Association of Genetic Variants at 3q22 with Nephropathy in Patients with Type 1 Diabetes Mellitus

Diabetic nephropathy (DN) is the primary cause of morbidity and mortality in patients with type 1 diabetes mellitus (T1DM) and affects about 30% of these patients. We have previously localized a DN locus on chromosome 3q with suggestive linkage in Finnish individuals. Linkage to this region has also been reported earlier by several other groups. To fine map this locus, we conducted a multistage case-control association study in T1DM patients, comprising 1822 cases with nephropathy and 1874 T1DM patients free of nephropathy, from Finland, Iceland, and the British Isles. At the screening stage, we genotyped 3072 tag SNPs, spanning a 28 Mb region, in 234 patients and 215 controls from Finland. SNPs that met the significance threshold of p < 0.01 at this stage were followed up by a series of sample sets. A genetic variant, rs1866813, in the noncoding region at 3q22 was associated with increased risk of DN (overall p = 7.07 × 10⁻⁶, combined odds ratio [OR] of the allele = 1.33). The estimated genotypic ORs of this variant in all Finnish samples suggested a codominant effect, resulting in significant association, with a p value of 4.7 × 10⁻⁵ (OR = 1.38; 95% confidence interval = 1.18–1.62). Additionally, an 11 kb segment flanked by rs62408925 and rs1866813, two strongly correlated variants (r² = 0.95), contains three elements highly conserved across multiple species. Independent replication will clarify the role of the associated variants at 3q22 in influencing the risk of DN.     

Podocyte apoptosis is prevented by blocking the Toll-like receptor pathway

High serum lipopolysaccharide (LPS) activity in normoalbuminuric patients with type 1 diabetes (T1D) predicts the progression of diabetic nephropathy (DN), but the mechanisms behind this remain unclear. We observed that treatment of cultured human podocytes with sera from normoalbuminuric T1D patients with high LPS activity downregulated 3-phosphoinositide-dependent kinase-1 (PDK1), an activator of the Akt cell survival pathway, and induced apoptosis. Knockdown of PDK1 in cultured human podocytes inhibited antiapoptotic Akt pathway, stimulated proapoptotic p38 MAPK pathway, and increased apoptosis demonstrating an antiapoptotic role for PDK1 in podocytes. Interestingly, PDK1 was downregulated in the glomeruli of diabetic rats and patients with type 2 diabetes before the onset of proteinuria, further suggesting that reduced expression of PDK1 associates with podocyte injury and development of DN. Treatment of podocytes in vitro and mice in vivo with LPS reduced PDK1 expression and induced apoptosis, which were prevented by inhibiting the Toll-like receptor (TLR) signaling pathway with the immunomodulatory agent GIT27. Our data show that LPS downregulates the cell survival factor PDK1 and induces podocyte apoptosis, and that blocking the TLR pathway with GIT27 may provide a non-nephrotoxic means to prevent the progression of DN.Lipopolysaccharides (LPS) are fat-soluble outer membrane components of the Gram-negative bacteria. It has been shown that normoalbuminuric patients with type 1 diabetes (T1D) who progress to microalbuminuria have higher baseline serum LPS activity than normoalbuminuric non-progressors.¹ This indicates that high LPS activity in sera of patients with T1D is associated with the development of microalbuminuria.¹ The origin of circulating endotoxins in patients with diabetes is not yet fully known. In addition to severe bacterial infections,² underlying systemic diseases (e.g., periodontitis) and life-style related factors (e.g., high-fat diet) may increase plasma levels of endotoxins in humans.^{3, 4, 5} Interestingly, LPS in the sera of septic patients has previously been shown to induce apoptosis of kidney cells,⁶ but the mechanism is not known.Podocytes are terminally differentiated and highly specialized cells that are required for normal glomerular function. Podocyte loss due to apoptosis or detachment is a key component of progressive glomerulosclerosis. Podocyte loss has been reported in patients with T1D⁷ and type 2 diabetes (T2D) with or without diabetic nephropathy (DN),^{8, 9, 10} and Verzola et al.⁸ reported glomerular apoptosis in the kidneys of patients with DN. In Pima Indians with T2D, decreasing number of podocytes per glomerulus has been shown to be the strongest indicator of the progression of the renal disease.⁹ Podocytes are also detected in the urine in patients with diabetes, and podocyte number in urine correlates with the severity of the disease.¹⁰ These data indicate that analysis of the regulation of apoptosis in podocytes is essential for better understanding of the pathophysiological mechanisms of glomerular diseases.The central role of the phosphoinositide 3-kinase (PI3K)-dependent Akt signaling pathway in the regulation of cell survival raises the molecules that modulate its activity to key roles in regulating apoptosis in podocytes. 3-Phosphoinositide-dependent protein kinase-1 (PDK1) is a 63-kDa serine/threonine kinase that functions downstream of PI3K but upstream of Akt and serves as a major regulatory point in Akt signaling.¹¹ Mice lacking PDK1 die in utero, and mice that lack PDK1 specifically in the pancreatic β cells develop progressive hyperglycemia as a result of the loss of islet mass.^{12, 13}We hypothesized that PDK1, the key regulator of the PI3K/Akt-mediated cell survival pathway, could have a role in regulating podocyte apoptosis, and that high LPS activity could downregulate PDK1, consequently inducing apoptosis and podocyte injury.     

