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Several cohort studies showed that obesity increases the risk of chronic disease such as T2DM, hypertension and non-alcoholic fatty liver disease and various types of cancer. Different factors were described that might be involving in these diseases in obesity. Some of these suggested factors were chronic infection, elevated free fatty acids, increased ROS formation, mitochondrial dysfunction and raised NAPDH oxidase activity. Obesity is a multifactorial disease and it is very hard to distinguish between all of these factors. In this study, we wanted to focus on the association between obesity, oxidative stress and genomic damage in kidney, liver and colon, which are the most relevant organs for cancer risk according to the cohort studies. Our findings indicated elevated oxidative stress in kidney, liver and colon together with elevated lipid, RNA and DNA oxidation in the whole body. Additionally, we were able to show increased DNA damage in kidney, liver and colon.
Since obesity has become an epidemic all over the world, possible therapeutic applications such as life style changes (diet and sport), pharmacological supplements and various type of surgeries are increasing. As a second question, we focused on the effect of weight loss, which is supplied either by Roux-en-Y gastric bypass surgery or by caloric restriction designed in a way to provide the same extent of weight loss, on oxidative stress and genomic damage. Our results indicated that weight loss either by gastric bypass surgery or by caloric restriction led to reduced oxidative stress and genomic damage in kidney, liver and colon. We could not find any difference between the weight loss methods, except the DNA oxidation and repair marker urinary 8-oxodG, which was still elevated after RYGB, but not after caloric restriction.
It is known that hyperinsulinemia and in the long term T2DM are among the biggest concerns in obese individuals. Since we know the mutagenic potential of elevated insulin levels from previous data in our working group, the correlation between the highly mutagenic DNA DBSs marker, γ-H2AX and the plasma insulin level was tested and the findings indicated a positive correlation. In order to demonstrate the association between insulin-related oxidative stress and genomic damage, we used in vitro and in vivo models with Pten deficiency. In this part of study, the work was focused on liver.
Pten is a known negative regulator of the PI3K/Akt pathway, which is responsible for the elevated NADPH oxidase activity and mitochondrial dysfunction through elevated insulin levels. Pten inhibition or deficiency were used to sensitize the system to insulin. Non-transformed immortalized human hepatocytes were used to show the mutagenic potential of elevated insulin and these in vitro data revealed once more the link between insulin signaling, elevated oxidative stress and genomic damage. Since the metabolic function of the liver is not only due to the extent of the hepatic insulin response but is also affected by systemic interactions, a whole-body Pten haplodeficient mouse model with an additional Pten+/-/Akt2-/- group was utilized for in vivo investigation of insulin-mediated toxicity. Our findings in this model suggested that Pten deficiency alone can cause an increase in oxidative stress. HFD alone was sufficient to increase the expression of HO-1 and genomic damage significantly. Moreover, the combination (whole-body Pten haplodeficient mice fed with HFD) showed significantly elevated oxidative stress and genomic damage in mouse liver. However, Akt2 knockout could only reduce the oxidative stress and DNA damage in high fat diet fed mice significantly.
All these findings demonstrated that obesity can induce oxidative stress and genomic damage. Elevated insulin levels are associated with obesity-mediated oxidative stress and genomic damage. However, the underlying mechanisms are surely multifaceted and complicated. For example, Pten as oncogene might also induce other mechanisms besides the elevation of the PI3K/Akt pathway activity.
In conclusion, it is clear that oxidative stress and DNA damage are linked to obesity and that weight loss can reduce these two factors. Since DNA-damage is associated with an elevated cancer risk, it might be logical to use an antioxidant therapy in obese individuals to reduce the side effects and oxidative stress dependent mutagenicity and cancer risk in these individuals. However, much more research will be needed to support this idea experimentally.
Modulation of insulin-induced genotoxicity in vitro and genomic damage in gestational diabetes
(2019)
Diabetes mellitus is a global health problem, where the risk of diabetes increases rapidly
due to the lifestyle changes. Patients with type II diabetes have many complications
with increased risk of morbidity and mortality. High levels of insulin may lead to DNA
oxidation and damage. Several studies proposed that hyperinsulinemia may be an
important risk factor for various types of cancer. To investigate insulin signaling
pathway inducing oxidative stress and genomic damage, pharmaceutical and natural
compounds which can interfere with the insulin pathway including PI3K inhibitors,
resveratrol, lovastatin, and RAD-001 were selected due to their beneficial effects
against metabolic disorder. Thus, the anti-genotoxic potential of these compounds
regarding insulin-mediated oxidative stress were investigated in normal rat kidney cells
in vitro. Our compounds showed protective effect against genotoxic damage and
significantly decreased reactive oxygen specious after treatment of cells with insulin
with different mechanisms of protection between the compounds. Thus, these
compounds may be attractive candidates for future support of diabetes mellitus therapy.
