Type 2 diabetes is a complex chronic metabolic disorder characterized by hyperglycemia associated with a relative deficiency of insulin secretion and a reduced response of target tissues to insulin. Considerable efforts have been put into the development of models describing the glucose-insulin system. The best known is Bergman’s “minimal” model for glucose, which is estimating glucose concentrations using fixed insulin concentrations as input. However, due to the involved feedback mechanisms, simultaneous modeling of both entities would be advantageous. This is particularly relevant if the model is intended to be used as a predictive tool. The mechanism-based glucose-insulin model presented in this thesis is able to simultaneously describe glucose and insulin profiles following a wide variety of clinical provocation experiments, such as intravenous and oral glucose tolerance tests, clamp studies and sequential meal tests over 24 hours. It consists of sub-models for glucose, labeled glucose and insulin kinetics. It also incorporates control mechanisms for the regulation of glucose production, insulin secretion, and glucose uptake. Simultaneous analysis of all data by nonlinear mixed effect modeling was performed in NONMEM. Even if this model is a crude representation of a complex physiological system, its ability to represent the main processes of this system was established by identifying: 1) the difference in insulin secretion and insulin sensitivity between healthy volunteers and type 2 diabetics, 2) the action of incretin hormones after oral administration of glucose, 3) the circadian variation of insulin secretion and 4) the correct mechanism of action of a glucokinase activator, a new oral antidiabetic compound acting on both the pancreas and the liver. These promising results represent a proof of concept of a mechanistic drug-disease model that could play an important role in the clinical development of anti-diabetic drugs.

Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.

In type 2 diabetes the concentration of glucose in the blood is increased, and tissues like fat and musclebecome less sensitive to insulin. These two phenomena are interrelated, but since the glucose-insulininterplay is highly complex, many aspects are still not understood. Here, a model-based approachmight help. Nevertheless, also a model-based approach has a limited impact, unless models for thesub-systems can be combined into a model for the whole-body regulation. Such a multi-level,module-based model is referred to as a hierarchical model, and this thesis is a proof-of-principle studyfor the future development of such models. We have extended one of the best available models for the whole-body regulations, to include azoomable module for the fat tissue. The first step was to implement the whole-body model in thesoftware MathModelica, which support hierarchical modeling. Second, the originally mergedinsulin-responding module was sub-divided, so that a fat tissue was singled out. Third, a model for theinput-output profile for the fat tissue was developed by combining mechanistic knowledge withexisting and novel data from human fat cells. Finally, this detailed model was fitted to the profile of theoriginal fat model, and inserted in the whole-body model, with negligible effect on the whole-bodysimulations. The resulting model has the ability to translate mechanistically oriented simulations on the biochemicallevel, which is the level were drugs act, to the whole-body level, which is of clinical interest. This is aquantum leap forward for modeling, and understanding, glucose homeostasis and type 2 diabetes.

Introdução: Especula-se que exista uma possível relação entre a ingestão de vitamina K e a diminuição da gordura corporal. Além disso, embora os resultados permaneçam controversos, há um número crescente de estudos que apoiam um papel chave dessa vitamina na melhora do perfil lipídico, da sensibilidade à insulina e na redução do risco de diabetes mellitus tipo 2, contudo pouco se sabe sobre quais mecanismos estariam envolvidos. Objetivo: Investigar as relações entre a ingestão de vitamina K (na forma de filoquinona - PK), gordura corporal, perfil lipídico e marcadores da homeostase da glicose em adultos e idosos. Métodos: Estudo transversal com 298 indivíduos de ambos os sexos, participantes do inquérito ISA - Capital 2015. Amostras de sangue foram coletadas para determinação do perfil lipídico, glicemia de jejum e concentrações de insulina; e índice de estimativa de resistência à insulina (HOMAIR), índice de estimativa da função de células β-pancreáticas (HOMA-β) e índice de estimativa da sensibilidade à insulina (QUICKI) foram calculados. A ingestão de vitamina K foi avaliada por meio de um recordatório alimentar de 24hrs (repetido em 75% da amostra), e a investigação quantitativa da massa gorda foi conduzida por meio da absorciometria de feixe duplo (DXA). Indivíduos com ingestão de vitamina K inferior aos valores de AI foram divididos em subgrupos de acordo com o estado nutricional e faixa etária. Foi realizada a Correlação de Spearman em grupos estratificados de acordo com o Índice de Massa Corporal (IMC) e com o Índice de Gordura Corporal (IGC). Para avaliar as associações entre a ingestão de vitamina K e cada uma das medidas bioquímicas e de adiposidade, foi realizada a regressão linear múltipla. Resultados: Dentre os avaliados, 46% eram do sexo masculino (n=136), com idade mediana de 61 anos (20 - 94 anos), e 56,4% apresentavam sobrepeso ou obesidade (n=168). A mediana de ingestão de vitamina K foi de 102,7 μg, ou 59,9 μg,/1000 kcal, sem diferença de acordo com sexo ou idade. A ingestão de vitamina K apresentou correlação negativa com o HOMA-IR (r = -0,603; p = 0,0134) e correlação positiva com QUICKI (r = 0,603; p = 0,0134) entre os adultos eutróficos do sexo masculino (n = 16). Em idosas com baixo peso (n = 12), a ingestão de vitamina K foi negativamente correlacionada com o Colesterol Total (CT) (r = -0,644; p = 0,0443). Entre as mulheres com elevado IGC e ingestão de vitamina K inferior aos valores de AI (n = 117), foram observadas correlações negativas entre a ingestão de vitamina K e HOMA-IR (r = -0,187; p = 0,0451) e correlações positivas com QUICKI (r = 0,187; p = 0,0451). Conclusões: Os resultados encontrados sugerem uma possível relação entre a ingestão dietética de filoquinona, gordura corporal, perfil lipídico e marcadores da homeostase da glicose, em amostra de adultos e idosos. / Introduction: Recent research have investigated a possible inverse relationship between vitamin K intake and body fat. In addition, although the results remain controversial, there is an increasing number of studies supporting a key role of this vitamin in improving lipid profile, insulin sensitivity and reducing the risk of type 2 diabetes mellitus, but little is known about what mechanisms would be involved. Objective: To investigate the relationship between vitamin K intake (in the form of phylloquinone - PK), body fat, lipid profile and markers of glucose homeostasis in adults and elderly. Methods: Cross-sectional study with 298 individuals of both sexes, participants in the ISA - Capital 2015 survey. Blood samples were collected for determination of lipid profile, fasting glycemia and insulin concentrations, and homeostasis model assesment estimate for insulin resistance (HOMA-IR), homeostasis model assessment estimate for β-cell function (HOMA-β) and the quantitative insulin sensitivity check index (QUICKI) were calculate accordingly. Vitamin K intake was assessed by a 24-hour dietary recall (repeated in 75% of the sample) and quantitative investigation of fat mass was conducted using dual-energy x-ray absorptiometry (DXA). Subjects with vitamin K intake lower than AI values were divided into subgroups according to nutritional status and age group. Spearman correlation was performed in stratified groups according to Body Mass Index (BMI) and Fat Mass Index (FMI). To evaluate the associations between vitamin K intake and each of the biochemical and adiposity measures, multiple linear regression were performed. Results: Among the sample, 46% were male (n = 136), with a median age of 61 years (20 - 94 years), and 56.4% were overweight or obese (n= 168). The median vitamin K intake was 102.7 μg, or 59.9 μg, / 1000 kcal, with no difference according to sex or age. Vitamin K intake presented negative correlation with HOMA-IR (r = -0.603; p = 0.0134) and positive correlation with QUICKI (r = 0.603; p=0.0134) among normal weight male adults (n=16). In underweight elderly women (n=12), vitamin K intake was negatively correlated with total cholesterol (TC) (r = -0.644, p = 0.0443). Among females with high FMI and vitamin K intake lower than AI values (n=117), vitamin K intake was negatively correlated with HOMA-IR (r = -0.187; p = 0.0451) and positively correlated with QUICKI (r 12 = 0.187; p = 0.0451). Conclusions: Results suggest a possible relationship between dietary intake of phylloquinone, body fat, lipid profile and glucose homeostasis, among a sample of adults and elderly.

