© 2005 by the American Diabetes Association, Inc.
The Influence of Adiponectin Gene Polymorphism on the Rosiglitazone Response in Patients With Type 2 Diabetes
1 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Address correspondence and reprint requests to Hyun Chul Lee, Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong Seodaemun-Gu, Seoul, 120-752, Korea. E-mail: endohclee{at}yumc.yonsei.ac.kr
OBJECTIVE The aim of this study was to examine the effects of rosiglitazone on adiponectin and plasma glucose levels in relation with common adiponectin gene (ACDC) polymorphisms. RESEARCH DESIGN AND METHODS A total of 166 patients with type 2 diabetes were treated with rosiglitazone (4 mg/day) for 12 weeks without changing any of their previous medications. In all, single nucleotide polymorphism (SNP)45 and SNP276 of ACDC were examined. RESULTS Regarding SNP45, there was a smaller reduction in the fasting plasma glucose (FPG) level and the HbA1c value in the carriers of the GG genotype than in the carriers of the other genotypes (P = 0.031 and 0.013, respectively). There was a smaller increase in the serum adiponectin concentration for the GG genotype than for the other genotypes (P = 0.003). Regarding SNP276, there was less reduction in the FPG level for the GG genotype than for the other genotypes (P = 0.001). In the haplotype analysis, the reductions in the FPG and HbA1c levels were smaller for the GG homozygote haplotype than for the other haplotypes (P = 0.001 and 0.001, respectively). The increase in the plasma adiponectin concentration for the GG homozygote haplotype was smaller than that of the other haplotypes (P = 0.003). CONCLUSIONS These data suggest that genetic variations in the adiponectin gene can affect the rosiglitazone treatment response of the circulating adiponectin level and blood glucose control in type 2 diabetic patients.
Abbreviations: FPG, fasting plasma glucose HOMA-IR, homeostasis model assessment of insulin resistance PPAR, peroxisome proliferatoractivated receptor PPRE, PPAR responsive element SNP, single nucleotide polymorphism.
Adiponectin is a circulating protein secreted by adipocytes and is associated with the development of insulin resistance and atherosclerosis (1, 2). Serum adiponectin concentrations are lower in patients with type 2 diabetes, obesity, and coronary heart disease than in healthy subjects (3,4). This molecule is known to be a potent insulin sensitizer. Thiazolidinediones lower the blood glucose level primarily by activating the peroxisome proliferatoractivated receptor (PPAR)- , which then improves insulin sensitivity (5). The synthetic PPAR- agonist, rosiglitazone, is reported to increase the serum adiponectin level in type 2 diabetes (6). Adiponectin is encoded by ACDC, which is located on chromosome 3q27 (7,8). Studies of ACDC mutations have revealed 16 single nucleotide polymorphisms (SNPs) (9). Among them 11377, +45, and +276 have been reported to be associated with type 2 diabetes, circulating adiponectin levels, and insulin resistance in a Japanese population (10,11). However, previous studies on the association between ACDC SNPs, type 2 diabetes, and adiponectin levels have shown that the specific SNPs associated with this process differ according to both the study and the ethnic population. The aim of this study was to examine the association between SNPs in ACDC and the response to rosiglitazone. In addition, this study also investigated the PPAR responsive element (PPRE) polymorphism in the ACDC promoter.
A total of 166 patients were treated with rosiglitazone (4 mg/day) during a 12-week treatment course without changing previous medications. Type 2 diabetic patients with a HbA1c values of 7.511.5% and fasting plasma glucose (FPG) levels of 7.814.0 mmol/l; (140252 mg/dl) were enrolled in this study. The inclusion criteria were 1) age 3580 years, 2) BMI 18.530 kg/m2, 3) no history of PPAR agonist use, 4) no medication changes in the previous 3 months, and 5) for women, postmenopausal or using appropriate contraceptive methods. Patients with type 1 diabetes, any history of ketoacidosis, ischemic heart disease, or congestive heart failure (New York Heart Association IIIV) or who were receiving insulin therapy and pregnant or lactating women were excluded from this study. The patients were advised to consume a fixed-calorie diet and maintain a constant level of physical activity throughout the study. The Institutional Review Board of Yonsei University College of Medicine approved the study protocol. All subjects were provided adequate information about this study and gave their informed consent.
