Biomarkers of diabetes

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Diabetes mellitus (DM) is a type of metabolic disease characterized by hyperglycemia. It is caused by either defected insulin secretion or damaged biological function, or both. The high-level blood glucose for a long time will lead to dysfunction of a variety of tissues. [1]

Contents

Type 2 diabetes is a progressive condition in which the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in the pancreas. [2]

Pre-diabetes means that the blood sugar level is higher than normal but not yet high enough to be type 2 diabetes. [3]

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. [4]

Type 2 diabetes mellitus and prediabetes are associated with changes in levels of metabolic markers, these markers could serve as potential prognostic or therapeutic targets for patients with prediabetes or Type 2 diabetes mellitus. [5]

Metabolic markers

[5]

-Biomarkers with insulin-sensitizing properties (irisin, omentin, oxytocin) [5]

-Biomarkers of metabolic dysfunction (HGF, Nesfatin and Betatrophin) [5]

Biomarkers with insulin-sensitizing properties

Oxytocin

Oxytocin (OXT), a hormone most commonly associated with labor and lactation, may have a wide variety of physiological and pathological functions, which makes Oxytocin and its receptor potential targets for drug therapy. [6] OXT may have positive metabolic effects; this is based on the change in glucose metabolism, lipid profile, and insulin sensitivity. It may modify glucose uptake and insulin sensitivity both through direct and indirect effects. It may also cause regenerative changes in diabetic pancreatic islet cells. So, the activation of the OXT receptor pathway by infusion of OXT, OXT analogues, or OXT agonists may represent a promising approach for the management of obesity and related metabolic diseases as well as diabetes and its complications. [6]

Oxytocin improves insulin sensitivity by: [6]

Oxytocin may cause β-cell regeneration by: [6]

Oxytocin levels: [5]

Omentin

Omentin is an anti-inflammatory adipokine produced preferentially by visceral adipose tissue. Plasma omentin-1 levels are significantly decreased in patients with obesity, insulin resistance and diabetes that contribute to the major components of the metabolic syndrome. Insulin resistance contributes to the changes of cholesterol synthesis and absorption as well. However, nothing is known about the relationship between Omentin and metabolic risk factors. So a study were held in Japan comprised 201 Japanese men who underwent annual health check-ups. Plasma Omentin levels were determined by enzyme-linked immunosorbent assay. They divided the subjects into 4 groups according to Omentin levels. A reduction of plasma Omentin levels significantly correlated with an increase in the mean number of metabolic risk factors such as increased waist circumference, Dyslipidemia, high blood pressure and glucose intolerance. They concluded that Circulating Omentin levels are negatively correlated with the multiplicity of metabolic risk factors, suggesting that Omentin acts as a biomarker of metabolic disorders. [1]

Irisin

Irisin, a newly identified hormone, was first reported by Bostromet al. in 2012, is a novel myokine which plays an important role in the homeostasis, metabolism and energy balance. Irisin is reported to be involved in insulin resistance in both humans and animal models. Circulating irisin levels progressively decrease with the worsening of the glucose tolerance. [7] A recent study conducted a comparative cross-sectional evaluation of baseline circulating levels of the novel hormone Irisin and the established adipokine adiponectin with metabolic syndrome, cardio-metabolic variables and cardiovascular disease risk, and they found out that the baseline irisin levels were significantly higher in subjects with metabolic syndrome than in subjects without metabolic syndrome. [7]

Biomarkers of metabolic dysfunction

Nesfatin-1

Nesfatin-1 is a peptide secreted by peripheral tissues, central and peripheral nervous system. It is involved in the regulation of energy, homeostasis related with food regulation and water intake. [8] Nesfatin-1 can pass through the blood-brain barrier in both directions. It suppresses feeding independently from the leptin pathway and increases insulin secretion from pancreatic beta islet cells. this is demonstrated by in-vitro studies that Nesfatin-1 stimulates the Preproinsulin mRNA expression and increases the glucose induced insulin release. That is why nesfatin-1 has drawn attention as a new therapeutic agent, especially for the treatment of obesity and diabetes mellitus. [8]

In T2DM patients Nesfatin-1 is elevated and this could possibly be as a result of a resistance. Thus, Nesfatin-1 acts as a potent Anorexigenic factor (anti-obesity) that improves insulin resistance and opposes weight gain. [8]

Hepatocyte growth factor (HGF)

