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.

The aim of this research was the development of mass spectrometry-based methodologies for the high-throughput quantitation of peptides in biological matrices. Glucagon and GLP-1, which are of interest as biomarkers and in the development of therapeutics, were chosen as model peptides. Immunoassays that are traditionally used to quantify these often perform poorly; therefore, necessitating the development of alternative methodologies. Application of mass spectrometry-based methodologies to these analytes has, however, been limited, primarily due to sensitivity challenges, but also due to analytical challenges associated with their endogenous nature and instability in biological matrices. Chapter 2 describes the development and qualification of the first liquid-chromatography coupled tandem mass spectrometry (LC-MS/MS) method for the quantitation of endogenous glucagon from human plasma. A novel 2D extraction procedure was developed to ensure robustness and sensitivity, whilst a novel surrogate matrix quantitation strategy took into account the endogenous nature of the analyte. A lower limit of quantitation (LLOQ) of 25 pg/mL was qualified, which was a considerable improvement over that previously reported in the literature (250 pg/mL) for a LC-MS/MS method. Clinical samples were cross-validated against a conventional radioimmunoassay (RIA), and similar pharmacokinetic (PK) profiles resulted, demonstrating that the methods were complementary. In Chapter 2 glucagon instability in biological matrix was noted. To characterise this further, in Chapter 3 in vitro glucagon metabolites were identified using high-resolution mass spectrometry (HRMS). Metabolites observed by others (glucagon19-29, glucagon3 29 and [pGlu]3glucagon3 29) in alternative matrices were identified, alongside novel metabolites (glucagon20-29 and glucagon21-29). Cross-interference of these metabolites in immunoassays may help to explain their poor performance, whilst knowledge of metabolism may also aid the development of future stabilisation strategies. The method developed in Chapter 2 was refined in Chapter 4 to improve sensitivity, robustness and throughput, and to add GLP-1 as a secondary analyte. The sensitivity achieved (glucagon: 15 pg/mL LLOQ, GLP-1: 25 pg/mL LLOQ) is the highest reported for both peptides for an extraction avoiding immunoenrichment. Specificity of endogenous glucagon quantitation was assured using a novel approach with a supercharging mobile phase additive to access a sensitive qualifier transition. A cross-validation against established immunoassays using physiological study samples demonstrated some similarities between the methods. Differences between the immunoassay results exemplified the need to develop alternative methodologies. The resulting LC-MS/MS method is considered a viable alternative to immunoassays, for the quantitation of endogenous glucagon, dosed glucagon and/or dosed GLP-1 in human plasma.

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.

Das Darmhormon Glucagon-like peptide-1 (GLP-1) ist ein vielversprechendes Therapeutikum in der Behandlung des Typ 2-Diabetes. Allerdings liegen nur wenige Daten über die molekulare Wirkung des Hormons vor. Daher wurden die intrazellulären Effekte, die GLP-1-induzierten Signaltransduktion und Genexpression am Beispiel der pankreatischen ß-Zellinie INS-1 untersucht. In den INS-1-Zellen zeigte sich nach einer GLP-1-Stimulation eine zeit-, dosis- und glukose-abhängige Phosphorylierung von ERK1/2 bzw. der Aktivierung der Transkriptionsfaktoren Elk-1 und CREB. Während GLP-1 die beiden Signalmoleküle bereits nach wenigen Minuten transient aktivierte, führte Glukose zu einer verzögerten, aber anhaltenden Aktivierung. Beide Stimulanzien gemeinsam bewirkten eine synergistische Aktivierung von ERK1/2 und CREB. Sowohl am Mechanismus der glukose- als auch GLP-1-induzierten Aktivierung sind Ca2[plus]-regulierte Signalprozesse in antagonistischer Weise involviert. So führte die Inhibition von CaM-Kinasen und der intrazellulären Ca2[plus]-Erhöhung zu einer Reduktion der GLP-1- und glukosestimulierten ERK1/2-Phosphorylierung, die induzierte Aktivierung von CREB wurde leicht verstärkt. Die Inhibition der PKA und MEK ließen die Rückschlüsse zu, daß die Aktivie-rung der MAPK-Kaskade teilweise durch die PKA vermittelt wird und eine Wechselwirkung zwischen den Kaskaden existiert. Insbesondere die Induktion der frühen Gene junB, c-fos, nur-77 und zif268, die mit der GLP-1-induzierten ERK1/2- und CREB-Phosphorylierung korrelierten, belegten, daß GLP-1 einen Teil seiner Wirkung über diese Signalwege vermittelt. Die Glukosewirkung hinsichtlich der IEG-Induktion war gering. Beide Stimuli gemeinsam führten analog zum synergistischen Effekt auf signaltransduktorischer Ebene zu einer gesteigerten und verlängerten IEG-Expression, die somit die physiologische Bedeutung von GLP-1 als Glukosekompetenzfaktor unterstrichen.

