Insulin and glucagon are released in pulses from pancreatic β- and α-cells, respectively. Both cell types are electrically excitable, and elevation of the cytoplasmic Ca2+ concentration ([Ca2+]i) due to depolarization with voltage-dependent entry of the cation is the main trigger of hormone secretion. Store-operated Ca2+ entry  (SOCE) also contributes to the [Ca2+]i elevation and this process has been suggested to be particularly important for glucagon secretion. cAMP is another important messenger that amplifies Ca2+-triggered secretion of both hormones, but little is known about cAMP dynamics in islet cells. In type-2 diabetes, there is deteriorated β-cell function associated with elevated concentrations of fatty acids, but the underlying mechanisms are largely unknown. To clarify the processes that regulate insulin and glucagon secretion, cAMP signalling and the store-operated pathway were investigated in β- and α-cells, primarily within their natural environment in intact mouse and human islets of Langerhans. Fluorescent biosensors and total internal reflection microscopy were used to investigate signalling specifically at the plasma membrane (PM). Adrenaline increased and decreased the sub-PM cAMP concentration ([cAMP]pm) in immuno-identified α-cells and β-cells, respectively, which facilitated cell identification. Glucagon elicited [cAMP]pm oscillations in α- and β-cells, demonstrating both auto- and paracrine effects of the hormone. Whereas glucagon-like peptide 1 (GLP-1) consistently elevated [cAMP]pm in β-cells, only few α-cells responded, indicating that GLP-1 regulates glucagon secretion without changes of α-cell [cAMP]pm. Both α- and β-cells responded to glucose with pronounced oscillations of [cAMP]pm that were partially Ca2+-dependent and synchronized among islet β-cells. The glucose-induced cAMP formation was mediated by plasma membrane-bound adenylyl cyclases. Several phosphodiesterases (PDEs), including the PDE1, -3, -4, and -8 families, were required for shaping the [cAMP]pm signals and pulsatile insulin secretion. Prolonged exposure of islets to the fatty acid palmitate deteriorated glucose-stimulated insulin secretion with loss of pulsatility. This defect was associated with impaired cAMP generation, while [Ca2+]i signalling was essentially unaffected. Stromal interacting molecule 1 (STIM1) is critical for activation of SOCE by sensing the Ca2+ concentration in the endoplasmic reticulum (ER). ER Ca2+ depletion caused STIM1 aggregation, co-clustering with the PM Ca2+ channel protein Orai1 and SOCE activation. Glucose, which inhibits SOCE by filling the ER with Ca2+, reversed the PM association of STIM1. Consistent with a role of the store-operated pathway in glucagon secretion, this effect was maximal at the low glucose concentrations that inhibit glucagon release, whereas considerably higher concentrations were required in β-cells. Adrenaline induced STIM1 translocation to the PM in α-cells and the reverse process in β-cells, partially reflecting the opposite effects of adrenaline on cAMP in the two cell types. However, cAMP-induced STIM1 aggregates did not co-cluster with Orai1 or activate SOCE, indicating that STIM1 translocation can occur independently of Orai1 clustering and SOCE.

Introdução: A prevalência de doenças crônicas tem crescido em decorrência do aumento da obesidade nos últimos anos. Peptídeos secretados pelo trato gastrointestinal, como o peptídeo semelhante ao glucagon 1 (GLP-1) e o peptídeo YY (PYY), exercem papel fundamental no controle da ingestão alimentar, pois levam informações acerca dos nutrientes ingeridos até o sistema nervoso central, possuindo efeitos anorexígenos e/ou orexígenos. Tanto GLP-1 quanto PYY são produzidos pelas células-L do íleo distal e cólon, sendo liberados após a ingestão alimentar. Além do efeito incretina produzido pelo GLP-1, ambos os peptídeos apresentam implicações no controle do apetite, o qual reflete na