Kenichi Izumi

Reduced Tyk2 gene expression in β-cells due to natural mutation determines susceptibility to virus-induced diabetes

Accumulating evidence suggests that viruses play an important role in the development of diabetes. Although the diabetogenic encephalomyocarditis strain D virus induces diabetes in restricted lines of inbred mice, the susceptibility genes to virus-induced diabetes have not been identified. We report here that novel Tyrosine kinase 2 (Tyk2) gene mutations are present in virus-induced diabetes-sensitive SJL and SWR mice. Mice carrying the mutant Tyk2 gene on the virus-resistant C57BL/6 background are highly sensitive to virus-induced diabetes. Tyk2 gene expression is strongly reduced in Tyk2-mutant mice, associated with low Tyk2 promoter activity, and leads to decreased expression of interferon-inducible genes, resulting in significantly compromised antiviral response. Tyk2-mutant pancreatic β-cells are unresponsive even to high dose of Type I interferon. Reversal of virus-induced diabetes could be achieved by β-cell-specific Tyk2 gene expression. Thus, reduced Tyk2 gene expression in pancreatic β-cells due to natural mutation is responsible for susceptibility to virus-induced diabetes.

TYK2 Promoter Variant and Diabetes Mellitus in the Japanese

Background Recently, natural mutation of Tyrosine kinase 2 (Tyk2) gene has been shown to determine susceptibility to murine virus-induced diabetes. In addition, a previous human genome-wide study suggested the type 1 diabetes (T1D) susceptibility region to be 19p13, where the human TYK2 gene is located (19p13.2). Methods Polymorphisms of TYK2 gene at the promoter region and exons were studied among 331 healthy controls, and 302 patients with T1D and 314 with type 2 diabetes (T2D) in the Japanese. Findings A TYK2 promoter haplotype with multiple genetic polymorphisms, which are in complete linkage disequilibrium, named TYK2 promoter variant, presenting decreased promoter activity, is associated with an increased risk of not only T1D (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.2 to 4.6; P = 0.01), but also T2D (OR, 2.1; 95% CI, 1.1 to 4.1; P = 0.03). The risk is high in patients with T1D associated with flu-like syndrome at diabetes onset and also those without anti-glutamic acid decarboxylase autoantibody. Interpretation The TYK2 promoter variant is associated with an overall risk for diabetes, serving a good candidate as a virus-induced diabetes susceptibility gene in humans. Funding Ministry of Education, Culture, Sports, Science and Technology and of Health, Labor and Welfare of Japan.

Change of Oral to Topical Corticosteroid Therapy Exacerbated Glucose Tolerance in a Patient with Plaque Psoriasis

Patient: Male, 80 Final Diagnosis: Plaque psoriasis• drug induced diabetes Symptoms: Hyperglycemia• adrenocortical dysfunction Medication: Oral steroid• Topical steroid• Insulin Clinical Procedure: Changing route and strength of steroid administration Specialty: Endocrinology• Dermatology Objective: Rare disease Background: Psoriasis is known as the most frequent disease treated by long-term topical steroids. It is also known that patients with thick, chronic plaques require the highest potency topical steroids. However, the treatment is limited to up to four weeks due to risk of systemic absorption. Case Report: An 80-year-old man was diagnosed with type 2 diabetes 16 years before, and was being administered insulin combined with alpha glucosidase inhibitor. He was diagnosed with plaque psoriasis and his oral steroid treatment was switched to topical steroid treatment due to lack of improvement and poorly controlled blood glucose level. The hypoglycemic events improved after the psoriatic lesions improved. Conclusions: Control of blood glucose level is difficult at the very beginning of topical steroid treatment for psoriasis especially if a patient is receiving insulin treatment. Intense monitoring of blood glucose level during initiation of topical steroid treatment is necessary to prevent unfavorable complications.

A case of ketoacidosis caused by the breakdown of the infusion syringe during continuous subcutaneous insulin infusion

IntroductionContinuous subcutaneous insulin injection (CSII) is an effective method for controlling blood glucose. However, complications include cutaneous complications (e.g., inflammation and infection) and uncontrollable blood glucose due to insulin leaks, obstruction, and technical problems, which may lead to hyperglycemia such as diabetic ketoacidosis (DKA) or hypoglycemia. However, other than islet or pancreas transplantation, CSII is the best method for controlling blood glucose.HistoryA patient with DKA using an old-type CSII instrument was referred to our hospital.InvestigationAt first, we could not understand why DKA had occurred because the skin at the infusion site appeared to be in good condition. However, the syringe was found to be broken when the instrument was unlocked and the pump was removed.ConclusionTo exchange older CSII instruments for newer models may be the safer alternative to prevent syringe accidents.

Light diffraction studies on director arrangement in the polymer‐pinned striped pattern obtained via the electric field‐induced Fréedericksz transition of nematics

We have observed an anomalous pattern forming phenomenon in which a striped pattern in a nematic liquid crystal appeared after removing an electric field following a Fréedericksz transition, and this pattern was preserved even in the equilibrium state in zero‐electric field. The nematic director arrangement in the striped pattern was investigated by light diffraction measurements. The stripes are proposed to consist of a periodic distortion of the nematic directors, specifically, tilted directors with the same absolute value of tilt angle but of opposite sign are alternately arrayed. The proposed model of the stripes is in good accord with the experimental results of light diffraction dependence on polarizing direction and light incidence angle.