also explored. The symposium was chaired by Prof Heinz Drexel and included insightful talks from an expert faculty comprising of Profs Jørgen Rungby, Jochen Seufert, and Kausik Ray.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123064323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-31DOI: 10.33590/emjdiabet/10311401
Angelos Liontos, M. Elisaf, T. Filippatos
Patients with Type 2 diabetes mellitus (T2DM) have increased cardiovascular disease (CVD) risk. The use of statins significantly reduces the rate of CVD events but many T2DM patients, especially those with mixed dyslipidaemia (MD), have residual CVD risk. The use of fibrates, which improve triglyceride and high-density lipoprotein cholesterol levels, is beneficial for the treatment of patients with MD. Evidence from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid study showed a possible beneficial effect on CVD events of the addition of fenofibrate (FF) to statin treatment in patients with T2DM and atherogenic MD. Furthermore, FF has been associated with slowing of the progression of early diabetic retinopathy. The combination of statin with a fibrate may improve the residual CVD risk and microvascular complications of patients with T2DM. However, trials specifically designed to assess the effects of fibrate-statin combination on cardiovascular outcomes in patients with T2DM are missing.
{"title":"Residual Cardiovascular Risk in Diabetic Patients: The Role of Fibrate Statin Combination","authors":"Angelos Liontos, M. Elisaf, T. Filippatos","doi":"10.33590/emjdiabet/10311401","DOIUrl":"https://doi.org/10.33590/emjdiabet/10311401","url":null,"abstract":"Patients with Type 2 diabetes mellitus (T2DM) have increased cardiovascular disease (CVD) risk. The use of statins significantly reduces the rate of CVD events but many T2DM patients, especially those with mixed dyslipidaemia (MD), have residual CVD risk. The use of fibrates, which improve triglyceride and high-density lipoprotein cholesterol levels, is beneficial for the treatment of patients with MD. Evidence from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid study showed a possible beneficial effect on CVD events of the addition of fenofibrate (FF) to statin treatment in patients with T2DM and atherogenic MD. Furthermore, FF has been associated with slowing of the progression of early diabetic retinopathy. The combination of statin with a fibrate may improve the residual CVD risk and microvascular complications of patients with T2DM. However, trials specifically designed to assess the effects of fibrate-statin combination on cardiovascular outcomes in patients with T2DM are missing.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125506641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-31DOI: 10.33590/emjdiabet/10312057
D. Harrop, William Y S Wang, A. Ng
Diabetic patients are at an increased risk of developing heart failure. The aetiology of diabetic heart disease is likely to be multifactorial, ranging from altered myocardial metabolism, increased interstitial fibrosis, endothelial dysfunction, microvascular disease, and coronary atherosclerosis. These factors act synergistically with resultant myocardial systolic and diastolic dysfunction. The aim of the present review is to illustrate the role of multimodality cardiac imaging such as echocardiography, nuclear imaging, computed tomography, and magnetic resonance imaging in providing insights into these pathological processes, and to quantify the extent of myocardial diastolic and systolic dysfunction.
{"title":"Pathophysiology and Imaging Techniques of Diabetic Heart Disease","authors":"D. Harrop, William Y S Wang, A. Ng","doi":"10.33590/emjdiabet/10312057","DOIUrl":"https://doi.org/10.33590/emjdiabet/10312057","url":null,"abstract":"Diabetic patients are at an increased risk of developing heart failure. The aetiology of diabetic heart disease is likely to be multifactorial, ranging from altered myocardial metabolism, increased interstitial fibrosis, endothelial dysfunction, microvascular disease, and coronary atherosclerosis. These factors act synergistically with resultant myocardial systolic and diastolic dysfunction. The aim of the present review is to illustrate the role of multimodality cardiac imaging such as echocardiography, nuclear imaging, computed tomography, and magnetic resonance imaging in providing insights into these pathological processes, and to quantify the extent of myocardial diastolic and systolic dysfunction.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130893412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-31DOI: 10.33590/emjdiabet/10311131
J. Jocken, G. Goossens, E. Blaak
With Type 2 diabetes mellitus and cardiovascular disease prevalence on the rise, there is a growing need for improved strategies to prevent or treat obesity and insulin resistance, both of which are major risk factors for these chronic diseases. Impairments in adipose tissue lipid metabolism seem to play a critical role in these disorders. In the classical picture of intracellular lipid breakdown, cytosolic lipolysis was proposed as the sole mechanism for triacylglycerol hydrolysis in adipocytes. Recent evidence suggests involvement of several hormones, membrane receptors, and intracellular signalling cascades, which has added complexity to the regulation of cytosolic lipolysis. Interestingly, a specific form of autophagy, called lipophagy, has been implicated as alternative lipolytic pathway. Defective regulation of cytosolic lipolysis and lipophagy might have substantial effects on lipid metabolism, thereby contributing to adipose tissue dysfunction, insulin resistance, and related cardiometabolic (cMet) diseases. This review will discuss recent advances in our understanding of classical lipolysis and lipophagy in adipocyte lipid metabolism under normal and pathological conditions. Furthermore, the question of whether modulation of adipocyte lipolysis and lipophagy might be a potential therapeutic target to combat cMet disorders will be addressed.
