BACKGROUND AND OBJECTIVES: Type 2 diabetes mellitus (T2DM) is a complex disease with genetic predisposition and histopathological characterization. Pancreatic islet amyloidosis, hyaline arteriolosclerosis, and diabetic glomerulopathy are histopathological hallmarks of T2DM at autopsy examination. The associations of genetic variants with diabetic amyloidosis, arteriosclerosis and glomerulopathy have not been fully elucidated. Several candidate genes including apolipoprotein E (ApoE), insulin degrading-enzyme (IDE) and glucose transporter-1 ( GLUT1) have been reported to increase risk of T2DM in human studies although results are not always consistent. Capitalizing on the pathological hallmarks of T2DM, I used autopsy specimens to investigate the risk associations of polymorphisms of ApoE (rs429358 and rs7412), IDE (rs6583813) and GLUT1 (rs710218) genes with clinical features and specific pathological changes in diabetic kidney and pancreas. I further explored the mechanisms of these associations by evaluating the histopathological changes and protein expression in pancreas and kidney. / CONCLUSIONS: These findings suggest that genetic factors have important effects in the development of tissue-specific changes and chronic complications in T2DM. Islet amyloidosis, arteriosclerosis and glomerulosclerosis in T2DM may share common pathogenetic processes as suggested by the coexistence of chaperone proteins, amyloid P and ApoE. Genetic--pathologic correlation studies are useful in advancing our understanding of the mechanisms of complex diseases such as T2DM. / METHODS AND MATERIALS: Genomic DNA was extracted from white blood cell-concentrated paraffin embedded formalin fixed spleen tissues. Genotyping for ApoE, IDE and GLUT1 polymorphisms was determined by polymerase chain reaction (PCR) and ligase detection reaction (LDR). The pathological changes were blindly assessed in pancreatic and kidney tissues of autopsy specimens. Protein expression of these genes was examined by immunostaining and quantified by using Metamorph image analysis system. / RESULTS: In a consecutive study population of 3693 autopsy specimens containing 328 T2DM and 209 control cases, the respective frequencies of genotypes were as follows: 1) TT of GLUT1 rs710218: 11.2% vs. 11.3%; 2) ApoE epsilon2: 19.4% vs. 10.9%; 3) ApoE epsilon4: 12.1% vs. 9.1% and 4) C carriers of IDE rs6583813: 51.2% vs. 47.9%. The key genotype-phenotype correlations were as follows. 1) In the T2DM cases, GLUT1 rs710218 IT genotype carriers (0% in TT genotype vs. 59.1% in AA genotype, P=0.0407) were less likely but ApoE epsilon 2 allele carriers (57.1% in epsilon2 allele carriers vs. 23.5% in epsilon3 allele carriers P=0.0382) were more likely to have diabetic glomerular hypertrophy than referential group. ApoE epsilon2 carriers showed increased glomerular ApoE protein expression with the immunoreactivity found mainly in the mesangial regions and nodular lesions. On the other hand, ApoE epsilon 3/epsilon4 cases had diffuse ApoE expression in glomerular capillaries. 2) ApoE epsilon4 carriers were more likely to have islet amyloidosis than non-carriers (62.5% in epsilon4 allele carriers vs. 23.6% in epsilon 3 allele carriers P=0.0232). There was immunolocalization of the chaperone proteins, amyloid P and ApoE in both islet amyloid deposits and arterial walls with hyaline arteriolosclerosis. 3) In T2DM cases, IDE rs6583813 C allele carriers had higher prevalence of vascular disorders [hypertension (67.4% vs. 43.6%, P=0.0332), death due to cardiovascular disease (58.1% vs. 25.6%, P=0.0479) and cerebral vascular accident (CVA) (20.9% vs. 2.4%, P=0.0412)1 than T allele carriers. / Guan, Jing. / Adviser: Chan Chung Ngor Juliana. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 175-192). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.