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Background: Obesity and related metabolic disorders have reached epidemic levels, calling for diverse therapeutic strategies. Altering nutrient intake, timing and quantity by intermittent fasting seems to elicit beneficial health effects by modulating endocrine and cell signaling networks. This study explores the impact of cyclic nutrient availability in the form of every-other-day fasting (EODF) on human adipose stem cells (ASCs). Methods: We subjected ASCs to repeated fasting/refeeding (F/R) cycles, mimicking low glucose/high fatty acid (LGHF) conditions, and assessed phenotypic and transcriptomic changes, lipid storage capacity, insulin sensitivity, and differentiation potential. Results: Four consecutive F/R cycles induced significant changes in adipogenic gene expression, with upregulation of FABP4 and PLIN1 during fasting, and increased lipid storage in the ASCs. Upon differentiation, ASCs exposed to LGHF conditions retained a transient increase in lipid droplet size and altered fatty acid metabolism gene expression until day 9. However, these changes dissipated by day 15 of differentiation, suggesting a limited duration of fasting-induced transcriptional and adipogenic memory. Despite initial effects, ASCs showed resilience, returning to a physiological trajectory during differentiation, with respect to gene expression and lipid metabolism. Conclusions: These findings suggest that the long-term effects of EODF on the ASC niche may be transient, emphasizing the ability of the adipose tissue to adapt and restore homeostasis. [ABSTRACT FROM AUTHOR]

Progression of diabetic retinopathy resists arrest even after institution of intensive glycemic control, suggesting a "metabolic memory" phenomenon, but the mechanism responsible for this phenomenon is still elusive. Gene expression and biological processes can also be regulated by long noncoding RNAs (LncRNAs), the RNAs with >200 nucleotides and no open reading frame for translation, and several LncRNAs are aberrantly expressed in diabetes. Our aim was to identify retinal LncRNAs that fail to reverse after termination of hyperglycemia. Microarray analysis was performed on retinal RNA from streptozotocin‐induced diabetic rats in poor glycemic control for 8 months, followed by in good glycemic control (blood glucose >400 mg/dL), or for 4 months, with four additional months of good glycemic control (blood glucose <150 mg/dL). Differentially expressed LncRNAs and mRNAs were identified through Volcano filtering, and their functions were predicted using gene ontology and pathway enrichment analyses. Compared with age‐matched normal rats, rats in continuous poor glycemic control had >1479 differentially expressed LncRNAs (710 downregulated, 769 upregulated), and among those, 511 common LncRNAs had similar expression in Diab and Rev groups (139 downregulated, 372 upregulated). Gene Ontology/pathway analysis identified limited LncRNAs in biological processes, but analysis based on biological processes/molecular function revealed >350 genes with similar expression in Diab and Rev groups; these genes were mainly associated with stress response, cell death, mitochondrial damage and cytokine production. Thus, identifying retinal LncRNAs and their gene targets that do not benefit from termination of hyperglycemia have potential to serve as therapeutic targets to slow down the progression of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Abstract Diabetes mellitus and its complications exploit significantly impact global human well-being and economic burden. Previous studies and clinical trials have provided insights into the concept of metabolic memory, which sustains even after hyperglycemia has been resolved, causing diabetic complications completely. The term “metabolic memory” refers to the body’s abnormal metabolism, which can have long-term effects and influence both health and disease conditions. It involves various molecular processes causing cellular shifts, tissue and organ dysfunctions, disease progression, and effects on offspring. The conceptual framework of metabolic memory is defined and strengthened, offering a comprehensive understanding of the underlying causes of diabetic nephropathy (DN) and providing a potential new approach for diagnosing and treating the disease. In this review, we elucidated the importance, characteristics, cellular and molecular importance, and therapeutic intervention to eradicate metabolic memory in DN once hyperglycemia has been eliminated. The regulation of metabolic memory is assisted based on an epigenetic mechanism. Therefore, this report traces the significant factors involved in regulating epigenetic modifications such as DNA methylation, histone modification, and chromatin remodeling. This mechanism significantly triggers epigenetic regulation, leading to glucose stress, oxidative stress induction, and apoptosis, causing DN. It occurs beyond various signaling cascades, resulting in alterations in transcription factors and receptor molecules, which enhance the metabolic memory in the post-sustenance of hyperglycemia. This condition can be modulated based on therapeutic interventions involving lifestyle modification and the inclusion of natural substances like bioactive compounds, polyphenols, and terpenoids in the diet, followed by medications acting as epigenetic modifiers.

Diabetes mellitus and its complications exploit significantly impact global human well-being and economic burden. Previous studies and clinical trials have provided insights into the concept of metabolic memory, which sustains even after hyperglycemia has been resolved, causing diabetic complications completely. The term "metabolic memory" refers to the body's abnormal metabolism, which can have long-term effects and influence both health and disease conditions. It involves various molecular processes causing cellular shifts, tissue and organ dysfunctions, disease progression, and effects on offspring. The conceptual framework of metabolic memory is defined and strengthened, offering a comprehensive understanding of the underlying causes of diabetic nephropathy (DN) and providing a potential new approach for diagnosing and treating the disease. In this review, we elucidated the importance, characteristics, cellular and molecular importance, and therapeutic intervention to eradicate metabolic memory in DN once hyperglycemia has been eliminated. The regulation of metabolic memory is assisted based on an epigenetic mechanism. Therefore, this report traces the significant factors involved in regulating epigenetic modifications such as DNA methylation, histone modification, and chromatin remodeling. This mechanism significantly triggers epigenetic regulation, leading to glucose stress, oxidative stress induction, and apoptosis, causing DN. It occurs beyond various signaling cascades, resulting in alterations in transcription factors and receptor molecules, which enhance the metabolic memory in the post-sustenance of hyperglycemia. This condition can be modulated based on therapeutic interventions involving lifestyle modification and the inclusion of natural substances like bioactive compounds, polyphenols, and terpenoids in the diet, followed by medications acting as epigenetic modifiers. [ABSTRACT FROM AUTHOR]

Low-grade inflammation (LGI) represents a key driver of type 2 diabetes (T2D) and its associated cardiovascular diseases (CVDs). Indeed, inflammatory markers such as hs-CRP and IL-6 predict the development of T2D and its complications, suggesting that LGI already increases before T2D diagnosis and remains elevated even after treatment. Overnutrition, unhealthy diets, physical inactivity, obesity, and aging are all recognized triggers of LGI, promoting insulin resistance and sustaining the pathogenesis of T2D. Once developed, and even before frank appearance, people with T2D undergo a pathological metabolic remodeling, with an alteration of multiple CVD risk factors, i.e., glycemia, lipids, blood pressure, and renal function. In turn, such variables foster a range of inflammatory pathways and mechanisms, e.g., immune cell stimulation, the accrual of senescent cells, long-lasting epigenetic changes, and trained immunity, which are held to chronically fuel LGI at the systemic and tissue levels. Targeting of CVD risk factors partially ameliorates LGI. However, some long-lasting inflammatory pathways are unaffected by common therapies, and LGI burden is still increased in many T2D patients, a phenomenon possibly underlying the residual inflammatory risk (i.e., having hs-CRP > 2 mg/dL despite optimal LDL cholesterol control). On the other hand, selected disease-modifying drugs, e.g., GLP-1RA, seem to also act on the pathogenesis of T2D, curbing the inflammatory trajectory of the disease and possibly preventing it if introduced early. In addition, selected trials demonstrated the potential of canonical anti-inflammatory therapies in reducing the rate of CVDs in patients with this condition or at high risk for it, many of whom had T2D. Since colchicine, an inhibitor of immune cell activation, is now approved for the prevention of CVDs, it might be worth exploring a possible therapeutic paradigm to identify subjects with T2D and an increased LGI burden to treat them with this drug. Upcoming studies will reveal whether disease-modifying drugs reverse early T2D by suppressing sources of LGI and whether colchicine has a broad benefit in people with this condition. [ABSTRACT FROM AUTHOR]

