TY - THES A1 - Aga-Barfknecht, Heja T1 - Investigation of the phenotype and genetic variant(s) of the diabetes locus Nidd/DBA N2 - Diabetes is a major public health problem with increasing global prevalence. Type 2 diabetes (T2D), which accounts for 90% of all diagnosed cases, is a complex polygenic disease also modulated by epigenetics and lifestyle factors. For the identification of T2D-associated genes, linkage analyses combined with mouse breeding strategies and bioinformatic tools were useful in the past. In a previous study in which a backcross population of the lean and diabetes-prone dilute brown non-agouti (DBA) mouse and the obese and diabetes-susceptible New Zealand obese (NZO) mouse was characterized, a major diabetes quantitative trait locus (QTL) was identified on chromosome 4. The locus was designated non-insulin dependent diabetes from DBA (Nidd/DBA). The aim of this thesis was (i) to perform a detailed phenotypic characterization of the Nidd/DBA mice, (ii) to further narrow the critical region and (iii) to identify the responsible genetic variant(s) of the Nidd/DBA locus. The phenotypic characterization of recombinant congenic mice carrying a 13.6 Mbp Nidd/DBA fragment with 284 genes presented a gradually worsening metabolic phenotype. Nidd/DBA allele carriers exhibited severe hyperglycemia (~19.9 mM) and impaired glucose clearance at 12 weeks of age. Ex vivo perifusion experiments with islets of 13-week-old congenic mice revealed a tendency towards reduced insulin secretion in homozygous DBA mice. In addition, 16-week-old mice showed a severe loss of β-cells and reduced pancreatic insulin content. Pathway analysis of transcriptome data from islets of congenic mice pointed towards a downregulation of cell survival genes. Morphological analysis of pancreatic sections displayed a reduced number of bi-hormonal cells co-expressing glucagon and insulin in homozygous DBA mice, which could indicate a reduced plasticity of endocrine cells in response to hyperglycemic stress. Further generation and phenotyping of recombinant congenic mice enabled the isolation of a 3.3 Mbp fragment that was still able to induce hyperglycemia and contained 61 genes. Bioinformatic analyses including haplotype mapping, sequence and transcriptome analysis were integrated in order to further reduce the number of candidate genes and to identify the presumable causative gene variant. Four putative candidate genes (Ttc39a, Kti12, Osbpl9, Calr4) were defined, which were either differentially expressed or carried a sequence variant. In addition, in silico ChIP-Seq analyses of the 3.3 Mbp region indicated a high number of SNPs located in active regions of binding sites of β-cell transcription factors. This points towards potentially altered cis-regulatory elements that could be responsible for the phenotype conferred by the Nidd/DBA locus. In summary, the Nidd/DBA locus mediates impaired glucose homeostasis and reduced insulin secretion capacity which finally leads to β-cell death. The downregulation of cell survival genes and reduced plasticity of endocrine cells could further contribute to the β-cell loss. The critical region was narrowed down to a 3.3 Mbp fragment containing 61 genes, of which four might be involved in the development of the diabetogenic Nidd/DBA phenotype. N2 - Die Diabetesprävalenz nimmt seit Jahren weltweit zu, wobei etwa 90% der diagnostizierten Diabeteserkrankungen einem Typ-2-Diabetes (T2D) zuzuordnen sind. T2D ist eine komplexe polygene Stoffwechselerkrankung, die auch durch epigenetische Faktoren und den Lebensstil beeinflusst wird. Die Identifizierung und Untersuchung von Diabetes-assoziierten Genen wird unter anderem durch Kopplungsanalysen und darauf aufbauende zuchtstrategische und bioinformatische Analysen ermöglicht. In einer vorangegangenen Studie wurde der schlanke, Diabetes-anfällige dilute brown non-agouti (DBA)-Mausstamm mit der adipösen und ebenfalls Diabetes-suszeptiblen New Zealand obese (NZO)-Maus verpaart und die erste Rückkreuzungsgeneration einer Kopplungsanalyse unterzogen. Hierbei wurde ein hoch signifikanter quantitative trait locus (QTL) für Diabetes auf Chromosom 4 nachgewiesen. Dieser Locus ist mit erhöhten Blutzuckerwerten, reduzierten Plasmainsulinkonzentrationen und einem niedrigen pankreatischen Insulingehalt assoziiert und wurde als Nidd/DBA (engl. für nicht insulinabhängiger Diabetes von DBA-Allelen) bezeichnet. Das Ziel der vorliegenden Arbeit war es, (i) das kritische Fragment des Nidd/DBA-Locus‘ zu verkleinern, (ii) die phänotypische Ausprägung des Nidd/DBA-Locus‘ zu untersuchen sowie (iii) die