Naoki Nakashima

Confirmation of Multiple Risk Loci and Genetic Impacts by a Genome-Wide Association Study of Type 2 Diabetes in the Japanese Population

OBJECTIVE To identify novel type 2 diabetes gene variants and confirm previously identified ones, a three-staged genome-wide association study was performed in the Japanese population. RESEARCH DESIGN AND METHODS In the stage 1 scan, we genotyped 519 case and 503 control subjects with 482,625 single nucleotide polymorphism (SNP) markers; in the stage 2 panel comprising 1,110 case subjects and 1,014 control subjects, we assessed 1,456 SNPs (P < 0.0025, stage 1); additionally to direct genotyping, 964 healthy control subjects formed the in silico control panel. Along with genome-wide exploration, we aimed to replicate the disease association of 17 SNPs from 16 candidate loci previously identified in Europeans. The associated and/or replicated loci (23 SNPs; P < 7 × 10–5 for genome-wide exploration and P < 0.05 for replication) were examined in the stage 3 panel comprising 4,000 case subjects and 12,569 population-based samples, from which 4,889 nondiabetic control subjects were preselected. The 12,569 subjects were used for overall risk assessment in the general population. RESULTS Four loci—1 novel with suggestive evidence (PEPD on 19q13, P = 1.4 × 10–5) and three previously reported—were identified; the association of CDKAL1, CDKN2A/CDKN2B, and KCNQ1 were confirmed (P < 10–19). Moreover, significant associations were replicated in five other candidate loci: TCF7L2, IGF2BP2, SLC30A8, HHEX, and KCNJ11. There was substantial overlap of type 2 diabetes susceptibility genes between the two populations, whereas effect size and explained variance tended to be higher in the Japanese population. CONCLUSIONS The strength of association was more prominent in the Japanese population than in Europeans for more than half of the confirmed type 2 diabetes loci.

G Alpha-q/11 Protein Plays a Key Role in Insulin-Induced Glucose Transport in 3T3-L1 Adipocytes

ABSTRACT We evaluated the role of the G alpha-q (Gαq) subunit of heterotrimeric G proteins in the insulin signaling pathway leading to GLUT4 translocation. We inhibited endogenous Gαq function by single cell microinjection of anti-Gαq/11 antibody or RGS2 protein (a GAP protein for Gαq), followed by immunostaining to assess GLUT4 translocation in 3T3-L1 adipocytes. Gαq/11 antibody and RGS2 inhibited insulin-induced GLUT4 translocation by 60 or 75%, respectively, indicating that activated Gαq is important for insulin-induced glucose transport. We then assessed the effect of overexpressing wild-type Gαq (WT-Gαq) or a constitutively active Gαq mutant (Q209L-Gαq) by using an adenovirus expression vector. In the basal state, Q209L-Gαq expression stimulated 2-deoxy-d-glucose uptake and GLUT4 translocation to 70% of the maximal insulin effect. This effect of Q209L-Gαq was inhibited by wortmannin, suggesting that it is phosphatidylinositol 3-kinase (PI3-kinase) dependent. We further show that Q209L-Gαq stimulates PI3-kinase activity in p110α and p110γ immunoprecipitates by 3- and 8-fold, respectively, whereas insulin stimulates this activity mostly in p110α by 10-fold. Nevertheless, only microinjection of anti-p110α (and not p110γ) antibody inhibited both insulin- and Q209L-Gαq-induced GLUT4 translocation, suggesting that the metabolic effects induced by Q209L-Gαq are dependent on the p110α subunit of PI3-kinase. In summary, (i) Gαq appears to play a necessary role in insulin-stimulated glucose transport, (ii) Gαq action in the insulin signaling pathway is upstream of and dependent upon PI3-kinase, and (iii) Gαq can transmit signals from the insulin receptor to the p110α subunit of PI3-kinase, which leads to GLUT4 translocation.

