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GIP Receptor Antagonism Eliminates Paradoxical Growth Hormone Secretion in Some Patients With Acromegaly. GIP 受体拮抗剂可消除某些肢端肥大症患者的生长激素分泌。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae583
Mette H Jensen, Lærke S Gasbjerg, Kirsa Skov-Jeppesen, Jens C B Jacobsen, Steen S Poulsen, Cuiqi Zhou, Ruta Jakubauskaite, Frantz R Poulsen, Christian Bonde, Mahmoud Albarazi, Bo Halle, Charlotte B Christiansen, Samra J Sanni, Sarah Byberg, Bjørn Hoe, Jens J Holst, Flemming Dela, Aase K Rasmussen, Filip K Knop, Mai C Arlien-Søborg, Shlomo Melmed, Jens Otto L Jørgensen, Marianne S Andersen, Bolette Hartmann, Marianne C Klose, Ulla Feldt-Rasmussen, Alexander H Sparre-Ulrich, Mette M Rosenkilde

Context: About 30% of patients with active acromegaly experience paradoxically increased growth hormone (GH) secretion during the diagnostic oral glucose tolerance test (OGTT). Endogenous glucose-dependent insulinotropic polypeptide (GIP) is implicated in this paradoxical secretion.

Objective: We used the GIP receptor (GIPR) antagonist GIP(3-30)NH2 to test the hypothesis that GIP mediates this paradoxical response when GIPR is abundantly expressed in somatotropinomas.

Methods: A total of 25 treatment-naive patients with acromegaly were enrolled. Each patient underwent one OGTT during simultaneous placebo infusion and one OGTT during a GIP(3-30)NH2 infusion. Blood samples were drawn at baseline and regularly after infusions to measure GH. We assessed pituitary adenoma size by magnetic resonance imaging and GIPR expression by immunohistochemistry on resected somatotropinomas. For mechanistic confirmation, we applied in vitro and ex vivo approaches. The main outcome measure was the effect of GIP(3-30)NH2 on paradoxical GH secretion during OGTT as a measure of GIP involvement.

Results: In 4 of 7 patients with paradoxical GH secretion, GIP(3-30)NH2 infusion completely abolished the paradoxical response (P = .0003). Somatotrophs were available from 3 of 4 of these patients, all showing abundant GIPR expression. Adenoma size did not differ between patients with and without paradoxical GH secretion.

Conclusion: Of 25 patients with acromegaly, 7 had paradoxical GH secretion during OGTT, and pharmaceutical GIPR blockade abolished this secretion in 4. Corresponding somatotroph adenomas abundantly expressed GIPR, suggesting a therapeutic target in this subpopulation of patients. In vitro and ex vivo analyses confirmed the role of GIP and the effects of the antagonist.

背景:大约 30% 的活动性肢端肥大症患者在诊断性口服葡萄糖耐量试验 (OGTT) 中会出现生长激素 (GH) 分泌增加的矛盾现象。内源性葡萄糖依赖性促胰岛素多肽(GIP)与这种矛盾性分泌有关:目的:我们使用 GIP 受体(GIPR)拮抗剂 GIP(3-30)NH2 来验证一个假设,即当 GIPR 在体细胞瘤中大量表达时,GIP 会介导这种矛盾反应:共招募了25名未经治疗的肢端肥大症患者。每位患者在同时输注安慰剂期间和输注 GIP(3-30)NH2 期间各进行一次 OGTT。在基线和输注后定期抽取血样以测量 GH。我们通过磁共振成像评估了垂体腺瘤的大小,并通过免疫组化评估了切除的体细胞瘤中 GIPR 的表达。主要结果指标:GIP(3-30)NH2对OGTT期间矛盾性GH分泌的影响,作为衡量GIP参与程度的指标:结果:在 7 例出现 GH 反常分泌的患者中,有 4 例输注 GIP(3-30)NH2 完全消除了 反常反应(P = 0.0003)。其中四名患者中有三名获得了体细胞瘤,均显示出丰富的 GIPR 表达。腺瘤大小在有和没有GH矛盾分泌的患者之间没有差异:结论:在25例肢端肥大症患者中,有7例在OGTT期间出现GH反常分泌,药物GIPR阻断可消除4例患者的GH分泌。相应的体细胞腺瘤大量表达 GIPR,这表明该亚群患者有治疗目标。体外和体内分析证实了 GIP 的作用和拮抗剂的效果。
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引用次数: 0
Approach to the Child and Adolescent With Adrenal Insufficiency. 肾上腺功能不全儿童和青少年的治疗方法。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae564
Giuseppa Patti, Alice Zucconi, Simona Matarese, Caterina Tedesco, Marta Panciroli, Flavia Napoli, Natascia Di Iorgi, Mohamad Maghnie