Upper body muscle strength and endurance in relation to peak exercise capacity during cycling in healthy sedentary male subjects

The aim of this study was to investigate the relation between upper body muscle strength and endurance, and exercise capacity during an incremental cycle exercise test in sedentary healthy male subjects before and after 6 months of combined supervised group training. Exercise capacity was measured as maximal oxygen consumption (VO?peak) and maximum work rate (WR(peak)). Muscle strength and endurance of the upper body were assessed by bench press and isometric measurement of trunk extensor and flexor maximum voluntary contraction (MVC) and trunk extensor and flexor endurance. Thirty-one subjects were studied before and after the training period. Bench press and trunk extensor MVC correlated to exercise capacity at baseline and after training. Training improved VO?peak and WR(peak). The correlation between trunk extensor MVC and exercise capacity improved after training. Upper body strength may affect exercise capacity by increasing the rider's ability to generate force on the handlebar that can be transmitted to the pedals. Resistance training of the arms, chest, and trunk may help improve cycling performance.     

Novel susceptibility locus at 22q11 for diabetic nephropathy in type 1 diabetes

Background

Diabetic nephropathy (DN) affects about 30% of patients with type 1 diabetes (T1D) and contributes to serious morbidity and mortality. So far only the 3q21–q25 region has repeatedly been indicated as a susceptibility region for DN. The aim of this study was to search for new DN susceptibility loci in Finnish, Danish and French T1D families.

Methods and Results

We performed a genome-wide linkage study using 384 microsatellite markers. A total of 175 T1D families were studied, of which 94 originated from Finland, 46 from Denmark and 35 from France. The whole sample set consisted of 556 individuals including 42 sib-pairs concordant and 84 sib-pairs discordant for DN. Two-point and multi-point non-parametric linkage analyses were performed using the Analyze package and the MERLIN software. A novel DN locus on 22q11 was identified in the joint analysis of the Finnish, Danish and French families by genome-wide multipoint non-parametric linkage analysis using the Kong and Cox linear model (NPL_pairs LOD score 3.58). Nominal or suggestive evidence of linkage to this locus was also detected when the three populations were analyzed separately. Suggestive evidence of linkage was found to six additional loci in the Finnish and French sample sets.

Conclusions

This study identified a novel DN locus at chromosome 22q11 with significant evidence of linkage to DN. Our results suggest that this locus may be of importance in European populations. In addition, this study supports previously indicated DN loci on 3q21–q25 and 19q13.     