Hepatocyte growth factor (HGF) is a mitogen and insulin tropic agent for the β cell. Inadequate β-cell mass can lead to insulin insufficiency and diabetes. During times of prolonged metabolic demand for insulin, the endocrine pancreas can respond by increasing β-cell mass, both by increasing cell size and by changing the balance between β-cell proliferation and apoptosis. [9] [10] It is important to know the effects of high glucose on the factors that may influence endothelial cell growth. A novel member of endothelium-specific growth factors, hepatocyte growth factor (HGF), is produced in vascular cells. In diabetic patient's, levels of the hepatocyte growth factor (HGF) were found in high levels, thus independently associated with increased the incidence of diabetes. There is a study that indicate that HGF/c-Met signalling is essential for maternal β-cell adaptation during pregnancy and that its absence/attenuation leads to gestational diabetes mellitus. [10] [9]

Betatrophin:

is a novel protein predominantly expressed in human liver and adipose tissues. Increasing evidence has revealed an association between betatrophin expression and serum lipid profiles, particularly in patients with obesity or diabetes, Thus betatrophin is closely related to diabetes treatment, it promotes greatly the proliferation of pancreatic beta cells, plays an important role in modulating glycolipid metabolism, and maybe replaces insulin in the effective treatment of diabetes. [11] studies showed that betatrophin could increase the quantity of cells that produce insulin in mice quickly. Others showed that the circulating level of betatrophin in T2DM patient blood was higher than that in control groups. [11] Expression of betatrophin correlates with β cell proliferation. Transient expression of betatrophin in mouse liver significantly and specifically promotes pancreatic β cell proliferation, expands β cell mass, and improves glucose tolerance. Thus, betatrophin treatment could augment or replace insulin injections by increasing the number of endogenous insulin-producing cells in diabetics. [11]

Others

Endothelin-1(ET-1)

Is a vasoconstrictor peptide released from vascular endothelial cells. At the cellular level, the balance between vasodilator (Nitric oxide) and vasoconstrictor (ET-1) actions determines the vascular response to insulin. So, high levels of ET-1, which achieved in insulin resistance states that includes patients that have T2DM or metabolic syndromes or they are obese, have inhibitory effect on nitric oxide production which results in low nitric oxide and heightened levels of ET-1. [12] ET-1 activity is also enhanced secondary to abnormalities in vascular insulin signalling, In addition to its direct vasoconstrictor effects. Furthermore, ET-1 induces a reduction in insulin sensitivity and may take part in the development of the metabolic syndrome. [12]

PVAT AND ET-1

ET-1 In addition to its direct vasoconstrictor effects, it causes changes in visceral and perivascular adipose tissue (PVAT), and may contribute to the pathogenesis of both insulin resistance and vascular dysfunction/damage. Perivascular adipose tissue seems to have anti contractile effect and this dilator effect was lost in obese patients. secondary to obesity, ET-1 high level changes on PVAT will lead to PVAT hypertrophy which will be associated with reduced partial oxygen pressure, an increase in the production of inflammatory cytokines such as TNF-α and IL-6, and elevation of reactive oxygen species. Thus, oxidative stress and hypoxia may promote imbalance in the production of vasoactive compounds and may affect vascular homeostasis by activating the ET-1 system. [9]

Fibroblast growth factor

fibroblast growth factor (FGF-21) has been recently characterized as a potent metabolic regulator. Systemic administration of FGF-21 reduced plasma glucose and triglycerides to near normal levels in genetically compromised diabetic rodents. [13]

FGF21 can function as a crucial regulator mediating beneficial metabolic effects of therapeutic agents such as metformin, glucagon/glucagonlike peptide1analogues, thiazolidinedione, sirtuin 1 activators, and lipoic acid. A study showed that when fibroblast growth factor-21 administered daily for 6 weeks to diabetic rhesus monkeys, it caused a dramatic decline in fasting plasma glucose, fructosamine, triglycerides, insulin and glucagon. In a significant point during the study, FGF-21 administration also led to significant improvements in lipoprotein profiles and a beneficial changes in the circulating levels of several cardiovascular risk markers. And the induction of a small but significant weight loss. These data support the development of FGF-21 for the treatment of diabetes and other metabolic diseases. [13]

Related Research Articles

<span class="mw-page-title-main">Insulin</span> Peptide hormone

Insulin is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (INS) gene. It is the main anabolic hormone of the body. It regulates the metabolism of carbohydrates, fats, and protein by promoting the absorption of glucose from the blood into cells of the liver, fat, and skeletal muscles. In these tissues the absorbed glucose is converted into either glycogen, via glycogenesis, or fats (triglycerides), via lipogenesis; in the liver, glucose is converted into both. Glucose production and secretion by the liver are strongly inhibited by high concentrations of insulin in the blood. Circulating insulin also affects the synthesis of proteins in a wide variety of tissues. It is thus an anabolic hormone, promoting the conversion of small molecules in the blood into large molecules in the cells. Low insulin in the blood has the opposite effect, promoting widespread catabolism, especially of reserve body fat.

