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La grossesse induit de profonds changements hémodynamiques et métaboliques de l’organisme maternel qui ont des conséquences sur le cœur. L’adaptation du cœur à cette condition physiologique nécessite un remodelage de sa structure et par conséquent des ajustements de sa fonction. Les mécanismes responsables de ces adaptations sont en grande partie inconnus. Cependant, ces connaissances sont essentielles pour la compréhension des complications cardiovasculaires, telle que l’hypertension gestationnelle (HG), qui constituent un risque pour la santé de la mère et du fœtus. Afin de caractériser les adaptations du cœur lors de la grossesse, l’originalité de notre approche expérimentale consistait à étudier le remodelage à l’échelle des cardiomyocytes du ventricule gauche. Ainsi, notre premier objectif était de déterminer les modifications structurales et fonctionnelles des cardiomyocytes chez la rate en vue d’identifier les altérations lors de l’HG. Chez les rates gestantes, le remodelage structural des cardiomyocytes se caractérise par une hypertrophie cellulaire avec une augmentation proportionnelle des dimensions. L’HG a été induite par un supplément sodique (0.9% NaCl) dans la diète. L’inadaptation structurale lors de l’HG se traduit par une diminution du volume cellulaire. L’étude des modifications fonctionnelles a révélé que lors de la gestation le fonctionnement contractile des cellules est dépendant de l’adaptation du métabolisme maternel. En effet, les substrats énergétiques, lactate et pyruvate, induisent une augmentation de la contractilité des cardiomyocytes. Cet effet est plus faible dans les cellules des rates hypertendues, ce qui suggère des anomalies du couplage excitation-contraction, dans lequel les courants calciques de type L (ICa-L) jouent un rôle important. Paradoxalement, le lactate et le pyruvate ont induit une augmentation de la densité des courants ICa-L seulement chez les rates hypertendues. Le récepteur aux minéralocorticoïdes (RM) est connu pour son implication dans le remodelage structuro-fonctionnel du cœur dans les conditions pathologiques mais pas dans celui induit par la grossesse. Notre deuxième objectif était donc de déterminer le rôle du RM dans l’adaptation de la morphologie et de la contractilité des cardiomyocytes. Des rates gestantes ont été traitées avec le canrénoate de potassium (20 mg/kg/jr), un antagoniste des RM. L’inhibition des RM pendant la gestation empêche l’hypertrophie cellulaire. De plus, l’inhibition des RM bloque l’effet du lactate et du pyruvate sur la contractilité. Chez la femme, la grossesse est associée à des changements des propriétés électriques du cœur. Sur l’électrocardiogramme, l’intervalle QTc est plus long, témoignant de la prolongation de la repolarisation. Les mécanismes régulant cette adaptation restent encore inconnus. Ainsi, notre troisième objectif était de déterminer le rôle du RM dans l’adaptation de la repolarisation. Chez la rate gestante, l’intervalle QTc est prolongé ce qui est corroboré par la diminution des courants potassiques Ito et IK1. L’inhibition des RM pendant la gestation empêche la prolongation de l’intervalle QTc et la diminution des courants Ito. Les travaux exposés dans cette thèse apportent une vision plus précise du remodelage cardiaque induit par la grossesse, qui est permise par l’étude à l’échelle cellulaire. Nos résultats montrent que lors de la gestation et de l’HG les cardiomyocytes subissent des remodelages morphologiques contrastés. Notre étude a aussi révélé que lors de la gestation, la fonction contractile est tributaire des adaptations métaboliques et que cette relation est altérée lors de l’HG. Nos travaux montrent que la régulation de ces adaptations gestationnelles fait intervenir le RM au niveau de la morphologie, de la relation métabolisme/fonctionnement contractile et de la repolarisation. En faisant avancer les connaissances sur l’hypertrophie de la grossesse, ces travaux vont permettre d’améliorer la compréhension des complications cardiovasculaires gestationnelles. / Pregnancy is characterized by marked hemodynamic and metabolic changes, which have consequences on the heart. The adaptation of the heart to this physiological situation requires a remodeling of its structure, and consequently functioning adjustments. Mechanisms responsible for these adaptations are largely unknown. However, this knowledge is essential for the understanding of cardiovascular complications, such as gestational hypertension (GH), which represents a risk for the mother and the fœtus. To characterize cardiac adaptations to pregnancy, our experimental approach consisted in studying this remodelling at the level of left ventricle cardiomyocytes. Therefore, our first objective was to determine structural and functional modifications of cardiomyocytes in pregnant rats to be able to identify their variations in GH. In pregnant rats, structural