{"title":"Targeting Adipose Tissue Lipid Metabolism to Improve Glucose Metabolism in Cardiometabolic Disease","authors":"J. Jocken, G. Goossens, E. Blaak","doi":"10.33590/emjdiabet/10311131","DOIUrl":"https://doi.org/10.33590/emjdiabet/10311131","url":null,"abstract":"With Type 2 diabetes mellitus and cardiovascular disease prevalence on the rise, there is a growing need for improved strategies to prevent or treat obesity and insulin resistance, both of which are major risk factors for these chronic diseases. Impairments in adipose tissue lipid metabolism seem to play a critical role in these disorders. In the classical picture of intracellular lipid breakdown, cytosolic lipolysis was proposed as the sole mechanism for triacylglycerol hydrolysis in adipocytes. Recent evidence suggests involvement of several hormones, membrane receptors, and intracellular signalling cascades, which has added complexity to the regulation of cytosolic lipolysis. Interestingly, a specific form of autophagy, called lipophagy, has been implicated as alternative lipolytic pathway. Defective regulation of cytosolic lipolysis and lipophagy might have substantial effects on lipid metabolism, thereby contributing to adipose tissue dysfunction, insulin resistance, and related cardiometabolic (cMet) diseases. This review will discuss recent advances in our understanding of classical lipolysis and lipophagy in adipocyte lipid metabolism under normal and pathological conditions. Furthermore, the question of whether modulation of adipocyte lipolysis and lipophagy might be a potential therapeutic target to combat cMet disorders will be addressed.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125395546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-01DOI: 10.33590/emjdiabet/10310389
S. Zanuso
The aim of this paper is to highlight the evidence on the interrelationships between exercise and Type 2 diabetes mellitus (T2DM) in the ageing population. The evidence addressed in the specific literature is presented in three domains: aerobic exercise, resistance exercise, and combined aerobic and resistance exercise. The effects of aerobic exercise are well established, but in the ageing population resistance training could be considered a superior intervention to help glycaemic control; the effects of resistance training on insulin sensitivity are attributable to an increase in muscle mass. Thus, although with resistance training body weight does not change much, the main effect of resistance training on body composition of the elderly should be a shift from fat to muscle mass, and the maintenance of a large muscle mass may reduce obesity related risk factors. Fewer studies have investigated the effects of combined resistance and aerobic training, but from the available evidences it would appear that combined exercise training seems to offer additional benefits if compared with aerobic training alone and resistance training alone.
{"title":"Exercise: A Powerful Tool to Manage Type 2 Diabetes in the Ageing Population","authors":"S. Zanuso","doi":"10.33590/emjdiabet/10310389","DOIUrl":"https://doi.org/10.33590/emjdiabet/10310389","url":null,"abstract":"The aim of this paper is to highlight the evidence on the interrelationships between exercise and Type 2 diabetes mellitus (T2DM) in the ageing population. The evidence addressed in the specific literature is presented in three domains: aerobic exercise, resistance exercise, and combined aerobic and resistance exercise. The effects of aerobic exercise are well established, but in the ageing population resistance training could be considered a superior intervention to help glycaemic control; the effects of resistance training on insulin sensitivity are attributable to an increase in muscle mass. Thus, although with resistance training body weight does not change much, the main effect of resistance training on body composition of the elderly should be a shift from fat to muscle mass, and the maintenance of a large muscle mass may reduce obesity related risk factors. Fewer studies have investigated the effects of combined resistance and aerobic training, but from the available evidences it would appear that combined exercise training seems to offer additional benefits if compared with aerobic training alone and resistance training alone.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130004925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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