Insulin resistance (IR) is a pathological condition in which cells either fail to respond normally to the hormone insulin or downregulate insulin receptors in response to hyperinsulinemia.

<span class="mw-page-title-main">Beta cell</span> Type of cell found in pancreatic islets

Beta cells (β-cells) are specialized endocrine cells located within the pancreatic islets of Langerhans responsible for the production and release of insulin and amylin. Constituting ~50–70% of cells in human islets, beta cells play a vital role in maintaining blood glucose levels. Problems with beta cells can lead to disorders such as diabetes.

<span class="mw-page-title-main">Type 2 diabetes</span> Form of diabetes mellitus

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often symptoms develop slowly. Long-term complications from high blood sugar include heart disease, stroke, diabetic retinopathy, which can result in blindness, kidney failure, and poor blood flow in the lower-limbs, which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

<span class="mw-page-title-main">Glucagon</span> Peptide hormone

Glucagon is a peptide hormone, produced by alpha cells of the pancreas. It raises the concentration of glucose and fatty acids in the bloodstream and is considered to be the main catabolic hormone of the body. It is also used as a medication to treat a number of health conditions. Its effect is opposite to that of insulin, which lowers extracellular glucose. It is produced from proglucagon, encoded by the GCG gene.

<span class="mw-page-title-main">Gestational diabetes</span> Medical condition

Gestational diabetes is a condition in which a person without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it increases the risk of pre-eclampsia, depression, and of needing a Caesarean section. Babies born to individuals with poorly treated gestational diabetes are at increased risk of macrosomia, of having hypoglycemia after birth, and of jaundice. If untreated, diabetes can also result in stillbirth. Long term, children are at higher risk of being overweight and of developing type 2 diabetes.

<span class="mw-page-title-main">Adiponectin</span> Mammalian protein found in Homo sapiens

Adiponectin is a protein hormone and adipokine, which is involved in regulating glucose levels and fatty acid breakdown. In humans, it is encoded by the ADIPOQ gene and is produced primarily in adipose tissue, but also in muscle and even in the brain.

<span class="mw-page-title-main">Resistin</span> Mammalian protein found in Homo sapiens

Resistin also known as adipose tissue-specific secretory factor (ADSF) or C/EBP-epsilon-regulated myeloid-specific secreted cysteine-rich protein (XCP1) is a cysteine-rich peptide hormone derived from adipose tissue that in humans is encoded by the RETN gene.

Maturity-onset diabetes of the young (MODY) refers to any of several hereditary forms of diabetes mellitus caused by mutations in an autosomal dominant gene disrupting insulin production. Along with neonatal diabetes, MODY is a form of the conditions known as monogenic diabetes. While the more common types of diabetes involve more complex combinations of causes involving multiple genes and environmental factors, each forms of MODY are caused by changes to a single gene (monogenic). GCK-MODY and HNF1A-MODY are the most common forms.

<span class="mw-page-title-main">Hyperinsulinemia</span> Abnormal increase in insulin in the bloodstream relative to glucose

Hyperinsulinemia is a condition in which there are excess levels of insulin circulating in the blood relative to the level of glucose. While it is often mistaken for diabetes or hyperglycaemia, hyperinsulinemia can result from a variety of metabolic diseases and conditions, as well as non-nutritive sugars in the diet. While hyperinsulinemia is often seen in people with early stage type 2 diabetes mellitus, it is not the cause of the condition and is only one symptom of the disease. Type 1 diabetes only occurs when pancreatic beta-cell function is impaired. Hyperinsulinemia can be seen in a variety of conditions including diabetes mellitus type 2, in neonates and in drug-induced hyperinsulinemia. It can also occur in congenital hyperinsulinism, including nesidioblastosis.

The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentrations of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity-onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

Nesfatin-1 is a neuropeptide produced in the hypothalamus of mammals. It participates in the regulation of hunger and fat storage. Increased nesfatin-1 in the hypothalamus contributes to diminished hunger, a 'sense of fullness', and a potential loss of body fat and weight.

<span class="mw-page-title-main">Prediabetes</span> Predisease state of hyperglycemia with high risk for diabetes

Prediabetes is a component of metabolic syndrome and is characterized by elevated blood sugar levels that fall below the threshold to diagnose diabetes mellitus. It usually does not cause symptoms but people with prediabetes often have obesity, dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension. It is also associated with increased risk for cardiovascular disease (CVD). Prediabetes is more accurately considered an early stage of diabetes as health complications associated with type 2 diabetes often occur before the diagnosis of diabetes.

