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Epigenetics in Psychology | Noba

Posted: November 24, 2022 at 12:45 am

DNA stands for Deoxyribonucleic Acid, and although each persons DNA is unique to that individual, it is 99.9% similar to every other human on the planet. [Image: CC0 Public Domain, https://goo.gl/m25gce%5D

Early childhood is not only a period of physical growth; it is also a time of mental development related to changes in the anatomy, physiology, and chemistry of the nervous system that influence mental health throughout life. Cognitive abilities associated with learning and memory, reasoning, problem solving, and developing relationships continue to emerge during childhood. Brain development is more rapid during this critical or sensitive period than at any other, with more than 700 neural connections created each second. Herein, complex geneenvironment interactions (or genotypeenvironment interactions, GE) serve to increase the number of possible contacts between neurons, as they hone their adult synaptic properties and excitability. Many weak connections form to different neuronal targets; subsequently, they undergo remodeling in which most connections vanish and a few stable connections remain. These structural changes (or plasticity) may be crucial for the development of mature neural networks that support emotional, cognitive, and social behavior. The generation of different morphology, physiology, and behavioral outcomes from a single genome in response to changes in the environment forms the basis for phenotypic plasticity, which is fundamental to the way organisms cope with environmental variation, navigate the present world, and solve future problems.

The challenge for psychology has been to integrate findings from genetics and environmental (social, biological, chemical) factors, including the quality of infantmother attachments, into the study of personality and our understanding of the emergence of mental illness. These studies have demonstrated that common DNA sequence variation and rare mutations account for only a small fraction (1%2%) of the total risk for inheritance of personality traits and mental disorders (Dick, Riley, & Kendler, 2010; Gershon, Alliey-Rodriguez, & Liu, 2011). Additionally, studies that have attempted to examine the mechanisms and conditions under which DNA sequence variation influences brain development and function have been confounded by complex cause-and-effect relationships (Petronis, 2010). The large unaccounted heritability of personality traits and mental health suggests that additional molecular and cellular mechanisms are involved.

Epigenetics has the potential to provide answers to these important questions and refers to the transmission of phenotype in terms of gene expression in the absence of changes in DNA sequencehence the name epi- (Greek: - over, above) genetics (Waddington, 1942; Wolffe & Matzke, 1999). The advent of high-throughput techniques such as sequencing-based approaches to study the distributions of regulators of gene expression throughout the genome led to the collective description of the epigenome. In contrast to the genome sequence, which is static and the same in almost all cells, the epigenome is highly dynamic, differing among cell types, tissues, and brain regions (Gregg et al., 2010). Recent studies have provided insights into epigenetic regulation of developmental pathways in response to a range of external environmental factors (Dolinoy, Weidman, & Jirtle, 2007). These environmental factors during early childhood and adolescence can cause changes in expression of genes conferring risk of mental health and chronic physical conditions. Thus, the examination of geneticepigeneticenvironment interactions from a developmental perspective may determine the nature of gene misregulation in psychological disorders.

This module will provide an overview of the main components of the epigenome and review themes in recent epigenetic research that have relevance for psychology, to form the biological basis for the interplay between environmental signals and the genome in the regulation of individual differences in physiology, emotion, cognition, and behavior.

Almost all the cells in our body are genetically identical, yet our body generates many different cell types, organized into different tissues and organs, and expresses different proteins. Within each type of mammalian cell, about 2 meters of genomic DNA is divided into nuclear chromosomes. Yet the nucleus of a human cell, which contains the chromosomes, is only about 2 m in diameter. To achieve this 1,000,000-fold compaction, DNA is wrapped around a group of 8 proteins called histones. This combination of DNA and histone proteins forms a special structure called a nucleosome, the basic unit of chromatin, which represents a structural solution for maintaining and accessing the tightly compacted genome. These factors alter the likelihood that a gene will be expressed or silenced. Cellular functions such as gene expression, DNA replication, and the generation of specific cell types are therefore influenced by distinct patterns of chromatin structure, involving covalent modification of both histones (Kadonaga, 1998) and DNA (Razin, 1998).

Importantly, epigenetic variation also emerges across the lifespan. For example, although identical twins share a common genotype and are genetically identical and epigenetically similar when they are young, as they age they become more dissimilar in their epigenetic patterns and often display behavioral, personality, or even physical differences, and have different risk levels for serious illness. Thus, understanding the structure of the nucleosome is key to understanding the precise and stable control of gene expression and regulation, providing a molecular interface between genes and environmentally induced changes in cellular activity.

DNA methylation is the best-understood epigenetic modification influencing gene expression. DNA is composed of four types of naturally occurring nitrogenous bases: adenine (A), thymine (T), guanine (G), and cytosine (C). In mammalian genomes, DNA methylation occurs primarily at cytosine residues in the context of cytosines that are followed by guanines (CpG dinucleotides), to form 5-methylcytosine in a cell-specific pattern (Goll & Bestor, 2005; Law & Jacobsen, 2010; Suzuki & Bird, 2008). The enzymes that perform DNA methylation are called DNA methyltransferases (DNMTs), which catalyze the transfer of a methyl group to the cytosine (Adams, McKay, Craig, & Burdon, 1979). These enzymes are all expressed in the central nervous system and are dynamically regulated during development (Feng, Chang, Li, & Fan, 2005; Goto et al., 1994). The effect of DNA methylation on gene function varies depending on the period of development during which the methylation occurs and location of the methylated cytosine. Methylation of DNA in gene regulatory regions (promoter and enhancer regions) usually results in gene silencing and reduced gene expression (Ooi, ODonnell, & Bestor, 2009; Suzuki & Bird, 2008; Sutter and Doerfler, 1980; Vardimon et al., 1982). This is a powerful regulatory mechanism that ensures that genes are expressed only when needed. Thus DNA methylation may broadly impact human brain development, and age-related misregulation of DNA methylation is associated with the molecular pathogenesis of neurodevelopmental disorders.

The modification of histone proteins comprises an important epigenetic mark related to gene expression. One of the most thoroughly studied modifications is histone acetylation, which is associated with gene activation and increased gene expression (Wade, Pruss, & Wolffe, 1997). Acetylation on histone tails is mediated by the opposing enzymatic activities of histone acetyltransferases (HATs) and histone deacetylases (HDACs) (Kuo & Allis, 1998). For example, acetylation of histone in gene regulatory regions by HAT enzymes is generally associated with DNA demethylation, gene activation, and increased gene expression (Hong, Schroth, Matthews, Yau, & Bradbury, 1993; Sealy & Chalkley, 1978). On the other hand, removal of the acetyl group (deacetylation) by HDAC enzymes is generally associated with DNA methylation, gene silencing, and decreased gene expression (Davie & Chadee, 1998). The relationship between patterns of histone modifications and gene activity provides evidence for the existence of a histone code for determining cell-specific gene expression programs (Jenuwein & Allis, 2001). Interestingly, recent research using animal models has demonstrated that histone modifications and DNA methylation of certain genes mediates the long-term behavioral effects of the level of care experienced during infancy.

The development of an individual is an active process of adaptation that occurs within a social and economic context. For example, the closeness or degree of positive attachment of the parent (typically mother)infant bond and parental investment (including nutrient supply provided by the parent) that define early childhood experience also program the development of individual differences in stress responses in the brain, which then affect memory, attention, and emotion. In terms of evolution, this process provides the offspring with the ability to physiologically adjust gene expression profiles contributing to the organization and function of neural circuits and molecular pathways that support (1) biological defensive systems for survival (e.g., stress resilience), (2) reproductive success to promote establishment and persistence in the present environment, and (3) adequate parenting in the next generation (Bradshaw, 1965).

The most comprehensive study to date of variations in parental investment and epigenetic inheritance in mammals is that of the maternally transmitted responses to stress in rats. In rat pups, maternal nurturing (licking and grooming) during the first week of life is associated with long-term programming of individual differences in stress responsiveness, emotionality, cognitive performance, and reproductive behavior (Caldji et al., 1998; Francis, Diorio, Liu, & Meaney, 1999; Liu et al., 1997; Myers, Brunelli, Shair, Squire, & Hofer, 1989; Stern, 1997). In adulthood, the offspring of mothers that exhibit increased levels of pup licking and grooming over the first week of life show increased expression of the glucocorticoid receptor in the hippocampus (a brain structure associated with stress responsivity as well as learning and memory) and a lower hormonal response to stress compared with adult animals reared by low licking and grooming mothers (Francis et al., 1999; Liu et al., 1997). Moreover, rat pups that received low levels of maternal licking and grooming during the first week of life showed decreased histone acetylation and increased DNA methylation of a neuron-specific promoter of the glucocorticoid receptor gene (Weaver et al., 2004). The expression of this gene is then reduced, the number of glucocorticoid receptors in the brain is decreased, and the animals show a higher hormonal response to stress throughout their life. The effects of maternal care on stress hormone responses and behaviour in the offspring can be eliminated in adulthood by pharmacological treatment (HDAC inhibitor trichostatin A, TSA) or dietary amino acid supplementation (methyl donor L-methionine), treatments that influence histone acetylation, DNA methylation, and expression of the glucocorticoid receptor gene (Weaver et al., 2004; Weaver et al., 2005). This series of experiments shows that histone acetylation and DNA methylation of the glucocorticoid receptor gene promoter is a necessary link in the process leading to the long-term physiological and behavioral sequelae of poor maternal care. This points to a possible molecular target for treatments that may reverse or ameliorate the traces of childhood maltreatment.

Several studies have attempted to determine to what extent the findings from model animals are transferable to humans. Examination of post-mortem brain tissue from healthy human subjects found that the human equivalent of the glucocorticoid receptor gene promoter (NR3C1 exon 1F promoter) is also unique to the individual (Turner, Pelascini, Macedo, & Muller, 2008). A similar study examining newborns showed that methylation of the glucocorticoid receptor gene promoter maybe an early epigenetic marker of maternal mood and risk of increased hormonal responses to stress in infants 3 months of age (Oberlander et al., 2008). Although further studies are required to examine the functional consequence of this DNA methylation, these findings are consistent with our studies in the neonate and adult offspring of low licking and grooming mothers that show increased DNA methylation of the promoter of the glucocorticoid receptor gene, decreased glucocorticoid receptor gene expression, and increased hormonal responses to stress (Weaver et al., 2004). Examination of brain tissue from suicide victims found that the human glucocorticoid receptor gene promoter is also more methylated in the brains of individuals who had experienced maltreatment during childhood (McGowan et al., 2009). These finding suggests that DNA methylation mediates the effects of early environment in both rodents and humans and points to the possibility of new therapeutic approaches stemming from translational epigenetic research. Indeed, similar processes at comparable epigenetic labile regions could explain why the adult offspring of high and low licking/grooming mothers exhibit widespread differences in hippocampal gene expression and cognitive function (Weaver, Meaney, & Szyf, 2006).

However, this type of research is limited by the inaccessibility of human brain samples. The translational potential of this finding would be greatly enhanced if the relevant epigenetic modification can be measured in an accessible tissue. Examination of blood samples from adult patients with bipolar disorder, who also retrospectively reported on their experiences of childhood abuse and neglect, found that the degree of DNA methylation of the human glucocorticoid receptor gene promoter was strongly positively related to the reported experience of childhood maltreatment decades earlier. For a relationship between a molecular measure and reported historical exposure, the effects size is extraordinarily large. This opens a range of new possibilities: given the large effect size and consistency of this association, measurement of the GR promoter methylation may effectively become a blood test measuring the physiological traces left on the genome by early experiences. Although this blood test cannot replace current methods of diagnosis, this unique and addition information adds to our knowledge of how disease may arise and be manifested throughout life. Near-future research will examine whether this measure adds value over and above simple reporting of early adversities when it comes to predicting important outcomes, such as response to treatment or suicide.

The old adage you are what you eat might be true on more than just a physical level: The food you choose (and even what your parents and grandparents chose) is reflected in your own personal development and risk for disease in adult life (Wells, 2003). Nutrients can reverse or change DNA methylation and histone modifications, thereby modifying the expression of critical genes associated with physiologic and pathologic processes, including embryonic development, aging, and carcinogenesis. It appears that nutrients can influence the epigenome either by directly inhibiting enzymes that catalyze DNA methylation or histone modifications, or by altering the availability of substrates necessary for those enzymatic reactions. For example, rat mothers fed a diet low in methyl group donors during pregnancy produce offspring with reduced DNMT-1 expression, decreased DNA methylation, and increased histone acetylation at promoter regions of specific genes, including the glucocorticoid receptor, and increased gene expression in the liver of juvenile offspring (Lillycrop, Phillips, Jackson, Hanson, & Burdge, 2005) and adult offspring (Lillycrop et al., 2007). These data suggest that early life nutrition has the potential to influence epigenetic programming in the brain not only during early development but also in adult life, thereby modulating health throughout life. In this regard, nutritional epigenetics has been viewed as an attractive tool to prevent pediatric developmental diseases and cancer, as well as to delay aging-associated processes.