Next, we explored the link between gestational diabetes mellitus and genomic damage
in cells derived from human blood. Moreover, we investigated the influence of
estradiol, progesterone, adrenaline and triiodothyronine on insulin-induced genomic
damage in vitro. First, we studied the effect of these hormones in human promyelocytic
leukemia cells and next ex vivo with non-stimulated and stimulated peripheral blood
mononuclear cells. In parallel, we also measured the basal genomic damage using three
conditions (whole blood, non-stimulated and stimulated peripheral blood mononuclear
cells) in a small patient study including non-pregnant controls with/without hormonal
contraceptives, with a subgroup of obese women, pregnant women, and gestational
diabetes affected women. A second-time point after delivery was also applied for
analysis of the blood samples. Our results showed that GDM subjects and obese
individuals exhibited higher basal DNA damage compared to lower weight nonpregnant
or healthy pregnant women in stimulated peripheral blood mononuclear cells
in both comet and micronucleus assays. On the other hand, the DNA damage in GDM
women had decreased at two months after birth. Moreover, the applied hormones also
showed an influence in vitro in the enhancement of the genomic damage in cells of the control and pregnant groups but this damage did not exceed the damage which existed
in obese and gestational diabetes mellitus patients with high level of genomic damage.
In conclusion, insulin can induce genomic damage in cultured cells, which can be
modulated by pharmaceutical and naturals substances. This may be for future use in the
protection of diabetic patients, who suffer from hyperinsulinemia during certain disease
stages. A particular form of diabetes, GDM, was shown to lead to elevated DNA
damage in affected women, which is reduced again after delivery. Cells of affected
women do not show an enhanced, but rather a reduced sensitivity for further DNA
damage induction by hormonal treatment in vitro. A potential reason may be an
existence of a maximally inducible damage by hormonal influences.
Einfluss des Gewichtsverlusts auf den oxidativen Stress und den DNS-Schaden in adipösen Patient*innen nach bariatrischer Chirurgie
Adipositas ist eine Erkrankung, die durch ein erhöhtes Krebsrisiko neben zahlreichen anderen Komorbiditäten mit weitreichenden Folgen für die Gesundheit adipöser Patient*innen einhergeht. In der Pathogenese der adipositas-assoziierten Krebsarten sind dabei ein erhöhter oxidativer Stress sowie die damit einhergehende Schädigung der DNS maßgeblich beteiligt. Im Umkehrschluss wurde in der vorliegenden Arbeit der Einfluss eines durch bariatrische Chirurgie induzierten Gewichtsverlusts auf den oxidativen Stress und DNS-Schaden in adipösen Patient*innen anhand von Blutproben präoperativ sowie 6 und 12 Monate postoperativ untersucht. In einer Subpopulation der Patient*innen konnte eine tendenzielle Verringerung des DNS-Schadens anhand des Comet-Assays in peripheren Lymphozyten beobachtet werden. Im Hinblick auf den oxidativen Stress wurde im Plasma die Eisenreduktionsfähigkeit als Maß für antioxidative Kapazität sowie Malondialdehyd als Surrogatmarker für das Ausmaß an Lipidperoxidation bestimmt. Weiterhin wurde in Erythrozyten das Gesamtglutathion und oxidierte Glutathion bestimmt. Die oxidativen Stressparameter zeigten insgesamt nach einer initialen Zunahme im oxidativen Stress 6 Monate postoperativ eine rückläufige Tendenz im oxidativen Stress am Studienende. Somit geben die Beobachtungen dieser Arbeit Anlass zur Hoffnung, dass adipöse Patient*innen durch einen bariatrisch induzierten Gewichtsverlust von einer Verringerung des Krebsrisikos profitieren könnten.
Adipositas ist eine Erkrankung, die durch ein erhöhtes Krebsrisiko neben zahlreichen anderen Komorbiditäten mit weitreichenden Folgen für die Gesundheit adipöser Patient*innen einhergeht. In der Pathogenese der adipositas-assoziierten Krebsarten sind dabei ein erhöhter oxidativer Stress sowie die damit einhergehende Schädigung der DNS maßgeblich beteiligt. Im Umkehrschluss wurde in der vorliegenden Arbeit der Einfluss eines durch bariatrische Chirurgie induzierten Gewichtsverlusts auf den oxidativen Stress und DNS-Schaden in adipösen Patient*innen anhand von Blutproben präoperativ sowie 6 und 12 Monate postoperativ untersucht. In einer Subpopulation der Patient*innen konnte eine tendenzielle Verringerung des DNS-Schadens anhand des Comet-Assays in peripheren Lymphozyten beobachtet werden. Im Hinblick auf den oxidativen Stress wurde im Plasma die Eisenreduktionsfähigkeit als Maß für die antioxidative Kapazität sowie Malondialdehyd als Surrogatmarker für das Ausmaß an Lipidperoxidation bestimmt. Weiterhin wurde in Erythrozyten das Gesamtglutathion und das oxidierte Glutathion bestimmt. Die oxidativen Stressparameter zeigten insgesamt nach einer initialen Zunahme im oxidativen Stress 6 Monate postoperativ eine rückläufige Tendenz im oxidativen Stress am Studienende. Somit geben die Beobachtungen dieser Arbeit Anlass zur Hoffnung, dass adipöse Patient*innen durch einen bariatrisch induzierten Gewichtsverlust von einer Verringerung des Krebsrisikos profitieren könnten.