<span class="mw-page-title-main">Neonatal diabetes</span> Medical condition

Neonatal diabetes mellitus (NDM) is a disease that affects an infant and their body's ability to produce or use insulin. NDM is a kind of diabetes that is monogenic and arises in the first 6 months of life. Infants do not produce enough insulin, leading to an increase in glucose accumulation. It is a rare disease, occurring in only one in 100,000 to 500,000 live births. NDM can be mistaken for the much more common type 1 diabetes, but type 1 diabetes usually occurs later than the first 6 months of life. There are two types of NDM: permanent neonatal diabetes mellitus (PNDM), a lifelong condition, and transient neonatal diabetes mellitus (TNDM), a form of diabetes that disappears during the infant stage but may reappear later in life.

Complications of diabetes are secondary diseases that are a result of elevated blood glucose levels that occur in diabetic patients. These complications can be divided into two types: acute and chronic. Acute complications are complications that develop rapidly and can be exemplified as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), lactic acidosis (LA), and hypoglycemia. Chronic complications develop over time and are generally classified in two categories: microvascular and macrovascular. Microvascular complications include neuropathy, nephropathy, and retinopathy; while cardiovascular disease, stroke, and peripheral vascular disease are included in the macrovascular complications.

Most cases of type 2 diabetes involved many genes contributing small amount to the overall condition. As of 2011 more than 36 genes have been found that contribute to the risk of type 2 diabetes. All of these genes together still only account for 10% of the total genetic component of the disease.

In recent years it has become apparent that the environment and underlying mechanisms affect gene expression and the genome outside of the central dogma of biology. It has been found that many epigenetic mechanisms are involved in the regulation and expression of genes such as DNA methylation and chromatin remodeling. These epigenetic mechanisms are believed to be a contributing factor to pathological diseases such as type 2 diabetes. An understanding of the epigenome of diabetes patients may help to elucidate otherwise hidden causes of this disease.

Ketosis-prone diabetes (KPD) is an intermediate form of diabetes that has some characteristics of type 1 and some of type 2 diabetes. Type 1 diabetes involves autoimmune destruction of pancreatic beta cells which create insulin. This occurs earlier in a person's life, leading to patients being insulin dependent, and the lack of natural insulin makes patients prone to a condition called diabetic ketoacidosis (DKA). Type 2 diabetes is different in that it is usually caused by insulin resistance in the body in older patients leading to beta cell burnout over time, and is not prone to DKA. KPD is a condition that involves DKA like type 1, but occurs later in life and can regain beta cell function like type 2 diabetes. However, it is distinct from latent autoimmune diabetes of adults (LADA), a form of type 1 sometimes referred to as type 1.5 that does not occur with DKA. There are also distinctions to be made between KPD and LADA as patients who exhibit KPD symptoms can regain beta cell function similar to type 2 diabetics whereas LADA will not exhibit this reclamation of beta cell function.

Asprosin is a protein hormone produced by mammals in tissues that stimulates the liver to release glucose into the blood stream. Asprosin is encoded by the gene FBN1 as part of the protein profibrillin and is released from the C-terminus of the latter by specific proteolysis. In the liver, asprosin activates rapid glucose release via a cyclic adenosine monophosphate (cAMP)-dependent pathway.

<span class="mw-page-title-main">Disposition index</span>

The Disposition index (DI) is a measure for the loop gain of the insulin-glucose feedback control system. It is defined as the product of insulin sensitivity times the amount of insulin secreted in response to blood glucose levels. "Metabolically healthy" Insulin resistant individuals can maintain normal responses to blood glucose due to the fact that higher levels of insulin are secreted as long as the beta cells of the pancreas are able to increase their output of insulin to compensate for the insulin resistance. But the ratio of the incremental increase in plasma insulin associated with an incremental increase in plasma glucose provides a better measure of beta cell function than the plasma insulin response to a glucose challenge. Loss of function of the beta cells, reducing their capacity to compensate for insulin resistance, results in a lower disposition index.

References

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  2. ↑ "Type 2 Diabetes". Diabetes Australia. Archived from the original on December 5, 2018. Retrieved December 1, 2018.
  3. ↑ Hess-Fischl, Amy. "Prediabetes". Endocrine Web. Archived from the original on December 7, 2018. Retrieved December 1, 2018.
  4. ↑ "High blood sugar during pregnancy: What to do-Gestational diabetes". Mayo Clinic. 2022-04-09. Retrieved 2024-08-20.
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