The best evidence relating to the impact of adverse environmental conditions development and health comes from studies of the children of women who were pregnant during two civilian famines of World War II: the Siege of Leningrad (194144) (Bateson, 2001) and the Dutch Hunger Winter (19441945) (Stanner et al., 1997). In the Netherlands famine, women who were previously well nourished were subjected to low caloric intake and associated environmental stressors. Women who endured the famine in the late stages of pregnancy gave birth to smaller babies (Lumey & Stein, 1997) and these children had an increased risk of insulin resistance later in life (Painter, Roseboom, & Bleker, 2005). In addition, offspring who were starved prenatally later experienced impaired glucose tolerance in adulthood, even when food was more abundant (Stanner et al., 1997). Famine exposure at various stages of gestation was associated with a wide range of risks such as increased obesity, higher rates of coronary heart disease, and lower birth weight (Lumey & Stein, 1997). Interestingly, when examined 60 years later, people exposed to famine prenatally showed reduced DNA methylation compared with their unexposed same-sex siblings (Heijmans et al., 2008).

Memories are recollections of actual events stored within our brains. But how is our brain able to form and store these memories? Epigenetic mechanisms inuence genomic activities in the brain to produce long-term changes in synaptic signaling, organization, and morphology, which in turn support learning and memory (Day & Sweatt, 2011).

Neuronal activity in the hippocampus of mice is associated with changes in DNA methylation (Guo et al., 2011), and disruption to genes encoding the DNA methylation machinery cause learning and memory impairments (Feng et al., 2010). DNA methylation has also been implicated in the maintenance of long-term memories, as pharmacological inhibition of DNA methylation and impaired memory (Day & Sweatt, 2011; Miller et al., 2010). These ndings indicate the importance of DNA methylation in mediating synaptic plasticity and cognitive functions, both of which are disturbed in psychological illness.

Changes in histone modications can also inuence long-term memory formation by altering chromatin accessibility and the expression of genes relevant to learning and memory. Memory formation and the associated enhancements in synaptic transmission are accompanied by increases in histone acetylation (Guan et al., 2002) and alterations in histone methylation (Schaefer et al., 2009), which promote gene expression. Conversely, a neuronal increase in histone deacetylase activity, which promotes gene silencing, results in reduced synaptic plasticity and impairs memory (Guan et al., 2009). Pharmacological inhibition of histone deacetylases augments memory formation (Guan et al., 2009; Levenson et al., 2004), further suggesting that histone (de)acetylation regulates this process.

In humans genetic defects in genes encoding the DNA methylation and chromatin machinery exhibit profound effects on cognitive function and mental health (Jiang, Bressler, & Beaudet, 2004). The two best-characterized examples are Rett syndrome (Amir et al., 1999) and Rubinstein-Taybi syndrome (RTS) (Alarcon et al., 2004), which are profound intellectual disability disorders. Both MECP2 and CBP are highly expressed in neurons and are involved in regulating neural gene expression (Chen et al., 2003; Martinowich et al., 2003).

Rett syndrome patients have a mutation in their DNA sequence in a gene called MECP2. MECP2 plays many important roles within the cell: One of these roles is to read the DNA sequence, checking for DNA methylation, and to bind to areas that contain methylation, thereby preventing the wrong proteins from being present. Other roles for MECP2 include promoting the presence of particular, necessary, proteins, ensuring that DNA is packaged properly within the cell and assisting with the production of proteins. MECP2 function also influences gene expression that supports dendritic and synaptic development and hippocampus-dependent memory (Li, Zhong, Chau, Williams, & Chang, 2011; Skene et al., 2010). Mice with altered MECP2 expression exhibit genome-wide increases in histone acetylation, neuron cell death, increased anxiety, cognitive deficits, and social withdrawal (Shahbazian et al., 2002). These findings support a model in which DNA methylation and MECP2 constitute a cell-specific epigenetic mechanism for regulation of histone modification and gene expression, which may be disrupted in Rett syndrome.

RTS patients have a mutation in their DNA sequence in a gene called CBP. One of these roles of CBP is to bind to specific histones and promote histone acetylation, thereby promoting gene expression. Consistent with this function, RTS patients exhibit a genome-wide decrease in histone acetylation and cognitive dysfunction in adulthood (Kalkhoven et al., 2003). The learning and memory deficits are attributed to disrupted neural plasticity (Korzus, Rosenfeld, & Mayford, 2004). Similar to RTS in humans, mice with a mutation of CBP perform poorly in cognitive tasks and show decreased genome-wide histone acetylation (for review, see Josselyn, 2005). In the mouse brain CBP was found to act as an epigenetic switch to promote the birth of new neurons in the brain. Interestingly, this epigenetic mechanism is disrupted in the fetal brains of mice with a mutation of CBP, which, as pups, exhibit early behavioral deficits following removal and separation from their mother (Wang et al., 2010). These findings provide a novel mechanism whereby environmental cues, acting through histone modifying enzymes, can regulate epigenetic status and thereby directly promote neurogenesis, which regulates neurobehavioral development.

Together, these studies demonstrate that misregulation of epigenetic modications and their regulatory enzymes is capable of orchestrating prominent decits in neuronal plasticity and cognitive function. Knowledge from these studies may provide greater insight into other mental disorders such as depression and suicidal behaviors.

Epigenome-wide studies have identied several dozen sites with DNA methylation alterations in genes involved in brain development and neurotransmitter pathways, which had previously been associated with mental illness (Mill et al., 2008). These disorders are complex and typically start at a young age and cause lifelong disability. Often, limited benefits from treatment make these diseases some of the most burdensome disorders for individuals, families, and society. It has become evident that the efforts to identify the primary causes of complex psychiatric disorders may significantly benefit from studies linking environmental effects with changes observed within the individual cells.

Epigenetic events that alter chromatin structure to regulate programs of gene expression have been associated with depression-related behavior and action of antidepressant medications, with increasing evidence for similar mechanisms occurring in post-mortem brains of depressed individuals. In mice, social avoidance resulted in decreased expression of hippocampal genes important in mediating depressive responses (Tsankova et al., 2006). Similarly, chronic social defeat stress was found to decrease expression of genes implicated in normal emotion processing (Lutter et al., 2008). Consistent with these findings, levels of histone markers of increased gene expression were down regulated in human post-mortem brain samples from individuals with a history of clinical depression (Covington et al., 2009).

Administration of antidepressants increased histone markers of increased gene expression and reversed the gene repression induced by defeat stress (Lee, Wynder, Schmidt, McCafferty, & Shiekhattar, 2006; Tsankova et al., 2006; Wilkinson et al., 2009). These results provide support for the use of HDAC inhibitors against depression. Accordingly, several HDAC inhibitors have been found to exert antidepressant effects by each modifying distinct cellular targets (Cassel et al., 2006; Schroeder, Lin, Crusio, & Akbarian, 2007).

There is also increasing evidence that aberrant gene expression resulting from altered epigenetic regulation is associated with the pathophysiology of suicide (McGowan et al., 2008; Poulter et al., 2008). Thus, it is tempting to speculate that there is an epigenetically determined reduced capacity for gene expression, which is required for learning and memory, in the brains of suicide victims.

While the cellular and molecular mechanisms that influence on physical and mental health have long been a central focus of neuroscience, only in recent years has attention turned to the epigenetic mechanisms behind the dynamic changes in gene expression responsible for normal cognitive function and increased risk for mental illness. The links between early environment and epigenetic modifications suggest a mechanism underlying gene-environment interactions. Early environmental adversity alone is not a sufficient cause of mental illness, because many individuals with a history of severe childhood maltreatment or trauma remain healthy. It is increasingly becoming evident that inherited differences in the segments of specific genes may moderate the effects of adversity and determine who is sensitive and who is resilient through a gene-environment interplay. Genes such as the glucocorticoid receptor appear to moderate the effects of childhood adversity on mental illness. Remarkably, epigenetic DNA modifications have been identified that may underlie the long-lasting effects of environment on biological functions. This new epigenetic research is pointing to a new strategy to understanding gene-environment interactions.

The next decade of research will show if this potential can be exploited in the development of new therapeutic options that may alter the traces that early environment leaves on the genome. However, as discussed in this module, the epigenome is not static and can be molded by developmental signals, environmental perturbations, and disease states, which present an experimental challenge in the search for epigenetic risk factors in psychological disorders (Rakyan, Down, Balding, & Beck, 2011). The sample size and epigenomic assay required is dependent on the number of tissues affected, as well as the type and distribution of epigenetic modications. The combination of genetic association maps studies with epigenome-wide developmental studies may help identify novel molecular mechanisms to explain features of inheritance of personality traits and transform our understanding of the biological basis of psychology. Importantly, these epigenetic studies may lead to identification of novel therapeutic targets and enable the development of improved strategies for early diagnosis, prevention, and better treatment of psychological and behavioral disorders.

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Epigenetics in Psychology | Noba

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Epigenetics: Definition, Mechanisms and Clinical Perspective

Posted: November 24, 2022 at 12:45 am

Semin Reprod Med. Author manuscript; available in PMC 2009 Dec 10.

Published in final edited form as:

PMCID: PMC2791696

NIHMSID: NIHMS160913

1 Departments of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan

2 Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan

1 Departments of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan

3 Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland

1 Departments of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan

2 Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan

1 Departments of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan

2 Department of Physiology, School of Medicine, Wayne State University, Detroit, Michigan

3 Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland

A vast array of successive epigenetic modifications ensures the creation of a healthy individual. Crucial epigenetic reprogramming events occur during germ cell development and early embryogenesis in mammals. As highlighted by the large offspring syndrome with in vitro conceived ovine and bovine animals, any disturbance during germ cell development or early embryogenesis has the potential to alter epigenetic reprogramming. Therefore the complete array of human assisted reproductive technology (ART), starting from ovarian hormonal stimulation to embryo uterine transfer, could have a profound impact on the epigenetic state of human in vitro produced individuals. Although some investigators have suggested an increased incidence of epigenetic abnormalities in in vitro conceived children, other researchers have refuted these allegations. To date, multiple reasons can be hypothesized why irrefutable epigenetic alterations as a result of ART have not been demonstrated yet.

Keywords: Epigenetics, X-chromosome inactivation, imprinting, transgenerational inheritance

Conrad Waddington introduced the term epigenetics in the early 1940s.1 He defined epigenetics as the branch of biology which studies the causal interactions between genes and their products which bring the phenotype into being.2 In the original sense of this definition, epigenetics referred to all molecular pathways modulating the expression of a genotype into a particular phenotype. Over the following years, with the rapid growth of genetics, the meaning of the word has gradually narrowed. Epigenetics has been defined and today is generally accepted as the study of changes in gene function that are mitotically and/or meiotically heritable and that do not entail a change in DNA sequence.3 The epigenetic modifications described in current literature generally comprise histone variants, posttranslational modifications of amino acids on the amino-terminal tail of histones, and covalent modifications of DNA bases. The validity of the current definition of epigenetics should be seriously questioned because the previously mentioned epigenetic modifications also have a crucial role in the silencing and expression of noncoding sequences.