Membrane-targeted Phosphatidylinositol 3-Kinase Mimics Insulin Actions and Induces a State of Cellular Insulin Resistance

Phosphatidylinositol (PI) 3-kinase plays an important role in various insulin-stimulated biological responses including glucose transport, glycogen synthesis, and protein synthesis. However, the molecular link between PI 3-kinase and these biological responses is still unclear. We have investigated whether targeting of the catalytic p110 subunit of PI 3-kinase to cellular membranes is sufficient and necessary to induce PI 3-kinase dependent signaling responses, characteristic of insulin action. We overexpressed Myc-tagged, membrane-targeted p110 (p110CAAX ), and wild-type p110 (p110WT) in 3T3-L1 adipocytes by adenovirus-mediated gene transfer. Overexpressed p110CAAX exhibited ∼2-fold increase in basal kinase activity in p110 immunoprecipitates, that further increased to ∼4-fold with insulin. Even at this submaximal PI 3-kinase activity, p110CAAX fully stimulated p70 S6 kinase, Akt, 2-deoxyglucose uptake, and Ras, whereas, p110WT had little or no effect on these downstream effects. Interestingly p110CAAX did not activate MAP kinase, despite its stimulation of p21 ras . Surprisingly, p110CAAX did not increase basal glycogen synthase activity, and inhibited insulin stimulated activity, indicative of cellular resistance to this action of insulin. p110CAAX also inhibited insulin stimulated, but not platelet-derived growth factor-stimulated mitogen-activated protein kinase phosphorylation, demonstrating that the p110CAAX induced inhibition of mitogen-activated protein kinase and insulin signaling is specific, and not due to some toxic or nonspecific effect on the cells. Moreover, p110CAAX stimulated IRS-1 Ser/Thr phosphorylation, and inhibited IRS-1 associated PI 3-kinase activity, without affecting insulin receptor tyrosine phosphorylation, suggesting that it may play an important role as a negative regulator for insulin signaling. In conclusion, our studies show that membrane-targeted PI 3-kinase can mimic a number of biologic effects normally induced by insulin. In addition, the persistent activation of PI 3-kinase induced by p110CAAX expression leads to desensitization of specific signaling pathways. Interestingly, the state of cellular insulin resistance is not global, in that some of insulin’s actions are inhibited, whereas others are intact.

Effects of a new oral hypoglycaemic agent (CS-045) on metabolic abnormalities and insulin resistance in type 2 diabetes.

The effects of a thiazolidinedione antidiabetic agent (CS‐045) on diabetic metabolic abnormalities were studied in a double‐blind clinical trial. Fourteen patients with Type 2 diabetes were selected according to study criteria. Eight were treated with oral CS‐045 at 400 mg daily, and six were given placebo. A multi‐step, hyperinsulinaemic, euglycaemic clamp study, with simultaneous plasma free fatty acid study, and glucagon tolerance test were performed before and after administration of drug. Following 3 months of treatment with CS‐045, there were significant decreases in the mean levels of fasting plasma glucose (from 9.18 ± 0.95 to 7.78 ± 0.44 mmol l−1), postprandial plasma glucose (from 11.8 ± 1.23 to 10.36 ± 1.06 mmol l−1), and haemoglobin A1c (from 9.3 ± 0.4 to 6.8 ± 0.4%). Insulin sensitivity also improved (1st step: from 3.12 ± 0.33 to 4.70 ± 0.47 mg kg−1 min−1 (p < 0.01); 2nd step: from 5.61 ± 0.63 to 7.54 ± 0.58 mg kg−1 min−1 (p< 0.01); 3rd step: from 9.21 ± 0.67 to 11.10 ± 0.87 mg kg−1 min−1). The fasting free fatty acid level decreased significantly from 0.28 ± 0.04 to 0.22 ± 0.02 g l−1. The residual free fatty acid level (%) under insulin infusion clamp conditions decreased significantly from 63.7 ± 9.7 to 45.0 ± 9.2%. CS‐045 treatment was associated with decrease in total cholesterol, total triglycerides, and increase in HDL cholesterol. Basal C‐peptide immunoreactivity level decreased, but there was no change in the peak C‐peptide immunoreactivity value. None of these changes was observed in the placebo group. CS‐045 improved hyperglycaemia as well as insulin resistance. CS‐045 appears to have a different mode of hypoglycaemic action from that of the sulphonylureas.