ursächliche(n) genetische(n) Variante(n) zu identifizieren. Die phänotypische Charakterisierung von kongenen Mäusen mit einem kritischen Fragment von 13.6 Mbp, welches 284 Gene enthält, zeigte bereits im Alter von 12 Wochen eine starke Hyperglykämie (~19.9 mM) und eine unzureichende Glucose-Clearance bei Nidd/DBA-Allelträgern. Ex-vivo Perifusionsversuche mit isolierten Inseln von 13 Wochen alten kongenen Mäusen zeigten eine tendenziell reduzierte Insulinsekretion in homozygoten DBA-Allelträgern. Im Alter von 16 Wochen wiesen die Tiere einen erheblichen Verlust der β-Zellen, sowie eine Abnahme der pankreatischen Insulinkonzentration auf. Transkriptomdaten der Langerhans-Inseln mit anschließender Signalweganalyse deuteten darauf hin, dass Nidd/DBA-Allelträger eine verminderte Expression von Genen aufzeigen, die für das Überleben von Zellen essentiell sind. In homozygoten DBA-Allelträgern wurde eine reduzierte Anzahl von Glucagon/Insulin-bi-hormonellen Zellen nachgewiesen, was auf eine verminderte Plastizität der endokrinen Zellen hinweisen könnte. Die Zucht weiterer kongener Mäuse und ihre Phänotypisierung ermöglichten die Isolierung eines 3.3 Mbp großen Fragments, das 61 Gene enthielt und eine Hyperglykämie auslöste. Bioinformatische Analysen, wie die Kartierung von Haplotypen und Datenbank-, Sequenz- sowie Transkriptomanalysen, wurden integriert, um die Anzahl der Kandidatengene weiter zu reduzieren und die Hyperglykämie auslösende(n) Genvariante(n) zu identifizieren. Es konnten vier potentielle Kandidatengene (Ttc39a, Osbpl9, Kti12, Calr4) definiert werden, die entweder eine differenzielle Expression oder eine Sequenzvariante aufwiesen. Mit Hilfe von in-silico-Analysen von ChIP-Seq-Daten wurden SNPs in aktiven Bindungsstellen von β-Zell-Transkriptionsfaktoren identifiziert. Diese könnten cis-regulatorische Elemente darstellen, die Gene außerhalb dieses 3.3 Mbp großen Fragments beeinflussen und möglichweise für den Phänotyp verantwortlich sind. Zusammenfassend konnte gezeigt werden, dass der Nidd/DBA-Locus für eine beeinträchtigte Glucosehomöostase und eine Verschlechterung der Insulinsekretion verantwortlich ist, welche langfristig zum Verlust von β-Zellen führen. Die bisherigen Ergebnisse deuten darauf hin, dass sowohl die verringerte Expression der für das Zellüberleben essentiellen Gene als auch eine verringerte Plastizität der endokrinen Zellen zum Untergang von Langerhans-Inseln beitragen. Das kritische Fragment wurde auf eine Größe von 3.3 Mbp mit 61 Genen reduziert, von denen vier Gene als verantwortliche Kandidaten für den beschriebenen Nidd/DBA-Phänotyp bedeutsam sein können KW - Diabetes KW - Genetics KW - Glucose intolerance KW - Insulin secretion KW - Susceptibility-genes KW - Diabetes KW - Genetik KW - Glukoseintoleranz KW - Insulinsekretion KW - Suszeptibilitätsgene Y1 - 2021 ER - TY - JOUR A1 - Hansen, Dominique A1 - Kraenkel, Nicolle A1 - Kemps, Hareld A1 - Wilhelm, Matthias A1 - Abreu, Ana A1 - Pfeiffer, Andreas F. H. A1 - Jordao, Alda A1 - Cornelissen, Veronique A1 - Völler, Heinz T1 - Management of patients with type 2 diabetes in cardiovascular rehabilitation JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - The clinical benefits of rehabilitation in cardiovascular disease are well established. Among cardiovascular disease patients, however, patients with type 2 diabetes mellitus require a distinct approach. Specific challenges to clinicians and healthcare professionals in patients with type 2 diabetes include the prevalence of peripheral and autonomic neuropathy, retinopathy, nephropathy, but also the intake of glucose-lowering medication. In addition, the psychosocial wellbeing, driving ability and/or occupational status can be affected by type 2 diabetes. As a result, the target parameters of cardiovascular rehabilitation and the characteristics of the cardiovascular rehabilitation programme in patients with type 2 diabetes often require significant reconsideration and a multidisciplinary approach. This review explains how to deal with diabetes-associated comorbidities in the intake screening of patients with type 2 diabetes entering a cardiovascular rehabilitation programme. Furthermore, we discuss diabetes-specific target parameters and characteristics of cardiovascular rehabilitation programmes for patients with type 2 diabetes in a multidisciplinary context, including the implementation of guideline-directed medical therapy. KW - Diabetes KW - cardiovascular rehabilitation KW - intake screening KW - exercise Y1 - 2019 U6 - https://doi.org/10.1177/2047487319882820 SN - 2047-4873 SN - 2047-4881 VL - 26 IS - 2_SUPPL SP - 133 EP - 144 