In addition to their importance in the commitment of cells to a particular mitotically inheritable form or function, epigenetic marks have a crucial role in guaranteeing genomic stability. Indeed, the silencing of centromeres, telomeres, and transposable elements (TEs) ensures the correct attachment of microtubules to centromeres, reduces excessive recombination between repetitive elements, and prevents transposition of TEs and resulting insertional mutagenesis.46

Although covalent modifications of DNA bases have been described since 1948,7 it was only in 1969 that Griffith and Mahler suggested that these modifications may modulate gene expression.8 The predominant modification in mammalian DNA is methylation of cytosine,7 followed by adenine and guanine methylation.7,9 Although methylation of cytosine bases in mammalian DNA has been primarily described in the context of CpG dinucleotides,10 evidence suggests that cytosines in non-CpG sequences are also frequently methylated.1113 Because the promoter regions of silenced genes possess significantly more methylated cytosines in comparison with actively transcribed genes, this modification has been implicated in transcriptional repression.14,15 Methylation of cytosine in the promoter region may repress gene expression by preventing the binding of specific transcription factors16 or may attract mediators of chromatin remodeling, such as histone-modifying enzymes or other repressors of gene expression.1720 In mammals, the mitotic inheritance of methylated DNA bases is primarily ensured by a maintenance of DNA methyltransferase (DNMT1),2123 whereas DNA methylation enzymes DNMT3A and DNMT3B are mainly responsible for de novo methylation of unmethylated sites.24 Various studies have shown that DNMT3A and DNMT3B target different sites for methylation depending on the cell type and the stage of development.6,25,26 De novo methyltransferases may be directly targeted to specific DNA sequences, may necessitate the interaction with other DNA binding proteins or may be guided by RNA interference (RNAi) in a process called RNA-directed DNA methylation (RdDM).27

Besides covalent modifications of DNA, histones and their posttranslational modifications have also been implicated in the organization of chromatin structure and regulation of gene transcription. Generally, histone classifications comprise the main histones or their variants H1, H2A, H2B, H3, and H4.2831 The fundamental building block of chromatin is the nucleosome and consists of DNA spooled around an octamer of histones. Each octamer contains two units of each principal or variant histone H2A, H2B, H3, and H4.32 Linker DNA connecting nucleosomes associates with the main form or variants of the linker histone H1. A variety of histone-modifying enzymes is responsible for a multiplicity of posttranslational modifications on specific serine, lysine, and arginine residues on the amino-terminal tail of these histones.33,34

The correlation of specific posttranslational modifications on the histones with transcriptional events has resulted in the histone code hypothesis.35 To date, the best characterized modifications are acetylations and methylations of lysine residues on histones H3 and H4. Although all acetylations of lysine residues on H3 and H4 have been associated with transcriptional activation (H3K9, H3K14, H3K18, H3K23, H4K5, H4K8, H4K12, and H4K16),3641 methylation of lysine residues may be either associated with transcriptional repression (H3K9, H3K27, and H4K20) or activation (H3K4, H3K36, and H3K79) depending on which amino acid and to what extent (monomethylation, dimethylation, or trimethylation) the residue is modi-fied.41 Although not as well documented, it has become clear that posttranslational modifications of other histones also have an important role in chromatin structure and gene regulation. Indeed, more recently it has been reported that mutations on specific sites of histones H2A and H2B modify the transcription of various genes.42,43 Similarly, as for DNA methylation enzymes, histone-modifying enzymes may be targeted to specific DNA sequences directly19,20 or may necessitate the interaction of intermediates such as Polycomb and Trithorax group proteins and/or RNAi.4447 In contrast to DNA methylation, it is unclear how and if histone modifications are correctly replicated during mitosis. Although a few investigators have claimed that histone complexes are distributed semiconservatively over the replicated genome,48 most researchers have refuted this manner of histone deposition.49 As a result, it should be questioned whether covalent histone modifications and histone variants are epigenetic marks according to the current definition of epigenetics.

During evolution, an alteration or acquisition of a sex-determining gene on one copy of a pair of chromosomes has resulted in the emergence of sex chromosomes. Consequently, the sexes are generally determined by the presence of a hetero- or homomorphic pair of allosomes. With time, as a result of reduced recombination events between these heteromorphic chromosomes, vastly dissimilar sex chromosomes have arisen. This dissimilarity between the allosomes is at the origin of a gene dosage inequality between the two different sexes.50 To remediate to this imbalance, many species have adopted gene dosage compensation mechanisms. The epigenetic gene dosage compensation mechanisms of genes located on the sex chromosomes vary with species, from simple transcriptional modulation to the entire silencing of one allosome.51 Although it is generally accepted that therian mammals (placentals and marsupials) equalize X-chromosome gene dosage between the sexes by inactivating one X chromosome in females, it has also been suggested that transcription from the active X chromosome is upregulated to maintain balance between autosomal and allosomal gene expression.52 Initially, the observation that female mice heterozygous for X-chromosome-linked coat color genes displayed a mosaic phenotype led to Mary Lyons hypothesis that either the paternally or maternally derived X chromosome could be inactivated in female animals.53 Later investigations revealed that this pattern of X-chromosome inactivation may differ depending on the species and the developmental status of the conceptus. Indeed, female offspring from placentals always possess a mixture of cells with an inactive X chromosome from either maternal or paternal origin, whereas marsupial offspring only present inactive X chromosomes from paternal origin.54,55 In addition, though random X-chromosome inactivation is reported in embryonic lineages from mouse postimplantation embryos, the paternally inherited X-chromosome is always preferentially silenced in preimplantation embryos56 and the resulting extraembryonic lineages.57 This latter form of X-chromosome inactivation is commonly referred to as imprinted X-chromosome inactivation. Although the ultimate outcome of both random and imprinted X-chromosome inactivation is the silencing of one X chromosome, studies suggest that the maintenance of epigenetic marks on the inactive X chromosome is markedly determined by whether the X chromosome underwent random or imprinted inactivation. Indeed, the silencing of imprinted inactive X chromosomes mainly depends on histone modifications applied by Polycomb proteins rather than DNA methylation, whereas DNA methylation is a crucial factor for the maintenance of the inactive state of randomly inactivated X chromosomes.58,59 To date no conclusive evidence exists for imprinted X-chromosome inactivation in human conceptuses.50

To permit random X-chromosome inactivation in the embryonic lineage of mice, a reactivation of the initially silenced X chromosome is necessary. Random X-chromosome inactivation is controlled by a region on the X chromosome called the X inactivation center (XIC). The XIC possesses the genes Xist and Tsix, which contain noncoding RNAs that are crucial for inactivating and maintaining activity of specific X chromosomes. Indeed, transcription of Xist on the inactive X chromosome mediates its silencing, whereas Tsix transcription from the active X chromosome prevents its inactivation.60 Although it remains unknown how X chromosomes are randomly selected for activity or inactivity, three mechanisms have been proposed for the selective silencing of the paternally derived X chromosome during early fetal development. Conceptually, the paternal X chromosome can enter the oocyte in a preinactivated condition or may be selectively silenced after fertilization.51 Meiotic sex chromosome inactivation (MSCI) during spermatogenesis supports the view that the paternal X chromosome can be inherited in an inactive state.61 However, it has also been claimed that MSCI is not crucial for imprinted X-chromosome inactivation because autosomes that do not undergo MSCI, but present Xist transgenes, are also preferentially silenced when paternally inherited.62 In opposition to the inheritance of a preinactivated X chromosome, the differential remodeling of the paternal and maternal chromatin and/or the translation of specific parental imprints on the X chromosomes after fertilization may be at the origin of the initial selective inactivation of the paternal X chromosome in female embryos. Indeed, Xist transcription may be instigated on the paternally derived X-chromosome as a result of the exchange of protamines in the paternal pronucleus with histone variants favoring transcription.63 Alternatively, imprinted X-chromosome inactivation has also been shown to be dependent on various differential epigenetic imprints on Xist and Tsix genes acquired during male and female germ cell development.64,65 In brief, X-chromosome inactivation in mammals has originated to compensate a gene dosage inequality between the two different sexes. Because of its necessity, the establishment and maintenance of X-chromosome inactivation seems to be controlled by a variety of redundant epigenetic marks and mechanisms.

Pronuclear transfer experiments in the early 1980s revealed that mammalian reproduction necessitates the contribution of a paternal and maternal genome to be successful.66,67 The preferential mono-allelic expression of specific genes from either the maternal or paternal allele was believed to be at the origin of this phenomenon. The first imprinted genes in mammals were identified in the early 1990s.6870 Genomic imprinting has been observed in angiosperms and mammals and would have independently evolved in these two taxa as a result of selective pressure on specific genes.71 Although many genes remain imprinted throughout the entire life of an organism, some genes are imprinted in a tissue-specific or temporal manner, similarly to the Xist gene. Imprinted genes are organized in clusters or domains, and their expression is under control of a cis-acting imprinting control element (ICE).72 Similarly to the XIC region on the X chromosome, ICE elements on autosomes acquire differential imprints during germ cell development, depending on their parental origin. Like X-chromosome imprints, autosomal imprints in female mammals are established during folliculogenesis, whereas imprints in males are reset during fetal development.7378 The fact that the imprinted inactivation of the paternal X chromosome and autosomal genes present many molecular similarities has led to the hypothesis that these phenomena have coevolved.79

Although the maintenance, as well as the erasure, of acquired epigenetic marks between generations has both beneficial and deleterious effects, it is unknown to what extent epigenetic marks are maintained or erased between generations in mammals. Because primordial germ cells are set aside during mammalian fetal development and because of epigenetic reprogramming events during germ cell development and early embryogenesis, acquired epigenetic states are believed to be rarely passed on to progeny.80 The erasure of epigenetic marks occurs in female and male mammals during primordial germ cell development and early embryogenesis, whereas the acquisition of epigenetic marks takes place at different times during female and male gametogenesis. Indeed, epigenetic marks in female germ cells are established during folliculogenesis, whereas male germ cells acquire their epigenetic marks during fetal development.7378 The fact that imprints are maintained during early embryogenesis highlights that some sequences may escape reprogramming events. Stella is among a group of proteins that may play an important role in the suppression of epigenetic reprogramming of these specific sequences.81 The failure to erase epigenetic marks during primordial germ cell development or subsequent early embryogenesis is at the origin of transgenerational inheritance of epigenetic traits. A clear example of a gene susceptible to transgenerational inheritance is the Agouti viable yellow (Avy) allele in mice.82 The variable epigenetic status of an intracisternal A particle element (IAP) located upstream from the coding region of Avy in mice is responsible for the variable expression of this allele in adult mice. As a result of incomplete erasure of epigenetic marks on IAPs, this variable expression is often transgenerationally inherited by offspring.82 Evidence suggests that many IAPs fail to undergo epigenetic reprogramming during germ cell development.83 The high incidence of IAPs in mammalian genomes has consequently led to the belief that this type of transgenerational inheritance may be more prevalent than initially conceived.

Given the extent of epigenetic reprogramming that occurs during gametogenesis and embryogenesis and the vulnerability of the process, it is not difficult to understand how alteration in reprogramming could be of clinical relevance. Because epigenetic reprogramming occurs during folliculogenesis and embryogenesis, any disturbance of the normal natural environment during these critical phases could cause epigenetic alterations. Accordingly, researchers have attempted to determine whether children conceived using assistive reproductive technology (ART) carry epigenetic reprogramming defects. A review of an association of ART and epigenetic alterations is covered in detail in articles later in this issue. Importantly, although the whole genome is reprogrammed during germ cell development and embryogenesis, it should be noted that to date only a limited number of loci have been investigated. These loci generally comprise genes in which their epigenetic status significantly affects a perceptible phenotype. Although a specific clinical phenotype has not yet been associated with an epigenetic change, it is it possible that pathology may emerge from a not yet recognized epigenetic alteration.84 An excess of epigenetic alterations could have an immediate impact that precipitates pre- or postnatal death.

At the other extreme, an epigenetic change might result in a perceptible alteration later in life such as cancer, coronary heart disease, stroke, or diabetes. An increased risk of heart disease, stroke, and diabetes is associated with malnutrition in utero and low birth-weight.85 Again, the role of nutrition and diet during pregnancy is covered in detail in ensuing articles in this issue, but it must be considered whether children of ART with a low birthweight could have a predisposition for these chronic phenotypes. Concerns have also been raised about the epigenetic status of tumor suppressors or fertility concerns in individuals exposed to environmental toxins. Subsequent articles address this issue in greater depth as well, but there is sufficient evidence in animals to warrant concern.

In conclusion, there is reason to suspect that early development is vulnerable to unwanted changes in epigenetic inheritance. Animal studies have shown that epigenetic reprogramming is a fragile process that is easily modified,8691 and such data provide compelling biologic plausibility for clinical concern. Although animal models may provide some information, the results may not always be representative of the epigenetic events that occur in humans. Because of the potential for adverse health effects in offspring conceived using ART and in children born from altered nutritional states in pregnancy or exposed to environmental toxins, further research is needed.

This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS (1R03HD046553, 1R21RR021881, and RO1HD045966, and the Reproductive Biology and Medicine Branch, NICHD).

Epigenetics in Reproduction; Guest Editors, James H. Segars, Jr., M.D., and Kjersti M. Aagaard-Tillery, M.D., Ph.D.

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Epigenetics: Definition, Mechanisms and Clinical Perspective

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Diabetes | Sutter Health

Posted: November 24, 2022 at 12:43 am

At Palo Alto Medical Foundation, our teams will work with you to personalize your diabetes care and prevent complications. We strive to understand your life goals and health history to develop a treatment plan based on your unique needs. We serve people with Type 1 diabetes, Type 2 diabetes, gestational diabetes and prediabetes.

Type 1 diabetes and Type 2 diabetes share a similar name, but they are very different conditions. Prediabetes is a term used to indicate a higher than normal level of blood sugar, but not high enough to meet the diagnosis of diabetes. Without treatment (diet, exercise, weight management and medications for some), prediabetes can lead to Type 2 diabetes, heart disease and stroke.

You dont have to face diabetes alone. PAMFs network of primary care doctors, specialist nurses and dietitians, and diabetes educators provide support, information and tools to help you feel confident in managing your diabetes and taking steps for better health.

We offer a wide range of diabetes-specific programs and services, including:

We also provide special services for pregnant women who develop gestational diabetes, ensuring mom and baby stay healthy throughout pregnancy and after birth.