Clinical laboratory tests
Genotyping
Statistical analysis
Table 1 shows the allele, genotype, and haplotype distribution of ACDC. No significant deviation from Hardy-Weinberg equilibrium was observed for either locus. Table 2 shows the clinical characteristics of the patients before and after rosiglitazone treatment. The FPG levels and HbA1c values were significantly lower after 12 weeks of treatment compared with the baseline. The serum adiponectin concentration was significantly higher after the rosiglitazone treatment (5.30 ± 4.79 µg/ml vs. 9.92 ± 6.81 µg/ml, P < 0.001). No mutation was observed at the PPRE of the adiponectin gene promoter region in any of 166 patients. Tables 3 and 4 show the clinical and biochemical characteristics of the patients according to the SNP45 and SNP276 genotypes. There were no significant differences in terms of age, duration of diabetes, and BMI according to the SNP45, SNP276, and SNP-11377 genotypes. The FPG levels, HbA1c values, and the plasma lipid profiles were not significantly different among the genotypes of SNP45, SNP276, and SNP-11377 at baseline (Tables 3 and 4 and online appendix Table A-3, respectively).
Regarding SNP45, there was a significant difference in the decrease in the FPG level between the GG genotype and the other genotypes (TT + TG, 1.68 ± 2.40 mmol/l; GG, 0.25 ± 2.95 mmol/l; P = 0.031) (Table 5). The degree of the reduction in the HbA1c value was smaller for the GG genotype than for the other genotypes (TT + TG, 0.85 ± 1.05%; GG, 0.05 ± 1.43%; P = 0.013) (Table 5). In addition, the degree of the increase in the serum adiponectin concentration was significantly smaller in the subjects with the GG genotype than in the subjects with the other genotypes (TT + TG, 4.81 ± 5.07 µg/ml; GG, 1.67 ± 4.45 µg/ml; P = 0.003) (Table 5).
Regarding SNP276, the degree of the decrease in the FPG level was significantly smaller in those patients with the GG genotype than in those with the other genotypes (GG, 0.86 ± 2.58 mmol/l; GT + TT, 2.23 ± 2.27 mmol/l; P = 0.001) (Table 5). There were no significant differences in terms of insulin resistance, decrease in the FPG, decrease in the HbA1c, and increase in the serum adiponectin levels according to SNP-11377 genotype (data are shown in the online appendix Table A-3). In the haplotype analysis, the degree of the decrease in the FPG level was smaller in those with the GG homozygote haplotype than in those with the other haplotypes (GG homozygote haplotype, 0.03 ± 3.15 mmol/l; other haplotypes, 1.69 ± 2.40 mmol/l; P = 0.001) (Table 5). The patients with the GG homozygote haplotype had a smaller decrease in the HbA1c level than those with the other haplotypes (GG homozygote haplotype, 0.18 ± 1.23%; other haplotypes, 0.85 ± 1.05%; P = 0.001) (Table 5). In addition, the degree of the increase in the serum adiponectin level after the rosiglitazone treatment was less in those patients with the GG homozygote haplotype than the subjects with the other haplotype (GG homozygote haplotype, 0.82 ± 3.62 µg/ml; other haplotypes, 4.81 ± 5.07 µg/ml; P = 0.003) (Table 5).
