Type 2 diabetes mellitus(T2DM)is a lifelong condition and a threat to human health.Thorough understanding of its pathogenesis is acutely needed in order to devise innovative,preventative,and potentially curative pharm...Type 2 diabetes mellitus(T2DM)is a lifelong condition and a threat to human health.Thorough understanding of its pathogenesis is acutely needed in order to devise innovative,preventative,and potentially curative pharmacological interventions.MicroRNAs(miRNA),are small,non-coding,one-stranded RNA molecules,that can target and silence around 60%of all human genes through translational repression.MiR-155 is an ancient,evolutionarily well-conserved miRNA,with distinct expression profiles and multifunctionality,and a target repertoire of over 241 genes involved in numerous physiological and pathological processes including hematopoietic lineage differentiation,immunity,inflammation,viral infections,cancer,cardiovascular conditions,and particularly diabetes mellitus.MiR-155 Levels are progressively reduced in aging,obesity,sarcopenia,and T2DM.Thus,the loss of coordinated repression of multiple miR-155 targets acting as negative regulators,such as C/EBPβ,HDAC4,and SOCS1 impacts insulin signaling,deteriorating glucose homeostasis,and causing insulin resistance(IR).Moreover,deranged regulation of the renin angiotensin aldosterone system(RAAS)through loss of Angiotensin II Type 1 receptor downregulation,and negated repression of ETS-1,results in unopposed detrimental Angiotensin II effects,further promoting IR.Finally,loss of BACH1 and SOCS1 repression abolishes cytoprotective,anti-oxidant,anti-apoptotic,and anti-inflam matory cellular pathways,and promotesβ-cell loss.In contrast to RAAS inhibitor treatments that further decrease already reduced miR-155 Levels,strategies to increase an ailing miR-155 production in T2DM,e.g.,the use of metformin,mineralocorticoid receptor blockers(spironolactone,eplerenone,finerenone),and verapamil,alone or in various combinations,represent current treatment options.In the future,direct tissue delivery of miRNA analogs is likely.展开更多
Type 2 diabetes mellitus(T2DM)is a lifelong condition and a grave threat to human health.Innovative efforts to relieve its detrimental effects are acutely needed.The sine qua non in T2DM management is consistent adher...Type 2 diabetes mellitus(T2DM)is a lifelong condition and a grave threat to human health.Innovative efforts to relieve its detrimental effects are acutely needed.The sine qua non in T2DM management is consistent adherence to a prudent lifestyle and nutrition,combined with aerobic and resistance exercise regimens,together repeatedly shown to lead to complete reversal and even longterm remission.Non-adherence to the above lifestyle adjustments condemns any treatment effort and ultimately the patient to a grim fate.It is thus imperative that every study evaluating the effects of innovative interventions in T2DM objectively compares the novel treatment modality to lifestyle modifications,preferably through double-blind controlled randomization,before claiming efficacy.展开更多
Erythropoietin(EPO)is the main mediator of erythropoiesis and an important tissue protective hormone that appears to mediate an ancestral neuroprotective innate immune response mechanism at an early age.When the young...Erythropoietin(EPO)is the main mediator of erythropoiesis and an important tissue protective hormone that appears to mediate an ancestral neuroprotective innate immune response mechanism at an early age.When the young brain is threatened-prematurity,neonatal hyperbilirubinemia,malaria-EPO is hypersecreted disproportionately to any concurrent anemic stimuli.Under eons of severe malarial selection pressure,neuroprotective EPO augmenting genetic determinants such as the various hemoglobinopathies,and the angiotensin converting enzyme(ACE)I/D polymorphism,have been positively selected.When malarial and other cerebral threats abate and the young child survives to adulthood,EPO subsides.Sustained high ACE and angiotensin II(Ang II)levels through the ACE D allele in adulthood may then become detrimental as witnessed by epidemiological studies.The ubiquitous renin angiotensin system(RAS)influences theα-klotho/fibroblast growth factor 23(FGF23)circuitry,and both are interconnected with EPO.Here we propose that at a young age,EPO augmenting genetic determinants through ACE D allele elevated Ang II levels in some or HbE/beta thalassemia in others would increase EPO levels and shield against coronavirus disease 2019,akin to protection from malaria and dengue fever.Human evolution may use ACE2 as a“bait”for severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)to gain cellular entry in order to trigger an ACE/ACE2 imbalance and stimulate EPO hypersecretion