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Effect of diet on type 2 diabetes mellitus: A review – PMC

Posted: November 24, 2022 at 12:43 am

Int J Health Sci (Qassim). 2017 Apr-Jun; 11(2): 6571.

1Faculty of Industrial Management, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia

2Department of Public Health & Community Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

3Department of Family Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

4Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

1Faculty of Industrial Management, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia

1Faculty of Industrial Management, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia

2Department of Public Health & Community Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

3Department of Family Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

4Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Globally, type 2 diabetes mellitus (T2DM) is considered as one of the most common diseases. The etiology of T2DM is complex and is associated with irreversible risk factors such as age, genetic, race, and ethnicity and reversible factors such as diet, physical activity and smoking. The objectives of this review are to examine various studies to explore relationship of T2DM with different dietary habits/patterns and practices and its complications. Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease. The stakeholders (health-care providers, health facilities, agencies involved in diabetes care, etc.) should encourage patients to understand the importance of diet which may help in disease management, appropriate self-care and better quality of life.

Keywords: Type 2 diabetes mellitus, diet, knowledge, attitude, practices, complications

Diabetes mellitus (DM) was first recognized as a disease around 3000 years ago by the ancient Egyptians and Indians, illustrating some clinical features very similar to what we now know as diabetes.1 DM is a combination of two words, diabetes Greek word derivative, means siphon - to pass through and the Latin word mellitus means honeyed or sweet. In 1776, excess sugar in blood and urine was first confirmed in Great Britain.2,3 With the passage of time, a widespread knowledge of diabetes along with detailed etiology and pathogenesis has been achieved. DM is defined as a metabolic disorder characterized by hyperglycemia resulting from either the deficiency in insulin secretion or the action of insulin. The poorly controlled DM can lead to damage various organs, especially the eyes, kidney, nerves, and cardiovascular system.4 DM can be of three major types, based on etiology and clinical features. These are DM type 1 (T1DM), DM type 2 (T2DM), and gestational DM (GDM). In T1DM, there is absolute insulin deficiency due to the destruction of cells in the pancreas by a cellular mediated autoimmune process. In T2DM, there is insulin resistance and relative insulin deficiency. GDM is any degree of glucose intolerance that is recognized during pregnancy. DM can arise from other diseases or due to drugs such as genetic syndromes, surgery, malnutrition, infections, and corticosteroids intake.5-7

T2DM factors which can be irreversible such as age, genetic, race, and ethnicity or revisable such as diet, physical activity and smoking.8, 9

Globally, T2DM is at present one of the most common diseases and its levels are progressively on the rise. It has been evaluated that around 366 million people worldwide or 8.3% in the age group of 20-79 years had T2DM in 2011. This figure is expected to rise to 552 million (9.9%) by 2030.10 This disease is associated with severe complications which affect patients health, productivity, and quality of life. More than 50% of people with diabetes die of cardiovascular disease (CVD) (primarily heart disease and stroke) and is a sole cause of end stage renal disease which requires either dialysis or kidney transplantation. It is also a major cause of blindness due to retinal damage in adult age group referred to as diabetic retinopathy (DR). People with T2DM have an increased risk of lower limb amputation that may be 25 times greater than those without the disease. This disease caused around 4.6 million deaths in the age-group of 20-79 years in 2011.11

A large number of cross-sectional as well as prospective and retrospective studies have found significant association between physical inactivity and T2DM.12 A prospective study was carried out among more than thousand nondiabetic individuals from the high-risk population of Pima Indians. During an average follow-up period of 6-year, it was found that the diabetes incidence rate remained higher in less active men and women from all BMI groups.13 The existing evidence suggests a number of possible biological pathways for the protective effect of physical activity on the development of T2DM. First, it has been suggested that physical activity increases sensitivity to insulin. In a comprehensive report published by Health and Human Services, USA, 2015 reported that physical activity enormously improved abnormal glucose tolerance when caused by insulin resistance primarily than when it was caused by deficient amounts of circulating insulin.14 Second, physical activity is likely to be most beneficial in preventing the progression of T2DM during the initial stages, before insulin therapy is required. The protective mechanism of physical activity appears to have a synergistic effect with insulin. During a single prolonged session of physical activity, contracting skeletal muscle enhances glucose uptake into the cells. This effect increases blood flow in the muscle and enhances glucose transport into the muscle cell.15 Third, physical activity has also been found to reduce intra-abdominal fat, which is a known risk factor for insulin resistance. In certain other studies, physical activity has been inversely associated with intra-abdominal fat distribution and can reduce body fat stores.16 Lifestyle and environmental factors are reported to be the main causes of extreme increase in the incidence of T2DM.17

Among the patients, diabetes awareness and management are still the major challenges faced by stakeholders worldwide. Poor knowledge related to diabetes is reported in many studies from the developing countries.18 Some studies have suggested that the occurrence of diabetes is different in various ethnic groups.19 Knowledge is a requirement to achieve better compliance with medical therapy.20 According to a study conducted by Mohammadi21 patients knowledge and self-care management regarding DM was not sufficient. Low awareness of DM affects the outcome of diabetes. Another study conducted in Slovakia by Magurov22 compared two groups of patients (those who received diabetes education and those who did not). The results indicated that receiving diabetes education significantly increased awareness about the disease in patients (p < 0.001). The study further concluded that having diabetes knowledge can notably improve patients quality of life and lessen the burden on their family. Dussa23 conducted a cross-sectional study on assessment of diabetes awareness in India. The study concluded that level of diabetes awareness among patients and general population was low. Another study conducted in India by Shah24 reported that 63% of T2DM patients did not know what DM is and the majority were also unaware about its complications.

According to the study conducted by Bani25 in Saudi Arabia, majority of the patients 97.3% males and 93.1% females were unaware about the importance of monitoring diabetes, with no significant gender difference. Diabetes knowledge, attitude, and practice were also studied in Qatari type 2 diabetics. The patients knowledge regarding diabetes was very poor, and their knowledge regarding the effect of diabetes on feet was also not appreciable.26 Results from a study conducted in Najran, Saudi Arabia27 reported that almost half of the patients did not have adequate knowledge regarding diabetes disease. Males in this study had more knowledge regarding diabetes than female patients. Diabetes knowledge among self-reported diabetic female teachers was studied in Al-Khobar, Saudi Arabia.28 The study concluded that diabetes knowledge among diabetic female teachers was very poor. It was further suggested that awareness and education about diabetes should be urgently given to sample patients. The knowledge of diabetes provides the information about eating attitude, workout, weight monitoring, blood glucose levels, and use of medication, eye care, foot care, and control of diabetes complications.29

The role of diet in the etiology of T2DM was proposed by Indians as mentioned earlier, who observed that the disease was almost confined to rich people who consumed oil, flour, and sugar in excessive amounts.30 During the First and Second World Wars, declines in the diabetes mortality rates were documented due to food shortage and famines in the involved countries such as Germany and other European countries. In Berlin, diabetes mortality rate declined from 23.1/100,000 in 1914 to 10.9 in 1919. In contrast, there was no change in diabetes mortality rate in other countries with no shortage of food at the same time period such as Japan and North American countries.31 Whereas few studies have found strong association of T2DM with high intake of carbohydrates and fats. Many studies have reported a positive association between high intake of sugars and development of T2DM.32 In a study, Ludwig33 investigated more than 500 ethnically diverse schoolchildren for 19 months. It was found that for each additional serving of carbonated drinks consumed, frequency of obesity increased, after adjusting for different parameters such as dietary, demographic, anthropometric, and lifestyle.

A study was conducted which included the diabetic patients with differing degrees of glycemic control. There were no differences in the mean daily plasma glucose levels or diurnal glucose profiles. As with carbohydrates, the association between dietary fats and T2DM was also inconsistent.34 Many of prospective studies have found relations between fat intake and subsequent risk of developing T2DM. In a diabetes study, conducted at San Louis Valley, a more than thousand subjects without a prior diagnosis of diabetes were prospectively investigated for 4 years. In that study, the researchers found an association between fat intake, T2DM and impaired glucose tolerance.35,36 Another study observed the relationship of the various diet components among two groups of women, including fat, fiber plus sucrose, and the risk of T2DM. After adjustment, no associations were found between intakes of fat, sucrose, carbohydrate or fiber and risk of diabetes in both groups.37

Recently, evidence suggested a link between the intake of soft drinks with obesity and diabetes, resulting from large amounts of high fructose corn syrup used in the manufacturing of soft drinks, which raises blood glucose levels and BMI to the dangerous levels.38 It was also stated by Assy39 that diet soft drinks contain glycated chemicals that markedly augment insulin resistance. Food intake has been strongly linked with obesity, not only related to the volume of food but also in terms of the composition and quality of diet.40 High intake of red meat, sweets and fried foods, contribute to the increased the risk of insulin resistance and T2DM.41 In contrast, an inverse correlation was observed between intake of vegetables and T2DM. Consumption of fruits and vegetables may protect the development of T2DM, as they are rich in nutrients, fiber and antioxidants which are considered as protective barrier against the diseases.42 Recently, in Japanese women, a report revealed that elevated intake of white rice was associated with an increased risk of T2DM.43 This demands an urgent need for changing lifestyle among general population and further increase the awareness of healthy diet patterns in all groups.

American Diabetes Association has defined self-dietary management as the key step in providing the diabetics, the knowledge and skill in relation with treatment, nutritional aspects, medications and complications. A study showed that the dietary knowledge of the targeted group who were at high risk of developing T2DM was poor. Red meat and fried food were consumed more by males as compared to females. The percent of males to females in daily rice consumption was significantly high.44

In recent times in Saudi Arabia, food choices, size of portions and sedentary lifestyle have increased dramatically that resulted in high risk of obesity. Unfortunately, many Saudis are becoming more obese because of the convenience of fast foods, and this adds to the scary diabetes statistics.45 On the other hand, Saudis drink too many high-sugar drinks. In addition, Backman46 reported dietary knowledge to be a significant factor that influences dietary behaviors. In another study conducted by Savoca and Miller47 stated that patients food selection and dietary behaviors may be influenced by the strong knowledge about diabetic diet recommendations. Significant positive relationship was observed between knowledge regarding diabetic diet and the amount of calorie needs (r = 0.27, p < 0.05).48 The study concluded that knowledge regarding diabetic diet is essential and is needed to achieve better dietary behaviors. Results of study conducted in Saudi Arabia25 reported that more than half of the diabetic patients denied modifying their dietary pattern, reduction in weight and perform exercise.

National Center for Health Statistics reported that socioeconomic status plays an important role in the development of T2DM; where it was known as a disease of the rich.49 On the contrary, the same reference reported that T2DM was more prevalent in lower income level and in those with less education. The differences may be due to the type of food consumed. Nutritionists advised that nutrition is very important in managing diabetes, not only type but also quantity of food which influences blood sugar. Meals should be consumed at regular times with low fat and high fiber contents including a limited amount of carbohydrates. It was observed that daily consumption of protein, fat and energy intake by Saudi residents were higher than what is recommended by the International Nutritional Organization.50

DM can be controlled through improvement in patients dietary knowledge, attitudes, and practices. These factors are considered as an integral part of comprehensive diabetes care.51 Although the prevalence of DM is high in gulf countries, patients are still deficient in understanding the importance of diet in diabetes management.52 Studies have shown that assessing patients dietary attitude may have a considerable benefit toward treatment compliance and decrease the occurrence rate of complications as well.52 A study conducted in Egypt reported that the attitude of the patients toward food, compliance to treatment, food control with and without drug use and foot care was inadequate.53 Another study presented that one-third of the diabetic patients were aware about the importance of diet planning, and limiting cholesterol intake to prevent CVD. Various studies have documented increased prevalence of eating disorders and eating disorder symptoms in T2DM patients. Most of these studies have discussed about the binge eating disorder, due to its strong correlation with obesity, a condition that leads to T2DM.53 Furthermore, a study revealed that the weight gain among diabetic patients was associated with the eating disorder due to psychological distress.54 In another study that examined eating disorder-related symptoms in T2DM patients, suggested that the dieting-bingeing sequence can be applied to diabetics, especially obese diabetic patients.55 Unhealthy eating habits and physical inactivity are the leading causes of diabetes. Failure to follow a strict diet plan and workout, along with prescribed medication are leading causes of complications among patients of T2DM.56 Previous studies57 conducted in Saudi Arabia have reported that diabetic patients do not regard the advice given by their physicians regularly regarding diet planning, diet modification and exercise.