Orientador: Marcio Alberto Torsoni / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-19T01:35:33Z (GMT). No. of bitstreams: 1 Roman_ErikaAnnedeFreitasRobles_D.pdf: 2154456 bytes, checksum: 96e67ff457e13cf663c712d985a8be21 (MD5) Previous issue date: 2011 / Resumo: Sobrepeso e obesidade são caracterizados por um aumento de tecido adiposo corpóreo, que resulta da interação entre muitos fatores, incluindo genéticos, metabólicos, comportamentais e ambientais. A obesidade está relacionada ao desenvolvimento de diabetes mellitus do tipo 2 (DM2). O principal mecanismo envolvido na associação entre obesidade e DM2 é a indução de uma resposta inflamatória subclínica capaz de gerar resistência à insulina. Este fenômeno é caracterizado pela capacidade reduzida deste hormônio em promover a homeostase glicêmica. O músculo esquelético (SM) é considerado um dos principais tecidos para a homeostase da glicose, já que ele responde por cerca de 80 % da captação total de glicose estimulada pela insulina no corpo. Sendo assim, a resistência à insulina em músculo esquelético é o maior determinante da hiperglicemia e DM2. Por outro lado, a leptina apresenta função crucial na homeostase glicêmica por agir no cérebro e sua ação neste órgão requer a atividade da PI3K para modular a homeostase da glicose e o metabolismo periférico. Contudo, o mecanismo envolvido neste fenômeno não é completamente entendido. Neste estudo nós aventamos a hipótese que a atividade hipotalâmica da PI3K é importante para a modulação da via da quinase dependente de AMP (AMPK)/acetil-CoA carboxilase (ACC), PGC1? e AKT em músculo esquelético. Para investigar esta questão, injetamos leptina no ventrículo lateral do hipotálamo de ratos. A leptina (ICV) aumentou a fosforilação da JAK2 (80 %) e AKT (350 %) hipotalâmica, quando comparado ao grupo controle. A administração prévia de LY294002 (inibidor químico da PI3K) reduziu a fosforilação da AKT hipotalâmica, induzida por leptina ICV. Adicionalmente, a leptina (ICV) melhorou a tolerância à glicose no GTT (50 %), mas a administração prévia de propranolol (10 mg/kg IP) ou LY294002 (1nmol-ICV) reduziu este efeito. Em músculo soleus a fosforilação da AKT, estimulada pela insulina, foi maior no grupo leptina (200 %) do que no grupo controle, contudo a administração prévia de propranolol (IP) reduziu (50 %) este efeito. Como o propranolol a administração prévia de LY294002 (ICV) reduziu (45 %) o efeito da leptina (ICV) sobre a fosforilação da AKT em músculo esquelético. A fosforilação da JAK2, em músculo esquelético, foi maior no grupo leptina (ICV) do que no grupo controle, mas a administração prévia de LY294002 (ICV) bloqueou este efeito. Adicionalmente, a ação central da leptina aumentou a expressão de PGC1? e a fosforilação da AMPK e ACC em músculo soleus. A administração prévia de LY294002 bloqueou estes efeitos. Concluímos que a ativação da via da PI3K hipotalâmica, induzida pela leptina, é importante para a fosforilação da AKT, bem como para a ativação de vias catabólicas através da AMPK e PGC1? em músculo esquelético. Assim, um defeito na via de sinalização da PI3K no hipotálamo pode contribuir para a resistência periférica à insulina associada à obesidade induzida por dieta / Abstract: Overweight and obesity are characterized by an increased body fat and result from the interaction of many factors, which include genetic, metabolic, behavioral, and environmental ones. Obesity is a clinical condition highly associated with type 2 diabetes mellitus (DM2). The major reason for the link between obesity and DM2 is the induction of a subclinical inflammatory response which leads to insulin resistance. This phenomenon is characterized by the reduced ability of the pancreatic hormone insulin to promote glucose homeostasis. Skeletal muscle (SM) is considered as one of the most important tissues in glucose homeostasis, because it accounts for 80 % of whole body insulin-stimulated glucose uptake. Therefore, skeletal muscle insulin resistance is a major determinant of hyperglycemia and DM2. In addition, leptin plays a central role in glucose homeostasis acting in the brain and its action in this organ requires PI3K activity to modulate glucose homeostasis and peripheral metabolism. However, the mechanism behind this phenomenon is not clearly