remodelling of cardiomyocytes was characterized by a proportional volume expansion. GH was induced by a high sodium supplement (0.9% NaCl). In hypertensive rats, we observe significant cell volume shrinkage. The study of functional modifications elicited a strong relationship between metabolic adaptations and cell contractility. According to our results, in pregnant rats cardiomyocyte contractility was increased in presence of energy substrates lactate and pyruvate. This effect was weaker in the cells from hypertensive rats. This suggested modifications of the excitation-contraction coupling, in which L-type calcium currents (ICa-L) play an important role. Unexpectedly, lactate and pyruvate induced a significant increase in ICa-L only in hypertensive rats. In pathological conditions, mineralocorticoid receptors (MR) have been shown to mediate structural as well as functional remodelling of the heart. Our study is the first to investigate MR involvement in cardiac remodelling during pregnancy. Thus, our second objective was to determine MR involvement in cardiomyocyte remodelling. For this study, pregnant rats were treated with potassium canrenoate of (20 mg / kg / day), a MR antagonist. Our results revealed that MR inhibition during the pregnancy elicited a significant decrease of cell volume. MR inhibition has also affected metabolism and cellular functioning relationship. Indeed, plasma concentration of lactate was lower, which was in correlation with its blunted effect on cell contractility. In women, pregnancy-induced hypertrophy is associated with changes in electrical properties of the heart. Indeed, repolarisation is prolonged, which is characterised by a longer duration of QTc interval on the electrocardiogram. Regulation mechanisms involved in this adaptation are still largely unknown. Our third objective was therefore to determine the role of MR in the adaptation of repolarisation to pregnancy. Pregnancy induced a prolongation in QTc interval, which correlates with a decrease in potassium currents Ito and IK1. MR inhibition prevented QTc interval prolongation and the lowering of Ito. Our study gives a new insight of pregnancy-induced cardiac hypertrophy, which is provided by investigations at the cellular level. Our results demonstrate that pregnancy and GH are characterised by opposite remodellings. Moreover, in pregnancy the contractile function is dependent on metabolic adaptations. This is all the more glaring in GH as metabolic alterations induced modifications of electric properties to maintain contractile functioning. Furthermore, our work reveals MR involvement in the regulation of morphology, metabolism/contractility relationship, and repolarisation. By improving the knowledge of hypertrophy during pregnancy, this work contributes to improve the understanding of pregnancy-induced cardiac complications.

A doença aterosclerótica macrovascular se inicia em fases precoces das alterações do metabolismo glicídico. Este estudo teve por objetivos: 1) avaliar a prevalência de aterosclerose subclínica diagnosticada por métodos não-invasivos em indivíduos com indicação de teste oral de tolerância a glicose; 2) avaliar a distribuição de biomarcadores e de marcadores genéticos nessa população; e 3) determinar os fatores de risco para aterosclerose subclínica em pacientes disglicêmicos. Indivíduos em prevenção primária foram inicialmente submetidos a teste oral de tolerância a glicose e classificados em grupos controle, glicemia de jejum alterada, intolerância à glicose e diabete melito; posteriormente, foram submetidos a pesquisa de aterosclerose subclínica e de biomarcadores, e a avaliação de polimorfismos genéticos e expressão gênica. Foram incluídos 103 pacientes no grupo controle, 80 no grupo glicemia de jejum alterada, 98 no grupo tolerância diminuída à glicose e 59 no grupo diabete melito, com média de idade de 59 + 7,4 anos, sendo 62,4% mulheres. Não foram encontradas diferenças quanto às características clínicas e laboratoriais entre os grupos. Foi observada alta prevalência de aterosclerose subclínica na população (77,1%) e, apesar de não haver diferença entre os grupos, houve tendência a prevalência crescente de acordo com a piora do perfil glicídico. Dentre os biomarcadores, foi encontrada diferença entre os grupos na análise de microalbuminúria, resistina, fator de necrose tumoral alfa e fosfolipase A2 associada a lipoproteína. Não houve diferença com relação aos polimorfismos, mas o grupo glicemia de jejum alterada apresentou maior expressão de mRNA do gene da fosfolipase A2 associada a lipoproteína. Concluímos que indivíduos com indicação de teste oral de tolerância a glicose têm alta prevalência de aterosclerose subclínica, independentemente do perfil glicídico. Após análise multivariada, os fatores que determinaram aterosclerose subclínica foram idade, pressão arterial sistólica, colesterol ligado à lipoproteína de alta densidade, fator de necrose tumoral alfa e uso de estatinas. / Atherosclerotic macrovascular disease begins in early phases of glucose metabolism alterations. The objectives were: 1) To evaluate the prevalence of subclinical atherosclerosis diagnosed by non-invasive methods in patients with an indication for oral glucose tolerance test. 2) To evaluate the distribution of biomarkers and genetic markers in this population. 