The lack of the C-terminal domain of adipose triglyceride lipase causes neutral lipid storage disease through impaired interactions with lipid droplets

CONTEXT The molecular mechanisms by which triglycerides in lipid droplets (LDs) are synthesized, stored, and degraded need to be elucidated. OBJECTIVE The objectives were to report siblings with neutral lipid storage disease with myopathy (NLSDM) with a novel mutation of adipose triglyceride lipase (ATGL) and determine whether the C-terminal part of ATGL containing the hydrophobic region plays a role in the interaction with LDs. DESIGN AND PATIENTS Skin fibroblasts and peripheral blood leukocytes were obtained from NLSDM patients. In vitro experiments were performed with fibroblasts and COS7 cells. MAIN OUTCOME MEASURES Transfection studies were used to assess the effects of various recombinant ATGL proteins on lipase activities and lipid contents. Fluorescence microscopy were used for determination of intracellular distribution of ATGL proteins. RESULTS The direct sequence of ATGL cDNA reveals that a patient is a homozygote for the 4-bp deletion, leading to a premature stop codon and causes the lack of the C terminus of the protein including the hydrophobic domain. Overexpressed control ATGL in NLSDM fibroblasts was found around the rims of LDs and caused significantly reduced cellular lipid accumulation. In contrast, NLSDM ATGL was homogeneously located in the cytoplasm despite the presence of LDs and had almost no effect on LD degradation despite its similar lipase activity. A series of C-terminal truncated ATGLs without the intact hydrophobic domain failed to localize around and degrade LDs. CONCLUSIONS These findings indicate that the domain including the hydrophobic region of ATGL was essential for association with LDs.

The Functional Role of CrkII in Actin Cytoskeleton Organization and Mitogenesis

Crk is a member of a family of adapter proteins predominantly composed of Src homology 2 and 3 domains, whose role in signaling pathways is presently unclear. Using an in situelectroporation system which permits the introduction of glutathioneS-transferase (GST) fusion proteins into cells, we found that c-CrkII bound to p130 cas , but not to paxillin in serum-starved rat-1 fibroblasts overexpressing the human insulin receptor (HIRc cells) in vivo. 17 nm insulin stimulation dissociated the binding of c-CrkII to p130 cas , whereas 13 nm insulin-like growth factor-I, 16 nm epidermal growth factor (EGF), and 10% serum each showed little or no effect. We found that stress fiber formation is consistent with a change in the p130 cas ·c-CrkII interactions before and after growth factor stimulation. Microinjection of either GST-Crk-SH2 or -Crk-(N)SH3 domains, or anti-Crk antibody each inhibited stress fiber formation before and after insulin-like growth factor-I, EGF, and serum stimulation. Insulin stimulation by itself caused stress fiber breakdown and there was no additive effect of microinjection. Microinjection of anti-p130 cas antibody also blocked stress fiber formation in quiescent cells. Microinjection of the Crk-inhibitory reagents also inhibited DNA synthesis after insulin-like growth factor-I, EGF, and serum stimulation, but not after insulin. These data suggest that the complex containing p130 cas ·c-CrkII may play a crucial role in actin cytoskeleton organization and in anchorage-dependent DNA synthesis.

Saturated non-esterified fatty acids stimulate de novo diacylglycerol synthesis and protein kinase c activity in cultured aortic smooth muscle cells