Diabetics dietary practices are mainly influenced by cultural backgrounds. Concerning each of the dimensions of dietary practices, there were significant positive relationships between knowledge regarding diabetic diet and dietary practices. Knowledge was a salient factor related to dietary behaviors control.46 Moreover, patients knowledge on a recommended diet indicates their understanding of dietary guidelines which influenced their food selection and eating patterns.47 The association between dietary knowledge and dietary practices among T2DM patients in the previous studies were inconsistent. Another study revealed that there was no relationship between dietary knowledge and compliance of dietary practices.58 On the other hand, the same study found that a high dietary knowledge score was associated with following dietary recommendations and knowledgeable patients performed self-management activities in a better way. Dietary knowledge significantly influences dietary practices. In Indonesia, a study was conducted to measure dietary practices among diabetic patients, which elaborated that the Indonesian people, preferred to consume high-fat foods which lead to an increased risk of CVD.59 The trend of skipping breakfast has dramatically increased over the past 10 years in children, adolescents, and adults.60,61 There is increasing evidence that skipping breakfast is related with overweight and other health issues.62 In addition, frequent eating or snacking may also increase the body weight and risk of metabolic diseases.63,64 Rimm65 demarcated western and prudent dietary patterns. The prudent dietary pattern was characterized by increased consumption of fish, poultry, various vegetables and fruits whereas; the western dietary pattern was characterized by an increased consumption of processed and red meat, chips, dairy products, refined grains, and sweets and desserts. These patterns were previously associated with T2DM risk. The glycemic index is an indicator of the postprandial blood glucose response to food per gram of carbohydrate compared with a reference food such as white bread or glucose. Hence, the glycemic load represents both the quality and quantity of the carbohydrates consumed.66-69 Another study conducted in Lebanon demonstrated direct correlation of the refined grains and desserts and fast food patterns with T2DM, however, in the same study an inverse correlation was observed between the traditional food pattern and T2DM among Lebanese adults.70

DM is the fourth among the leading causes of global deaths due to complications. Annually, more than three million people die because of diabetes or its complications. Worldwide, this disease weighs down on health systems and also on patients and their families who have to face too much financial, social and emotional strains. Diabetic patients have an increased risk of developing complications such as stroke, myocardial infarction, and coronary artery disease. However, complications such as retinopathy, nephropathy, and neuropathy can have a distressing impact on patients quality of life and a significant increase in financial burden. The prevalence reported from studies conducted worldwide on the complications of T2DM showed varying rates. The prevalence of cataracts was 26-62%, retinopathy 17-50%, blindness 3%, nephropathy 17-28%, cardiovascular complications 10-22.5%, stroke 6-12%, neuropathy 19-42%, and foot problems 5-23%. Mortality from all causes was reported between 14% and 40%.71 In a study, researchers found that 15.8% incidence of DR is in the developing countries. The prevalence of DR reported from Saudi Arabia, Sri Lanka, and Brazil was 30%, 31.3%, and 35.4%, respectively; while in Kashmir it was 27% and in South Africa it was 40%. The prevalence of DR 26.1% was observed among 3000 diabetic patients from Pakistan; it was significantly higher than that what was reported in India (18%) and in Malaysia (14.9%).72-76 Studies conducted on diabetes complications in Saudi Arabia are very few and restricted. A 1992 study from Saudi Arabia showed that in T2DM patients; occurrence rate of cataract was 42.7%, neuropathy in 35.9% patients, retinopathy in 31.5% patients, hypertension in 25% patients, nephropathy in 17.8% patients, ischemic heart disease in 41.3% patients, stroke in 9.4% patients, and foot infections in 10.4% of the patients. However, this study reported complications for both types of diabetes.77

Interventional studies showed that high carbohydrate and high monounsaturated fat diets improve insulin sensitivity, whereas glucose disposal dietary measures comprise the first line intervention for control of dyslipidemia in diabetic patients.78 Several dietary interventional studies recommended nutrition therapy and lifestyle changes as the initial treatment for dyslipidemia.79,80 Metabolic control can be considered as the cornerstone in diabetes management and its complications. Acquiring HbA1c target minimizes the risk for developing microvascular complications and may also protect CVD, particularly in newly diagnosed patients.81 Carbohydrate intake has a direct effect on postprandial glucose levels in people with diabetes and is the principal macronutrient of worry in glycemic management.82 In addition, an individuals food choices and energy balance have an effect on body weight, blood pressure, and lipid levels directly. Through the mutual efforts, health-care professionals can help their patients in achieving health goals by individualizing their nutrition interventions and continuing the support for changes.83-85 A study suggested that intake of virgin olive oil diet in the Mediterranean area has a beneficial effect on the reduction of progression of T2DM retinopathy.86 Dietary habits are essential elements of individual cardiovascular and metabolic risk.87 Numerous health benefits have been observed to the Mediterranean diet over the last decades, which contains abundant intake of fruit and vegetables. The beneficial effects of using fish and olive oil have been reported to be associated with improved glucose metabolism and decreased risk of T2DM, obesity and CVD.88

The review of various studies suggests that T2DM patients require reinforcement of DM education including dietary management through stakeholders (health-care providers, health facilities, etc.) to encourage them to understand the disease management better, for more appropriate self-care and better quality of life. The overall purpose of treating T2DM is to help the patients from developing early end-organ complications which can be achieved through proper dietary management. The success of dietary management requires that the health professionals should have an orientation about the cultural beliefs, thoughts, family, and communal networks of the patients. As diabetes is a disease which continues for the lifetime, proper therapy methods with special emphasis on diet should be given by the healthcare providers in a way to control the disease, reduce the symptoms, and prevent the appearance of the complications. The patients should also have good knowledge about the disease and diet, for this purpose, the health-care providers must inform the patients to make changes in their nutritional habits and food preparations. Active and effective dietary education may prevent the onset of diabetes and its complications.

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Effect of diet on type 2 diabetes mellitus: A review - PMC

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Efficacy of Berberine in Patients with Type 2 Diabetes – PMC

Posted: November 24, 2022 at 12:43 am

Metabolism. Author manuscript; available in PMC 2009 May 1.

Published in final edited form as:

PMCID: PMC2410097

NIHMSID: NIHMS49995

aDepartment of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

bPennington Biomedical Research Center, Baton Rouge, Louisiana 70808, U.S.A.

aDepartment of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

aDepartment of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

aDepartment of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

bPennington Biomedical Research Center, Baton Rouge, Louisiana 70808, U.S.A.

Berberine has been shown to regulate glucose and lipid metabolism in vitro and in vivo. This pilot study was to determine the efficacy and safety of berberine in the treatment of type 2 diabetic patients. In study A, 36 adults with newly diagnosed type 2 diabetes were randomly assigned to treatment with berberine or metformin (0.5 g t.i.d.) in a 3-month trial. The hypoglycemic effect of berberine was similar to that of metformin. Significant decreases in hemoglobin A1c (HbA1c; from 9.5% 0.5% to 7.5% 0.4%, P<0.01), fasting blood glucose (FBG; from 10.6 0.9 mmol/L to 6.9 0.5 mmol/L, P<0.01), postprandial blood glucose (PBG; from 19.8 1.7 to 11.1 0.9 mmol/L, P<0.01) and plasma triglycerides (from 1.13 0.13 mmol/L to 0.89 0.03 mmol/L, P<0.05) were observed in the berberine group. In study B, 48 adults with poorly controlled type 2 diabetes were treated supplemented with berberine in a 3-month trial. Berberine acted by lowering FBG and PBG from one week to the end of the trial. HbA1c decreased from 8.1% 0.2% to 7.3% 0.3% (P<0.001). Fasting plasma insulin and HOMA-IR were reduced by 28.1% and 44.7% (P<0.001), respectively. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) were decreased significantly as well. During the trial, 20 (34.5%) patients suffered from transient gastrointestinal adverse effects. Functional liver or kidney damages were not observed for all patients. In conclusion, this pilot study indicates that berberine is a potent oral hypoglycemic agent with beneficial effects on lipid metabolism.

Type 2 diabetes is a worldwide health threat and treatment of this disease is limited by availability of effective medications. All of the existing oral hypoglycemic agents have subsequent failure after long term administration. Thus, new oral medications are needed for long-term control of blood glucose in patients with type 2 diabetes. Certain botanical products from generally regarded as safe (GRAS) plants have been widely used in diabetes care because of their anti-oxidation, anti-inflammation, anti-obesity and anti-hyperglycemia properties.[1, 2]. However, the drawback of using GRAS plants is the difficulty in control their quality as most of these botanical products are mixtures of multiple compounds. Compared to other products from GRAS plants, berberine is a single purified compound, and has glucose-lowering effect in vitro and in vivo [3-6].

Berberine (molecular formula C20H19NO5 and molecular weight of 353.36) is the main active component of an ancient Chinese herb Coptis chinensis French, which has been used to treat diabetes for thousands of years. Berberine is an Over-the-Counter (OTC) drug, which is used to treat gastrointestinal infections in China. Berberine hydrochloride (BHClnH2O) - the most popular form of berberine, is used in this pilot study. The chemical structure of Berberine and related isoquinoline alkaloids are quite different from the commonly used other hypoglycemic agents, such as sulphonylureas, biguanides, thiazolidinediones, or acarbose. Hence, if the efficacy and safety of berberine are confirmed, it can serve as a new class of anti-diabetic medication.

This pilot study was to assess the efficacy of berberine in human subjects with type 2 diabetes. Berberine was given to both newly diagnosed diabetic patients and poorly controlled diabetic patients alone or combination with other hypoglycemic agents for three months. HbA1c, blood glucose and HOMA index were used to determine the efficacy of berberine.

The subjects were recruited from diabetes outpatient department of Xinhua Hospital by advertising in the clinic. Ninety-seven Chinese volunteers were screened, and 13 subjects were excluded from the study due to failure to meet the recruitment criteria. Thus, 84 subjects (49 women and 35 men) with type 2 diabetes were included in the study. All participants received written and oral information regarding the natural and potential risks of the study and gave their informed consent. The experimental protocol was approved by the ethics committee of Xinhua Hospital. The monotherapy study was designed to compare berberine with metformin (study A, n = 36). The combination therapy was aimed at evaluating additive or synergistic effects of berberine on the classical anti-diabetic agents (study B, n = 48).

Major inclusion criteria were hemoglobin A1c (HbA1c) > 7.0% or fasting blood glucose (FBG) > 7.0 mmol/L, BMI > 22 kg/m2, age 25-75 years, and a negative pregnancy test for female patients. A total of 36 patients who were newly diagnosed for type 2 diabetes were assigned to study A. After a two-month phase during which the patients were treated with diet alone, they were randomly assigned to receive berberine or metformin. A total of 48 type 2 diabetic patients inadequately treated with diet plus sulfonylureas, metformin, acarbose or insulin therapy alone or with a combination were assigned to study B (). The dose of the medications was stable for at least 2 months before enrollment in the study and remained unchanged throughout the study. All participants were instructed to maintain their lifestyle habits during the course of the study.

Baseline characteristics of administration of hypoglycemic agents

Each study involved a 13-week treatment. For study A, 18 subjects took 500 mg berberine three times daily at the beginning of each major meal or 500 mg metformin three times daily after major meals. For study B, 500 mg berberine three times daily was added to their previous treatment for 3 months. If heavy gastrointestinal side-effects occurred, the dose of berberine was reduced to 300 mg three times daily.

Patients were evaluated weekly for the first 5 weeks of treatment and then every 4 weeks until the end of study. The primary efficacy end point was glycemic control as determined by HbA1c levels. Secondary efficacy parameters included changes in fasting blood glucose (FBG), postprandial blood glucose (PBG), plasma triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) concentrations. Adverse events were recorded throughout the study by direct questioning.

Blood glucose was determined by a glucose oxidase method (Roche, Basel, Switzerland). Serum insulin and C-peptide were determined by radioimmunoassay (Linco Research, St. Charles, MO). HbA1c was analyzed using the high-pressure liquid chromatography (BioRad, Hercules, CA). Plasma triglyceride, total cholesterol, HDL-C, LDL-C, alanine thansaminase (ALT), glutamyl transpeptidase (-GT) and creatinine concentrations were determined by enzymatic assays (Roche, Basel, Switzerland). The HOMA method was used to compare differences in the profiles for insulin resistance (HOMA-IR) and for -cell dysfunction (HOMA- cell) [7]. Ten insulin-treated subjects were excluded from the HOMA analysis.

HOMA-IR = fasting insulin (U/ml)fasting glucose (mmol/L)/22.5

HOMA- cell = [20 fasting insulin (U/ml)] / [fasting glucose (mmol/L) - 3.5]

Descriptive statistics and analysis were performed in SPSS 12.0 for Windows. In study A, the significance of the differences between means of metformin and berberine groups was analyzed by Wilcoxon Rank Sum Test. The statistical differences between baseline and endpoint were calculated using Wilcoxon signed rank test. In study B, the significance of the differences among different time points was analyzed by repeated measure ANOVA. The level was set at 0.05.