understood. We hypothesize that hypothalamic PI3K activity is important for the modulation of AMP-activated protein kinase (AMPK)/acetil-CoA carboxylase (ACC) pathway, PGC1?, and AKT in skeletal muscle. To address this issue, we injected leptin into the lateral ventricle of rats. ICV leptin increased the phosphorylation of hypothalamic JAK2 (80 %) and AKT (350 %) when compared to the control group. Previous ICV LY294002 (chemical inhibitior of PI3K) administration reduced hypothalamic AKT phosphorylation, induced by ICV leptin. In addition, ICV leptin improved the clearance of glucose in GTT (50%), but the previous administration of propranolol (10 mg/kg bw-IP) or ICV LY294002 (1nmol-ICV) reduced this effect. In the soleus muscle, the AKT phosphorylation, stimulated by insulin, was higher in leptin group (200 %) than the control group, but the previous administration of propranalol (IP) reduced (50 %) this effect. Like propranalol the previous administration of LY294002 (ICV) reduced (45 %) the effect of ICV leptin on AKT phosphorylation in the skeletal muscle. JAK2 phosphorylation, in skeletal muscle, was higher in leptin (ICV) group than the control group, but the previous ICV administration of LY294002 blocked this effect. Additionally, the central action of leptin increased PGC1? expression, AMPK and ACC phosphorylation in the soleus muscle. Previous ICV administration of LY294002 blocked these effects. We conclude that the activation of hypothalamic PI3K pathway is important for leptin-induced AKT phosphorylarion, as well as for an active catabolic pathway through AMPK and PGC1? in skeletal muscle. Thus, a defective leptin signaling PI3K pathway in the hypothalamus may contribute to peripheral resistance to insulin associated to diet-induced obesity / Doutorado / Fisiologia / Doutor em Biologia Funcional e Molecular

Le muscle squelettique est un tissu hétérogène et dynamique jouant un rôle important dans la mobilité et le métabolisme d’un organisme. C’est un organe actif qui sécrète de nombreuses cytokines participant au « crosstalk » entre tous les tissus impliqués dans ce métabolisme. Parmi ces myokines, la myostatine agit à la fois comme un régulateur négatif du développement musculaire et un médiateur dans l’homéostasie du glucose. En effet, les souris déficientes pour le gène de la myostatine (Mstn-/-) présentent une augmentation de leur masse musculaire associée à une hyperplasie et une hypertrophie des myofibres. Elles présentent également une diminution de leur masse adipeuse. L’expression de la myostatine est finement régulée par des inhibiteurs comme la follistatine, FSTL3 ou les protéines GASP-1 et GASP-2. Si de nombreuses études ont déjà été réalisées sur les autres inhibiteurs, les protéines GASPs sont à l’heure actuelle encore peu étudiées. Le modèle murin surexprimant Gasp-1 (Tg(Gasp-1) généré dans le laboratoire présente un phénotype hypermusclé associé à une hypertrophie mais sans hyperplasie et ne présentent pas de diminution de leur masse adipeuse. Afin de mieux comprendre les conséquences fonctionnelles de la surexpression de Gasp-1, nous avons analysé des cellules musculaires dérivées de cellules satellites de souris Tg(Gasp-1). Cette étude a révélé une dérégulation de l’expression de plusieurs gènes dont une surexpression de la myostatine qui pourrait expliquer l’absence d’hyperplasie. Nous avons voulu également expliquer l’absence de variation de masse adipeuse dans les souris Tg(Gasp-1) en réalisant des analyses métaboliques sur des souris jeunes et âgées. Ces travaux ont révélé une dérégulation globale de l’homéostasie du glucose dans les souris Tg(Gasp-1) associé à une dérégulation du sécrétome musculaire. Enfin nous avons voulu appréhender le rôle de GASP-2 dans le contexte musculaire. / Skeletal muscle is a heterogeneous and dynamic tissue which plays an important role in mobility and metabolism of organisms. It is an active organ that secretes numerous cytokines involved in "crosstalk" between all tissues implicated in metabolism. Among these myokines, myostatin acts both as a negative regulator of muscle development and a mediator in glucose homeostasis. Indeed, mice deficient for the myostatin gene (Mstn-/-) have an increase of muscle mass associated with hyperplasia and hypertrophy of myofibers. Mstn-/- mice