Insulin reduces neuronal excitability by turning on GABA(A) channels that generate tonic current

Insulin signaling to the brain is important not only for metabolic homeostasis but also for higher brain functions such as cognition. GABA (γ-aminobutyric acid) decreases neuronal excitability by activating GABA(A) channels that generate phasic and tonic currents. The level of tonic inhibition in neurons varies. In the hippocampus, interneurons and dentate gyrus granule cells normally have significant tonic currents under basal conditions in contrast to the CA1 pyramidal neurons where it is minimal. Here we show in acute rat hippocampal slices that insulin (1 nM) "turns on" new extrasynaptic GABA(A) channels in CA1 pyramidal neurons resulting in decreased frequency of action potential firing. The channels are activated by more than million times lower GABA concentrations than synaptic channels, generate tonic currents and show outward rectification. The single-channel current amplitude is related to the GABA concentration resulting in a single-channel GABA affinity (EC(50)) in intact CA1 neurons of 17 pM with the maximal current amplitude reached with 1 nM GABA. They are inhibited by GABA(A) antagonists but have novel pharmacology as the benzodiazepine flumazenil and zolpidem are inverse agonists. The results show that tonic rather than synaptic conductances regulate basal neuronal excitability when significant tonic conductance is expressed and demonstrate an unexpected hormonal control of the inhibitory channel subtypes and excitability of hippocampal neurons. The insulin-induced new channels provide a specific target for rescuing cognition in health and disease.     

Strategies for conditional two-locus nonparametric linkage analysis

In this article we deal with two-locus nonparametric linkage (NPL) analysis, mainly in the context of conditional analysis. This means that one incorporates single-locus analysis information through conditioning when performing a two-locus analysis. Here we describe different strategies for using this approach. Cox et al. [Nat Genet 1999;21:213-215] implemented this as follows: (i) Calculate the one-locus NPL process over the included genome region(s). (ii) Weight the individual pedigree NPL scores using a weighting function depending on the NPL scores for the corresponding pedigrees at speci fi c conditioning loci. We generalize this by conditioning with respect to the inheritance vector rather than the NPL score and by separating between the case of known (prede fi ned) and unknown (estimated) conditioning loci. In the latter case we choose conditioning locus, or loci, according to prede fi ned criteria. The most general approach results in a random number of selected loci, depending on the results from the previous one-locus analysis. Major topics in this article include discussions on optimal score functions with respect to the noncentrality parameter (NCP), and how to calculate adequate p values and perform power calculations. We also discuss issues related to multiple tests which arise from the two-step procedure with several conditioning loci as well as from the genome-wide tests.     

Molecular correlates for maximal oxygen uptake and type 1 fibers

Maximal oxygen uptake (Vo(2max)) and the amount of type 1 fibers are interrelated, but the underlying unifying molecular mechanisms are poorly understood. To explore these mechanisms, we related gene expression profiles in skeletal muscle biopsies of 43 age-matched men from published datasets with Vo(2max) and the amount of type 1 fibers and replicated some of the findings in muscle biopsies from 154 young and elderly individuals using real-time PCR. We identified 66 probe sets (genes or expressed sequence tags) positively and 83 probe sets inversely correlated with Vo(2max) and 171 probe sets positively and 217 probe sets inversely correlated with percentage of type 1 fibers in human skeletal muscle. Genes involved in oxidative phosphorylation (OXPHOS) showed high expression in individuals with high Vo(2max), whereas the opposite was not the case in individuals with low Vo(2max). Instead, genes such as AHNAK and BCL6 were associated with low Vo(2max). Also, expression of the OXPHOS genes NDUFB5 and ATP5C1 increased with exercise training and decreased with aging. In contrast, expression of AHNAK in skeletal muscle decreased with exercise training and increased with aging. Eleven genes (NDUFB4, COX5A, UQCRB, ATP5C1, ATP5G3, ETHE1, FABP3, ISCA1, MYST4, C9orf3, and PKIA) were positively correlated with both Vo(2max) and the percentage of type 1 fibers. Vo(2max) closely reflects expression of OXPHOS genes, particularly that of NDUFB5 and ATP5C1, in skeletal muscle, suggesting good muscle fitness. In contrast, a high expression of AHNAK was associated with a low Vo(2max) and poor muscle fitness.