using tissue RAS,uncoupled from hemoglobin levels.In subjects without EPO augmenting genetic determinants at any age,ACE2 binding and internalization upon SARS-CoV-2 entry would trigger an ACE/ACE2 imbalance,and Ang II oversecretion leading to protective EPO stimulation.In children,low nasal ACE2 Levels would beneficially augment this imbalance,especially for those without protective genetic determinants.On the other hand,in predisposed adults with the ACE D allele,ACE/ACE2 imbalance,may lead to uncontrolled RAS overactivity and an Ang II induced proinflammatory state and immune dysregulation,with interleukin 6(IL-6),plasminogen activator inhibitor,and FGF23 elevations.IL-6 induced EPO suppression,aggravated through co-morbidities such as hypertension,diabetes,obesity,and RAS pharmacological interventions may potentially lead to acute respiratory distress syndrome,cytokine storm and/or autoimmunity.HbE/beta thalassemia carriers would enjoy protection at any age as their EPO stimulation is uncoupled from the RAS system.The timely use of rhEPO,EPO analogs,acetylsalicylic acid,bioactive lipids,or FGF23 antagonists in genetically predisposed individuals may counteract those detrimental effects.展开更多
Several mechanisms may explain how exercise training mechanistically confers protection against coronavirus disease 2019(COVID-19).Here we propose two new perspectives through which cardiorespiratory fitness may prote...Several mechanisms may explain how exercise training mechanistically confers protection against coronavirus disease 2019(COVID-19).Here we propose two new perspectives through which cardiorespiratory fitness may protect against severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).Physical exercise-activated adenosine monophosphate(AMP)-activated protein kinase(AMPK)signaling induces endothelial nitric oxide(NO)synthase(eNOS),increases NO bio-availability,and inhibits palmitoylation,leading to specific and immediate SARS-CoV-2 protection.AMPK signaling also induces angiotensin 1-7 release and enhances eNOS activation thus further mediating cardio-and renoprotection.Irisin,a myokine released from skeletal muscles during aerobic exercise,also participates in the AMPK/Akt-eNOS/NO pathway,protects mitochondrial functions in endothelial cells,and antagonizes renin angiotensin system proinflammatory action leading to reductions in genes associated with severe COVID-19 outcomes.Collectively,all the above findings point to the fact that increased AMPK and irisin activity through exercise training greatly benefits molecular processes that mediate specific,immediate,and delayed SARS-CoV-2 protection.Maintaining regular physical activity levels is a safe and affordable lifestyle strategy against the current and future pandemics and may also mitigate against obesity and cardiometabolic disease syndemics.Move more because a moving target is harder to kill.展开更多
文摘Type 2 diabetes mellitus(T2DM)is a lifelong condition and a threat to human health.Thorough understanding of its pathogenesis is acutely needed in order to devise innovative,preventative,and potentially curative pharmacological interventions.MicroRNAs(miRNA),are small,non-coding,one-stranded RNA molecules,that can target and silence around 60%of all human genes through translational repression.MiR-155 is an ancient,evolutionarily well-conserved miRNA,with distinct expression profiles and multifunctionality,and a target repertoire of over 241 genes involved in numerous physiological and pathological processes including hematopoietic lineage differentiation,immunity,inflammation,viral infections,cancer,cardiovascular conditions,and particularly diabetes mellitus.MiR-155 Levels are progressively reduced in aging,obesity,sarcopenia,and T2DM.Thus,the loss of coordinated repression of multiple miR-155 targets acting as negative regulators,such as C/EBPβ,HDAC4,and SOCS1 impacts insulin signaling,deteriorating glucose homeostasis,and causing insulin resistance(IR).Moreover,deranged regulation of the renin angiotensin aldosterone system(RAAS)through loss of Angiotensin II Type 1 receptor downregulation,and negated repression of ETS-1,results in unopposed detrimental Angiotensin II effects,further promoting IR.Finally,loss of BACH1 and SOCS1 repression abolishes cytoprotective,anti-oxidant,anti-apoptotic,and anti-inflam matory cellular pathways,and promotesβ-cell loss.In contrast to RAAS inhibitor treatments that further decrease already reduced miR-155 Levels,strategies to increase an ailing miR-155 production in T2DM,e.g.,the use of metformin,mineralocorticoid receptor blockers(spironolactone,eplerenone,finerenone),and verapamil,alone or in various combinations,represent current treatment options.In the future,direct tissue delivery of miRNA analogs is likely.