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Hocher, Berthold A1 - Reichetzeder, Christoph A1 - Alter, Markus L. T1 - Renal and cardiac effects of DPP-4 inhibitors - from preclinical development to clinical research JF - Kidney & blood pressure research : official organ of the Gesellschaft für Nephrologie N2 - Inhibitors of type 4 dipeptidyl peptidase (DDP-4) were developed and approved for the oral treatment of type 2 diabetes. Its mode of action is to inhibit the degradation of incretins, such as type 1 glucagon like peptide (GLP-1), and GIP. GLP-1 stimulates glucose-dependent insulin secretion from pancreatic beta-cells and suppresses glucagon release from alpha-cells, thereby improving glucose control. Besides its action on the pancreas type 1 glucagon like peptide has direct effects on the heart, vessels and kidney mainly via the type 1 glucagon like peptide receptor (GLP-1R). Moreover, there are substrates of DPP-4 beyond incretins that have proven renal and cardiovascular effects such as BNP/ANP, NPY, PYY or SDF-1 alpha. Preclinical evidence suggests that DPP-4 inhibitors may be effective in acute and chronic renal failure as well as in cardiac diseases like myocardial infarction and heart failure. Interestingly, large cardiovascular meta-analyses of combined Phase II/III clinical trials with DPP-4 inhibitors point all in the same direction: a potential reduction of cardiovascular events in patients treated with these agents. A pooled analysis of pivotal Phase III, placebo-controlled, registration studies of linagliptin further showed a significant reduction of urinary albumin excretion after 24 weeks of treatment. The observation suggests direct renoprotective effects of DPP-4 inhibition that may go beyond its glucose-lowering potential. Type 4 dipeptidyl peptidase inhibitors have been shown to be very well tolerated in general, but for those excreted via the kidney dose adjustments according to renal function are needed to avoid side effects. In conclusion, the direct cardiac and renal effects seen in preclinical studies as well as meta-analysis of clinical trials may offer additional potentials - beyond improvement of glycemic control - for this newer class of drugs, such as acute kidney failure, chronic kidney failure as well as acute myocardial infarction and heart failure. KW - DDP-4 inhibition KW - Diabetes KW - GLP-1 KW - Cardiovascular effects KW - Myocardial infarction KW - Kidney KW - Diabetic nephropathy KW - Acute renal failure Y1 - 2012 U6 - https://doi.org/10.1159/000339028 SN - 1420-4096 VL - 36 IS - 1 SP - 65 EP - 84 PB - Karger CY - Basel ER - TY - JOUR A1 - Warschburger, Petra A1 - Kamrath, Clemens A1 - Lanzinger, Stefanie A1 - Sengler, Claudia A1 - Wiegand, Susanna A1 - Göldel, Julia Marlen A1 - Weihrauch-Blüher, Susann A1 - Holl, Reinhard A1 - Minden, Kirsten T1 - A prospective analysis of the long-term impact of the COVID-19 pandemic on well-being and health care among children with a chronic condition and their families BT - a study protocol of the KICK-COVID study JF - BMC pediatrics N2 - Background There is consistent evidence that the COVID-19 pandemic is associated with an increased psychosocial burden on children and adolescents and their parents. Relatively little is known about its particular impact on high-risk groups with chronic physical health conditions (CCs). Therefore, the primary aim of the study is to analyze the multiple impacts on health care and psychosocial well-being on these children and adolescents and their parents. Methods We will implement a two-stage approach. In the first step, parents and their underage children from three German patient registries for diabetes, obesity, and rheumatic diseases, are invited to fill out short questionnaires including questions about corona-specific stressors, the health care situation, and psychosocial well-being. In the next step, a more comprehensive, in-depth online survey is carried out in a smaller subsample. Discussion The study will provide insights into the multiple longer-term stressors during the COVID-19 pandemic in families with a child with a CC. The simultaneous consideration of medical and psycho-social endpoints will help to gain a deeper understanding of the complex interactions affecting family functioning, psychological well-being, and health care delivery. KW - Chronic conditions KW - COVID-19 KW - Children and adolescents KW - Parents KW - Risk perception KW - Psychosocial strain KW - Diabetes KW - Rheumatic diseases KW - Obesity Y1 - 2023 U6 - https://doi.org/10.1186/s12887-023-03912-7 SN - 1471-2431 VL - 23 IS - 1 PB - BioMed Central CY - London ER -