The management of adrenal insufficiency (AI) is challenging, and the overall goals of treatment are to prevent life-threatening adrenal crises, to optimize linear growth, to control androgen levels without overdosing in patients with congenital adrenal hyperplasia (CAH), and to improve quality of life in affected individuals. Standard glucocorticoid formulations fail to replicate the circadian rhythm of cortisol and control the adrenal androgen production driven by adrenocorticotropin. To personalize and tailor glucocorticoid therapy and to improve patient outcomes, new pharmacological strategies have been developed that best mimic physiological cortisol secretion. Novel therapeutic approaches in the management of AI include new ways to deliver circadian cortisol replacement as well as various adjunctive therapies to reduce androgen production and/or androgen action/effects. Preclinical studies are exploring the role of restorative cell-based therapies, and a first recombinant adeno-associated virus-based gene therapy is also being developed in humans with CAH. In this article, we present 3 illustrative cases of AI with different underlying etiologies and times of presentation. Diagnostic and management processes are discussed with an emphasis on treatment and outcomes. We have also provided the most up-to-date evidence for the tailored management of children and adolescents with AI.

肾上腺功能不全的治疗极具挑战性,治疗的总体目标是预防危及生命的肾上腺危象、优化线性生长、控制先天性肾上腺增生症(CAH)患者的雄激素水平而不致用药过量,以及改善患者的生活质量。标准的糖皮质激素配方无法复制皮质醇的昼夜节律,也无法控制肾上腺皮质激素驱动的肾上腺雄激素分泌。为了实现糖皮质激素治疗的个性化和定制化,并改善患者的治疗效果,人们开发出了最能模拟皮质醇生理性分泌的新药物治疗策略。治疗肾上腺功能不全的新疗法包括提供昼夜皮质醇替代的新方法,以及减少雄激素分泌和/或雄激素作用/影响的各种辅助疗法。临床前研究正在探索以细胞为基础的恢复性疗法的作用,而第一种以重组腺相关病毒为基础的基因疗法也正在CAH患者中开发。在本文中,我们介绍了三个肾上腺功能不全的病例,这些病例的病因和发病时间各不相同。文章讨论了诊断和管理过程,重点是治疗和结果。我们还为儿童和青少年肾上腺功能不全患者的针对性治疗提供了最新证据。
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引用次数: 0
Deficiency of Peptidylglycine-alpha-amidating Monooxygenase, a Cause of Sarcopenic Diabetes Mellitus. 肽基甘氨酸-α-酰胺化单氧酶缺乏症是导致肥胖性糖尿病的原因之一。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae510
Alice Giontella, Mikael Åkerlund, Kevin Bronton, Cristiano Fava, Luca A Lotta, Aris Baras, John D Overton, Marcus Jones, Andreas Bergmann, Paul Kaufmann, Yulia Ilina, Olle Melander

Context: Peptidylglycine-α-amidating monooxygenase (PAM) is a critical enzyme in the endocrine system responsible for activation, by amidation, of bioactive peptides.

Objective: To define the clinical phenotype of carriers of genetic mutations associated with impaired PAM-amidating activity (PAM-AMA).

Design: We used genetic and phenotypic data from cohort studies: the Malmö Diet and Cancer (MDC; 1991-1996; reexamination in 2002-2012), the Malmö Preventive Project (MPP; 2002-2006), and the UK Biobank (UKB; 2012).

Setting: Exome-wide association analysis was used to identify loss-of-function (LoF) variants associated with reduced PAM-AMA and subsequently used for association with the outcomes.

Patients or other participants: This study included n∼4500 participants from a subcohort of the MDC (MDC-Cardiovascular cohort), n∼4500 from MPP, and n∼300,000 from UKB.