redução do peso corpóreo. Objetivos: Demonstrar um aumento na secreção de GLP-1 e PYY após sobrecarga oral de diferentes tipos de lipídios, comparados à controle negativo (água) e positivo (glicose). Métodos: Foi realizado um estudo experimental controlado em ratos Wistar, distribuídos em 4 grupos de acordo com a sobrecarga oral: grupo MUFA (óleo de oliva); grupo SAT (banha suína); grupo GLUC (glicose) e grupo CONT (água), foram avaliadas as concentrações séricas de GLP-1 ativo e PYY3-36 nos tempos: 0, 15, 30, 60 e 120 minutos. As sobrecargas foram isovolumétricas e isocalóricas, com exceção do grupo controle. Resultados: Houve pico de secreção do GLP-1 pós-sobrecarga no grupo MUFA no ponto 120’ vs CONT e GLUC (p≤0,001) e no ponto 30’ quando comparado ao seu baseline. Também observou-se pico de secreção de PYY no grupo MUFA vs CONT no ponto 30’ (p=0,015); no ponto 60’ vs CONT e GLUC (p=0,019) e no ponto 120’ vs CONT e SAT (p=0,02). A carga secretada do PYY foi maior no MUFA quando comparada ao CONT (p=0,04). Verificou-se forte correlação entre os níveis basais e AUC’s do GLP-1 e PYY (r=0,57; (p= 0,02); r=0,39; (p≤0,001)). A proporção GLP-1/PYY apresentou um coeficiente médio de 3,77 (±2,04). O grupo MUFA evidenciou níveis menores de glicose e maiores de insulina no ponto 15’, enquanto SAT mostrou níveis maiores de glicose e menores de insulina neste ponto, porém, sem diferença significativa. Conclusão: A sobrecarga oral de fontes de ácidos graxos monoinsaturados promoveu um pico de secreção do GLP-1 de forma rápida e no que diz respeito ao PYY, o pico foi mais sustentado. Estudos adicionais são necessários, a fim de se avalir o efeito de fontes distintas de lipídeos da dieta sobre a secreção destes peptídeos e seus efeitos na saciedade. / Background: The increased prevalence of chronic diseases has risen due to obesity. Gut peptides, such as glucagon-like peptide 1 (GLP-1) and peptide YY (PYY), play an important role controlling food intake in response to a meal. GLP-1 exerts the known incretin effect stimulating the release of insulin in a glucosedependent manner. Besides its insulinotropic effects, it is well established that GLP-1 slows gastric emptying, and also inhibits inappropriate glucagon release, additionally improves satiety. Both PYY and GLP-1 are produced by L cells of the distal ileum and colon. Objective: Demonstrate an increased secretion of PYY and GLP-1 after oral overload of different types of lipids, compared to negative (water) and positive (glucose) control. Methods: We conducted a controlled experimental study in Wistar rats, divided into 4 groups according to oral overload: MUFA group (olive oil), SAT group (lard:), carbohydrates group (glucose) and CONT group (water), It was evaluated the serum concentration of active GLP-1 and PYY3-36 in the times: 0, 15, 30, 60 and 120 minutes. Overloads were isovolumetric and isocaloric, but the control group. Results: It was verified a higher peak secretion of GLP-1 in MUFA group at 120' after overload vs. CONT and carbohydrates (p ≤ 0.001) and at 30' when compared to its baseline (p=0,01). It was shown a higher secretion peak of GLP-1 after MUFA overload at time 120’ vs CONT e GLUC (p≤0,001) and at time 30’ when compared to its baseline. It was also verified a PYY release peak in MUFA vs CONT at time 30’ (p=0,015); 60’ vs CONT e GLUC (p=0,019) and 120’ vs CONT e SAT (p=0,02). PYY release load presented higher in MUFA group when compared to CONT (p=0,04). A strong correlation was seen between baseline PYY and GLP-1 (r=0,57; p= 0,02) as their AUC’s (r=0,39; p≤0,001). GLP-1/PYY proportion release presented a mean coefficient of 3, 77(±2,04).Conclusion: monounsaturated fatty acids promoted a release peak of GLP-1 in a faster manner and concerning PYY this peak was more sustained. Further studies are necessary to evaluate whether distinct diet fatty acids can ameliorate these gut peptides release and their role on satiety.