3) Determine the risk factors for subclinical atherosclerosis in dysglycemic patients. Individuals in primary prevention underwent oral glucose tolerance test and were classified as controls, impaired fasting glucose, decreased glucose tolerance and diabetics and submitted to subclinical atherosclerosis search, evaluation of biomarkers, genetic polymorphisms and gene expression. A group of 103 patients were included as controls, 80 as impaired fasting glucose, 98 as decreased glucose tolerance and 59 as diabetes with a mean age of 59 ± 7.4 years, 62.4% women. No differences were found between clinical and laboratory characteristics of the groups. High prevalence of subclinical atherosclerosis (77.1%) was observed, although there was no significant difference between groups, a tendency of higher prevalence according to worsening of glucose increasing profile was verified. Among the biomarkers difference between groups were found in the analysis of microalbuminuria, resistin, tumor necrosis factor alfa and phospholipase A2 associated with lipoprotein. There was no difference regardind the polymorphisms, but the impaired fasting glucose group had higher expression of PLA2G7. After multivariate analysis, the factors that determined subclinical atherosclerosis were age, systolic blood pressure, HDL-cholesterol, tumor necrosis factor alfa and statins. We concluded that individuals with indication of oral glucose tolerance test have a high prevalence of subclinical atherosclerosis regardless of glucose profile. The factors that determine the presence of subclinical atherosclerosis were age, systolic blood pressure, HDL-cholesterol, tumor necrosis factor alfa and statins.

Ziel: In der vorliegenden Studie wurden kontinuierliche Blutzuckertagesprofile über 48 h bei Schwangeren unterschiedlicher Glukosetoleranz erhoben und mit der Ernährung zu häuslichen Bedingungen verglichen. Ergebnisse: Bei den Gestationsdiabetikerinnen wurden statistisch signifikant länger Konzentrationen über 130 mg/dl gemessen als bei den gesunden Schwangeren. Keine Unterschiede ergaben sich in Bezug auf folgende Werte: Mittelwert, Zeitdauern mit Blutzuckerwerten < 50 mg/dl, >120 mg/dl, >140 mg/dl, >150 mg/dl. Periprandial wurden bei den Gestationsdiabetikerinnen und den Schwangeren mit IGT signifikant höhere Maximalwerte im Anschluss an die Mahlzeit gemessen, als bei gesunden Schwangeren. Keine Unterschiede ergaben sich hinsichtlich der Anfangswerte und der Area under the curve. In einigen Gruppen bestanden positive Korrelationen zwischen der Zufuhr von Disacchariden und Parametern der Glukosemessung, in der Gruppe der Gestationsdiabetikerinnen bestand eine signifikante negative Korrelation zwischen dem Stärkekonsum und dem Mittelwert der Glukosemessung. Nach Mahlzeiten, deren Hauptkohlenhydratquelle mit einem höheren glykämischen Index nach Jenkins attribuiert war, fiel die Glukosereaktion größer aus, als bei Mahlzeiten mit niedrigem glykämischem Index. Zusammenfassung: In dieser prospektiven Studie konnte mit Hilfe der Technik der kontinuierlichen Glukosemessung die Verbindung zwischen Blutzuckertagesprofil und Ernährungsgewohnheiten zu häuslichen- also nicht klinisch- artifiziellen- Bedingungen hergestellt werden. / Objective: In the present study continuous glucose profiles in pregnant women with various levels of glucose tolerance were evaluated and compared with their diet in domestic conditions. Results: In women with GDM significantly longer periods with glucose levels above 130 mg/dl were measured than in healthy women. No differences were assessed as to average glucose levels and periods with glucose levels < 50 mg/dl, >120 mg/dl, >140 mg/dl, >150 mg/dl. In pregnant women with gestational diabetes or impaired glucose tolerance higher maximum glucose levels after a meal were found than in healthy women. No differences were found as to glucose levels at the beginning of the meal and area under the curve. In some groups positive correlations were calculated between intake of disaccharides and the glucose measurement, in gestational diabetic women a negative correlation between intake of starch and the average of the glucose level was found. After meals in which the main carbohydrate source was attributed with a high glycemic index change of the glucose level was higher than after meals with a low glycemic index. Conclusion: In the present prospective study we established the relation between glucose profiles measured by the method of continuous glucose monitoring and dietary habits in domestic conditions in pregnant women.