also exhibit a decrease of fat mass. Expression of myostatin is tightly regulated by inhibitors such follistatin, FSTL-3 or GASP-1 and GASP-2 proteins. While many studies have already been performed on the other inhibitors, GASPs proteins are still poorly studied. The mouse model overexpressing Gasp-1 (Tg (Gasp-1)) generated in our lab presents a hypermuscular phenotype associated with hypertrophy without hyperplasia and exhibit no decrease in fat mass. To better understand the functional consequences of Gasp-1 overexpression, we analyzed muscle cells derived from Tg(Gasp-1) satellite cells This study revealed a deregulation of the expression of several genes with an upregulation of myostatin which could explain the absence of hyperplasia in the Tg(Gasp-1) mice. We then want to explain the absence of fat mass changes by performing metabolic assays in young and aged mice. These studies have revealed an overall dysregulation of glucose homeostasis and deregulation of muscle secretome in Tg(Gasp-1) mice. Finally we wanted to capture the role of GASP-2 in a muscular context.

A incidência da obesidade e do diabetes do tipo 2 tomou proporções epidêmicas nos últimos anos, atingindo bilhões de indivíduos em todo o mundo. A descoberta de formas inovadoras capazes de reduzir as alterações metabólicas associadas a estas doenças é fundamental para minimizar o seu impacto na qualidade de vida da população e na economia dos países. Muitos estudos têm demonstrado que os compostos bioativos de alimentos possuem efeitos benéficos à saúde. O camu-camu e o cupuaçu são frutas nativas da região amazônica com potencial agroeconômico ainda inexplorado, que contêm um grande número de compostos fitoquímicos que podem atuar sobre o metabolismo corporal. Desta forma, o objetivo deste estudo foi verificar os efeitos dos compostos fenólicos de extratos do camu-camu e do cupuaçu no desenvolvimento da obesidade e do diabetes tipo 2 em ensaios in vivo e in vitro, e identificar os possíveis metabólitos envolvidos nestes efeitos. Os extratos ricos em compostos fenólicos da polpa comercial destes frutos foram extraídos em fase sólida, caracterizados por cromatografia líquida de alta eficiência (CLAE/DAD) e avaliados quanto à inibição da atividade de enzimas digestivas in vitro. Os extratos obtidos foram então testados em duas diferentes concentrações (2,25 e 4,5 mg de equivalentes de catequina/Kg de peso corporal para o cupuaçu; 7 e 14 mg de equivalentes de ácido gálico/Kg de peso corporal para o camu camu) em um modelo animal de obesidade e resistência insulínica induzida por dieta com alto teor de lipídios e sacarose em camundongos C57BL/6J. Foram investigados os efeitos destes compostos sobre as homeostases glicídica e lipídica através de análises séricas, testes de tolerância à insulina e à glicose e conteúdo de lipídios hepáticos e fecais. O extrato do camu camu apresentou flavonóis, ácido elágico e elagitaninos em sua composição. A suplementação com o extrato de compostos fenólicos do camu camu reduziu o ganho de peso corporal e diminuiu a intolerância à glicose e à insulina, independente da dose administrada. No entanto, a administração destes extratos não apresentou efeitos sobre o metabolismo lipídico. Estes resultados foram associados a um possível efeito de saciedade, com consequente redução da ingestão da dieta e da glicolipotoxicidade, e com um efeito anti-inflamatório devido à diminuição dos níveis de proteína C reativa. Já o extrato de cupuaçu apresentou flavanóis, flavonas e proantocianidinas em sua composição. A suplementação com o extrato de cupuaçu na maior dose testada melhorou a homeostase da glicose e principalmente dos lipídios, protegendo o tecido hepático dos danos causados pela dieta com alto teor de lipídios e sacarose. Estes efeitos foram associados à inibição de enzimas digestivas, com consequente menor absorção de lipídios provenientes da dieta, reduzindo assim a resistência à insulina no fígado, a hiperglicemia e a dislipidemia. Ainda, foi avaliada a distribuição de metabólitos no trato gastrointestinal de camundongos após a administração aguda do extrato de cupuaçu. Foi possível identificar a complexa mistura de polifenóis presentes no extrato de cupuaçu ao longo do trato gastrointestinal, que posteriormente foi metabolizada pela