Main outcome measures: Endocrine-metabolic traits suggested by prior literature, muscle mass, muscle function, and sarcopenia.

Results: Two LoF variants in the PAM gene, Ser539Trp (minor allele frequency: 0.7%) and Asp563Gly (5%), independently contributed to a decrease of 2.33 [95% confidence interval (CI): 2.52/2.15; P = 2.5E-140] and 0.98 (1.04/0.92; P = 1.12E-225) SD units of PAM-AMA, respectively. The cumulative effect of the LoF was associated with diabetes, reduced insulin secretion, and higher levels of GH and IGF-1. Moreover, carriers had reduced muscle mass and function, followed by a higher risk of sarcopenia. Indeed, the Ser539Trp mutation increased the risk of sarcopenia by 30% (odds ratio 1.31; 95% CI: 1.16/1.47; P = 9.8E-06), independently of age and diabetes.

Conclusion: PAM-AMA genetic deficiency results in a prediabetic sarcopenic phenotype. Early identification of PAM LoF carriers would allow targeted exercise interventions and calls for novel therapies that restore enzymatic activity.

背景:肽基甘氨酸-α-酰胺化单氧酶(PAM)是内分泌系统中的一种重要酶,负责通过酰胺化激活生物活性肽:界定与 PAM-酰胺化活性受损(PAM-AMA)相关的基因突变携带者的临床表型:设计:我们使用了来自以下队列研究的遗传和表型数据:马尔默饮食与癌症(MDC,1991-1996年;2002-2012年复查)、马尔默预防项目(MPP,2002-2006年)和英国生物库(UKB,2012年):全外显子关联分析用于确定与PAM-AMA降低相关的功能缺失(LoF)变异,随后用于确定与结果的关联:该研究包括来自MDC(MDC-心血管队列)子队列的n∼4500名参与者、来自MPP的n∼4500名参与者以及来自UKB的n∼300,000名参与者:主要结果测量指标:先前文献提出的内分泌代谢特征、肌肉质量、肌肉功能和肌肉疏松症:PAM基因中的两个LoF变异Ser539Trp(小等位基因频率:0.7%)和Asp563Gly(5%)分别导致PAM-AMA的SD单位下降2.33[95%置信区间(CI):2.52/2.15;P = 2.5E-140]和0.98 (1.04/0.92;P = 1.12E-225)。LoF的累积效应与糖尿病、胰岛素分泌减少、GH和IGF-1水平升高有关。此外,携带者的肌肉质量和功能降低,患肌肉疏松症的风险更高。事实上,Ser539Trp 突变使肌肉疏松症的风险增加了 30%(几率比 1.31;95% CI:1.16/1.47;P = 9.8E-06),与年龄和糖尿病无关:结论:PAM-AMA 基因缺陷会导致糖尿病前期肌肉疏松表型。结论:PAM-AMA 基因缺失会导致糖尿病前期肌肉疏松表型,早期识别 PAM LoF 基因携带者可进行有针对性的运动干预,并呼吁采用可恢复酶活性的新型疗法。
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引用次数: 0
Congenital Hypopituitarism: Current Agnostic Genetics Faces Its Limits. 先天性垂体功能减退症:当前不可知论遗传学面临局限。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae361
Pierre Bougnères
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引用次数: 0
The Effect of Adrenalectomy on Overall Survival in Metastatic Adrenocortical Carcinoma. 肾上腺切除术对转移性肾上腺皮质癌总生存期的影响。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae571
Anis Assad, Reha-Baris Incesu, Simone Morra, Lukas Scheipner, Andrea Baudo, Carolin Siech, Mario De Angelis, Zhe Tian, Sascha Ahyai, Nicola Longo, Felix K H Chun, Shahrokh F Shariat, Derya Tilki, Alberto Briganti, Fred Saad, Pierre I Karakiewicz

Context: Although complete surgical resection provides the only means of cure in adrenocortical carcinoma (ACC), the magnitude of the survival benefit of adrenalectomy in metastatic ACC (mACC) is unknown.

Objective: This work aimed to assess the effect of adrenalectomy on survival outcomes in patients with mACC in a real-world setting.