Ratos foram tratados com salina, óleos de peixe (OP) ou soja (OS) por via intragástrica durante 20 dias antes da indução do IAM. A área de infarto e atividades da creatina quinase no plasma e da caspase 3 no ventrículo esquerdo (VE) foram menores no grupo OP comparado a salina ou OS. Os conteúdos de IL-1&beta;, TNF-&alpha;, CINC 2&alpha;/&beta;, IL-6 e VEGF-&alpha; no VE e de IL-1&beta;, TNF-&alpha;, MIP-3, IL-6 e VEGF-&alpha; no fígado foram elevados pelo OS. O OP aumentou os conteúdos de ATP e lactato e diminuiu o de glicogênio no VE. A redução do fluxo coronariano no VE dos animais infartados foi abolida pelo OP. A expressão gênica de iNOS, eNOS, HIF-1&alpha;, GLUT-1, VEGF-&alpha;, p53 e Bax2 no VE aumentou pelo OP. A fração de ejeção, fração de encurtamento e velocidade de encurtamento das fibras cardíacas foram mais elevadas pelo OP. Portanto, o tratamento com OP induziu um estado de pré-condicionamento que conferiu proteção do miocárdio à injúria isquêmica. / Rats were treated with saline, fish (FO) or soybean (SO) oils by gavage for 20 days before myocardial infarction (MI). Infarct size, activities of plasma CK and caspase 3 in the left ventricle (LV) were decreased by FO as compared with saline or SO. The contents of IL-1&beta;, TNF-&alpha;, CINC 2&alpha;/&beta;, IL-6, VEGF-&alpha; in the LV and of IL-1&beta;, TNF-&alpha;, MIP-3, IL-6, VEGF-&alpha; in the liver were increased by SO. Contents of ATP and lactate in the LV were increased and of glycogen decreased by FO. FO prevented the decrease in the coronary blood flow in the LV of infarcted rats. The mRNA contents of iNOS, eNOS, HIF-1&alpha;, GLUT 1, VEGF-&alpha;, p53 and Bax2 in the VE were increased by FO. Ejection fraction, fractional shortening and velocity of circumferential fiber-shortening were also increased by FO. So, treatment with FO leads to a preconditioning state that protected the heart from MI injury.