Introdução: A prevalência de doenças crônicas tem crescido em decorrência do aumento da obesidade nos últimos anos. Peptídeos secretados pelo trato gastrointestinal, como o peptídeo semelhante ao glucagon 1 (GLP-1) e o peptídeo YY (PYY), exercem papel fundamental no controle da ingestão alimentar, pois levam informações acerca dos nutrientes ingeridos até o sistema nervoso central, possuindo efeitos anorexígenos e/ou orexígenos. Tanto GLP-1 quanto PYY são produzidos pelas células-L do íleo distal e cólon, sendo liberados após a ingestão alimentar. Além do efeito incretina produzido pelo GLP-1, ambos os peptídeos apresentam implicações no controle do apetite, o qual reflete na redução do peso corpóreo. Objetivos: Demonstrar um aumento na secreção de GLP-1 e PYY após sobrecarga oral de diferentes tipos de lipídios, comparados à controle negativo (água) e positivo (glicose). Métodos: Foi realizado um estudo experimental controlado em ratos Wistar, distribuídos em 4 grupos de acordo com a sobrecarga oral: grupo MUFA (óleo de oliva); grupo SAT (banha suína); grupo GLUC (glicose) e grupo CONT (água), foram avaliadas as concentrações séricas de GLP-1 ativo e PYY3-36 nos tempos: 0, 15, 30, 60 e 120 minutos. As sobrecargas foram isovolumétricas e isocalóricas, com exceção do grupo controle. Resultados: Houve pico de secreção do GLP-1 pós-sobrecarga no grupo MUFA no ponto 120’ vs CONT e GLUC (p≤0,001) e no ponto 30’ quando comparado ao seu baseline. Também observou-se pico de secreção de PYY no grupo MUFA vs CONT no ponto 30’ (p=0,015); no ponto 60’ vs CONT e GLUC (p=0,019) e no ponto 120’ vs CONT e SAT (p=0,02). A carga secretada do PYY foi maior no MUFA quando comparada ao CONT (p=0,04). Verificou-se forte correlação entre os níveis basais e AUC’s do GLP-1 e PYY (r=0,57; (p= 0,02); r=0,39; (p≤0,001)). A proporção GLP-1/PYY apresentou um coeficiente médio de 3,77 (±2,04). O grupo MUFA evidenciou níveis menores de glicose e maiores de insulina no ponto 15’, enquanto SAT mostrou níveis maiores de glicose e menores de insulina neste ponto, porém, sem diferença significativa. Conclusão: A sobrecarga oral de fontes de ácidos graxos monoinsaturados promoveu um pico de secreção do GLP-1 de forma rápida e no que diz respeito ao PYY, o pico foi mais sustentado. Estudos adicionais são necessários, a fim de se avalir o efeito de fontes distintas de lipídeos da dieta sobre a secreção destes peptídeos e seus efeitos na saciedade. / Background: The increased prevalence of chronic diseases has risen due to obesity. Gut peptides, such as glucagon-like peptide 1 (GLP-1) and peptide YY (PYY), play an important role controlling food intake in response to a meal. GLP-1 exerts the known incretin effect stimulating the release of insulin in a glucosedependent manner. Besides its insulinotropic effects, it is well established that GLP-1 slows gastric emptying, and also inhibits inappropriate glucagon release, additionally improves satiety. Both PYY and GLP-1 are produced by L cells of the distal ileum and colon. Objective: Demonstrate an increased secretion of PYY and GLP-1 after oral overload of different types of lipids, compared to negative (water) and positive (glucose) control. Methods: We conducted a controlled experimental study in Wistar rats, divided into 4 groups according to oral overload: MUFA group (olive oil), SAT group (lard:), carbohydrates group (glucose) and CONT group (water), It was evaluated the serum concentration of active GLP-1 and PYY3-36 in the times: 0, 15, 30, 60 and 120 minutes. Overloads were isovolumetric and isocaloric, but the control group. Results: It was verified a higher peak secretion of GLP-1 in MUFA group at 120' after overload vs. CONT and carbohydrates (p ≤ 0.001) and at 30' when compared to its baseline (p=0,01). It was shown a higher secretion peak of GLP-1 after MUFA overload at time 120’ vs CONT e GLUC (p≤0,001) and at time 30’ when compared to its baseline. It was also verified a PYY release peak in MUFA vs CONT at time 30’ (p=0,015); 60’ vs CONT e GLUC (p=0,019) and 120’ vs CONT e SAT (p=0,02). PYY release load presented higher in MUFA group when compared to CONT (p=0,04). A strong correlation was seen between baseline PYY and GLP-1 (r=0,57; p= 0,02) as their AUC’s (r=0,39; p≤0,001). GLP-1/PYY proportion release presented a mean coefficient of 3, 77(±2,04).Conclusion: monounsaturated fatty acids promoted a release peak of GLP-1 in a faster manner and concerning PYY this peak was more sustained. Further studies are necessary to evaluate whether distinct diet fatty acids can ameliorate these gut peptides release and their role on satiety.