Methods: Patients with mACC aged 18 years or older with metastatic ACC at initial presentation who were treated between 2004 and 2020 were identified within the Surveillance, Epidemiology, and End Results database (SEER 2004-2020), and we tested for differences according to adrenalectomy status. Intervention included primary tumor resection status (adrenalectomy vs no adrenalectomy). Kaplan-Meier plots, multivariable Cox regression models, and landmark analyses were used. Sensitivity analyses focused on use of systemic therapy, contemporary (2012-2020) vs historical (2004-2011), single vs multiple metastatic sites, and assessable specific solitary metastatic sites (lung only and liver only).

Results: Of 543 patients with mACC, 194 (36%) underwent adrenalectomy. In multivariable analyses, adrenalectomy was associated with lower overall mortality without (hazard ratio [HR]: 0.39; P < .001), as well as with 3 months' landmark analyses (HR: 0.57; P = .002). The same association effect with 3 months' landmark analyses was recorded in patients exposed to systemic therapy (HR: 0.49; P < .001), contemporary patients (HR: 0.57; P = .004), historical patients (HR: 0.42; P < .001), and in those with lung-only solitary metastasis (HR: 0.50; P = .02). In contrast, no statistically significant association was recorded in patients naive to systemic therapy (HR: 0.68; P = .3), those with multiple metastatic sites (HR: 0.55; P = .07), and those with liver-only solitary metastasis (HR: 0.98; P = .9).

Conclusion: The present results indicate a potential protective effect of adrenalectomy in mACC, particularly in patients exposed to systemic therapy and those with lung-only metastases.

背景:尽管完全手术切除是治愈肾上腺皮质癌(ACC)的唯一方法,但肾上腺切除术对转移性ACC(mACC)患者生存的益处尚不清楚:目的:评估肾上腺切除术在现实世界中对mACC患者生存结果的影响:我们在监测、流行病学和最终结果数据库(SEER 2004-2020)中确定了mACC患者,并检测了肾上腺切除术状态的差异:患者:年龄≥18岁、初次发病时患有转移性ACC、在2004-2020年间接受过治疗的患者:主要结果和测量:采用卡普兰-梅耶图、多变量考克斯回归模型和地标分析。敏感性分析的重点是系统疗法的使用、当代(2012-2020年)与历史(2004-2011年)、单个转移部位与多个转移部位以及可评估的特定单发转移部位(仅肺部和肝脏):结果:在543例mACC患者中,194例(36%)接受了肾上腺切除术。在多变量分析中,肾上腺切除术与较低的总死亡率无关(危险比 [HR]:0.39;p结论:目前的研究结果表明,肾上腺切除术对mACC有潜在的保护作用,尤其是对接受全身治疗和仅有肺转移的患者。
{"title":"The Effect of Adrenalectomy on Overall Survival in Metastatic Adrenocortical Carcinoma.","authors":"Anis Assad, Reha-Baris Incesu, Simone Morra, Lukas Scheipner, Andrea Baudo, Carolin Siech, Mario De Angelis, Zhe Tian, Sascha Ahyai, Nicola Longo, Felix K H Chun, Shahrokh F Shariat, Derya Tilki, Alberto Briganti, Fred Saad, Pierre I Karakiewicz","doi":"10.1210/clinem/dgae571","DOIUrl":"10.1210/clinem/dgae571","url":null,"abstract":"<p><strong>Context: </strong>Although complete surgical resection provides the only means of cure in adrenocortical carcinoma (ACC), the magnitude of the survival benefit of adrenalectomy in metastatic ACC (mACC) is unknown.</p><p><strong>Objective: </strong>This work aimed to assess the effect of adrenalectomy on survival outcomes in patients with mACC in a real-world setting.</p><p><strong>Methods: </strong>Patients with mACC aged 18 years or older with metastatic ACC at initial presentation who were treated between 2004 and 2020 were identified within the Surveillance, Epidemiology, and End Results database (SEER 2004-2020), and we tested for differences according to adrenalectomy status. Intervention included primary tumor resection status (adrenalectomy vs no adrenalectomy). Kaplan-Meier plots, multivariable Cox regression models, and landmark analyses were used. Sensitivity analyses focused on use of systemic therapy, contemporary (2012-2020) vs historical (2004-2011), single vs multiple metastatic sites, and assessable specific solitary metastatic sites (lung only and liver only).</p><p><strong>Results: </strong>Of 543 patients with mACC, 194 (36%) underwent adrenalectomy. In multivariable analyses, adrenalectomy was associated with lower overall mortality without (hazard ratio [HR]: 0.39; P < .001), as well as with 3 months' landmark analyses (HR: 0.57; P = .002). The same association effect with 3 months' landmark analyses was recorded in patients exposed to systemic therapy (HR: 0.49; P < .001), contemporary patients (HR: 0.57; P = .004), historical patients (HR: 0.42; P < .001), and in those with lung-only solitary metastasis (HR: 0.50; P = .02). In contrast, no statistically significant association was recorded in patients naive to systemic therapy (HR: 0.68; P = .3), those with multiple metastatic sites (HR: 0.55; P = .07), and those with liver-only solitary metastasis (HR: 0.98; P = .9).</p><p><strong>Conclusion: </strong>The present results indicate a potential protective effect of adrenalectomy in mACC, particularly in patients exposed to systemic therapy and those with lung-only metastases.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"748-757"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Aldosterone Synthase Inhibitors: A Revival for Treatment of Renal and Cardiovascular Diseases. 醛固酮合成酶抑制剂:肾脏和心血管疾病治疗的潜在复兴。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae823
Michel Azizi, Julien Riancho, Laurence Amar