Diabetes, a chronic disease characterized by hyperglycemia, is associated with significantly accelerated complications, including diabetic kidney disease (DKD), which increases morbidity and mortality. Hyperglycemia and other diabetes-related environmental factors such as overnutrition, sedentary lifestyles, and hyperlipidemia can induce epigenetic changes. Working alone or with genetic factors, these epigenetic changes that occur without alterations in the underlying DNA sequence, can alter the expression of pathophysiological genes and impair functions of associated target cells/organs, leading to diabetic complications like DKD. Notably, some hyperglycemia-induced epigenetic changes persist in target cells/tissues even after glucose normalization, leading to sustained complications despite glycemic control, so-called metabolic memory. Emerging evidence from in vitro and in vivo animal models and clinical trials with subjects with diabetes identified clear associations between metabolic memory and epigenetic changes including DNA methylation, histone modifications, chromatin structure, and noncoding RNAs at key loci. Targeting such persistent epigenetic changes and/or molecules regulated by them can serve as valuable opportunities to attenuate, or erase metabolic memory, which is crucial to prevent complication progression. Here, we review these cell/tissue-specific epigenetic changes identified to-date as related to diabetic complications, especially DKD, and the current status on targeting epigenetics to tackle metabolic memory. We also discuss limitations in current studies, including the need for more (epi)genome-wide studies, integrative analysis using multiple epigenetic marks and Omics datasets, and mechanistic evaluation of metabolic memory. Considering the tremendous technological advances in epigenomics, genetics, sequencing, and availability of genomic datasets from clinical cohorts, this field is likely to see considerable progress in the upcoming years. [ABSTRACT FROM AUTHOR]

Aim: This research endeavored to explore the impact and underlying mechanisms of resveratrol on the phenomenon of "metabolic memory" in cultured human retinal vascular endothelial cells (HRVECs) under high-glucose (HG) conditions. Materials and Methods: According to the glucose level and treatment, cultured HRVECs were divided into seven groups: normal glucose (NG), HG, high glucose followed by NG (HN), mannitol (Man), resveratrol, thioredoxin-interacting protein (TXNIP)-small interfering ribonucleic acid (siRNA), and N -acetylcysteine (NAC). The expression levels of TXNIP, nucleotide oligomerization domain (NOD)-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, intercellular adhesion molecule 1 (ICAM-1), caspase-1, interleukin-1β (IL-1β), B-cell lymphoma 2 (Bcl-2), caspase-3, and Bcl-2-associated X (BAX), as well as reactive oxygen species (ROS) production, were measured. Cell apoptosis was assessed through a terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. Results: In HRVECs from the HG group, expression levels of TXNIP, NLRP3, caspase-1, ICAM-1, and IL-1β were upregulated. However, in the HN group, the above upregulations were not reversed. After the administration of resveratrol, the expression levels of TXNIP, NLRP3, and other inflammatory cytokines were significantly reduced. Resveratrol mitigated the elevated ROS production induced by HG conditions. In the NAC group, the expression of TXNIP and inflammatory cytokines was downregulated. TXNIP-siRNA treatment showed similar effects. Resveratrol inhibited apoptosis as well as reversed the downregulation of BCL-2 and the upregulation of caspase-3 and BAX induced by HG conditions. Conclusion: Resveratrol mitigated the HG-induced phenomenon of "metabolic memory" by inhibiting inflammation and apoptosis via modulation of the ROS/TXNIP/NLRP3 signaling pathway in cultured HRVECs. Therefore, resveratrol may have therapeutic potential to treat diabetic retinopathy and related metabolic memory complications. [ABSTRACT FROM AUTHOR]

Short hyperglycaemic episodes trigger metabolic memory (MM) in which managing hyperglycaemia alone is not enough to tackle the progression of Diabetic nephropathy on the epigenetic axis. We used a structural similarity search approach to identify phytochemicals similar to natural epigenetic modifiers and docked with SIRT1 protein and did ADME studies. We found that UMB was 84.3% similar to esculetin. Upon docking, we found that UMB had a binding energy of −9.2 kcal/mol while the standard ligand had −11.8 kcal/mol. ADME showed UMB to be a good lead. 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay showed it to be a good antioxidant with IC50 of 107 µg/mL and MTT stands for 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) showed that it does not promote cell death. Oxidative biomarkers in vitro showed UMB was able to ameliorate glycemic memory induced by high glucose. Western blot revealed decreased histone acetylation under hyperglycaemic conditions and upon treatment with UMB along with DR, its levels increased. This led us to check our hypothesis of whether concomitant diet reversal (DR) together with UMB can alleviate high-fat diet-induced metabolic memory and diabetic nephropathy (DN) in SD rats. UMB was able to decrease blood glucose, lipid, renal, and liver profile concluding UMB was able to ameliorate DN and MM by increasing the histone acetylation level. [ABSTRACT FROM AUTHOR]

Abstract Progression of diabetic retinopathy resists arrest even after institution of intensive glycemic control, suggesting a “metabolic memory” phenomenon, but the mechanism responsible for this phenomenon is still elusive. Gene expression and biological processes can also be regulated by long noncoding RNAs (LncRNAs), the RNAs with >200 nucleotides and no open reading frame for translation, and several LncRNAs are aberrantly expressed in diabetes. Our aim was to identify retinal LncRNAs that fail to reverse after termination of hyperglycemia. Microarray analysis was performed on retinal RNA from streptozotocin‐induced diabetic rats in poor glycemic control for 8 months, followed by in good glycemic control (blood glucose >400 mg/dL), or for 4 months, with four additional months of good glycemic control (blood glucose 1479 differentially expressed LncRNAs (710 downregulated, 769 upregulated), and among those, 511 common LncRNAs had similar expression in Diab and Rev groups (139 downregulated, 372 upregulated). Gene Ontology/pathway analysis identified limited LncRNAs in biological processes, but analysis based on biological processes/molecular function revealed >350 genes with similar expression in Diab and Rev groups; these genes were mainly associated with stress response, cell death, mitochondrial damage and cytokine production. Thus, identifying retinal LncRNAs and their gene targets that do not benefit from termination of hyperglycemia have potential to serve as therapeutic targets to slow down the progression of diabetic retinopathy.