L’objectif de la thèse était d'identifier s’il existait des différences d’utilisation digestive et métabolique des glucides alimentaires entre deux lignes de truite sélectionnées pour leur teneur divergente en lipides intramusculaires: la lignée maigre (L) à faible taux de lipides dans le muscle et la lignée grasse (F) à teneur élevée de lipides musculaires. Dans ce but les deux lignées ont été nourries avec deux aliments, un contenant des glucides alimentaires (20% d’amidon), l’autre ne contenant pas. Chez les deux lignées, la présence d’amidon dans les régimes n’a pas eu d’effets sur la croissance, a été associée à une épargne protéique, et a provoqué une hyperglycémie postprandiale modérée, en induisant les acteurs impliqués dans la signalisation cellulaire (TOR/AMPK). Aucune différence entre les deux lignées n’a été observée pour la digestion de l'amidon, le niveau d’expression des gènes codant les transporteurs de glucose dans l’intestin, la glycémie postprandiale et l'utilisation périphérique du glucose (muscle et tissu adipeux). Par contre, la lignée F se caractérise par une croissance et une efficacité alimentaire plus faibles, des capacités plus élevées de stockage du glucose sous forme de glycogène hépatiques et de lipogenèse (sans impact sur l’utilisation des glucides) et un métabolisme lipidique spécifique (plus faible catabolisme des acides gras, plus fortes capacités à synthétiser des chylomicrons et à bio-convertir des acides gras). Dans une seconde étude, le remplacement de l'huile de poisson de l’aliment par un mélange d'huiles végétales a supprimé la plupart des différences moléculaires observées précédemment entre les deux génotypes. Toutefois, l’apport de glucides alimentaires a alors entrainé des modifications métaboliques au niveau intestinal et hépatique avec, par exemple, l’induction des capacités moléculaires de bioconversions des acides gras. Globalement, nos données ont donc démontré qu’il existait des différences métaboliques importantes entre les deux lignées mais que cela n’aboutissait pas à une meilleure utilisation des glucides alimentaires. En outre, nos travaux soulignent l'importance de la composition des aliments dans les réponses' des différents génotypes de poissons. / The aim of the thesis was to characterise the differences in digestive and metabolic utilisation of dietary carbohydrates between two lines of rainbow trout divergently selected for muscle fat content (Fat-F and Lean-L), when fed diets with (20%) or without gelatinised starch. In both lines, starch intake did not adversely affect growth, resulted in a moderate postprandial hyperglycemia, enhanced protein/lipid retention and a distinct intracellular signalling pattern in the liver involving the energy sensor AMPK and nutrient sensor TOR-S6. No difference between the two lines was observed for the apparent digestibility of starch, the mRNA levels of genes encoding glucose transporters in the intestine, regulation of postprandial glycemia and utilisation of glucose in the peripheral tissues (muscle and adipose tissue). However when compared to the L line, the F line was characterised by lower growth and feed efficiency; better capacity to store excess glucose as indicated by higher glycogen levels and mRNA levels of lipogenic markers in the liver (with no impact on glucose homeostasis); and a specific lipid metabolism (a greater potential to synthesise chylomicrons and to bioconvert fatty acids, coupled with a lower potential to oxidise fatty acids). In a separate study, replacement of fish oil in the diet with a blend of vegetable oils was found to suppress most of the molecular differences previously observed between the two genotypes. Starch intake under the vegetable oil diet regime led to different metabolic changes in the intestine and liver, for example, elicited a higher transcriptional response of key desaturase and elongase enzymes in both lines. Overall, our data demonstrated the existence of significant metabolic differences between the two trout lines, but it did not lead to better utilisation of dietary carbohydrates. In addition, our work highlights the importance of diet composition in the growth and metabolic response of different genotypes of fish.

La truite arc-en-ciel carnivore (Oncorhynchus mykiss) est considérée comme une espèce pauvre utilisatrice de glucides alimentaires. Des études récentes ont montré qu'une hypométhylation globale de l'ADN hépatique induite par un régime alimentaire riche en glucides et pauvre en protéines pourrait être impliquée dans l'établissement / le maintien du de ce phénotype chez la truite, mais le détail des mécanismes sous-jacents reste inconnu. La thèse vise à étudier les mécanismes épigénétiques sous-jacents à ce phénotype de faible utilisation des glucides alimentaire chez la truite et à examiner si le métabolisme du glucose et l’épigénome chez les juvéniles peuvent être programmés par un stimulus hypoxique précoce. Nous avons d’abord identifié tous les gènes paralogues liés aux voies de méthylation / déméthylation de l’ADN (dnmt, tet et tdg) dans le génome de la truite, clarifié leurs histoires évolutives et analysé leurs profils d’expression au cours de la gamétogenèse et de l’embryogenèse chez la truite. Nous avons ensuite étudiés plus en détail les processus et les mécanismes potentiellement à l’origine de l'hypométhylation de l'ADN hépatique global constatée chez la truite après un régime riche en glucides et pauvre en protéines. Les résultats ont montré pour la première fois qu'une diminution