Introdução: A prevalência de doenças crônicas tem crescido em decorrência do aumento da obesidade nos últimos anos. Peptídeos secretados pelo trato gastrointestinal, como o peptídeo semelhante ao glucagon 1 (GLP-1) e o peptídeo YY (PYY), exercem papel fundamental no controle da ingestão alimentar, pois levam informações acerca dos nutrientes ingeridos até o sistema nervoso central, possuindo efeitos anorexígenos e/ou orexígenos. Tanto GLP-1 quanto PYY são produzidos pelas células-L do íleo distal e cólon, sendo liberados após a ingestão alimentar. Além do efeito incretina produzido pelo GLP-1, ambos os peptídeos apresentam implicações no controle do apetite, o qual reflete na redução do peso corpóreo. Objetivos: Demonstrar um aumento na secreção de GLP-1 e PYY após sobrecarga oral de diferentes tipos de lipídios, comparados à controle negativo (água) e positivo (glicose). Métodos: Foi realizado um estudo experimental controlado em ratos Wistar, distribuídos em 4 grupos de acordo com a sobrecarga oral: grupo MUFA (óleo de oliva); grupo SAT (banha suína); grupo GLUC (glicose) e grupo CONT (água), foram avaliadas as concentrações séricas de GLP-1 ativo e PYY3-36 nos tempos: 0, 15, 30, 60 e 120 minutos. As sobrecargas foram isovolumétricas e isocalóricas, com exceção do grupo controle. Resultados: Houve pico de secreção do GLP-1 pós-sobrecarga no grupo MUFA no ponto 120’ vs CONT e GLUC (p≤0,001) e no ponto 30’ quando comparado ao seu baseline. Também observou-se pico de secreção de PYY no grupo MUFA vs CONT no ponto 30’ (p=0,015); no ponto 60’ vs CONT e GLUC (p=0,019) e no ponto 120’ vs CONT e SAT (p=0,02). A carga secretada do PYY foi maior no MUFA quando comparada ao CONT (p=0,04). Verificou-se forte correlação entre os níveis basais e AUC’s do GLP-1 e PYY (r=0,57; (p= 0,02); r=0,39; (p≤0,001)). A proporção GLP-1/PYY apresentou um coeficiente médio de 3,77 (±2,04). O grupo MUFA evidenciou níveis menores de glicose e maiores de insulina no ponto 15’, enquanto SAT mostrou níveis maiores de glicose e menores de insulina neste ponto, porém, sem diferença significativa. Conclusão: A sobrecarga oral de fontes de ácidos graxos monoinsaturados promoveu um pico de secreção do GLP-1 de forma rápida e no que diz respeito ao PYY, o pico foi mais sustentado. Estudos adicionais são necessários, a fim de se avalir o efeito de fontes distintas de lipídeos da dieta sobre a secreção destes peptídeos e seus efeitos na saciedade. / Background: The increased prevalence of chronic diseases has risen due to obesity. Gut peptides, such as glucagon-like peptide 1 (GLP-1) and peptide YY (PYY), play an important role controlling food intake in response to a meal. GLP-1 exerts the known incretin effect stimulating the release of insulin in a glucosedependent manner. Besides its insulinotropic effects, it is well established that GLP-1 slows gastric emptying, and also inhibits inappropriate glucagon release, additionally improves satiety. Both PYY and GLP-1 are produced by L cells of the distal ileum and colon. Objective: Demonstrate an increased secretion of PYY and GLP-1 after oral overload of different types of lipids, compared to negative (water) and positive (glucose) control. Methods: We conducted a controlled experimental study in Wistar rats, divided into 4 groups according to oral overload: MUFA group (olive oil), SAT group (lard:), carbohydrates group (glucose) and CONT group (water), It was evaluated the serum concentration of active GLP-1 and PYY3-36 in the times: 0, 15, 30, 60 and 120 minutes. Overloads were isovolumetric and isocaloric, but the control group. Results: It was verified a higher peak secretion of GLP-1 in MUFA group at 120' after overload vs. CONT and carbohydrates (p ≤ 0.001) and at 30' when compared to its baseline (p=0,01). It was shown a higher secretion peak of GLP-1 after MUFA overload at time 120’ vs CONT e GLUC (p≤0,001) and at time 30’ when compared to its baseline. It was also verified a PYY release peak in MUFA vs CONT at time 30’ (p=0,015); 60’ vs CONT e GLUC (p=0,019) and 120’ vs CONT e SAT (p=0,02). PYY release load presented higher in MUFA group when compared to CONT (p=0,04). A strong correlation was seen between baseline PYY and GLP-1 (r=0,57; p= 0,02) as their AUC’s (r=0,39; p≤0,001). GLP-1/PYY proportion release presented a mean coefficient of 3, 77(±2,04).Conclusion: monounsaturated fatty acids promoted a release peak of GLP-1 in a faster manner and concerning PYY this peak was more sustained. Further studies are necessary to evaluate whether distinct diet fatty acids can ameliorate these gut peptides release and their role on satiety.