AIM: To examine the regulatory role of microRNA-204 (miR-204) on silent information regulator 1 (SIRT1) and vascular endothelial growth factor (VEGF) under high-glucose-induced metabolic memory in human retinal pigment epithelial (hRPE) cells. METHODS: Cells were cultured with either normal (5 mmol/L) or high D-glucose (25 mmol/L) concentrations for 8d to establish control and high-glucose groups, respectively. To induce metabolic memory, cells were cultured with 25 mmol/L D-glucose for 4d followed by culture with 5 mmol/L D-glucose for 4d. In addition, exposed in 25 mmol/L D-glucose for 4d and then transfected with 100 nmol/L miR-204 control, miR-204 inhibitor or miR-204 mimic in 5 mmol/L D-glucose for 4d. Quantitative reverse transcription-polymerase chain reaction (RT-qPCR) was used to detect miR-204 mRNA levels. SIRT1 and VEGF protein levels were assessed by immunohistochemical and Western blot. Flow cytometry was used to investigate apoptosis rate. RESULTS: It was found that high glucose promoted miR-204 and VEGF expression, and inhibited SIRT1 activity, even after the return to normal glucose culture conditions. Upregulation of miR-204 promoted apoptosis inhibiting SIRT1 and increasing VEGF expression. However, downregulation of miR-204 produced the opposite effects. CONCLUSION: The study identifies that miR-204 is the upstream target of SIRT1and VEGF, and that miR-204 can protect hRPE cells from the damage caused by metabolic memory through increasing SIRT1 and inhibiting VEGF expression.

The response of retinal pathology to interventions in diabetic retinopathy (DR) is often independent of the glycated hemoglobin (HbA1c) values at the point of care. This is despite glucose control being one of the strongest risk factors for the development and progression of DR. Previous preclinical and clinical research has indicated metabolic memory, whereby past cumulative glucose exposure may continue to impact DR for a prolonged period. Preclinical studies have evaluated punitive metabolic memory through poor initial control of DM, whereas clinical studies have evaluated protective metabolic memory through good initial control of DM. In this narrative review, we evaluate the preclinical and clinical evidence regarding metabolic memory and discuss how this may form the basis of preventive care for DR by inducing “metabolic amnesia” in people with a history of uncontrolled diabetes in the past. While our review suggested mitochondrial biology may be one such target, research is still far from a possible clinical trial. We discuss the challenges in such research.

Abstract Diabetes mellitus, a chronic metabolic disease, often leads to numerous chronic complications, significantly contributing to global morbidity and mortality rates. High glucose levels trigger epigenetic modifications linked to pathophysiological processes like inflammation, immunity, oxidative stress, mitochondrial dysfunction, senescence and various kinds of cell death. Despite glycemic control, transient hyperglycemia can persistently harm organs, tissues, and cells, a latent effect termed "metabolic memory" that contributes to chronic diabetic complications. Understanding metabolic memory's mechanisms could offer a new approach to mitigating these complications. However, key molecules and networks underlying metabolic memory remain incompletely understood. This review traces the history of metabolic memory research, highlights its key features, discusses recent molecules involved in its mechanisms, and summarizes confirmed and potential therapeutic compounds. Additionally, we outline in vitro and in vivo models of metabolic memory. We hope this work will inform future research on metabolic memory's regulatory mechanisms and facilitate the development of effective therapeutic compounds to prevent diabetic complications.

Diabetic kidney disease (DKD) is characterized by complex pathogenesis and poor prognosis; therefore, an exploration of novel etiological factors may be beneficial. Despite glycemic control, the persistence of transient hyperglycemia still induces vascular complications due to metabolicmemory. However, its contribution to DKD remains unclear. Using single-cell RNA sequencing data from the Gene Expression Omnibus (GEO) database, we clustered 12 cell types and employed enrichment analysis and a cell‒cell communication network. Fibrosis, a characteristic of DKD, was found to be associated with metabolic memory. To further identify genes related tometabolic memory and fibrosis in DKD, we combined the above datasets from humans with a rat renal fibrosis model and mouse models of metabolic memory. After overlapping, NDRG1, NR4A1, KCNC4 and ZFP36 were selected. Pharmacology analysis and molecular docking revealed that pioglitazone and resveratrol were possible agents affecting these hub genes. Based on the ex vivo results, NDRG1was selected for further study. Knockdown of NDRG1 reduced TGF-β expression in human kidney-2 cells (HK-2 cells). Compared to that in patientswho had diabetes for more than 10 years but not DKD, NDRG1 expression in blood samples was upregulated in DKD patients. In summary, NDRG1 is a key gene involved in regulating fibrosis in DKD from a metabolic memory perspective. Bioinformatics analysis combined with experimental validation provided reliable evidence for identifying metabolic memory in DKD patients. [ABSTRACT FROM AUTHOR]

The response of retinal pathology to interventions in diabetic retinopathy (DR) is often independent of the glycated hemoglobin (HbA1c) values at the point of care. This is despite glucose control being one of the strongest risk factors for the development and progression of DR. Previous preclinical and clinical research has indicated metabolic memory, whereby past cumulative glucose exposure may continue to impact DR for a prolonged period. Preclinical studies have evaluated punitive metabolic memory through poor initial control of DM, whereas clinical studies have evaluated protective metabolic memory through good initial control of DM. In this narrative review, we evaluate the preclinical and clinical evidence regarding metabolic memory and discuss how this may form the basis of preventive care for DR by inducing “metabolic amnesia” in people with a history of uncontrolled diabetes in the past. While our review suggested mitochondrial biology may be one such target, research is still far from a possible clinical trial. We discuss the challenges in such research. [ABSTRACT FROM AUTHOR]

Diabetes mellitus, a chronic metabolic disease, often leads to numerous chronic complications, significantly contributing to global morbidity and mortality rates. High glucose levels trigger epigenetic modifications linked to pathophysiological processes like inflammation, immunity, oxidative stress, mitochondrial dysfunction, senescence and various kinds of cell death. Despite glycemic control, transient hyperglycemia can persistently harm organs, tissues, and cells, a latent effect termed "metabolic memory" that contributes to chronic diabetic complications. Understanding metabolic memory's mechanisms could offer a new approach to mitigating these complications. However, key molecules and networks underlying metabolic memory remain incompletely understood. This review traces the history of metabolic memory research, highlights its key features, discusses recent molecules involved in its mechanisms, and summarizes confirmed and potential therapeutic compounds. Additionally, we outline in vitro and in vivo models of metabolic memory. We hope this work will inform future research on metabolic memory's regulatory mechanisms and facilitate the development of effective therapeutic compounds to prevent diabetic complications. [ABSTRACT FROM AUTHOR]

Grazing management significantly contributes to low beef production in cow-calf systems within the Rio de la Plata native grasslands. An herbage allowance (HA) of 4 kg DM/kg BW increased the productive response of primiparous cows grazing shallow soils compared to 2.5. However, the impact of HA on metabolic changes and its association with productive response were not studied. We studied two levels of native grassland HA from −150 days relative to calving (DC) to weaning (195 DC) in spring-calving primiparous beef cows undergoing temporary weaning (TW) and flushing at 86 ± 12 DC on herbage intake (HI), body condition score (BCS), BW, milk yield, calf weight, concentrations of metabolic hormones, and the probability of ovulation and pregnancy. Thirty-one heifers were assigned to HA treatments that fluctuated throughout seasons: autumn (−150 to −90 DC) at 5 and 3 kg DM/kg BW, winter (−90 to 0 DC) at 3 and 3 kg DM/kg BW, and spring-summer (0 to 195 DC) at 4 and 2 kg DM/kg BW for High and Low HA, respectively. Data were analysed using linear models and generalised linear models for continuous and categorical variables, respectively. During the autumn period, HI, insulin, IGF-I, BCS, and BW were higher in High HA than Low, despite small differences in herbage mass between HA. Throughout the winter, spring, and summer, HI, insulin, leptin, and BCS changes did not differ between HA. However, IGF-I concentrations were greater at −65 and −40 DC (84 vs 55 ± 8.6 ng/mL; P