Inappropriate aldosterone excess plays a key role in the pathophysiology of various cardiovascular, endocrine, and renal diseases. Mineralocorticoid receptor antagonists (MRAs) such as spironolactone block of the harmful effects of aldosterone and are recommended treatment in these various conditions. However, the sexual adverse effects of spironolactone from its lack of specificity for the mineralocorticoid receptor and the risk of hyperkalemia in patients with decreased renal function, limit its use. While eplerenone is a more selective MRA, it is less potent than spironolactone. Newer nonsteroidal MRAs, though promising, are either unavailable globally or still under development. Moreover, aldosterone exerts both genomic and nongenomic effects, the latter not fully blocked by MRAs. Aldosterone synthase inhibitors (ASIs) have thus emerged as potential alternatives to MRAs, though the development of selective ASIs has been challenging. This is due to the close homology between the final step of aldosterone synthesis, mediated by CYP11B2 in the zona glomerulosa of the adrenal cortex, and cortisol synthesis, mediated by CYP11B1 in the zona fasciculata. Despite these challenges, new ASIs have demonstrated high in vitro as well as in vivo selectivity for CYP11B2, effectively reducing aldosterone production without affecting cortisol synthesis in humans across large dose ranges. Early phase II trials demonstrated that these ASIs decrease (1) blood pressure in uncontrolled hypertension and (2) urinary albumin excretion in proteinuric chronic kidney disease. Further longer term trials will evaluate their efficacy in lowering blood pressure as well as in reducing kidney disease progression and cardiovascular outcomes in heart failure when given alone or in combination with SGLT2 inhibitors.

醛固酮过量在各种心血管、内分泌和肾脏疾病的病理生理中起着关键作用。矿化皮质激素受体(MR)拮抗剂(MRAs),如螺内酯阻断醛固酮的有害影响,并推荐治疗这些不同的条件。然而,由于螺内酯对MR缺乏特异性以及肾功能下降患者高钾血症的风险,其性不良反应限制了其使用。虽然埃普利酮是一种选择性更强的MRA,但它的效力不如螺内酯。新的非甾体类MRAs虽然很有前景,但在全球范围内无法获得或仍在开发中。此外,醛固酮同时发挥基因组和非基因组效应,后者不能被mra完全阻断。醛固酮合成酶抑制剂(ASIs)因此成为MRAs的潜在替代品,尽管选择性ASIs的发展一直具有挑战性。这是由于肾上腺皮质小球带中CYP11B2介导的醛固酮合成的最后一步与束状带中CYP11B1介导的皮质醇合成具有密切的同源性。尽管存在这些挑战,新的ASIs已经显示出对CYP11B2的高体外和体内选择性,在大剂量范围内有效地减少醛固酮的产生,而不影响人体皮质醇的合成。早期II期试验表明,这些ASIs可降低1)未控制的高血压患者的血压,以及(2)蛋白尿慢性肾病患者的尿白蛋白排泄。进一步的长期试验将评估它们在单独或与SGLT2抑制剂联合使用时降低血压、减少肾脏疾病进展和心力衰竭心血管结局方面的疗效。
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引用次数: 0
Expression of Bile Acid Receptors and Transporters Along the Intestine of Patients With Type 2 Diabetes and Controls. 2 型糖尿病患者和对照组肠道中胆汁酸受体和转运体的表达。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae261
Henriette H Nerild, Hannah Gilliam-Vigh, Anne-Marie Ellegaard, Julie L Forman, Tina Vilsbøll, David P Sonne, Andreas Brønden, Filip K Knop