文摘Type 2 diabetes mellitus(T2DM)is a lifelong condition and a grave threat to human health.Innovative efforts to relieve its detrimental effects are acutely needed.The sine qua non in T2DM management is consistent adherence to a prudent lifestyle and nutrition,combined with aerobic and resistance exercise regimens,together repeatedly shown to lead to complete reversal and even longterm remission.Non-adherence to the above lifestyle adjustments condemns any treatment effort and ultimately the patient to a grim fate.It is thus imperative that every study evaluating the effects of innovative interventions in T2DM objectively compares the novel treatment modality to lifestyle modifications,preferably through double-blind controlled randomization,before claiming efficacy.
文摘Erythropoietin(EPO)is the main mediator of erythropoiesis and an important tissue protective hormone that appears to mediate an ancestral neuroprotective innate immune response mechanism at an early age.When the young brain is threatened-prematurity,neonatal hyperbilirubinemia,malaria-EPO is hypersecreted disproportionately to any concurrent anemic stimuli.Under eons of severe malarial selection pressure,neuroprotective EPO augmenting genetic determinants such as the various hemoglobinopathies,and the angiotensin converting enzyme(ACE)I/D polymorphism,have been positively selected.When malarial and other cerebral threats abate and the young child survives to adulthood,EPO subsides.Sustained high ACE and angiotensin II(Ang II)levels through the ACE D allele in adulthood may then become detrimental as witnessed by epidemiological studies.The ubiquitous renin angiotensin system(RAS)influences theα-klotho/fibroblast growth factor 23(FGF23)circuitry,and both are interconnected with EPO.Here we propose that at a young age,EPO augmenting genetic determinants through ACE D allele elevated Ang II levels in some or HbE/beta thalassemia in others would increase EPO levels and shield against coronavirus disease 2019,akin to protection from malaria and dengue fever.Human evolution may use ACE2 as a“bait”for severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)to gain cellular entry in order to trigger an ACE/ACE2 imbalance and stimulate EPO hypersecretion using tissue RAS,uncoupled from hemoglobin levels.In subjects without EPO augmenting genetic determinants at any age,ACE2 binding and internalization upon SARS-CoV-2 entry would trigger an ACE/ACE2 imbalance,and Ang II oversecretion leading to protective EPO stimulation.In children,low nasal ACE2 Levels would beneficially augment this imbalance,especially for those without protective genetic determinants.On the other hand,in predisposed adults with the ACE D allele,ACE/ACE2 imbalance,may lead to uncontrolled RAS overactivity and an Ang II induced proinflammatory state and immune dysregulation,with interleukin 6(IL-6),plasminogen activator inhibitor,and FGF23 elevations.IL-6 induced EPO suppression,aggravated through co-morbidities such as hypertension,diabetes,obesity,and RAS pharmacological interventions may potentially lead to acute respiratory distress syndrome,cytokine storm and/or autoimmunity.HbE/beta thalassemia carriers would enjoy protection at any age as their EPO stimulation is uncoupled from the RAS system.The timely use of rhEPO,EPO analogs,acetylsalicylic acid,bioactive lipids,or FGF23 antagonists in genetically predisposed individuals may counteract those detrimental effects.
文摘Several mechanisms may explain how exercise training mechanistically confers protection against coronavirus disease 2019(COVID-19).Here we propose two new perspectives through which cardiorespiratory fitness may protect against severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).Physical exercise-activated adenosine monophosphate(AMP)-activated protein kinase(AMPK)signaling induces endothelial nitric oxide(NO)synthase(eNOS),increases NO bio-availability,and inhibits palmitoylation,leading to specific and immediate SARS-CoV-2 protection.AMPK signaling also induces angiotensin 1-7 release and enhances eNOS activation thus further mediating cardio-and renoprotection.Irisin,a myokine released from skeletal muscles during aerobic exercise,also participates in the AMPK/Akt-eNOS/NO pathway,protects mitochondrial functions in endothelial cells,and antagonizes renin angiotensin system proinflammatory action leading to reductions in genes associated with severe COVID-19 outcomes.Collectively,all the above findings point to the fact that increased AMPK and irisin activity through exercise training greatly benefits molecular processes that mediate specific,immediate,and delayed SARS-CoV-2 protection.Maintaining regular physical activity levels is a safe and affordable lifestyle strategy against the current and future pandemics and may also mitigate against obesity and cardiometabolic disease syndemics.Move more because a moving target is harder to kill.