Diabetic kidney disease (DKD) is a clinical syndrome that is one of the major causes of end-stage renal disease (ESRD). The pathogenesis of DKD is complex and multifaceted, with most studies indicating its association with genetics, advanced glycosylation end-product deposition, polyol pathway and protein C activation, lipid metabolism abnormalities, microcirculatory dysfunction, oxidative stress, inflammatory factors, and the kallikrein-kinin system. Epigenetics is the science studying gene expression regulation without changes in the DNA sequence. In recent years, increasing evidence has shown that epigenetic mechanisms play a crucial role in the initiation and progression of DKD. For instance, epigenetic modifications such as DNA methylation, histone modifications, and non-coding RNAs can influence the expression of DKD-related genes, thereby regulating the development and progression of DKD. On the other hand, metabolic memory is an important concept in DKD research. Metabolic memory refers to the phenomenon where cells maintain a certain metabolic state even after the disappearance of metabolic stress factors. This state can influence cell function and fate. In DKD, metabolic stress factors such as hyperglycemia can lead to metabolic memory in renal cells, affecting their function and fate, ultimately leading to the development and progression of DKD. Therefore, to further explore the pathogenesis of DKD, research on epigenetics should be strengthened, aiming to provide new ideas and methods for the prevention and treatment of DKD. [ABSTRACT FROM AUTHOR]

Metabolic memory refers to the long-term effects of achieving early glycemic control and the adverse implications of high blood glucose levels, including the development and progression of diabetes complications. Our study aimed to investigate whether the phenomenon of metabolic memory plays a role in the immune profile of young patients with uncomplicated type 1 diabetes (T1D). The study group included 67 patients with uncomplicated type 1 diabetes with a mean age of 15.1 ± 2.3 years and a minimum disease duration of 1.2 years. The control group consisted of 27 healthy children and adolescents with a mean age of 15.1 ± 2.3 years. Patients were divided into three groups according to their HbA1c levels at the onset of T1D, and the average HbA1c levels after one and two years of disease duration. The subgroup A1 had the lowest initial HbA1c values, while the subgroup C had the highest initial HbA1c values. Cytokine levels (including TNF-α, IL-35, IL-4, IL-10, IL-18, and IL-12) were measured in all study participants. Our data analysis showed that subgroup A1 was characterized by significantly higher levels of IL-35 and IL-10 compared to all other groups, and significantly higher levels of IL-4 compared to group B. Additionally, a comparative analysis of cytokine levels between the groups of diabetic patients and healthy controls demonstrated that subgroup A1 had significantly higher levels of anti-inflammatory cytokines. The lipid profile was also significantly better in subgroup A1 compared to all other patient groups. Based on our findings, it appears that an inflammatory process, characterized by an imbalance between the pro- and anti-inflammatory cytokines, is associated with poor glycemic control at the onset of diabetes and during the first year of disease duration. These findings also suggest that both metabolic memory and inflammation contribute to the abnormal lipid profile in patients with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Aims: The impact of donor abdominal fat‐to‐muscle ratio (FMR) on kidney transplant (KT) outcomes was assessed. Given the transient nature of the donor's metabolic environment in transplant recipients, this study investigated the capacity of body composition to induce metabolic memory effects. Materials and Methods: KT patients (n = 895) who received allografts from living donors (2003–2013) were included. Donor fat and muscle were quantified using pre‐KT abdominal computed tomography scans. Patients were categorised into donor FMR tertiles and followed up for graft outcomes. Additionally, genome‐wide DNA methylation analysis was performed on 28 kidney graft samples from KT patients in the low‐ and high‐FMR groups. Results: Mean recipient age was 42.9 ± 11.4 years and 60.9% were males. Donor FMR averaged 1.67 ± 0.79. Over a median of 120.9 ± 42.5 months, graft failure (n = 127) and death‐censored graft failure (n = 109) were more frequent in the higher FMR tertiles. Adjusted hazard ratios for the highest versus lowest FMR tertile were 1.71 (95% CI, 1.06–2.75) for overall graft failure and 1.90 (95% CI, 1.13–3.20) for death‐censored graft failure. Genome‐wide DNA methylation analysis identified 58 differentially methylated regions (p < 0.05, |Δβ| > 0.2) and 35 genes showed differential methylation between the high‐ (FMR >1.91) and low‐FMR (FMR <1.27) groups. Conclusions: Donors with increased fat and reduced muscle composition may negatively impact kidney allograft survival in recipients, possibly through the transmission of epigenetic changes, implying a body‐composition‐related metabolic memory effect. [ABSTRACT FROM AUTHOR]

The study of the young and old animals’ adaptation characteristics to the chronic effect of ethyl alcohol provides a quick solution of problems in biomedicine and gerontology, such as the formation of age related dependencies on pathologies. We studied the chronic effect of 15 % ethanol on young and old rats (3 and 20 month) of the Wistar line, which require free access to alcohol, for 160 days (5.3 months). The time of death occurrence, the relative mass dynamics of the liver, spleen and kidneys, the activity of alcohol dehydrogenase in the post-mitochondrial supernatant of liver, the content of carbonylated proteins and the activity of aconitate hydrotase in the mitochondria of the liver, as well as the serum creatinine level after 10, 20 and 40 days from the start of taking ethyl alcohol were determined. It was shown that the “initial” functional state of the increased activity elements in the formation of ethanol tolerance in young and old animals was different, this is evidenced by changes in the ratios of such indicators as: the relative mass of the liver, kidneys and spleen, the activity of alcohol dehydrogenase, aconitate hydrotase, the content of carbonylated proteins in the liver. We came to a combination that in young rats a “compensatory delayed” adaptation to the chronic effect of alcohol is realized, while (about 50 %) have a “compensatory delayed”, and the rest have a “pathogenetic” strategy; the choice of an adaptation strategy depends on the “initial” functional state, an extremely probable participation in the exchange of ethanol.

Low-grade inflammation (LGI) represents a key driver of type 2 diabetes (T2D) and its associated cardiovascular diseases (CVDs). Indeed, inflammatory markers such as hs-CRP and IL-6 predict the development of T2D and its complications, suggesting that LGI already increases before T2D diagnosis and remains elevated even after treatment. Overnutrition, unhealthy diets, physical inactivity, obesity, and aging are all recognized triggers of LGI, promoting insulin resistance and sustaining the pathogenesis of T2D. Once developed, and even before frank appearance, people with T2D undergo a pathological metabolic remodeling, with an alteration of multiple CVD risk factors, i.e., glycemia, lipids, blood pressure, and renal function. In turn, such variables foster a range of inflammatory pathways and mechanisms, e.g., immune cell stimulation, the accrual of senescent cells, long-lasting epigenetic changes, and trained immunity, which are held to chronically fuel LGI at the systemic and tissue levels. Targeting of CVD risk factors partially ameliorates LGI. However, some long-lasting inflammatory pathways are unaffected by common therapies, and LGI burden is still increased in many T2D patients, a phenomenon possibly underlying the residual inflammatory risk (i.e., having hs-CRP > 2 mg/dL despite optimal LDL cholesterol control). On the other hand, selected disease-modifying drugs, e.g., GLP-1RA, seem to also act on the pathogenesis of T2D, curbing the inflammatory trajectory of the disease and possibly preventing it if introduced early. In addition, selected trials demonstrated the potential of canonical anti-inflammatory therapies in reducing the rate of CVDs in patients with this condition or at high risk for it, many of whom had T2D. Since colchicine, an inhibitor of immune cell activation, is now approved for the prevention of CVDs, it might be worth exploring a possible therapeutic paradigm to identify subjects with T2D and an increased LGI burden to treat them with this drug. Upcoming studies will reveal whether disease-modifying drugs reverse early T2D by suppressing sources of LGI and whether colchicine has a broad benefit in people with this condition.