Context: The enterohepatic circulation of bile acids depends on intestinal absorption by bile acid transporters and activation of bile acid receptors, which stimulates secretion of hormones regulating glucose and lipid metabolism and appetite. Distribution of bile acid transporters and receptors in the human gut and their potential involvement in type 2 diabetes (T2D) pathophysiology remain unknown.

Objective: We explored the expression of genes involved in bile acid metabolism throughout the intestines of patients with T2D and matched healthy controls.

Methods: Intestinal mucosa biopsies sampled along the intestinal tract in 12 individuals with T2D and 12 healthy controls underwent messenger RNA (mRNA) sequencing. We report expression profiles of apical sodium-dependent bile acid transporter (ASBT), organic solute transporter (OST) α/β, farnesoid X receptor (FXR), Takeda G receptor 5 (TGR5), fibroblast growth factor 19 (FGF19), and FGF receptor 4 (FGFR4).

Results: Expression of ASBT and OSTα/β was evident in the duodenum of both groups with increasing levels through the small intestine, and no (ASBT) or decreasing levels (OSTα/β) through the large intestine. The FXR expression pattern followed that of OSTα/β whereas FGFR4 was evenly expressed through the intestines. Negligible levels of TGR5 and FGF19 were evident. Patients with T2D exhibited lower levels of FGF19, FXR, ASBT, and OSTα/β mRNAs compared with healthy controls, although the differences were not statistically significant after adjusting for multiple testing.

Conclusion: We demonstrate distinct expression patterns of bile acid transporters and receptors through the intestinal tract with signs of reduced ASBT, OSTα/β, FXR, and FGF19 mRNAs in T2D.

背景:胆汁酸的肠肝循环取决于肠道对胆汁酸转运体的吸收和胆汁酸受体的激活,胆汁酸受体刺激调节葡萄糖和脂质代谢及食欲的激素分泌。胆汁酸转运体和受体在人体肠道中的分布及其在 2 型糖尿病(T2D)病理生理学中的潜在参与仍然未知:目的:我们探讨了胆汁酸代谢相关基因在 T2D 患者和匹配的健康对照组肠道中的表达情况:方法:对 12 名 T2D 患者和 12 名健康对照者沿肠道取样的肠粘膜活检组织进行 mRNA 测序。我们报告了顶端钠依赖性胆汁酸转运体(ASBT)、有机溶质转运体(OST)α/β、类法尼斯X受体(FXR)、武田G受体5(TGR5)、成纤维细胞生长因子19(FGF19)和成纤维细胞生长因子受体4(FGFR4)的表达谱:结果:ASBT和OSTα/β在两组患者的十二指肠中均有明显表达,小肠中的表达水平不断升高,大肠中无表达(ASBT)或表达水平不断降低(OSTα/β)。FXR 的表达模式与 OSTα/β 相同,而 FGFR4 则在肠道中均匀表达。TGR5和FGF19的水平微乎其微。与健康对照组相比,T2D 患者的 FGF19、FXR、ASBT 和 OSTα/β mRNA 水平较低,但经多重检验调整后,差异无统计学意义:结论:我们证明了胆汁酸转运体和受体在肠道中的不同表达模式,T2D患者的ASBT、OSTα/β、FXR和FGF19 mRNA有减少的迹象。
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引用次数: 0
Response to Letter to the Editor From Chen and Shan: "Moderate-intensity Combined Training Induces Lipidomic Changes in Individuals With Obesity and Type 2 Diabetes". 对 Chen 和 Shan 致编辑的信:"中等强度的联合训练可诱导肥胖症和 2 型糖尿病患者的血脂组变化 "的回复。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae685
Renata Garbellini Duft, Ivan Luiz Padilha Bonfante, Susana Alejandra Palma-Duran, Mara Patrícia Traina Chacon-Mikahil, Julian Leether Griffin, Cláudia Regina Cavaglieri
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引用次数: 0
Sex Differences in "Life's Essential 8" Cardiovascular Health and Type 2 Diabetes Mellitus Risk Across Menopause Stages. 不同更年期阶段 "生命必需 8 "心血管健康和 2 型糖尿病风险的性别差异。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae557
Wenke Cheng, Shanshan Geng, Yukun Li, Rundong Chen, Zhongyan Du