In study A, 36 patients were included and randomly assigned to metformin or berberine treatment. Three patients of the berberine group and two patients of the metformin group withdrew from the study because of treatment failure. In study B, 48 patients were included, and 5 subjects were excluded from the study before week 13. Among the five subjects, three failed to complete the study in lack of efficacy, one failed in lack of participation time, and one was excluded due to lack of compliance (pill count < 80%). Thus, 74 participants were eligible for the final analysis.

In newly-diagnosed diabetic patients, berberine reduced blood glucose and lipids (). There were significant decreases in HbA1c (by 2%; P < 0.01), FBG (by 3.8 mmol/L; P < 0.01) and PBG (by 8.8 mmol/L; P < 0.01) in the berberine group. The FBG (or PBG) declined progressively during the berberine treatment, reaching a nadir that was 3.7 mmol/L (or 8.7 mmol/L) below baseline by week 5, and remained at this level until the end of the study (). Triglycerides and total cholesterol decreased by 0.24 mmol/L (P < 0.05) and 0.57 mmol/L (P < 0.05) with berberine treatment. It seemed there was a declining trend of HDL-C and LDL-C; however, no significant differences between week 1 and week 13 were observed in the berberine group. Compared with metformin, berberine exhibited an identical effect in the regulation of glucose metabolism, such as HbA1c, FBG, PBG, fasting insulin and postprandial insulin. In the regulation of lipid metabolism, berberine activity is better than metformin. By week 13, triglycerides and total cholesterol in the berberine group had decreased and were significantly lower than in the metformin group (P<0.05).

Both berberine and metformin decreased FBG and PBG of type 2 diabetic patients significantly from week 1 to week 13. A, means SEM of 15 patients treated with berberine alone. B, means SEM of 16 patients treated with metformin alone. C, means SEM of 43 patients with combination-therapy including berberine.

Monotherapeutic effects of metformin and berberine

In the first 7 days of treatment, berberine led to a reduction in FBG from 9.6 2.7 mmol/L to 7.8 1.8 mmol/L (P<0.001; ) and in PBG from 14.8 4.1 mmol/L to 11.7 3.6 mmol/L (P<0.001). During the second week, FBG and PBG declined further, reached a nadir that was 2.1 mmol/L (7.5 2.1 mmol/L) and 3.3 mmol/L (10.5 2.5 mmol/L) below the baseline, respectively, and remained at this level thereafter.

In the combination-therapy for 5 weeks, berberine led to a reduction in HbA1c from 8.1% to 7.3% (P < 0.001; ). FBG and PBG declined remarkably, too (P < 0.001). Fasting insulin and HOMA-IR reduced by 29.0% (P < 0.01) and 46.7% (P < 0.001), respectively. Blood lipids including triglyceride, total cholesterol and LDL-C decreased and were significantly lower than baseline. In the absence of weight change, waist and waist/hip of the patients declined significantly. No significant changes in the criteria were observed between week 5 and week 13 except the increment of fasting C-peptide (P < 0.05) and postprandial C-peptide (P < 0.01). During the study, fasting C-peptide of the patients with insulin treatment went down then up and postprandial C-peptide increased by 70.5% (P<0.01) at 13 weeks.

Berberine in combination-therapy

Incidence of gastrointestinal adverse events was 34.5% during the 13 weeks of berberine treatment including monotherapy and combination-therapy. These events included diarrhea (n: 6; percentage: 10.3%), constipation (4; 6.9%), flatulence (11; 19.0%) and abdominal pain (2; 3.4%). The side effects were observed only in the first four weeks in most patients. In 14 (24.1%) patients, berberine dosage decreased from 0.5 g t.i.d. to 0.3 g t.i.d. as a consequence of gastrointestinal adverse events. Of the 14 patients, ten were treated with metformin or acarbose in combination with berberine. The rest were treated with insulin combined with berberine. None of the patients suffered from severe gastrointestinal adverse events when berberine was used alone. In combination-therapy, the adverse events disappeared in one week after reduction in berberine dosage. The data suggest that berberine at dosage of 0.3 g t.i.d. is well tolerated in combination-therapy.

Liver and kidney functions were monitored in this study. No significant changes of plasma ALT, -GT and creatinine were observed during the 13 weeks of berberine treatment (). None of the patients were observed with pronounced (more than 50%) elevation in liver enzymes or creatinine.

The hypoglycemic effect of berberine was reported in 1988 when it was used to treat diarrhea in diabetic patients in China [8]. Since then, berberine has often been used as an anti-hyperglycemic agent by many physicians in China. There are substantial numbers of clinical reports about the hypoglycemic action of berberine in Chinese literature. However, most of the previous studies were not well-controlled and experiments were not well-designed. Additionally, none of them used HbA1c as a parameter due to poor research conditions. Thus, the anti-diabetic effect of berberine needs to be carefully evaluated.

In this pilot study, berberine significantly decreased HbA1c levels in diabetic patients. The effect of decreasing HbA1c was comparable to that of metformin, a widely-used oral hypoglycemic agent [9, 10]. In monotherapy, berberine and metformin all improved glycemic parameters (HbA1c, FBG and PBG). But their effects on lipid metabolism were different. Berberine decreased serum triglyceride and total cholesterol significantly. HDL-C and LDL-C levels of patients treated with barbering were also reduced but the decreases did not reach statistic significance. Whether berberine has a lowering effect on HDL-C needs further investigation. Compared with berberine, metformin had little effects on these lipid parameters.

In combination with other agents, berberine exhibited consistent activities in improvement of glycemic and lipid parameters in diabetic patients. Insulin sensitivity was enhanced by berberine as the HOMA-IR value was reduced by nearly 50%. This effect may be related to fat distribution by berberine because waist and waist/hip of the patients were decreased significantly in the absence of weight change. Interestingly, both fasting and postprandial C-peptides increased significantly in patients when berberine was used together with insulin, which suggests that long-term berberine treatment may improve insulin secretion of the patients with consequent failure of oral hypoglycemic agents. The effects of berberine on islet function need further studies.

The mechanism of berberine on glucose metabolism is still under investigation. We and others have demonstrated that berberine has an insulin sensitizing effect in vivo and in vitro [3, 4, 5, 11, 12]. In diet-induced obese rats, berberine reduced insulin resistance, similar to metformin [13, 6]. In hepatocytes, adipocytes and myotubes, berberine increased glucose consumption and/or glucose uptake in the absence of insulin [3, 6, 14]. Berberine enhancing glucose metabolism may be due to stimulation of glycolysis, which is related to inhibition of oxidation in mitochondria [6]. Berberine may also act as an alpha-glucosidase inhibitor. It inhibited disaccharidases activities and decreased glucose transportation cross the intestinal epithelium [15, 16]. This may contribute to the adverse gastrointestinal effects of berberine in some patients. This side effect was often observed when berberine was used in combination with metformin or acarbose, which also have similar gastrointestinal side effects by themselves. Thus, when combined with these two agents, the dosage of berberine should be reduced to 0.3 g t.i.d. to avoid the severe flatulence or diarrhea.

Berberine is proposed to have potential as a therapeutic agent for lipid lowering. In this pilot study, berberine reduced serum cholesterol, triglycerides and LDL-C. This activity is similar to that reported elsewhere in vivo [17, 18]. However, further studies including outcome studies in humans are needed to confirm this activity and its benefit. The mechanism of berberine regulating lipid metabolism has been investigated by several groups. In hamsters with hyperlipidemia, berberine reduced serum cholesterol and LDL-C, and increased LDL receptor mRNA as well as protein in the liver [19]. These effects were partly due to stabilization of LDL receptor mRNA mediated by the ERK signaling pathway [20]. In addition to up-regulation of the LDL receptor, berberine was reported to inhibit lipid synthesis in human hepatocytes through activation of AMPK [21].

In summary, that berberine is a potent oral hypoglycemic agent with modest effect on lipid metabolism. It is safe and the cost of treatment by berberine is very low. It may serve as a new drug candidate in the treatment of type 2 diabetes. However, this is a pilot study. The efficacy of berberine needs to be tested in a much larger population and characterized as a function of the known duration of the diabetes. Further studies are needed to evaluate the action of berberine on type 2 diabetes in other ethnic groups.

Financial support for this study was provided by Xinhua Hospital. This study is partially supported by NIH grant (P50 AT02776-020002) to J Ye.

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First Drug to Delay Type 1 Diabetes Approved by FDA – Smithsonian Magazine

Posted: November 24, 2022 at 12:43 am

  1. First Drug to Delay Type 1 Diabetes Approved by FDA  Smithsonian Magazine
  2. FDA approves first treatment to delay onset of type 1 diabetes  CNN
  3. FDA Approves a Drug That Can Delay Type 1 Diabetes  The New York Times
  4. FDA Approves First Drug That Can Delay Onset of Type 1 Diabetes  FDA.gov
  5. FDA Approves First Drug to Delay Onset of Type 1 Diabetes  Laboratory Equipment
  6. View Full Coverage on Google News

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First Drug to Delay Type 1 Diabetes Approved by FDA - Smithsonian Magazine

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Transhumanism: advances in technology could already put evolution into …

Posted: November 24, 2022 at 12:39 am

Biological evolution takes place over generations. But imagine if it could be expedited beyond the incremental change envisaged by Darwin to a matter of individual experience. Such things are dreamt of by so-called transhumanists. Transhumanism has come to connote different things to different people, from a belief system to a cultural movement, a field of study to a technological fantasy. You cant get a degree in transhumanism, but you can subscribe to it, invest in it, research its actors, and act on its tenets.

So what is it? The term transhumanism gained widespread currency in 1990, following its formal inauguration by Max More, the CEO of Alcor Life Extension Foundation. It refers to an optimistic belief in the enhancement of the human condition through technology in all its forms. Its advocates believe in fundamentally enhancing the human condition through applied reason and a corporeal embrace of new technologies.

It is rooted in the belief that humans can and will be enhanced by the genetic engineering and information technology of today, as well as anticipated advances, such as bioengineering, artificial intelligence, and molecular nanotechnology. The result is an iteration of Homo sapiens enhanced or augmented, but still fundamentally human.

The central premise of transhumanism, then, is that biological evolution will eventually be overtaken by advances in genetic, wearable and implantable technologies that artificially expedite the evolutionary process. This was the kernel of Mores founding definition in 1990. Article two of the periodically updated, multi-authored transhumanist declaration continues to assert the point: We favor morphological freedom the right to modify and enhance ones body, cognition and emotions.

To date, areas to improve on include natural ageing (including, for die-hards, the cessation of involuntary death) as well as physical, intellectual and psychological capacities. Some distinguished scientists, such as Hans Moravec and Raymond Kurzweil, even advocate a posthuman condition: the end of humanitys reliance on our congenital bodies by transforming our frail version 1.0 human bodies into their far more durable and capable version 2.0 counterparts.

The push back against such unchecked optimism is emphatic. Some find the rhetoric distasteful in its assumptions about the desire for a prosthetic future.

And potential ethical problems, in particular, are raised. Tattoos, piercings and cosmetic surgery remain a matter of individual choice, and amputations a matter of medical necessity. But if augmented sensory capacity, for instance, were to become normative in a particular field, it might coerce others to make similar changes to their bodies in order to compete. As Isaiah Berlin once put it: Freedom for the wolves has often meant death to the sheep.

In order to really get to grips with the meaning of all this, though, an example is needed. Take the hypothetical augmentation of human hearing, something I am researching within a broader project on sound and materialism. Within discussions of transhumanism, ears are not typically among the sense organs figured for enhancement.

But human hearing is already being augmented. Algorithms for transposing auditory frequencies already exist (common to most speech processors in cochlear implants and hearing aids). Research into the regeneration of cilia hairs in the cochlear duct is also ongoing. Following this logic, augmenting unimpaired hearing need be no different, in principle, to correcting impaired hearing.

What next? Acoustic sound vibrations sit alongside the vast, inaudible electromagnetic spectrum, and various animals access different portions of this acoustic space, portions to which we as humans have no access. Could this change?

If it does, this may well alter the identity of sound itself. Speculations as to whether what is visible as light might under other circumstances be perceivable as sound have arisen at various points over the past two centuries. This raises heady questions about the very definition of sound. Must it be perceived by a human ear to constitute sound? By a sentient animal? Can a machine hear sufficiently to define sound beyond the human auditory range? What about aesthetics? Aesthetics itself as the (human) study of the beautiful may no longer even be applicable.

The technologies for broaching such questions are arguably already at hand. Examples of auditory sense augmentation (broadly conceived) include Norbert Wieners so-called hearing glove, which stimulated the finger of a deaf person with electromagnetic vibrations; an implanted colour sensor that for its colour-blind recipient, Neil Harbisson converts the colour spectrum into sounds, including ultraviolet and infrared signals; and a cochlear implant that streams sounds wirelessly from Apples mass market devices directly to the auditory nerve of its recipients.