Objective To construct an in vitro "metabolic memory" cell model of HT-22 mouse hippocampal neurons induced by high glucose, and to investigate the effect of "metabolic memory" on apoptosis and histone acetylation in HT-22 cells. Methods HT-22 cells were cultured in high glucose medium (glucose concentration was 55 mmol/L) and conventional glucose medium (glucose concentration was 25 mmol/L), and cells were divided into the control group (NG 4, 6 and 8 groups, 25 mmol/L glucose was cultured for 4, 6 and 8 days, respectively), the high glucose group (HG 4, 6 and 8 groups, respectively) and the metabolic memory group (HG2NG2, HG2NG4, HG2NG6, HG4NG2 and HG4NG4 groups, high glucose culture for 2 days to 25 mmol/L glucose culture for 2, 4 or 6 days, high glucose culture for 4 days to 25 mmol/L glucose culture for 2 or 4 days). Cell viability was detected by CCK-8 method. The release of lactate dehydrogenase (LDH) in cell culture supernatant was detected, and the optimal time to establish a "metabolic memory" model was selected. Subsequently, cells were divided into the NG4 group, the NG8 group, the HG4 group, the HG4NG4 group and the HG8 group, and the cell morphology of each group was observed by optical microscope. The apoptosis rate was detected by flow cytometry. The activities of deacetylase (HDAC) and histone acetyltransferase (HAT) were detected by enzyme-linked immunosorbent assay (ELISA). Western blot assay was used to detect expression levels of histone deacetylase 4 (HDAC4), B lymphocyte tumor 2 (Bcl-2), Bcl-2 related X protein (Bax) and Caspase-3 protein. Results The HG4NG4 group was the ideal cell model with high glucose metabolic memory. Cells of the NG4 group and the NG8 group were interwoven into a dense network, growing well, with spindle shaped cells and distinct synaptic structures. However, in the HG4 group and the HG8 group, the cell body became round, synaptic structure disappeared and growth was inhibited. In the HG4NG4 group, the number of cells increased but their morphology was damaged. Results of flow cytometry showed that compared with the NG8 group, the apoptosis rates were significantly increased in the HG8 group and the HG4NG4 group (P＜0.05). ELISA results showed that compared with the NG8 group, the expression levels of HDAC4, Bax, and Caspase-3 proteins increased in the HG8 group and the HG4NG4 group, while the expression level of Bcl-2 protein significantly decreased (P＜0.05). Compared with the HG8 group, there were no significant differences in protein expression levels of HAT and HDAC in the HG4NG4 group. Western blot reslts showed that compared with the NG8 group, the levels of HDAC4, Bax and Caspase-3 protein increased in the HG8 group and the HG4NG4 group (P＜0.05). Compared with the HG8 group, there were no significant differences in protein expression levels in the HG4NG4 group. Conclusion HT-22 mouse hippocampal neurons cultured with 55mmol/L high glucose for 4 days, and then cultured with 25 mmol/L glucose for 4 days are the ideal "metabolic memory" cell model. The mechanism may be related to the increased activity of HDAC, HAT and HDAC4 expression in the hyperglycemic model. [ABSTRACT FROM AUTHOR]

Retinopathy fails to halt even after diabetic patients in poor glycemic control try to institute tight glycemic control, suggesting a "metabolic memory" phenomenon, and the experimental models have demonstrated that mitochondria continue to be damaged/dysfunctional, fueling into the vicious cycle of free radicals. Our aim was to investigate the role of removal of the damaged mitochondria in the metabolic memory. Using human retinal endothelial cells (HRECs), incubated in 20 mM D-glucose for 4 days, followed by 5 mM D-glucose for 4 additional days, mitochondrial turnover, formation of mitophagosome, and mitophagy flux were evaluated. Mitophagy was confirmed in a rat model of metabolic memory where the rats were kept in poor glycemic control (blood glucose ~ 400 mg/dl) for 3 months soon after induction of streptozotocin-induced diabetes, followed by 3 additional months of good control (BG < 150 mg/dl). Reversal of high glucose by normal glucose had no effect on mitochondrial turnover and mitophagosome formation, and mitophagy flux remained compromised. Similarly, 3 months of good glycemic control in rats, which had followed 3 months of poor glycemic control, had no effect on mitophagy flux. Thus, poor turnover/removal of the damaged mitochondria, initiated during poor glycemic control, does not benefit from the termination of hyperglycemic insult, and the damaged mitochondria continue to produce free radicals, suggesting the importance of mitophagy in the metabolic memory phenomenon associated with the continued progression of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

The prevalence of Diabetes is steadily increasing, raising public health concerns. Hyperglycemia leads to microvascular and macrovascular diseases through several metabolic and biochemical pathways. Previous clinical trials and observational studies have demonstrated that tight glycemic control can reduce the incidence of diabetic complications, with the greatest benefit shown in younger patients with diabetes of shorter duration and those who have no prior history of cardiovascular disease. Moreover, previous studies highlight the concept of metabolic memory and legacy effect, since controlling diabetes early can have an impact on long-term prognosis of the disease. As to whether it is time to consider shifting the treatment focus for patients with type 2 diabetes from a glucose-centric to a weight-centric or a cardio-centric approach, the dilemma remains theoretical; glucose control, weight loss and effective treatment of metabolic and cardio-vascular co-morbidities are interrelated components of an integrated plan of care that should be addressed simultaneously and effectively. [ABSTRACT FROM AUTHOR]

Glycated haemoglobin in the first year after diagnosis of type 1 diabetes is an independent risk factor for diabetic retinopathy: The IMDIAB 25 years follow-up study Effect of intensive diabetes therapy on the progression of diabetic retinopathy in patients with type 1 diabetes: 18 years of follow-up in the DCCT/EDIC. Keywords: HbA1c; metabolic memory; retinopathy; type 1 diabetes EN HbA1c metabolic memory retinopathy type 1 diabetes 3415 3419 5 10/05/23 20231101 NES 231101 BACKGROUND Intensive glycaemic control lowers the risk of microvascular complications.[1] This effect has been shown to persist for up to 18 years of follow-up.[[2], [4]] Whether the glycaemic control obtained during the first months after type 1 diabetes (T1D) onset has an impact on the future risk of chronic complications has not been clarified. Linear regression models were used to test the presence of any association between HbA1c at diabetes onset, mean-first-year HbA1c and HbA1c measured at last follow-up and to test baseline features associated with first-year HbA1c. [Extracted from the article]