Context: Existing guidelines often lack sex-specific prevention strategies for type 2 diabetes mellitus (T2DM). Life's Essential 8 (LE8) highlights the role of health behaviors in influencing cardiovascular health (CVH). Due to inherent sex differences, the impact of CVH on T2DM risk may vary between men and women, especially across menopausal stages.

Objective: The purpose of this paper is to explore sex-based differences in CVH and the incidence of T2DM among women at different menopausal stages and men.

Methods: A prospective cohort study was conducted, involving 126 818 participants without preexisting T2DM from the UK Biobank. CVH was assessed using the LE8. Absolute risks (ARs) and hazard ratios (HRs) were separately employed to assess the association between increased CVH and T2DM risk. The accelerated failure time model assessed the effect of CVH on the time to T2DM onset.

Results: Over a mean follow-up of 168 months, 4315 cases of T2DM were documented. In men, each 1-point increase in CVH was associated with a 0.268% decrease in AR and a 6.4% decrease in HR for T2DM. In premenopausal, perimenopausal, and postmenopausal women, each unit increase in CVH resulted in a 0.105%, 0.180%, and 0.166% decrease in AR and a 7.7%, 5.2%, and 6.4% decrease in HR of T2DM. The adjusted median time to T2DM onset was delayed by 12.46, 9.83, 11.5, and 21.43 months in the highest quintile of men, premenopausal, perimenopausal, and postmenopausal women, respectively, compared with the lowest CVH quintile.

Conclusion: As CVH improved, the reduction in AR for T2DM was more prominent in men than in women. HR trends for CVH and T2DM were similar in men and postmenopausal women. Increased CVH delayed the onset of T2MD both in men and women, with the most significant delay observed in postmenopausal women.

目的:本文旨在探讨不同绝经期女性和男性在心血管健康(CVH)和 2 型糖尿病(T2DM)发病率方面的性别差异:我们进行了一项前瞻性队列研究,涉及英国生物库中的 126818 名未患 T2DM 的参与者。CVH 采用生命基本指数 8 进行评估。分别采用绝对风险(AR)和危险比(HR)来评估CVH增加与T2DM风险之间的关系。加速衰竭时间模型评估了CVH对T2DM发病时间的影响:结果:在平均 168 个月的随访期间,共记录了 4315 例 T2DM 病例。在男性中,CVH每增加一个点,T2DM的AR就会下降0.268%,HR下降6.4%。在绝经前、围绝经期和绝经后妇女中,CVH 每增加一个单位,AR 分别下降 0.105%、0.180% 和 0.166%,T2DM 的 HR 分别下降 7.7%、5.2% 和 6.4%。与 CVH 最低的五分位数相比,CVH 最高的五分位数男性、绝经前、围绝经期和绝经后女性 T2DM 发病的调整后中位时间分别推迟了 12.46 个月、9.83 个月、11.5 个月和 21.43 个月:结论:随着 CVH 的改善,T2DM 患者 AR 的降低在男性中比在女性中更为明显。男性和绝经后女性的 CVH 和 T2DM 的 HR 趋势相似。在男性和女性中,CVH 的增加会延迟 T2MD 的发生,绝经后女性的延迟最为显著。
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引用次数: 0
Role of SAA1 in Endometrial Extracellular Matrix Remodeling in Polycystic Ovary Syndrome: Implication for Pregnancy Loss. SAA1 在多囊卵巢综合征子宫内膜细胞外基质重塑中的作用:对妊娠失败的影响。
IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-02-18 DOI: 10.1210/clinem/dgae596
Qinling Zhu, Yuan Wang, Lizhen Xu, Mengjia Shi, Yiwen Meng, Chongwen Shao, Yao Lu, Yaqiong He, Jiaan Huang, Xinyu Li, Boyu Li, Yijing Long, Ying Ding, Jia Qi, Wangsheng Wang, Yanzhi Du, Yun Sun