No description available.

Bypass or resection of the stomach and oesophagus, has long been recognised to result in profound changes in the handling of ingested nutrients. This results in significant morbidity after radical surgery for oesophago-gastric cancer, in particular post-prandial hypoglycaemia, altered appetite, early satiety and noxious post-prandial symptoms. By profiling and challenging the gut hormone axis in healthy volunteers and patients who had undergone total or subtotal gastrectomy, or oesophagectomy, this thesis explores the possible causative mechanisms for the challenges faced by this patient population. In the surgical groups, an oral glucose tolerance test (OGTT) resulted in enhanced secretion of satiety and incretin gut hormones (GLP-1, GIP, PYY) and insulin, followed by hypoglycaemia in a cohort of patients. Continuous glucose monitoring of gastrectomy participants over two weeks of normal lifestyle identified an increased incidence of day and night time hypoglycaemia. RNAseq and mass spectrometry based peptidomics of human and murine enteroendocrine cells in the pre- and post-operative populations revealed no significant change in the underlying cellular pathways for nutrient sensing and gut hormone secretion, indicating that the altered hormone secretion is primarily driven by accelerated nutrient transit, rather than adaptive changes in the gut. Finally, specific blockade of the GLP-1 receptor in post-gastrectomy patients using Exendin 9-39 normalised insulin secretion and prevented reactive hypoglycaemia after an OGTT. In conclusion, profound changes in gut hormone secretion as a result of enhanced nutrient transit after foregut surgery likely underlie the early and late post-prandial symptoms seen in this group, and therapies specifically targeting the gut hormone axis, and GLP-1 in particular, could be the first targeted treatments for post-gastrectomy syndromes.

Dans la perspective de trouver de nouvelles thérapies dans le traitement du diabète de type II, non insulino-dépendant, le Glucagon-Like Peptide-1 (GLP-1) constitue un excellent candidat. Si son mécanisme d'action est bien connu, il reste toutefois à résoudre de grands problèmes fondamentaux, avant de le substituer aux molécules utilisées pour une telle pathologie. En particulier, la compréhension de la liaison du GLP-1 à son récepteur demeure un point crucial. Une meilleure connaissance des structures du ligand et du récepteur sont nécessaires. De plus, ce peptide ne peut être utilisé dans sa forme native, dû à une inactivation rapide par les protéases.<br /><br />Pour essayer d'augmenter la stabilité du peptide, et en tenant compte des positions clés définies dans la littérature, plusieurs analogues du GLP-1-(7-37) sont conçus, et synthétisés. Ils possèdent principalement des pharmacomodulations au niveau de la partie N-terminale. Des substitutions sont également réalisées dans la partie centrale du peptide, permettant de vérifier certaines hypothèses concernant sa conformation. Considérant les résultats de liaison et d'efficacité in vitro, certains analogues sont sélectionnés pour des études in vivo d'activité et de stabilité métabolique. Le [a8,desR36]GLP-1-(7-37) se distingue des autres tant par sa grande stabilité que son efficacité, supérieure à la molécule native. Ce composé est en phase de développement pré-clinique.<br /><br />Parallèlement, la conformation de chaque analogue est étudiée (CD, IR) et ainsi, confrontée aux résultats in vitro, il est possible de proposer une conformation bioactive.<br /><br />Enfin, pour appréhender plus en avant les mécanismes de liaison du peptide avec son récepteur spécifique, la modélisation moléculaire du récepteur fait ressortir quelques hypothèses quant à la localisation probable de l'interaction hormone-récepteur. Des analyses biophysiques et la synthèse de fragments du récepteur, ont permis d'étayer de telles hypothèses.