Abstract Background Diabetic foot is a significant cause of morbidity in diabetic patients, with a rate that is approximately twice that of patients without foot ulcers. “Metabolic memory” represents the epigenetic changes induced by chronic hyperglycaemia, despite the correction of the glucose levels themselves. These epigenetic modifications appear to perpetuate the damage caused by persistently elevated glucose levels even in their absence, acting at various levels, mostly affecting the molecular processes of diabetic ulcer healing. Methods The aim of our cross-sectional study was to analyse a cohort of patients with diabetes with and without lower limb ulcers. We examined the effects of epigenetic changes on miRNA 126, 305, and 217 expression and the frequency of the SNPs of genes encoding inflammatory molecules (e.g., IL-6 and TNF-alpha) and their correlations with serum levels of proangiogenic molecules (e.g., ENOS, VEGF and HIF-1alpha) and several adipokines as well as with endothelial dysfunction, assessed noninvasively by reactive hyperaemia peripheral artery tonometry. Between March 2021 and June 2022, 110 patients were enrolled into the study: 50 diabetic patients with diabetic foot injuries, 40 diabetic patients without ulcerative complications and 20 nondiabetic patients as the control group. Results Diabetic subjects with lower limb ulcerative lesions exhibited higher levels of inflammatory cytokines, such as VEGF (191.40 ± 200 pg/mL vs. 98.27 ± 56.92 pg/mL vs. 71.01 ± 52.96 pg/mL; p = 0.22), HIF-1alpha (40.18 ± 10.80 ng/mL vs. 33.50 ± 6.16 ng/mL vs. 33.85 ± 6.84 ng/mL; p = 0.10), and Gremlin-1 (1.72 ± 0.512 ng/mL vs. 1.31 ± 0.21 ng/mL vs. 1.11 ± 0.19 ng/mL; p

Despite constant therapeutic achievements as well as technological advances in the treatment and control of diabetes mellitus (DM), the percentage of patients who do not reach their individual glycated hemoglobin (HbA1c) target level is still significant. Large-scale clinical studies prove that effective for prevention of long-term diabetic complications is not only optimal glycemic control itself but its early achievement in the course of the disease. The latter defines the so-called “metabolic memory”, whose pathophysiological mechanisms are not completely known. However, the leading role of advanced glycation end products (AGEs) and associated tissue damage is assumed. AGEs are a heterogeneous group of compounds derived from a nonenzymatic glycation of proteins, lipids and nucleic acids in different tissues and fluids with sufficient glucose concentration. Their formation is increased in a multitude of conditions associated with acute or chronic oxidative stress, including DM. AGEs are believed to play a central role in the pathogenesis of diabetic complications by triggering various signaling pathways related to oxidative stress, chronic inflammation, and apoptosis. It is well known that HbA1c allows for relatively short-term monitoring of glycemic control. On the other hand, the ability of AGEs to irreversibly bind to long-term proteins makes them a potential biomarker for long-term retrospective glycemic control and associated chronic diabetic complications. Skin autofluorescence has been established as a fast, easily applicable, non-invasive technique for the measurement of skin accumulated AGEs. This method relies on the fluorescent properties of several glycated products and has been validated with the “gold standard” for assessment of tissue-bound AGEs – the skin biopsy. [ABSTRACT FROM AUTHOR]

Epigenetics focuses on DNA methylation, histone modification, chromatin remodeling, noncoding RNAs, and other gene regulation mechanisms beyond the DNA sequence. In the past decade, epigenetic modifications have drawn more attention as they participate in the development and progression of diabetic retinopathy despite tight control of glucose levels. The underlying mechanisms of epigenetic modifications in diabetic retinopathy still urgently need to be elucidated. The diabetic condition facilitates epigenetic changes and influences target gene expression. In this review, we summarize the involvement of epigenetic modifications and metabolic memory in the development and progression of diabetic retinopathy and propose novel insights into the treatment of diabetic retinopathy.

Background: Diabetic foot is a significant cause of morbidity in diabetic patients, with a rate that is approximately twice that of patients without foot ulcers. "Metabolic memory" represents the epigenetic changes induced by chronic hyperglycaemia, despite the correction of the glucose levels themselves. These epigenetic modifications appear to perpetuate the damage caused by persistently elevated glucose levels even in their absence, acting at various levels, mostly affecting the molecular processes of diabetic ulcer healing. Methods: The aim of our cross-sectional study was to analyse a cohort of patients with diabetes with and without lower limb ulcers. We examined the effects of epigenetic changes on miRNA 126, 305, and 217 expression and the frequency of the SNPs of genes encoding inflammatory molecules (e.g., IL-6 and TNF-alpha) and their correlations with serum levels of proangiogenic molecules (e.g., ENOS, VEGF and HIF-1alpha) and several adipokines as well as with endothelial dysfunction, assessed noninvasively by reactive hyperaemia peripheral artery tonometry. Between March 2021 and June 2022, 110 patients were enrolled into the study: 50 diabetic patients with diabetic foot injuries, 40 diabetic patients without ulcerative complications and 20 nondiabetic patients as the control group. Results: Diabetic subjects with lower limb ulcerative lesions exhibited higher levels of inflammatory cytokines, such as VEGF (191.40 ± 200 pg/mL vs. 98.27 ± 56.92 pg/mL vs. 71.01 ± 52.96 pg/mL; p = 0.22), HIF-1alpha (40.18 ± 10.80 ng/mL vs. 33.50 ± 6.16 ng/mL vs. 33.85 ± 6.84 ng/mL; p = 0.10), and Gremlin-1 (1.72 ± 0.512 ng/mL vs. 1.31 ± 0.21 ng/mL vs. 1.11 ± 0.19 ng/mL; p < 0.0005), than those without lower limb ulcers and healthy controls. Furthermore, we observed that miR-217-5p and miR-503-5p were 2.19-fold (p < 0.05) and 6.21-fold (p = 0.001) more highly expressed in diabetic foot patients than in healthy controls, respectively. Additionally, diabetic patients without lower limb ulcerative complications showed 2.41-fold (p = 0) and 2.24-fold (p = 0.029) higher expression of miR-217-5p and miR-503-5p, respectively, than healthy controls. Finally, diabetic patients with and without ulcerative complications of the lower limbs showed higher expression of the VEGFC2578A CC polymorphism (p = 0.001) and lower expression of the VEGFC2578A AC polymorphism (p < 0.005) than the healthy control population. We observed a significant increase in Gremlin-1 levels in patients with diabetic foot, suggesting that this inflammatory adipokine may serve as a predictive marker for the diagnosis of diabetic foot. Conclusions: Our results highlighted that patients with diabetic foot showed predominant expression of the VEGF C2578A CC polymorphism and reduced expression of the AC allele. Additionally, we found an overexpression of miR-217-5p and miR-503-5p in diabetic patients with and without diabetic foot syndrome compared with healthy controls. These results align with those reported in the literature, in which the overexpression of miR-217-5p and miR-503-5p in the context of diabetic foot is reported. The identification of these epigenetic modifications could therefore be helpful in the early diagnosis of diabetic foot and the treatment of risk factors. However, further studies are necessary to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

