Identifying new strategies for prevention of cardiovascular complications of diabetes

确定预防糖尿病心血管并发症的新策略

• 批准号: 9893203
• 负责人: Karin E. Bornfeldt
• 金额: $ 103.78万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9893203
• 关键词: Adult; Age; Apolipoproteins; Arterial Fatty Streak; Atherosclerosis; Biological Assay; Cardiovascular Diseases; Cardiovascular system; Child; Chylomicrons; Complications of Diabetes Mellitus; Data; Diabetes Mellitus; Diabetic mouse; Event; Flow Cytometry; Glycolysis; Goals; Health; Human; Hypertriglyceridemia; Incidence; Insulin-Dependent Diabetes Mellitus; LDL Cholesterol Lipoproteins; Lesion; Link; Lipoproteins; Methods; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Normal Range; Patients; Plasma; Population; Positioning Attribute; Prediabetes syndrome; Prevalence; Prevention strategy; Prospective Studies; Proteomics; Reporting; Residual state; Risk Factors; Serum; Severities; Stroke; Time; Triglyceride Metabolism; Triglycerides; Very low density lipoprotein; cardiovascular disorder risk; cardiovascular risk factor; clinically significant; endoplasmic reticulum stress; macrophage; novel; particle; prevent; single-cell RNA sequencing; targeted treatment; treatment strategy

Currently, almost 10% of the US population (over 30 million people) suffer from type 1 or type 2 diabetes mellitus (T1DM or T2DM) and more than 30% have pre-diabetes. Approximately 1.4 million children and adults have T1DM. Because the prevalence of diabetes continues to rise, because both T1DM and T2DM markedly increase the risk of cardiovascular disease (CVD), and because CVD events occur at younger ages in patients with diabetes, it is critical to understand how diabetes increases CVD risk and how CVD can be prevented. Patients with increased CVD risk are generally treated with statins to lower LDL cholesterol. However, even with statin treatment, patients with diabetes have residual CVD risk and a greater incidence of heart attack and stroke than subjects without diabetes. This residual CVD risk in patients with T2DM and elevated triglycerides (TGs) has been linked to abnormal metabolism of triglyceride-rich lipoproteins (TRLs). However, TG levels are normal in most T1DM patients, and current dogma maintains that TRLs do not drive CVD risk in these patients. We hypothesize that plasma TGs do not accurately reflect levels of the atherogenic remnant lipoprotein particles (RLPs) derived from VLDL or chylomicrons because RLPs and small VLDL contain much less TG than do TRLs. We have developed a new method to quantify RLPs and small VLDL. Furthermore, our data show that elevated serum apolipoprotein C3 (APOC3) levels predict CVD events in subjects with T1DM when adjusted for diabetes severity and other traditional risk factors; this correlation was found in subjects with normal TGs. APOC3 increases levels of TRLs and RLPs. We have previously reported that TRLs contribute to atherosclerotic plaque instability in mouse models of diabetes. We have also found that diabetes leads to suppression of glycolysis in macrophages, and that this in turn is linked to ER stress and plaque instability. During the next 7 years, this project will reveal mechanisms behind increased CVD risk in humans, focusing on RLPs and APOC3 as CVD risk factors in patients with T1DM and T2DM and TG levels in the normal range. By using our mechanistic mouse models of diabetes-accelerated atherosclerosis, we will also clarify the diabetes- induced mechanisms that promote early and advanced atherosclerosis. As part of these mechanistic studies, we will reveal how diabetes, APOC3 and RLPs alter lesion macrophages, by using proteomics, single cell RNA-sequencing, flow cytometry, and functional assays. By combining prospective studies on CVD risk in humans with diabetes and our mechanistic mouse models of diabetes-accelerated atherosclerosis, we believe we are in an excellent position to fill an important and clinically significant gap in our understanding of how diabetes promotes CVD and to identify new treatment and prevention strategies.

目前，几乎10％的美国人口（超过3000万人）患有1型或2型糖尿病 Mellitus（T1DM或T2DM）和30％以上的糖尿病前期。大约140万儿童和成人 有T1DM。因为糖尿病的患病率继续升高，因为T1DM和T2DM均显着 增加心血管疾病（CVD）的风险，并且由于CVD事件发生在患者年龄较小 对于糖尿病，了解糖尿病如何增加CVD风险以及如何预防CVD至关重要。 CVD风险增加的患者通常用他汀类药物治疗以降低LDL胆固醇。但是，甚至 通过他汀类药物治疗，糖尿病患者具有残留的CVD风险，心脏病发作的发生率更高 中风比没有糖尿病的受试者。 T2DM患者和甘油三酸酯升高的患者的残留CVD风险 （TGS）与富含甘油三酸酯脂蛋白（TRL）的异常代谢有关。但是，TG水平是 在大多数T1DM患者中，正常情况下，目前的教条表明，TRL在这些患者中不会造成CVD风险。 我们假设血浆TGS不能准确反映动脉粥样硬化的脂蛋白的水平 由于RLP和小VLDL包含的TG少得多 比TRL。我们已经开发了一种量化RLP和小VLDL的新方法。此外，我们的数据 表明血清载脂蛋白C3（APOC3）水平升高预测T1DM受试者的CVD事件 针对糖尿病的严重程度和其他传统危险因素进行调整；在患者中发现了这种相关性 正常TG。 APOC3增加了TRL和RLP的水平。我们以前已经报道了TRL有助于 糖尿病小鼠模型中的动脉粥样硬化斑块不稳定性。我们还发现糖尿病会导致 巨噬细胞中糖酵解的抑制，这反过来又与ER应力和斑块不稳定性有关。 在接下来的7年中，该项目将揭示人类CVD风险增加的机制，重点关注 正常范围内T1DM和T2DM和TG水平患者的RLP和APOC3作为CVD风险因素。经过 使用我们的糖尿病加速动脉粥样硬化的小鼠模型，我们还将阐明糖尿病 - 诱导促进早期和晚期动脉粥样硬化的机制。作为这些机械研究的一部分， 我们将通过使用蛋白质组学，单细胞来揭示糖尿病，apoc3和RLP如何改变病变巨噬细胞 RNA测序，流式细胞仪和功能测定。通过结合有关CVD风险的前瞻性研究 患有糖尿病的人和我们的糖尿病的机械小鼠模型 - 加速性动脉粥样硬化，我们相信 我们在理解如何理解如何填补重要且临床上显着的差距的绝佳位置 糖尿病促进CVD并确定新的治疗和预防策略。