Aims/hypothesis. Insulin resistance is linked with a cluster of multiple risk factors and excessive acceleration of atherosclerosis. The underlying mechanism is not, however, fully understood. Methods. To determine the link between insulin resistance and altered vascular function, we focused on the effect of various non-esterified fatty acids on diacylglycerol-protein kinase C pathway and mitogen-activated protein kinase activity in cultured aortic smooth muscle cells. Results.Incubation of the cells with saturated non-esterified fatty acids (200 μmol/l) for 24 h, such as palmitate or stearate, induced a significant increase in diacylglycerol concentrations by about fivefold or eightfold, respectively, whereas oleate induced a slight increase in diacylglycerol concentrations by 1.8-fold and arachidonate induced none. In addition, the increased diacylglycerol concentrations induced by palmitate were completely restored to control concentrations by triacsin C, acyl-CoA synthetase inhibitor. These results suggest that saturated non-esterified fatty acids may increase diacylglycerol concentrations through de novo pathway by stepwise acylation. In parallel with the increased diacylglycerol, incubation of the cells with saturated non-esterified fatty acids significantly induced the activation of protein kinase C and mitogen-activated protein kinase. The palmitate-induced increase in mitogen-activated protein kinase activity was restored to control concentrations by GF109203X (5 · 10–7 mol/l), a specific protein kinase C inhibitor, suggesting a protein kinase C-dependent activation of mitogen-activated protein kinase. Conclusion/interpretation. Saturated non-esterified fatty acids induced an increase in de novo diacylglycerol synthesis and subsequent activation of protein kinase C and mitogen-activated protein kinase in cultured aortic smooth muscle cells. This could contribute to the altered vascular functions in the insulin resistant state. [Diabetologia (2001) 44: 614–620]

Effect of dehydroepiandrosterone on glucose uptake in cultured human fibroblasts

Dehydroepiandrosterone (DHEA) and its sulfate derivative (DHEA-S) reportedly have antidiabetic and antiobesity effects. The effect of DHEA on glucose uptake in cultured human fibroblasts was examined. Incubation of cells with supraphysiologic concentrations of DHEA (10(-5) mol/L) for > or = 10 hours enhanced 2-deoxyglucose (2-DG) uptake significantly (P < .05). Supraphysiologic concentrations of insulin (10(-7) mol/L) increased the sensitivity of glucose uptake to DHEA. Conversely, the sensitivity of glucose uptake to insulin was increased by incubating cells with 10(-6) mol/L DHEA. Both the abundance of transcripts encoding glucose transporter-1 (Glut-1) and the maximal velocity (Vmax) of 2-DG transport were increased in cultured fibroblasts incubated with DHEA. Cultured fibroblasts expressed a specific binding factor with low affinity for [3H]DHEA (maximal number of binding sites, 18,496 sites per cell; Kd, 298 nmol/L). Other androgen hormones exerted a less-marked effect on glucose uptake; DHEA-S had no effect. These results suggested that DHEA increases Glut-1 mRNA through binding to a specific factor in cultured human fibroblasts and thereby stimulates glucose uptake in these cells.

A remote surgery experiment between Japan and Thailand over Internet using a low latency CODEC system

Remote surgery is one of the most desired applications in the context of recent advanced medical technologies. For a future expansion of remote surgery, it is important to use conventional network infrastructures such as Internet. However, using such conventional network infrastructures, we are confronting time-delay problems of data transmission. In this paper, a remote surgery experiment between Japan and Thailand using a research and development Internet is presented. In the experiment, the image and audio information was transmitted by a newly developed low latency CODEC system to shorten the time-delay. By introducing the low latency CODEC system, the time-delay was shortened compared with the past remote surgery experiments despite the longer distance. We also conducted several network measurements such as a comparison between TCP/IP and UDP/IP about the control signal transmission.

International transmission of uncompressed endoscopic surgery images via superfast broadband Internet connections

BackgroundAlthough telecommunication is increasing in popularity, poor-quality images sent through a narrowband network limit its use in the medical field.MethodsKyushu University Hospital in Japan and four hospitals in Korea were linked via superfast broadband Internet connection. The digital video transfer system, which can transmit digital videos without loss of image quality, was used, and the bandwidth was 30 Mbps per line.ResultsOf the 16 teleconferences conducted, 6 demonstrated real-time endoscopic surgery. In addition to the surgical images, preoperative diagnostic images, images of the operating room, and images of the staff in the conference room were transmitted to facilitate discussion. The network remained stable, and the sound delay was restricted to less than 0.3 s. In the other 10 teleconferences, recorded video images were used for discussion.ConclusionsThe authors have established a high-quality, practical teleconference system that is economical and easy to use in clinical practice. This system shows promise for remote education beyond geographic borders.