An impaired healing response underlies diabetic foot wound chronicity, frequently translating to amputation, disability, and mortality. Diabetics suffer from underappreciated episodes of post-epithelization ulcer recurrence. Recurrence epidemiological data are alarmingly high, so the ulcer is considered in "remission" and not healed from the time it remains epithelialized. Recurrence may result from the combined effects of behavioral and endogenous biological factors. Although the damaging role of behavioral, clinical predisposing factors is undebatable, it still remains elusive in the identification of endogenous biological culprits that may prime the residual scar tissue for recurrence. Furthermore, the event of ulcer recurrence still waits for the identification of a molecular predictor. We propose that ulcer recurrence is deeply impinged by chronic hyperglycemia and its downstream biological effectors, which originate epigenetic drivers that enforce abnormal pathologic phenotypes to dermal fibroblasts and keratinocytes as memory cells. Hyperglycemia-derived cytotoxic reactants accumulate and modify dermal proteins, reduce scar tissue mechanical tolerance, and disrupt fibroblast-secretory activity. Accordingly, the combination of epigenetic and local and systemic cytotoxic signalers induce the onset of "at-risk phenotypes" such as premature skin cell aging, dysmetabolism, inflammatory, pro-degradative, and oxidative programs that may ultimately converge to scar cell demise. Post-epithelialization recurrence rate data are missing in clinical studies of reputed ulcer healing therapies during follow-up periods. Intra-ulcer infiltration of epidermal growth factor exhibits the most consistent remission data with the lowest recurrences during 12-month follow-up. Recurrence data should be regarded as a valuable clinical endpoint during the investigational period for each emergent healing candidate. [ABSTRACT FROM AUTHOR]

[Display omitted] • Pathogenesis and salugenesis are the first and second stages of the two-stage problem of disease production and health recovery. • Salugenesis, the healing cycle, the integrated stress response (ISR), and the cell danger response (CDR) each describe different aspects of the same biology. • The healing cycle cannot progress without programmatic changes in mitochondrial function needed for local and organelle-to-organism signaling. • The rise and fall of extracellular ATP (eATP) after stress or injury is a key driver of salugenesis and the healing cycle. • The rising tide of chronic disease can be traced to impaired salugenesis, incomplete healing, pollution, and ecosystem changes caused in part by anthropogenic factors. Pathogenesis and salugenesis are the first and second stages of the two-stage problem of disease production and health recovery. Salugenesis is the automatic, evolutionarily conserved, ontogenetic sequence of molecular, cellular, organ system, and behavioral changes that is used by living systems to heal. It is a whole-body process that begins with mitochondria and the cell. The stages of salugenesis define a circle that is energy- and resource-consuming, genetically programmed, and environmentally responsive. Energy and metabolic resources are provided by mitochondrial and metabolic transformations that drive the cell danger response (CDR) and create the three phases of the healing cycle: Phase 1—Inflammation, Phase 2—Proliferation, and Phase 3—Differentiation. Each phase requires a different mitochondrial phenotype. Without different mitochondria there can be no healing. The rise and fall of extracellular ATP (eATP) signaling is a key driver of the mitochondrial and metabolic reprogramming required to progress through the healing cycle. Sphingolipid and cholesterol-enriched membrane lipid rafts act as rheostats for tuning cellular sensitivity to purinergic signaling. Abnormal persistence of any phase of the CDR inhibits the healing cycle, creates dysfunctional cellular mosaics, causes the symptoms of chronic disease, and accelerates the process of aging. New research reframes the rising tide of chronic disease around the world as a systems problem caused by the combined action of pathogenic triggers and anthropogenic factors that interfere with the mitochondrial functions needed for healing. Once chronic pain, disability, or disease is established, salugenesis-based therapies will start where pathogenesis-based therapies end. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy continues to progress even when hyperglycemia is terminated, suggesting a 'metabolic memory' phenomenon. Mitochondrial dysfunction is closely associated with the development of diabetic retinopathy, and mitochondria remain dysfunctional. Quality control of mitochondria requires a fine balance between mitochondrial fission–fusion, removal of the damaged mitochondria (mitophagy) and formation of new mitochondria (biogenesis). In diabetes, while mitochondrial fusion protein (Mfn2) is decreased, fission protein (Drp1) is increased, resulting in fragmented mitochondria. Re-institution of normal glycemia fails to reverse mitochondrial fragmentation, and dysfunctional mitochondria continue to accumulate. Our aim was to investigate the direct effect of regulation of the mitochondrial fusion process during normal glycemia that follows a high glucose insult on mitochondrial quality control in the 'metabolic memory' phenomenon. Human retinal endothelial cells, incubated in 20 mM glucose for four days, followed by 5 mM glucose for four additional days, with or without the Mfn2 activator leflunomide, were analyzed for mitochondrial fission (live cell imaging), mitophagy (flow cytometry and immunofluorescence microscopy), and mitochondrial mass (mitochondrial copy numbers and MitoTracker labeling). Mitochondrial health was determined by quantifying mitochondrial reactive oxygen species (ROS), respiration rate (Seahorse XF96) and mitochondrial DNA (mtDNA) damage. Addition of leflunomide during normal glucose exposure that followed high glucose prevented mitochondrial fission, facilitated mitophagy and increased mitochondrial mass. Glucose-induced decrease in mitochondrial respiration and increase in ROS and mtDNA damage were also prevented. Thus, direct regulation of mitochondrial dynamics can help maintain mitochondrial quality control and interfere with the metabolic memory phenomenon, preventing further progression of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Summary: Background: A delay in reaching HbA1c targets in patients with newly-diagnosed type 2 diabetes (T2D) is associated with an increased long-term risk of developing cardiovascular diseases (CVD), a phenomenon referred to as legacy effect. Whether an early introduction of glucose-lowering drugs with proven benefit on CVD can attenuate this phenomenon is unknown. Methods: Using data derived from a large Italian clinical registry, i.e. the AMD Annals, we identified 251,339 subjects with newly-diagnosed T2D and without CVD at baseline. Through Cox regressions adjusted for multiple risk factors, we examined the association between having a mean HbA1c between 7.1 and 8% or >8%, compared with ≤7%, for various periods of early exposure (0–1, 0–2, 0–3 years) and the development of later (mean subsequent follow-up 4.6 ± 2.9 years) CVD, evaluated as a composite of myocardial infarction, stroke, coronary or peripheral revascularization, and coronary or peripheral bypass. We performed this analysis in the overall cohort and then splitting the population in two groups of patients: those that introduced sodium-glucose transport protein 2 inhibitors (SGLT-2i) during the exposure phase and those not treated with these drugs. Findings: Considering the whole cohort, subjects with both a mean HbA1c between 7.1 and 8% and >8%, compared with patients attaining a mean HbA1c ≤ 7%, showed an increased risk of developing the outcome in all the three early exposure periods assessed, with the highest risk observed in patients with mean HbA1c > 8% in the 3 years exposure period (hazard ratio [HR]1.33; 95% confidence interval [CI] 1.063–1.365). The introduction of SGLT-2i during the exposure periods of 0–1 and 0–2 years eliminated the association between poor glycemic control and the outcome (p for interaction 0.006 and 0.003, respectively, vs. patients with the same degree of glycemic control but not treated with these drugs). Interpretation: Among patients with newly diagnosed T2D and free of CVD at baseline, a poor glycemic control in the first three years after diagnosis is associated with an increased subsequent risk of CVD. This association is no longer evident when SGLT-2i are introduced in the first two years, suggesting that these drugs attenuate the phenomenon of legacy effect. An early treatment with these drugs might thus promote a long-lasting benefit in patients not attaining proper glycemic control after T2D diagnosis. Funding: This work was supported, in part, by the Italian Ministry of Health (Ricerca Corrente) to IRCCS MultiMedica.