The discussion is not entirely hypothetical, in other words. So what does all this mean?

There is a famous scene in the film The Matrix in which Morpheus asks Neo whether he wants to take the blue pill or the red pill. One returns him unawares to his life of total physical and mental enslavement within the simulation programme of the Matrix, the other gives him access to the real world with all its brutal challenges. But after experiencing this, he can never go back to life within the Matrix, and must survive outside it.

Advocates of transhumanism face a similar choice today. One option is to take advantage of the advances in nanotechnologies, genetic engineering and other medical sciences to enhance the biological and mental functioning of human beings (never to go back). The other is to legislate to prevent these artificial changes from becoming an entrenched part of humanity, with all the implied coercive bio-medicine that would entail for the species.

Of course, the reality of this debate is more complex. Holding our scepticism in abeyance, it still supersedes individual choice. Hence the question of agency remains: who should have the right to decide?

Editors note: this article was updated on March 29 to clarify that acoustic sound is not part of the electromagnetic spectrum.

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Neural stem cell – Wikipedia

Posted: November 24, 2022 at 12:35 am

Precursor cells of neurons and glia during embryonic development

Neural stem cells (NSCs) are self-renewing, multipotent cells that firstly generate the radial glial progenitor cells that generate the neurons and glia of the nervous system of all animals during embryonic development.[1] Some neural progenitor stem cells persist in highly restricted regions in the adult vertebrate brain and continue to produce neurons throughout life. Differences in the size of the central nervous system are among the most important distinctions between the species and thus mutations in the genes that regulate the size of the neural stem cell compartment are among the most important drivers of vertebrate evolution. [2]

Stem cells are characterized by their capacity to differentiate into multiple cell types.[3] They undergo symmetric or asymmetric cell division into two daughter cells. In symmetric cell division, both daughter cells are also stem cells. In asymmetric division, a stem cell produces one stem cell and one specialized cell.[4] NSCs primarily differentiate into neurons, astrocytes, and oligodendrocytes.

In the adult mammalian brain, the subgranular zone in the hippocampal dentate gyrus, the subventricular zone around the lateral ventricles, and the hypothalamus (precisely in the dorsal 1, 2 region and the "hypothalamic proliferative region, located in the adjacent median eminence) have been reported to contain neural stem cells.[5]

There are two basic types of stem cell: adult stem cells, which are limited in their ability to differentiate, and embryonic stem cells (ESCs), which are pluripotent and have the capability of differentiating into any cell type.[3]

Neural stem cells are more specialized than ESCs because they only generate radial glial cells that give rise to the neurons and to glia of the central nervous system (CNS).[4] During the embryonic development of vertebrates, NSCs transition into radial glial cells (RGCs) also known as radial glial progenitor cells, (RGPs) and reside in a transient zone called the ventricular zone (VZ).[1][6] Neurons are generated in large numbers by (RGPs) during a specific period of embryonic development through the process of neurogenesis, and continue to be generated in adult life in restricted regions of the adult brain.[7] Adult NSCs differentiate into new neurons within the adult subventricular zone (SVZ), a remnant of the embryonic germinal neuroepithelium, as well as the dentate gyrus of the hippocampus.[7]

Adult NSCs were first isolated from mouse striatum in the early 1990s. They are capable of forming multipotent neurospheres when cultured in vitro. Neurospheres can produce self-renewing and proliferating specialized cells. These neurospheres can differentiate to form the specified neurons, glial cells, and oligodendrocytes.[7] In previous studies, cultured neurospheres have been transplanted into the brains of immunodeficient neonatal mice and have shown engraftment, proliferation, and neural differentiation.[7]

NSCs are stimulated to begin differentiation via exogenous cues from the microenvironment, or stem cell niche. Some neural cells are migrated from the SVZ along the rostral migratory stream which contains a marrow-like structure with ependymal cells and astrocytes when stimulated. The ependymal cells and astrocytes form glial tubes used by migrating neuroblasts. The astrocytes in the tubes provide support for the migrating cells as well as insulation from electrical and chemical signals released from surrounding cells. The astrocytes are the primary precursors for rapid cell amplification. The neuroblasts form tight chains and migrate towards the specified site of cell damage to repair or replace neural cells. One example is a neuroblast migrating towards the olfactory bulb to differentiate into periglomercular or granule neurons which have a radial migration pattern rather than a tangential one.[8]

Neural stem cell proliferation declines as a consequence of aging.[9] Various approaches have been taken to counteract this age-related decline.[10] Because FOX proteins regulate neural stem cell homeostasis,[11] FOX proteins have been used to protect neural stem cells by inhibiting Wnt signaling.[12]

Epidermal growth factor (EGF) and fibroblast growth factor (FGF) are mitogens that promote neural progenitor and stem cell growth in vitro, though other factors synthesized by the neural progenitor and stem cell populations are also required for optimal growth.[13] It is hypothesized that neurogenesis in the adult brain originates from NSCs. The origin and identity of NSCs in the adult brain remain to be defined.

The most widely accepted model of an adult NSC is a radial, glial fibrillary acidic protein-positive cell. Quiescent stem cells are Type B that are able to remain in the quiescent state due to the renewable tissue provided by the specific niches composed of blood vessels, astrocytes, microglia, ependymal cells, and extracellular matrix present within the brain. These niches provide nourishment, structural support, and protection for the stem cells until they are activated by external stimuli. Once activated, the Type B cells develop into Type C cells, active proliferating intermediate cells, which then divide into neuroblasts consisting of Type A cells. The undifferentiated neuroblasts form chains that migrate and develop into mature neurons. In the olfactory bulb, they mature into GABAergic granule neurons, while in the hippocampus they mature into dentate granule cells.[14]

Epigenetic modifications are important regulators of gene expression in differentiating neural stem cells. Key epigenetic modifications include DNA cytosine methylation to form 5-methylcytosine and 5-methylcytosine demethylation.[15][16] These types of modification are critical for cell fate determination in the developing and adult mammalian brain.

DNA cytosine methylation is catalyzed by DNA methyltransferases (DNMTs). Methylcytosine demethylation is catalyzed in several distinct steps by TET enzymes that carry out oxidative reactions (e.g. 5-methylcytosine to 5-hydroxymethylcytosine) and enzymes of the DNA base excision repair (BER) pathway.[15]

NSCs have an important role during development producing the enormous diversity of neurons, astrocytes and oligodendrocytes in the developing CNS. They also have important role in adult animals, for instance in learning and hippocampal plasticity in the adult mice in addition to supplying neurons to the olfactory bulb in mice.[7]

Notably the role of NSCs during diseases is now being elucidated by several research groups around the world. The responses during stroke, multiple sclerosis, and Parkinson's disease in animal models and humans is part of the current investigation. The results of this ongoing investigation may have future applications to treat human neurological diseases.[7]

Neural stem cells have been shown to engage in migration and replacement of dying neurons in classical experiments performed by Sanjay Magavi and Jeffrey Macklis.[17] Using a laser-induced damage of cortical layers, Magavi showed that SVZ neural progenitors expressing Doublecortin, a critical molecule for migration of neuroblasts, migrated long distances to the area of damage and differentiated into mature neurons expressing NeuN marker. In addition, Masato Nakafuku's group from Japan showed for the first time the role of hippocampal stem cells during stroke in mice.[18] These results demonstrated that NSCs can engage in the adult brain as a result of injury. Furthermore, in 2004 Evan Y. Snyder's group showed that NSCs migrate to brain tumors in a directed fashion. Jaime Imitola, M.D and colleagues from Harvard demonstrated for the first time, a molecular mechanism for the responses of NSCs to injury. They showed that chemokines released during injury such as SDF-1a were responsible for the directed migration of human and mouse NSCs to areas of injury in mice.[19] Since then other molecules have been found to participate in the responses of NSCs to injury. All these results have been widely reproduced and expanded by other investigators joining the classical work of Richard L. Sidman in autoradiography to visualize neurogenesis during development, and neurogenesis in the adult by Joseph Altman in the 1960s, as evidence of the responses of adult NSCs activities and neurogenesis during homeostasis and injury.

The search for additional mechanisms that operate in the injury environment and how they influence the responses of NSCs during acute and chronic disease is matter of intense research.[20]

Cell death is a characteristic of acute CNS disorders as well as neurodegenerative disease. The loss of cells is amplified by the lack of regenerative abilities for cell replacement and repair in the CNS. One way to circumvent this is to use cell replacement therapy via regenerative NSCs. NSCs can be cultured in vitro as neurospheres. These neurospheres are composed of neural stem cells and progenitors (NSPCs) with growth factors such as EGF and FGF. The withdrawal of these growth factors activate differentiation into neurons, astrocytes, or oligodendrocytes which can be transplanted within the brain at the site of injury. The benefits of this therapeutic approach have been examined in Parkinson's disease, Huntington's disease, and multiple sclerosis. NSPCs induce neural repair via intrinsic properties of neuroprotection and immunomodulation. Some possible routes of transplantation include intracerebral transplantation and xenotransplantation.[21][22]

An alternative therapeutic approach to the transplantation of NSPCs is the pharmacological activation of endogenous NSPCs (eNSPCs). Activated eNSPCs produce neurotrophic factors, several treatments that activate a pathway that involves the phosphorylation of STAT3 on the serine residue and subsequent elevation of Hes3 expression (STAT3-Ser/Hes3 Signaling Axis) oppose neuronal death and disease progression in models of neurological disorder.[23][24]

Human midbrain-derived neural progenitor cells (hmNPCs) have the ability to differentiate down multiple neural cell lineages that lead to neurospheres as well as multiple neural phenotypes. The hmNPC can be used to develop a 3D in vitro model of the human CNS. There are two ways to culture the hmNPCs, the adherent monolayer and the neurosphere culture systems. The neurosphere culture system has previously been used to isolate and expand CNS stem cells by its ability to aggregate and proliferate hmNPCs under serum-free media conditions as well as with the presence of epidermal growth factor (EGF) and fibroblast growth factor-2 (FGF2). Initially, the hmNPCs were isolated and expanded before performing a 2D differentiation which was used to produce a single-cell suspension. This single-cell suspension helped achieve a homogenous 3D structure of uniform aggregate size. The 3D aggregation formed neurospheres which was used to form an in vitro 3D CNS model.[25]

Traumatic brain injury (TBI) can deform the brain tissue, leading to necrosis primary damage which can then cascade and activate secondary damage such as excitotoxicity, inflammation, ischemia, and the breakdown of the blood-brain-barrier. Damage can escalate and eventually lead to apoptosis or cell death. Current treatments focus on preventing further damage by stabilizing bleeding, decreasing intracranial pressure and inflammation, and inhibiting pro-apoptotic cascades. In order to repair TBI damage, an upcoming therapeutic option involves the use of NSCs derived from the embryonic peri-ventricular region. Stem cells can be cultured in a favorable 3-dimensional, low cytotoxic environment, a hydrogel, that will increase NSC survival when injected into TBI patients. The intracerebrally injected, primed NSCs were seen to migrate to damaged tissue and differentiate into oligodendrocytes or neuronal cells that secreted neuroprotective factors.[26][27]

Galectin-1 is expressed in adult NSCs and has been shown to have a physiological role in the treatment of neurological disorders in animal models. There are two approaches to using NSCs as a therapeutic treatment: (1) stimulate intrinsic NSCs to promote proliferation in order to replace injured tissue, and (2) transplant NSCs into the damaged brain area in order to allow the NSCs to restore the tissue. Lentivirus vectors were used to infect human NSCs (hNSCs) with Galectin-1 which were later transplanted into the damaged tissue. The hGal-1-hNSCs induced better and faster brain recovery of the injured tissue as well as a reduction in motor and sensory deficits as compared to only hNSC transplantation.[8]

Neural stem cells are routinely studied in vitro using a method referred to as the Neurosphere Assay (or Neurosphere culture system), first developed by Reynolds and Weiss.[28] Neurospheres are intrinsically heterogeneous cellular entities almost entirely formed by a small fraction (1 to 5%) of slowly dividing neural stem cells and by their progeny, a population of fast-dividing nestin-positive progenitor cells.[28][29][30] The total number of these progenitors determines the size of a neurosphere and, as a result, disparities in sphere size within different neurosphere populations may reflect alterations in the proliferation, survival and/or differentiation status of their neural progenitors. Indeed, it has been reported that loss of 1-integrin in a neurosphere culture does not significantly affect the capacity of 1-integrin deficient stem cells to form new neurospheres, but it influences the size of the neurosphere: 1-integrin deficient neurospheres were overall smaller due to increased cell death and reduced proliferation.[31]

While the Neurosphere Assay has been the method of choice for isolation, expansion and even the enumeration of neural stem and progenitor cells, several recent publications have highlighted some of the limitations of the neurosphere culture system as a method for determining neural stem cell frequencies.[32] In collaboration with Reynolds, STEMCELL Technologies has developed a collagen-based assay, called the Neural Colony-Forming Cell (NCFC) Assay, for the quantification of neural stem cells. Importantly, this assay allows discrimination between neural stem and progenitor cells.[33]

The first evidence that neurogenesis occurs in certain regions of the adult mammalian brain came from [3H]-thymidine labeling studies conducted by Altman and Das in 1965 which showed postnatal hippocampal neurogenesis in young rats.[34] In 1989, Sally Temple described multipotent, self-renewing progenitor and stem cells in the subventricular zone (SVZ) of the mouse brain.[35] In 1992, Brent A. Reynolds and Samuel Weiss were the first to isolate neural progenitor and stem cells from the adult striatal tissue, including the SVZ one of the neurogenic areas of adult mice brain tissue.[28] In the same year the team of Constance Cepko and Evan Y. Snyder were the first to isolate multipotent cells from the mouse cerebellum and stably transfected them with the oncogene v-myc.[36] This molecule is one of the genes widely used now to reprogram adult non-stem cells into pluripotent stem cells. Since then, neural progenitor and stem cells have been isolated from various areas of the adult central nervous system, including non-neurogenic areas, such as the spinal cord, and from various species including humans.[37][38]

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Neural stem cell - Wikipedia

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Donate Stem Cells | Bone Marrow Donation – American Cancer Society

Posted: November 24, 2022 at 12:35 am

People usually volunteer to donate stem cells for an allogeneic transplant either because they have a loved one or friend who needs a match or because they want to help people. Some people give their stem cells so they can get them back later if they need an autologous transplant.