L’obésité et le diabète de type 2 (DT2) sont des pathologies métaboliques associées à des perturbations de l’homéostasie glucidique et énergétique. Les enterohormones sont des acteurs importants de la regulation des mécanismes perturbés lors de ces pathologies. Parmi ces enterohormones, le GLP-1, sécrété par les cellules entéroendocrines de type L suite à un repas, permet d’amplifier la sécrétion d’insuline par les cellules β-pancréatiques et de diminuer la prise alimentaire. L’objectif de ma thèse a été de caractériser le rôle du récepteur nucléaire HNF-4γ dans l’homéostasie énergétique et la fonction endocrine de l’intestin.A l’aide d’un modèle murin d’invalidation totale et constitutive du facteur de transcription HNF-4γ, notre équipe a mis en évidence que l’absence de HNF-4γ induit une amélioration de la tolérance au glucose grâce à une augmentation du nombre de cellules L et de la quantité plasmatique de GLP-1 en réponse au glucose. L’ensemble de ces données démontre pour la première fois un rôle de HNF-4γ dans l’homéostasie glucidique via une modulation du lignage enteroendocrine spécifique du GLP-1 et suggère que son absence pourrait protéger les souris de l’établissement d’un DT2.Par ailleurs, la perte d’expression de HNF-4γ confère une protection vis-à-vis de la prise de poids et de l’intolérance au glucose normalement induites par six semaines d’un régime riche en lipides et en fructose grâce une perte énergétique accrue dans les fécès essentiellement due à une malabsorption des acides gras.En conclusion, cette étude met en exergue le rôle du récepteur nucléaire intestinal HNF-4γ dans la fonction enteroendocrine et la susceptibilité à l’obésité et au DT2. / Obesity and type 2 diabetes (T2D) are metabolic pathologies associated with glucose and energy homeostasis perturbations. Enterohormones are important players in the regulation of the mechanisms disturbed during these pathologies. Among these enterohormones, GLP-1, secreted by enteroendocrine L cells in response to a meal, potentiates insulin secretion by pancreatic β cells and inhibits food intake. The aim of my thesis was to characterize the role of the nuclear receptor HNF-4γ in the energy homeostasis and the endocrine function of the intestine.By using a total and constitutive HNF-4γ knock-out mouse model, our team has highlighted that the loss of hnf-4γ induces an improved glucose tolerance. This effect is due to an increased GLP-1 cell number and GLP-1 plasma levels in response to glucose. All together these data demonstrate for the first time a role of HNF-4γ in glucose homeostasis through a modulation of the enteroendocrine lineage specific for GLP-1 and suggest that its absence could protect mice from the T2D establishment.The loss of HNF-4γ protects mice from body weight gain and glucose intolerance normally induced by six weeks of a high-fat/high-fructose diet demonstrating its involvement in obesity and T2D. HNF-4γ -/- mice are protected from obesity by a greater energy loss in faeces mainly due to lipid malabsorption. These results demonstrate that HNF-4γ is necessary for the intestinal fatty acids uptake.In conclusion, this study highlights the role of the intestinal nuclear receptor HNF-4γ in enteroendocrine function and susceptibility to obesity and T2D.

Indiana University-Purdue University Indianapolis (IUPUI) / Coronary artery disease (CAD) is a leading cause of death among Americans and is fueled by underlying metabolic syndrome (MetS). The prevalence and lethality of CAD necessitates rigorous investigations into its underlying mechanisms and to facilitate the development of effective treatment options. Coronary smooth muscle (CSM) phenotypic modulation from quiescent to synthetic, proliferative, and osteogenic phenotypes is a key area of investigation, with underlying mechanisms that remain poorly understood. Using a well-established pre-clinical model of CAD and MetS, the Ossabaw miniature swine, we established for the first time the time course of Ca2+ dysregulation during MetS-induced CAD progression. In particular, we used the fluorescent Ca2+ dye, fura-2, to examine alterations in CSM intracellular Ca2+ regulation during CAD progression, as perturbations in intracellular Ca2+ regulation are implicated in several cellular processes associated with CAD pathology, including CSM contractile responses and proliferative pathways. These studies revealed that the function of several CSM Ca2+ handling proteins is elevated in early CAD, followed by loss of function in severe atherosclerotic plaques. Decreased intracellular Ca2+ regulation occurred concurrently with reductions in CSM proliferation, measured with Ki-67 staining. In particular, alterations in sarcoplasmic reticulum (SR) Ca2+ store together with altered function of the sarco/endoplasmic reticulum Ca2+ ATPase (SERCA) were associated with induction of proliferation. Organ culture of coronary arterial segments revealed that culture-induced medial thickening was prevented by SERCA inhibition with cyclopiazonic acid (CPA). Activation of SERCA with the small molecule activator, CDN1163, increased CSM proliferation, which was attenuated by treatment with CPA, thus establishing upregulated SERCA function as a proximal inducer of CSM proliferation. Further, we demonstrated that in vitro treatment of CSM from lean Ossabaw swine with the glucagon-like peptide-1 (GLP-1) receptor agonist, exenatide, increased SERCA function. However, in vivo treatment of Ossabaw swine with MetS with the GLP-1 receptor agonist, AC3174, had no effect on CAD progression and in vitro examination revealed resistance of SERCA to GLP-1 receptor agonism in MetS. These findings further implicate SERCA in CAD progression. Collectively, these are the first data directly linking SERCA dysfunction to CSM proliferation and CAD progression, providing a key mechanistic step in CAD progression.