du taux deprotéines et une augmentation du taux de glucides dans l’aliment induisent de manière indépendante et en interaction une hypométhylation hépatique globale chez la truite, qui semble établie par le biais d'une voie de déméthylation active. Nous avons également constaté qu’une forte hyperglycémie induite par une injection de glucose induit une hypométhylation globale de l’ADN au niveau des sites CmCGG dans le foie de la truite. Les mécanismes détaillés de ces processus de déméthylation restent à élucider. Enfin, grâce à la stratégie de programmation métabolique, nous avons pour la première fois confirmé que l’utilisation d’un stimulus non nutritionnel au début de la vie, l’hypoxie, pouvait moduler de façon persistante la transcription des gènes liés au métabolisme du glucose chez la truite juvénile sans nuire aux performances de croissance. De plus, selon sa nature chronique ou aigue, l’hypoxie, a tendance à induire des effets de programmation opposés sur les gènes codants pour les transporteurs au glucose notamment dans le foie et le muscle de la truite juvénile. Dans son ensemble, la thèse met en avant notre compréhension du rôle du méthylome dans la contribution à la faible capacité d'utilisation des glucides alimentaires chez la truiteLa thèse met aussi en lumière le potentiel d'utilisation de l'hypoxie comme stimulus pour programmer le métabolisme du glucose, l'épigénome et l'utilisation des glucides alimentaires chez la truite arc-en-ciel. / The carnivorous rainbow trout (Oncorhynchus mykiss) is considered as a poor user of dietary carbohydrates. Recent studies showed that a high-carbohydrate/low protein diet inducing hepatic global DNA hypomethylation could be involved in the establishment/maintenance of the poor dietary carbohydrates utilisation phenotype in trout, but the detail mechanisms remain unclear. The present thesis aimed at investigating the epigenetic mechanisms underlying this poor dietary carbohydrate utilisation phenotype in trout, and exploring if the glucose metabolism and the epigenome in juveniles can be programmed through a hypoxic stimulus during early life. We first identified all the paralogous genes related to DNA methylation/demethylation pathways (dnmt, tet and tdg) in trout genome, clarified their molecular evolution histories and monitored their transcriptional expression patterns during gametogenesis and embryogenesis in trout. Besides, we investigate further the causes, processes and potential mechanisms about the hepatic global DNA hypomethylation in trout after feeding a high carbohydrate/low protein diet. Results for the first time demonstrated that a decrease in protein content and an increase in carbohydrate content in the diet can independently as well as interactively induce hepatic global hypomethylation in trout. This global loss of methylation is probably established through an active demethylation pathway. We also found that a strong hyperglycaemia induced by glucose injection induces global CmCGG hypomethylation in the liver of trout. The detailed mechanisms of these demethylation processes remain to be elucidated. Finally, through metabolic programming strategy, we confirmed for the first time that using a non-nutritional stimulus, hypoxia, during early life stage persistently modulates the transcription of glucose metabolism-related genes in juvenile trout without negative effects on growth performance. Moreover, acute and chronic hypoxia tended to induce opposite programming effects on glucose-transporter encoding genes in both liver and muscle of juvenile trout. Together, the present thesis brings forward our understandings about the roles of epigenetics in contributing to the low ability to use dietary carbohydrates in trout, and sheds light on the potential of using hypoxia as the stimulus in metabolic programming strategy to tailor the glucose metabolism, the epigenome and dietary carbohydrate utilisation in rainbow trout.

Objective: IGF1 is associated with metabolic parameters and involved in glucose metabolism. Low-IGF1 has been implicated in the etiology of glucose intolerance and subjects with pathological causes of either low- or high-IGF1 are at risk of diabetes. We hypothesized that both low- and high-IGF1 levels increase the risk of diabetes and aimed to assess the role of IGF1 in the risk of developing diabetes in a large prospective study. Design: An analysis of two prospective cohort studies, the DETECT study and SHIP. Methods: We measured IGF1 levels in 7777 nondiabetic subjects and assessed incident diabetes mellitus during follow-up. Results: There were 464 cases of incident diabetes during 32 229 person-years (time of follow-up in the DETECT study and SHIP: 4.5 and 5 years respectively). There was no heterogeneity between both studies (P>0.4). The hazard ratios (HRs) of incident diabetes in subjects with IGF1 levels below the 10th or above the 90th age- and sex-specific percentile, compared to subjects with intermediate IGF1 levels, were 1.44 (95% confidence interval (CI) 1.07–1.94) and 1.55 (95% CI 1.06–2.06) respectively, after multiple adjustment. After further adjustment for metabolic parameters, the HR for low-IGF1 became insignificant. Analysis of IGF1 quintiles revealed a U-shaped association of IGF1 with risk of diabetes. Results remained similar after exclusion of patients with onset of new diabetes within 1 year or with borderline glucose or HbA1c levels at baseline. Conclusions: Subjects with low- or high-IGF1 level are at increased risk of developing diabetes.