Recently, Iwaki et al. (13) characterized the PPAR- binding site, PPRE, in the human adiponectin gene promoter. Although a great deal of effort has been made to identify the mutation in this region, this study could not detect any mutation in the 166 type 2 diabetic patients examined. Previous studies have shown that thiazolidinediones increase the serum adiponectin concentration by increasing the level of adiponectin transcription (14,15). Also, the association between an adiponectin gene polymorphism and the risk of type 2 diabetes has been examined in many studies (911,16). SNP45 and SNP276 were reported to be associated with type 2 diabetes in a Japanese population (10), whereas it was reported that SNP-11391 and SNP-11377 were related to type 2 diabetes in a French population (16). Therefore, the SNPs of ACDC for type 2 diabetes and insulin resistance appear to be different among different populations. This prospective intervention study was performed to evaluate how rosiglitazone response varies with adiponectin gene polymorphisms. Our data suggest that there is no association between SNP-11377 genotype and rosiglitazone response, but patients with the GG genotype at SNP45 and/or the GG genotype at SNP276 are unlikely to respond to rosiglitazone. In addition, a smaller increase in the serum adiponectin concentration was observed in patients with the SNP45 GG genotype than for those with the other genotypes. It was also observed that the degree of the decrease in the FPG level and HbA1c value was smaller in the patients with the GG homozygote haplotype than in those with the other haplotypes. In addition, patients with the GG homozygote haplotype had a smaller degree of increase in the serum adiponectin levels than in those with the other haplotypes. Patients with the GG homozygote haplotype are unlikely to respond to rosiglitazone. The ACDC SNP45 is located in exon 2 and is a silent mutation for Gly15 (GGT to GGG). However, it might inactivate the gene or affect the adiponectin concentration by influencing the pre-mRNA splicing or the stability of the mRNA (17). Alternatively, it may be related to another functional locus via a linkage disequilibrium not yet identified. SNP276 is located in intron two of ACDC. The intronic SNP can affect the expression level of the gene via an unknown mechanism. There may be a specific linkage structure or gene-environmental interaction. Although baseline and posttreatment FPG, HbA1c, and serum adiponectin levels were not significantly different between the GG homozygote haplotype and the other haplotypes, there were significant differences in the changes of the FPG, HbA1c, and serum adiponectin levels. The difference in either the adiponectin transcription activity or the adiponectin mRNA stability according to the ACDC genotypes could be responsible for the reduced serum adiponectin concentration in the GG homozygote haplotype compared with the other haplotypes. A low adiponectin level in patients with the GG homozygote haplotype may result in increased insulin resistance, which in turn contributes to a smaller decrease in the FPG levels and HbA1c values by several mechanisms (18,19). Multiple regression tests were performed and revealed that age, sex, and BMI were not found to be major confounding factors of serum adiponectin levels according to the ACDC genotypes (data shown in online appendix). Our findings are in contrast to those reported by Yang et al. (20), who found that subjects with the TT genotype at SNP45 are associated with insulin resistance. This discrepancy could be due to the different study population. Yang et al. (20) examined nondiabetic subjects, which is in contrast to the diabetic patients in this study. Moreover, they used HOMA-IR as an index of insulin resistance, which is not believed to be an accurate indicator for insulin resistance in patients with a low BMI and insulin secretory defect (21). Menzaghi et al. (22) reported that subjects with the TT genotype at SNP276 had a higher serum adiponectin level than the other genotypes. However, no difference was observed in the serum adiponectin level at the baseline among the SNP276 genotypes in this study. This discordance could be explained by differences in the ethnicity or specific study population. In conclusion, this study suggests that patients with G allele homozygosity at locus 45 and locus 276 are unlikely to respond to rosiglitazone. It was found that variations in the adiponectin gene could affect the rosiglitazone treatment response to the serum adiponectin level and blood glucose control. These findings may be clinically relevant in the prediction of patients who will best respond to rosiglitazone treatment. However, further investigations will be needed to elucidate the functional mechanism of these polymorphisms.
This study was supported by the Brain Korea 21 Project for Medical Science, Yonsei University, and by Grant 03-PJ10-PG13-GD01-0002 from the Korea Health 21 R&D Project, Ministry of Health and Welfare.
Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received for publication August 16, 2004. Accepted for publication January 23, 2005.
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