Medical guidelines are in place to protect the health of potential donors, as well as the health of bone marrow and stem cell transplant patients. Many factors can affect if a person is eligible to register as a donor.

People, including cancer survivors,who want to donate stem cells or join a volunteer registry can check the eligibility list available through the registry. They can also speak with a health care provider or contact the National Marrow Donor Program to find the nearest donor center. Potential donors are asked questions to make sure they are healthy enough to donate and dont pose a risk of infection to the recipient. For more information about donor eligibility guidelines, contact Be the Match or the donor center in your area.

Be the Match (formerly the National Marrow Donor Program)Toll-free number: 1-800-MARROW-2 (1-800-627-7692)Website: http://www.bethematch.org

A simple blood test is done to learn the potential donors HLA type. There may be a one-time, tax-deductible fee of about $75 to $100 for this test. People who join a volunteer donor registry will most likely have their tissue type kept on file until they reach age 60.

Pregnant women who want to donate their babys cord blood should make arrangements for it early in the pregnancy, at least before the third trimester. Donation is safe, free, and does not affect the birth process.

If a possible stem cell donor is found to be a good match for a recipient, steps are taken to teach the donor about the transplant process and make sure they are making an informed decision. If a person decides to donate, a consent form must be signed after the risks of donating are fully discussed. The donor is not pressured to take part. Its always a choice.

If a person decides to donate, a medical exam and blood tests will be done to make sure they are in good health.

Stem cells may be collected from these 3 different sources:

Each method of collection is explained here.

This process is often called bone marrow harvest. Its done in an operating room, while the donor is under general anesthesia (given medicine to put them into a deep sleep so they dont feel pain). The marrow cells are taken from the back of the pelvic (hip) bone. The donor lies face down, and a large needle is put through the skin and into the back of the hip bone. Its pushed through the bone to the center and the thick, liquid marrow is pulled out through the needle. This is repeated several times until enough marrow has been taken out (harvested). The amount taken depends on the donors weight. Often, about 10% of the donors marrow, or about 2 pints, are collected. This takes about 1 to 2 hours. The body will replace these cells within 4 to 6 weeks. If blood was taken from the donor before the marrow donation, its often given back to the donor at this time.

After the bone marrow is harvested, the donor is taken to the recovery room while the anesthesia wears off. The donor may then be taken to a hospital room and watched until fully alert and able to eat and drink. In most cases, the donor is able to leave the hospital within a few hours or by the next morning.

The donor may have soreness, bruising, and aching at the back of the hips and lower back for a few days. Over-the-counter pain medications or nonsteroidal anti-inflammatory drugs are helpful. Some people may feel tired or weak, and have trouble walking for a few days. The donor might be told to take iron supplements until the number of red blood cells returns to normal. Most donors get back to their usual activities in 2 to 3 days. But it could take 2 or 3 weeks before they feel completely back to normal.

There arent many risks for donors and serious complications are rare. But bone marrow donation is a surgical procedure. Rare complications could include anesthesia reactions, infection, nerve or muscle damage, transfusion reactions (if a blood transfusion of someone elses blood is needed this doesnt happen if you get your own blood), or injury at the needle insertion sites. Problems such as sore throat or nausea may be caused by anesthesia.

Allogeneic stem cell donors do not have to pay for the harvesting because the recipients insurance company usually covers the cost. Even so, be sure to ask about insurance coverage before you decide to have the bone marrow harvest done.

Once the cells are collected, they are filtered through fine mesh screens. This prevents bone or fat particles from being given to the recipient. For an allogeneic or syngeneic transplant, the cells may be given to the recipient through a vein soon after they are harvested. Sometimes theyre frozen, for example, if the donor lives far away from the recipient.

For several days before starting the donation process, the donor is given a daily injection (shot) of a drug that causes the bone marrow to make and release a lot of stem cells into the blood. Filgrastim can cause some side effects, the most common being bone pain and headaches. These may be helped by over-the-counter pain medications or nonsteroidal anti-inflammatory drugs. Nausea, sleeping problems, low-grade (mild) fevers, and tiredness are other possible effects. These go away once the injections are finished and collection is completed.

After the shots, blood is removed through a catheter (a thin, flexible plastic tube) thats put in a large vein in the arm. Its then cycled through a machine that separates the stem cells from the other blood cells. The stem cells are kept while the rest of the blood is returned to the donor, often through the same catheter. (In some cases, a catheter may be put in each arm one takes out blood and the other puts it back.) This process is called apheresis. It takes about 2 to 4 hours and is done as an outpatient procedure. Often the process needs to be repeated daily for a few days, until enough stem cells have been collected.

Possible side effects of the catheter can include trouble placing the catheter in the vein, blockage of the catheter, or infection of the catheter or at the area where it enters the vein. Blood clots are another possible side effect. During the apheresis procedure, donors may have problems caused by low calcium levels from the anti-coagulant drug used to keep the blood from clotting in the machine. These can include feeling lightheaded or tingly, and having chills or muscle cramps. These go away after donation is complete, but may be treated by giving the donor calcium supplements.

The process of donating cells for yourself (autologous stem cell donation) is pretty much the same as when someone donates them for someone else (allogeneic donation). Its just that in autologous stem cell donation the donor is also the recipient, giving stem cells for their own use later on. For some people, there are a few differences. For instance, sometimes chemotherapy (chemo) is given before the growth factor drug is used to tell the body to make stem cells. Also, sometimes it can be hard to get enough stem cells from a person with cancer. Even after several days of apheresis, there may not be enough for the transplant. This is more likely to be a problem if the patient has had certain kinds of chemo in the past, or if they have an illness that affects their bone marrow.

Cord blood is the blood thats left in the placenta and umbilical cord after a baby is born. Collecting it does not pose any health risk to the infant or the mother. Cord blood transplants use blood that would otherwise be thrown away. After the umbilical cord is clamped and cut, the placenta and umbilical cord are cleaned. The cord blood is put into a sterile container, mixed with a preservative, and frozen until needed.

Some parents choose to donate their infants cord blood to a public blood bank, so that it may be used by anyone who needs it. Many hospitals collect cord blood for donation, which makes it easier for parents to donate. Parents can donate their newborns cord blood to volunteer or public cord blood banks at no cost. For more about donating your newborns cord blood, call 1-800-MARROW2 (1-800-627-7692) or visit Be the Match.

Other parents store their newborns cord blood in private cord blood banks just in case the child or a close relative needs it someday. If you want to donate or bank (save) your childs cord blood, youll need to arrange it before the baby is born. Some banks require you to set it up before the 28th week of pregnancy, although others accept later setups. Among other things, youll be asked to answer health questions and sign a consent form.

Parents may want to bank their childs cord blood if the family has a history of diseases that may benefit from stem cell transplant. There are several private companies offer this service. But here are some things to think about:

More information on private family cord blood banking can be found at the Parents Guide to Cord Blood Foundation. You can visit their website at http://www.parentsguidecordblood.org.

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Donate Stem Cells | Bone Marrow Donation - American Cancer Society

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Japan Stem Cells Market to be at Forefront by 2028

Posted: November 24, 2022 at 12:31 am

Stem Cells Market: Introduction

According to the report, the globalstem cells marketwas valued at US$11.73Bn in 2020 and is projected to expand at a CAGR of10.4%from 2021 to 2028. Stem cells are defined as specialized cells of the human body that can develop into various different kinds of cells. Stem cells can form muscle cells, brain cells and all other cells in the body. Stem cells are used to treat various illnesses in the body.

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North America was the largest market for stem cells in 2020. The region dominated the global market due to substantial investments in the field, impressive economic growth, increase in incidence of target chronic diseases, and technological progress. Moreover, technological advancements, increase in access to healthcare services, and entry of new manufacturers are the other factors likely to fuel the growth of the market in North America during the forecast period.

Asia Pacific is projected to be a highly lucrative market for stem cells during the forecast period. The market in the region is anticipated to expand at a high CAGR during the forecast period. High per capita income has increased the consumption of diagnostic and therapy products in the region. Rapid expansion of the market in the region can be attributed to numerous government initiatives undertaken to improve the health care infrastructure. The market in Asia Pacific is estimated to expand rapidly compared to other regions due to shift in base of pharmaceutical companies and clinical research industries from developed to developing regions such as China and India. Moreover, changing lifestyles and increase in urbanization in these countries have led to a gradual escalation in the incidence of lifestyle-related diseases such as cancer, diabetes, and heart diseases.

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Technological Advancements to Drive Market

Several companies are developing new approaches to culturing or utilizing stem cells for various applications. Stem cell technology is a rapidly developing field that combines the efforts of cell biologists, geneticists, and clinicians, and offers hope of effective treatment for various malignant and non-malignant diseases. The stem cell technology is progressing as a result of multidisciplinary effort, and advances in this technology have stimulated a rapid growth in the understanding of embryonic and postnatal neural development.

Adult Stem Cells Segment to Dominate Global Market

In terms of product type, the global stem cells market has been classified into adult stem cells, human embryonic stem cells, and induced pluripotent stem cells. The adult stem cells segment accounted for leading share of the global market in 2020. The capability of adult stem cells to generate a large number of specialized cells lowers the risk of rejection and enables repair of damaged tissues.

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Autologous Segment to Lead Market

Based on source, the global stem cells market has been bifurcated into autologous and allogenic. The autologous segment accounted for leading share of the global market in 2020. Autologous stem cells are used from ones own body to replace damaged bone marrow and hence it is safer and is commonly being practiced.

Regenerative Medicines to be Highly Lucrative

In terms of application, the global stem cells market has been categorized into regenerative medicines (neurology, oncology, cardiology, and others) and drug discovery & development. The regenerative medicines segment accounted for major share of the global market in 2020, as regenerative medicine is a stem cell therapy and the medicines are made using stem cells in order to repair an injured tissue. Increase in the number of cardiac diseases and other health conditions drive the segment.

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Therapeutics Companies Emerge as Major End-users

Based on end-user, the global stem cells market has been divided into therapeutics companies, cell & tissue banks, tools & reagents companies, and service companies. The therapeutics companies segment dominated the global stem cells market in 2020. The segment is driven by increase in usage of stem cells to treat various illnesses in the body. Therapeutic companies are increasing the utilization of stem cells for providing various therapies. However, the cell & tissue banks segment is projected to expand at a high CAGR during the forecast period. Increase in number of banks that carry out research on stem cells required for tissue & cell growth and elaborative use of stem cells to grow various cells & tissues can be attributed to the growth of the segment.

Regional Analysis

In terms of region, the global stem cells market has been segmented into North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. North America dominated the global stem cells market in 2020, followed by Europe. Emerging markets in Asia Pacific hold immense growth potential due to increase in income levels in emerging markets such as India and China leading to a rise in healthcare spending.

Competition Landscape

The global stem cells market is fragmented in terms of number of players. Key players in the global market include STEMCELL Technologies, Inc., Astellas Pharma, Inc., Cellular Engineering Technologies, Inc., BioTime, Inc., Takara Bio, Inc., U.S. Stem Cell, Inc., BrainStorm Cell Therapeutics, Inc., Cytori Therapeutics, Inc., Osiris Therapeutics, Inc., and Caladrius Biosciences, Inc.

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Japan Stem Cells Market to be at Forefront by 2028

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