Overweight and obesity are enormous problems, causing both reduced life expectancy as well as socioeconomic consequences. In 2016, almost 40 % of the global population was classified as obese. Obesity is a major risk factor to numerous serious health issues, including high blood pressure, stroke, diabetes and it is connected to an increased risk of certain types of cancer.    Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved by the European Union in 2022 for treatment of obesity and some types of overweight. Semaglutide supports the regulation of blood sugar, hunger and satiety, similar to the hormone glucagon-like peptid-1 (GLP-1).   This review examined research related to expected length of treatment for weight loss with semaglutide. Specifically, it considered whether it is an option to end treatment with semaglutide once the patient reached the target weight and improved health, or if continuous treatment with semaglutide is necessary to prevent weight regain.    The studies reviewed were connected to the clinical trials “Semaglutide Treatment Effect in People with obesity” (STEP), that studied change of weight. The basic design of these trials combined once weekly injections of Semaglutide 2.4 mg or placebo with 150 minutes weekly exercise, 500 calories reduction in daily intake and ongoing supportive counselling. The trial objective, length and population varied, still all trials resulted in about 15 % mean weight loss with semaglutide treatment compared to 2-6 % with placebo treatment.    Investigation in changes in weight and cardiometabolic endpoints up to one year after discontinued 68 weeks of treatment, found that only -5% weight loss from base line remained, even with on-going lifestyle changes. Neither intensive behavioural therapy and 8 weeks of initial low-carb diet nor a prolonged 104 weeks study showed additional weight loss.    A questionnaire regarding the control of food cravings, hunger and satiety found that the semaglutide group had in average less cravings for savoury food and an increased control of general food craving than placebo.    It is not possible, based on examined trials of subcutaneous semaglutide 2.4 mg, to conclude that ending treatment will result in a permanent stable weight loss, even with continued lifestyle changes and supportive follow ups. Additional research, especially on long-term treatment with semaglutide 2.4 mg, is needed to investigate results as weight loss, other improved parameters and reported side effects. Still the reported side effects have not raised any alarm and parameters connected to some of the serious risk factors that are increased when obese or over-weight were indicated as improved compared to placebo.    Despite the need for more research, the absence of severe adverse effects, above positive indications related to reduced risk factors, and the fact that nearly 70 % of participants in average lost at least -10 % of their weight at base line, and closer to 35 % lost at least 20 %, all support a positive view of semaglutide 2.4 mg as a potential lifelong treatment option. / Fetma är ett globalt hälsoproblem, med flera allvarliga följdsjukdomar som kan leda till både förkortad förväntad livslängd och socioekonomiska konsekvenser. Semaglutid är en glukagonliknande peptid-1 receptoragonist (GLP-1RA) som godkändes för behandling av fetma och viss övervikt av Europeiska unionen år 2022. Precis som kroppsegen glukagonliknande peptid-1 (GLP-1) stödjer semaglutid glukoshomeostas genom att både stimulera insulinproduktionen och hämma glukagonutsöndring. Semaglutid bidrar även till minskade hungerkänslor och ökad mättnadskänsla. Denna litteraturstudie har undersökt forskningsresultat gällande förväntad behandlingstid vid behandling av övervikt och fetma med veckovis subkutan semaglutid 2,4 mg; en kortare kur med semaglutid som följs av fortsatta livsstilsförändringar för att bibehålla önskad vikt, eller livslång farmakologisk behandling. Utvalda studier har varit kopplade till de randomiserade, dubbelblinda kliniska studierna ”Semaglutide Treatment Effect in People with obesity” (STEP) som undersökte procentuell viktnedgång och där livsstilsförändring i form av 150 min rörelse per vecka, 500 kalorier minskat dagligt kaloriintag samt uppföljningssamtal kombinerades med behandling med veckovis subkutan 2,4 mg semaglutid.  