Context: Abnormal endometrial extracellular matrix (ECM) remodeling compromises endometrial receptivity and diminishes the probability of a successful live birth. Serum amyloid A1 (SAA1), a modulator of inflammation, is elevated in the circulation of polycystic ovary syndrome (PCOS) patients and involved in ECM remodeling during tissue repair. However, the specific role of SAA1 in endometrial ECM remodeling and subsequent risk of pregnancy loss in PCOS patients remains unclear.

Objective: To examine the role and underlying mechanism of SAA1 in ECM remodeling in the endometrium of PCOS patients.

Design: Serum samples from PCOS and control patients were utilized to investigate the relationship between the abundance of SAA1 and pregnancy loss. Human endometrial tissues and primary human endometrial stromal cells were used to examine the role and underlying mechanism of SAA1 in ECM remodeling.

Results: Serum SAA1 concentration was elevated and could serve as an independent risk of pregnancy loss in PCOS patients. Increased SAA1 abundance was also observed in endometrium obtained from these patients. Further mechanistic studies showed that SAA1 stimulated collagen I chains synthesis (COL1A1 and COL1A2) in endometrial stromal cells, suggesting excessive SAA1 may contribute to endometrial ECM remodeling, resulting in a nonsupportive environment for ongoing pregnancy. This effect was abolished by either a toll-like receptor 2/4 antagonist or a nuclear factor κB inhibitor.

Conclusion: The locally elevated levels of SAA1 in endometrium contribute to ECM overdeposition by inducing collagen I synthesis in PCOS patients, which may hamper embryo implantation and increase the risk of pregnancy loss. These observations highlight the crucial role of heightened SAA1 in orchestrating endometrial dysfunction and shed light on potential therapeutic avenues for improving reproductive outcomes in PCOS patients.

背景:子宫内膜细胞外基质(ECM)重塑异常会损害子宫内膜的接受能力,降低成功活产的概率。血清淀粉样蛋白 A1(SAA1)是炎症的调节剂,在多囊卵巢综合征(PCOS)患者的血液循环中升高,并参与组织修复过程中的 ECM 重塑。然而,SAA1 在多囊卵巢综合征患者子宫内膜 ECM 重塑和随后的妊娠失败风险中的具体作用仍不清楚:研究 SAA1 在多囊卵巢综合征患者子宫内膜 ECM 重塑中的作用及其内在机制:设计:利用多囊卵巢综合征患者和对照组患者的血清样本研究 SAA1 丰度与妊娠失败之间的关系。利用人类子宫内膜组织和原代人类子宫内膜基质细胞研究 SAA1 在 ECM 重塑中的作用和潜在机制:结果:血清 SAA1 浓度升高,可能是多囊卵巢综合征患者妊娠失败的独立风险因素。在这些患者的子宫内膜中也观察到 SAA1 丰度增加。进一步的机理研究表明,SAA1 可刺激子宫内膜基质细胞中胶原 I 链(COL1A1 和 COL1A2)的合成,这表明过量的 SAA1 可能会导致子宫内膜 ECM 重塑,从而造成不利于持续妊娠的环境。收费样受体2/4拮抗剂或核因子κB抑制剂均可消除这种效应:结论:多囊卵巢综合征患者子宫内膜中局部升高的 SAA1 水平通过诱导胶原 I 的合成导致 ECM 过度沉积,这可能会阻碍胚胎着床并增加妊娠失败的风险。这些观察结果凸显了 SAA1 水平升高在协调子宫内膜功能障碍中的关键作用,并为改善多囊卵巢综合症患者的生殖预后提供了潜在的治疗途径。
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Journal of Clinical Endocrinology & Metabolism
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