microbiota. Entre os metabólitos encontrados estão as agliconas hipolaetina e isoscutelareína, e os metabolitos microbianos da epicatequina como o 3,4-diHPP-2-ol e a 5-(3,4-dihidroxiphenil)-γ-valerolactona. De acordo com estes resultados, as diferenças na composição de compostos fenólicos encontradas entre os extratos das duas frutas foram responsáveis pelos diferentes resultados nos protocolos in vivo e a identificação dos metabólitos microbianos possibilita o conhecimento dos compostos possivelmente implicados nos efeitos benéficos. Novos estudos podem contribuir para um melhor entendimento dos mecanismos, bem como quais metabólitos estão associados aos efeitos benéficos que os compostos presentes nestas duas frutas apresentaram neste estudo. / The incidence of obesity and type 2 diabetes reached epidemic proportions in recent years, arriving to billions of people around the world. The discovery of innovative ways that can reduce the metabolic abnormalities associated with these diseases is essential to minimize its impact on the population\'s quality of life and the economy of the countries. Many studies have demonstrated that food bioactive compounds have beneficial health effects. Camu-camu and cupuassu are native fruits of the Amazon region with unexplored agroeconomic potential, which contain a large number of phytochemical compounds that can act on body metabolism. Thus, the objective of this study was verify the effects of phenolic compounds of camu-camu and cupuassu extracts on the development of obesity and type 2 diabetes in vivo and in vitro, and identfy the possible metabolites involved in these effects. The phenolic compound-rich extracts were obtained from commercial frozen fruit pulps by solid phase extraction, characterized by high-performance liquid chromatography (HPLC/DAD) and evaluated for inhibition of digestive enzymes activities in vitro. Then, the extracts were tested at two different doses (2.25 and 4.5 mg catechin equivalents/kg body weight for cupuassu; 7 and 14 mg of gallic acid equivalents/kg body weight for camu camu) in an animal model (C57BL/6J mice) of obesity and insulin resistance induced by high fat high sucrose diet. The effects of extract supplementation on glucose and lipid homeostasis were assessed by serum analysis, insulin and glucose tolerance tests in mice, and contents of fat in liver and fecal samples. Camu camu extract presented flavonols, ellagic acid and ellagitannins in its composition. Supplementation with camu camu phenolic extract reduced weight gain and decreased glucose and insulin intolerance independent of the dose administered. However, no effects on lipid metabolism were found. These findings were associated with a possible effect of satiety with a consequent reduction in energy intake and glicolipotoxicity, and anti-inflammatory properties. Cupuassu extract presented flavanols, flavones and proanthocyanidins in its composition. Supplementation with cupuacu extract at the highest dose improved glucose homeostasis and plasmatic lipid levels, protecting the liver tissue from damage caused by diet rich in lipids and sucrose. These effects were associated with inhibition of digestive enzymes, with consequent lower absorption of lipids from the diet, thereby reducing the insulin resistance in the liver, the hyperglycemia and dyslipidemia. Furthermore, the distribution of metabolites in the gastrointestinal tract of mice was evaluated after acute administration of cupussu extract by HPLC-ESI-QTOF. We identified the complex mixture of polyphenols present in cupuassu extract along the gastrointestinal tract, which was subsequently metabolized by the intestinal microbiota. Among detected metabolites are hypolaetin and isoscutellarein aglycones and microbial metabolites of epicatechin as 3,4-diHPP-2-ol and 5-(3,4-dihydroxyphenyl)-γvalerolactone. According to these results, the differences in the composition of phenolic compounds found between the two fruit extracts were responsible for the different effects in vivo and identification of microbial metabolites enables the knowledge of the compounds potentially implicated in the beneficial effects. New studies can contribute to a better understanding of the metabolism and mechanisms of action.

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