Samtliga studier, som undersökte förändring av vikt, gav trots skillnader i studiernas längd och andra parametrar likvärdiga effektkurvor som planade ut runt 15 % jämfört med omkring 2-6 % genomsnittlig viktreduktion för placebo. Efter 20 veckor sågs 10,6 % genomsnittlig viktnedgång, efter 68 veckor cirka 15 % och 104 veckors behandling med semaglutid gav inte ytterligare procentuell viktnedgång. Inte heller intensiv beteendeterapi eller inledande lågkalorikost bidrog till ökad viktnedgång. Däremot visade en av studierna en statistiskt signifikant förbättrad upplevd kontroll av begär efter mat och begär efter salta livsmedel för den grupp som behandlades med semaglutid.  Vid avbruten behandling återgick vikten till ungefär – 5% av ursprungsvikten efter 48-52 veckor utan semaglutid, oavsett om livsstilsförändringar bibehölls eller ej. Utifrån undersökta studier av subkutan semaglutid 2,4 mg går det inte att dra slutsatsen att en kortare behandlingskur åtföljs av en bestående viktminskning, inte ens i de fall där semaglutid ersätts med fortsatt icke-farmakologisk behandling i form av ökad rörelse, minskat kaloriintag samt kontinuerliga stödsamtal.  Fler långtidsstudier kring effekt och biverkan behövs, men rapporterad biverkan är framför allt lindrig och övergående, kardiometabola parametrar indikerar en förbättring jämfört med placebo men försämring vid avbruten behandling. Detta och en bibehållen viktnedgång där det för nästan 70 % leder det till minst 10 % viktminskning och närmare 35 % får minst 20 % bestående viktminskning är en anledning till att se positivt till möjlig livslång behandling med subkutan semaglutid 2.4 mg.

Es ist bekannt, dass eine diabetische Stoffwechsellage über einen gesteigerten Proteinabbau zu einer Muskelatrophie führen kann. Ein zentrales System beim Abbau von Muskelproteinen ist hierbei das Ubiquitin-Proteasom-System mit seinen zwei spezifischen E3-Ligasen MuRF-1 und MAFbx. Ziel dieser Arbeit war es, den Einfluss einer Hyperglykämie auf die Expression von Proteinen des Ubiquitin-Proteasom-Systems im Skelett- und Herzmuskel zeit- und konzentrationsabhängig zu untersuchen. Insbesondere stand die Expression der E3-Ligasen MuRF-1 und MAFbx sowie die daraus folgende Auswirkung auf die Protein-Ubiquitinylierung im Fokus der Untersuchungen. Weiterhin sollte der Einfluss der Hyperglykämie auf die Apoptoserate von Skelett- und Herzmuskelzellen analysiert werden. Seit Kurzem stehen die GLP-1-Analoga als neue Antidiabetika für die Therapie des Diabetes mellitus Type II zur Verfügung. Da in Studien bereits positive Effekte der GLP-1-Analoga am Herzmuskel festgestellt wurden, sollte in der vorliegenden Studie geprüft werden, ob das GLP-1-Analogon Liraglutid die Veränderungen am Herzmuskel beeinflussen kann. Um die Fragestellungen zu klären, wurden verschiedene Untersuchungen in der Zellkultur durchgeführt. Skelettmuskel Myoblasten (undifferenzierte C2C12-Zellen), Skelettmuskel Myotuben (differenzierte C2C12-Zellen) und neonatale Rattenkardiomyozyten wurden unterschiedlichen Glukosekonzentrationen (5mM, 12mM, 25mM) für 24 oder 72 Stunden ausgesetzt. Die Herzmuskelzellen wurden zusätzlich in den Glukosekonzentrationen unter Zusatz von 12 mg/ml Liraglutid für 72h inkubiert. Die Expression der E3-Ligasen wurde mit qRT-PCR (MuRF-1 und MAFbx) und Western Blot (MuRF-1) quantifiziert. Die Poly-Ubiquitinylierung wurde mittels Western Blot bestimmt. Unter Verwendung des Cell Death Detection ELISA (Roche Diagnostics) wurde die Apoptoserate evaluiert. Die Inkubation von Skelett- und Herzmuskelzellen für 24 h mit hyperglykämischen Medium hatte kaum einen Einfluss auf die Expression von MuRF-1 und MAFbx sowie die Apoptoserate. Bei einer Inkubationszeit von 72 h konnten signifikante Erhöhungen bei 25mM Glukose für MuRF-1, MAFbx, der Poly-Ubiquitinylierung und der Apoptoserate in Skelett und Herzmuskelzellen festgestellt werden. Diese Anstiege konnten durch den Zusatz von Liraglutid beim Herzmuskel verhindert werden. Die Ergebnisse der vorliegenden Studie konnten zeigen, dass eine Hyperglykämie in der Zellkultur nach 72 h die Expression von zwei wichtigen Ubiquitin-E3-Ligasen sowie die Steigerung der Apoptoserate induzieren kann und dass dies durch Liraglutid am Herzmuskel verhindert werden kann. Diese Vorgänge können eventuell den Proteinverlust bzw. die Muskelatrophie beim Diabetes mellitus zum Teil erklären. Durch die positive Beeinflussung von Liraglutid an den Herzmuskelzellen könnte sich hier ein therapeutisches Potential zur Muskelatrophiebehandlung ergeben.