Spinal muscular atrophy (SMA) is the leading genetic cause of death of young children. It is an autosomal recessive disease caused by the mutation and/or the deletion within the ubiquitously expressed survival motor neuron 1 (SMN1) gene. SMA pathology is characterized by spinal cord motor neuron degeneration, neuromuscular junction (NMJ) defects and muscular atrophy. Upon disease onset, SMA patients progressively become paralyzed and in the most severe cases, they die due to respiratory complications. Over the years, it has become clear that SMN is a multi-functional protein with important roles in small nuclear ribonucleoprotein (snRNP) assembly, RNA metabolism, axonal outgrowth and pathfinding, mRNA transport as well as in the functional development of NMJs, skeletal muscle and cardiac muscle. However, it remains unclear which of these functions, and the respective perturbed molecular pathways, dictate SMA pathogenesis. Here, we have established Smn-depleted PC12 cells and an intermediate SMA mouse model to characterize a role for Smn in the regulation of actin cytoskeleton dynamics. We find that Smn depletion results in the increased expression of profilin IIa and active RhoA (RhoA-GTP) as well as the decreased expression of plastin 3 and Cdc42. Importantly, the inhibition of rho-kinase (ROCK), a direct downstream regulator of RhoA, significantly increased the lifespan of SMA mice and shows beneficial potential as a therapeutic strategy for SMA. In an addition, we have uncovered a muscle- and motor neuron-independent role for SMN in the regulation of pancreatic development and glucose metabolism in SMA mice and type 1 SMA patients. This finding highlights the importance of combining a glucose tolerance assessment of SMA patients with their existing clinical care management. Thus, our work has uncovered two novel and equally important roles for the SMN protein, both of which contribute significantly to SMA pathogenesis.

Type 1 diabetes (T1D) is an auto-immune disease characterized by insulin-deficiency. Insulin is a metabolic hormone that is involved in lowering blood glucose (BG) levels in order to control BG level to a tight range. In T1D this glycemic control is lost, causing chronic hyperglycemia (excess glucose in blood stream). Chronic hyperglycemia damages vital tissues. Therefore, glycemic control must be restored. A common therapy for restoring glycemic control is intensive insulin therapy, where the missing insulin is replaced with regular insulin injections. When dosing this compensatory insulin many factors that affect glucose metabolism must be considered. Linkura is a company that has developed tools for monitoring the most important factors, which are meals and exercise. In the Linkura meal and exercise tools, the nutrition content in meals and the calorie consumption during exercise are estimated. Another tool designed to aid control of BG is the bolus calculator. Bolus calculators use input of BG level, carbohydrate intake, and insulin history to estimate insulin need. The accuracy of these insulin bolus calculations suffer from two problems. First, errors occur when users inaccurately estimate the carbohydrate content in meals. Second, exercise is not included in bolus calculations. To reduce these problems, it was suggested that the Linkura web tools could be utilized in combination with a bolus calculator. For this purpose, a bolus calculator was developed. The bolus calculator was based on existing models that utilize clinical parameters to relate changes in BG levels to meals, insulin, and exercise stimulations. The bolus calculator was evaluated using data collected from Linkura's web tools. The collected data showed some inconsistencies which cannot be explained by any model.  The performance of the bolus calculator in predicting BG levels using general equations to derive the clinical parameters was inadequate. Performance was increased by adopting an update-algorithm where the clinical parameters were updated daily using previous data. Still, better model performance is prefered for use in a bolus calculator.   The results show potential in developing bolus calculator tools combined with the Linkura tools. For such bolus calculator, further evaluation on modeling long-term exercise and additional safety features minimizing risk of hypoglycemia are required.