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Type 2 diabetes is still rapidly on the rise today, affecting 10.5% of individuals in the United States between the ages 45 to 64 and 18.4% of those between the ages of 65 to 74. In the past two decades, type 2 diabetes has doubled in all age groups. Many adults with type 2 diabetes experience difficulty managing their blood sugars, which can result in a range of further complications. One of the newest treatment options on the market today is a glucagon-like peptide-1 (GLP-1) receptor agonist, Bydureon. Similar to Byetta, Bydureon has a main ingredient of exenatide. It offers once a week dosing as opposed to twice-a-day, which may be more appealing to patients. The purpose of this study was to examine the efficacy of a newly FDA released medication, Bydureon, once weekly dosage in adults with type 2 diabetes. A descriptive, comparative, retrospective study of 35 patients evaluated efficacy by examining Hgb A1C and body mass index in adults with type 2 diabetes at baseline and 3 months after Bydureon was prescribed. Data were collected by a chart review of records in a primary care practice. Results demonstrated a statistically significant difference between baseline to 3 month means in both Hgb A1C (t (34)= -3.05, p=.0044) and BMI (t (34) = -2.86, p = .0072) for patients using Bydureon. Health care providers need to individualize the patients’ plans of care to address multifactorial areas of their diabetes care and provide them with an opportunity to successfully meet their goals. Practitioners must be knowledgeable about the treatment options available, including the newer GLP-1 receptor agonist, Bydureon and its efficacy for adults with type 2 diabetes.

Indiana University-Purdue University Indianapolis (IUPUI) / Recent advancements in the management of systemic glucose regulation in obesity/T2DM include drug therapies designed to utilize components of the incretin system specifically related to glucagon-like peptide 1 (GLP-1). More recently, GLP-1 has been investigated for potential cardioprotective effects. Several investigations have revealed that acute/sub-acute intravenous administration of GLP-1 significantly reduces myocardial infarct size following ischemia/reperfusion injury and improves cardiac contractile function in the settings of coronary artery disease, myocardial ischemia/reperfusion injury, and heart failure. Despite an abundance of data indicating that intravenous infusion of GLP-1 is cardioprotective, information has been lacking on the cardiac effects of iv GLP-1 in the MetS or T2DM population. Some important questions this study aimed to address are 1) what are the direct, dose-dependent cardiac effects of GLP-1 in-vivo 2) are the cardiac effects influenced by cardiac demand (MVO2) and/or ischemia, 3) does GLP-1 effect myocardial blood flow, glucose uptake or total oxidative metabolism in human subjects, and 4) are the cardiac effects of GLP-1 treatment impaired in the settings of obesity/MetS and T2DM. Initial studies conducted in canines demonstrated that GLP-1 had no direct effect on coronary blood flow in-vivo or vasomotor tone in-vitro, but preferentially increased myocardial glucose uptake in ischemic myocardium independent of effects on cardiac contractile function or coronary blood flow. Parallel translational studies conducted in the humans and Ossabaw swine demonstrate that iv GLP-1 significantly increases myocardial glucose uptake at rest and in response to increases in cardiac demand (MVO2) in lean subjects, but not in the settings of obesity/MetS and T2DM. Further investigation in isolated cardiac tissue from lean and obese/MetS swine indicate that this impairment in GLP-1 responsiveness is related to attenuated activation of p38-MAPK, independent of alterations in GLP-1 receptor expression or PKA-dependent signaling. Our results indicate that the affects of GLP-1 to reduce cardiac damage and increase left ventricular performance may be impaired by obesity/MetS and T2DM.