Obesity has grown to epidemic proportions, and in lack of efficient life-style and medical treatments, the bariatric surgeries are performed in rising numbers. The most common surgery is the Gastric Bypass (GBP) surgery, with the Biliopancreatic diversion with duodenal switch (DS) as an option for the most extreme cases with a BMI>50 kg/m2. In paper I 20 GBP-patients were examined during the first post-operative year regarding the natriuretic peptide, NT-ProBNP, which is secreted from the cardiac ventricles. Levels of NT-ProBNP quickly increased during the first post-surgery week, and later established itself on a higher level than pre-surgery. In paper II we report of 5 patient-cases after GBP-surgery with severe problems with postprandial hypoglycaemia that were successfully treated with GLP-1-analogs. The effect of treatment could be observed both symptomatically and in some cases using continuous glucose measuring systems (CGMS). In paper III three groups of subjects; 15 post-GBP patients, 15 post-DS, and 15 obese controls were examined for three days using CGMS during everyday life. The post-GBP group had high glucose variability as measured by MAGE and CONGA, whereas the post-DS group had low variability. Both post-operative groups exhibited significant time in hypoglycaemia, about 40 and 80 minutes per day <3.3mmol/l and 20 and 40 minutes < 2.8mmol/l, respectively, longer time for DS-group. Remarkably, only about 20% of these hypoglycaemic episodes were accompanied with symptoms. In Paper IV the hypoglycaemia counter regulatory system was investigated; 12 patients were examined before and after GBP-surgery with a stepped hypoglycaemic hyperinsulinemic clamp. The results show a downregulation of symptoms, counter regulatory hormones (glucagon, cortisol, epinephrine, norepinephrine, growth hormone), incretin hormones (GLP-1 and GIP), and sympathetic nervous response. In conclusion patients post bariatric surgery exhibit a downregulated counter regulatory response to hypoglycaemia, accompanied by frequent asymptomatic hypoglycaemic episodes in everyday life. Patients suffering from severe hypoglycaemic episodes can often be treated successfully with GLP-1-analogues.

The prevalence of childhood obesity and Type 2 Diabetes Mellitus (T2DM) has increased during recent decades. T2DM is accompanied with functional changes in the islets of Langerhans, which can be identified early in the pathogenesis. The aim of this thesis was to explore how metabolic changes caused by obesity early in life relate to islet function prior to overt T2DM. To address this, Uppsala Longitudinal Study of Childhood Obesity (ULSCO) was established (paper I). Initially, the association between palmitate and insulin secretion was investigated using a translational approach with obese and lean normoglycemic juveniles and isolated human islets (paper II). Secondly, dynamics of islet-hormones insulin and glucagon, and gut-hormones glucagon like-peptide 1 (GLP-1) and glicentin (paper III) and magnetic resonance imaging of pancreatic fat fraction (PFF) (paper IV) were studied in association to glucose tolerance and beta-cell function. Finally, a novel method of analysing shape features of oral glucose tolerance test (OGTT) curves was introduced and evaluated (paper V). Obese subjects had high prevalence of prediabetes and metabolic syndrome (MetS) (paper I). In obese pre-pubertal children with elevated palmitate levels, hyperinsulinemia was observed (paper II). In contrast, obese pubertal adolescents with similar palmitate levels showed moderate insulin levels during OGTT with delayed first phase insulin response. To explore mechanisms for these variations, isolated human islets were exposed to palmitate for different time periods in vitro. After 2 days accentuated insulin response was observed. Impaired beta-cell function and apoptosis were evident after 7 days, however. Hyperglucagonemia and disturbed GLP-1 and glicentin levels were associated with obesity and glycaemic status, with fasting glicentin being predictive of prediabetes (paper III). Furthermore, PFF was increased in obese subjects and associated to MetS and visceral adipose tissue, but not to beta-cell function (paper IV). OGTT curves were converted into geometric centres, centroids, which correlated with differences in glucose tolerance (paper V). In conclusion, the islet function in obese children was associated with elevated levels of palmitate, but not pancreatic fat. Fasting palmitate and glicentin levels, as well as centroid analyses of OGTT curves, could potentially identify obese children at risk of prediabetes and subsequent T2DM.