Diabetes retinopathy(DR)may continue to develop even if blood sugar is well controlled, which indicates that previous hyperglycemia will lead to long-term harmful vascular dysfunction, and this phenomenon is defined as “metabolic memory” of diabetes retinopathy. Because the onset of DR is insidious, clinical symptomatic treatment is mainly used. Effective means of early diagnosis, accurate treatment and prognosis are lacking and new diagnosis and treatment ideas need to be developed urgently. In recent years, many new studies have shown that epigenetic modification is involved in the pathogenesis of DR “metabolic memory” in DNA methylation, histone post-translational modification and microRNA(microRNAs,miRNAs)regulation, which provides a direction and strategy for the exploration of DR molecular mechanism. In this review, we discussed the role of epigenetic modification in the pathogenesis of DR and analyzed the challenges and prospects of its application in the treatment of DR, with a view to provide a reference for early diagnosis and treatment of DR in the future.

Biochemical abnormalities in the course of type 1 diabetes (T1D) may cause the production/activation of various proteins and peptides influencing treatment and causing a risk of complications. The aim of this study was to assess concentrations of selected serum substances involved in the pathogenesis and course of T1D and to correlate their concentrations with the duration of T1D. The study included patients with T1D (n = 156) at the age of 3–17, who were divided according to the duration of the disease into those newly diagnosed (n = 30), diagnosed after 3–5 (n = 77), 6–7 (n = 25), and over 7 (n = 24) years from the onset of T1D, and age-matched healthy controls (n = 30). Concentrations of amylin (IAPP), proamylin (proIAPP), catestatin (CST), chromogranin A (ChgA), nerve growth factor (NFG), platelet-activating factor (PAF), uromodulin (UMOD), and intestinal fatty acid binding protein (I-FABP) were measured in sera using immunoenzymatic tests. There were significant differences in concentrations of all the substances except UMOD and NGF between T1D patients and healthy children. The duration of the disease affected concentrations of CST, ChgA, PAF, and NGF, i.e., proteins/peptides which could have an impact on the course of T1D and the development of complications. In long-term patients, a decrease in concentrations of CST and ChgA, and an increase in PAF concentrations were found. In the case of NGF, a decrease was observed after the initial high values, followed by an increase over 7 years after T1D diagnosis. Concluding, the results show that concentrations of selected serum indicators may change in the course of T1D. Further studies are needed to establish whether these indicators could be used in the context of predicting long-term complications. [ABSTRACT FROM AUTHOR]

Since lycopene has antioxidant activity, its combination with metformin may be useful to contrast diabetic complications related to oxidative stress. This study aimed to investigate the effects of metformin combined with lycopene on high-fat diet (HFD)-induced obese mice. Seventy-two C57BL-6J mice were divided into six groups: C (control diet-fed mice), H (HFD-fed mice for 17 weeks), H-V (HFD-fed mice treated with vehicle), H-M (HFD-fed mice treated with 50 mg/kg metformin), H-L (HFD-fed mice treated with 45 mg/kg lycopene), and H-ML (HFD-fed mice treated with 50 mg/kg metformin + 45 mg/kg lycopene). Treatments were administered for 8 weeks. Glucose tolerance, insulin sensitivity, fluorescent AGEs (advanced glycation end products), TBARS (thiobarbituric acid-reactive substances), and activities of antioxidant enzymes paraoxonase-1 (PON-1; plasma), superoxide dismutase, catalase and glutathione peroxidase (liver and kidneys) were determined. Metformin plus lycopene reduced body weight; improved insulin sensitivity and glucose tolerance; and decreased AGEs and TBARS in plasma, liver and kidneys. Combined therapy significantly increased the activities of antioxidant enzymes, mainly PON-1. Lycopene combined with metformin improved insulin resistance and glucose tolerance, and caused further increases in endogenous antioxidant defenses, arising as a promising therapeutic strategy for combating diabetic complications resulting from glycoxidative stress. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) and chronic kidney disease are the diseases that have exceeded epidemic thresholds in terms of prevalence all over the world. That made it possible to classify them as non-communicable epidemics of the XXI century. Diabetic nephropathy (DN) is implicated with high levels of disablement and mortality. Advanced glycation end products (AGE) play a key role in the progression of DN. Increased formation of AGE occurs due to hyperglycemia under the conditions of diabetes. Moreover, there are additional factors in DN that increase the elaboration of AGE, such as high levels of oxidative stress and decreased renal clearance which slows down the AGE excretion. Both immediate effects of AGE and interaction of AGE with its cell-bound receptor (RAGE) result in a сascade of events that lead to further progression of DN. Thus, the research of the new therapeutic approaches targeted on the AGE-RAGE system is of great interest to slow progression of DN and improve the prognosis.

Diabetic nephropathy (DN), which is a common microvascular complication with a high incidence in diabetic patients, greatly increases the mortality of patients. With further study on DN, it is found that epigenetics plays a crucial role in the pathophysiological process of DN. Epigenetics has an important impact on the development of DN through a variety of mechanisms, and promotes the generation and maintenance of metabolic memory, thus ultimately leading to a poor prognosis. In this review we discuss the methylation of DNA, modification of histone, and regulation of non-coding RNA involved in the progress of cell dysfunction, inflammation and fibrosis in the kidney, which ultimately lead to the deterioration of DN.

Cellular memory is a controversial concept representing the ability of cells to "write and memorize" stressful experiences via epigenetic operators. The progressive course of chronic, non-communicable diseases such as type 2 diabetes mellitus, cancer, and arteriosclerosis, is likely driven through an abnormal epigenetic reprogramming, fostering the hypothesis of a cellular pathologic memory. Accordingly, cultured diabetic and cancer patient-derived cells recall behavioral traits as when in the donor's organism irrespective to culture time and conditions. Here, we analyze the data of studies conducted by our group and led by a cascade of hypothesis, in which we aimed to validate the hypothetical existence and transmissibility of a cellular pathologic memory in diabetes, arteriosclerotic peripheral arterial disease, and cancer. These experiments were based on the administration to otherwise healthy animals of cell-free filtrates prepared from human pathologic tissue samples representative of each disease condition. The administration of each pathologic tissue homogenate consistently induced the faithful recapitulation of: (1) Diabetic archetypical changes in cutaneous arterioles and nerves. (2) Non-thrombotic arteriosclerotic thickening, collagenous arterial encroachment, aberrant angiogenesis, and vascular remodeling. (3) Pre-malignant and malignant epithelial and mesenchymal tumors in different organs; all evocative of the donor's tissue histopathology and with no barriers for interspecies transmission. We hypothesize that homogenates contain pathologic tissue memory codes represented in soluble drivers that "infiltrate" host's animal cells, and ultimately impose their phenotypic signatures. The identification and validation of the actors in behind may pave the way for future therapies. [ABSTRACT FROM AUTHOR]

Inherent and acquired abnormalities in gene regulation due to the influence of genetics and epigenetics (traits related to environment rather than genetic factors) underlie many diseases including diabetes. Diabetes could lead to multiple complications including retinopathy, nephropathy, and cardiovascular disease that greatly increase morbidity and mortality. Epigenetic changes have also been linked to diabetes-related complications. Genes associated with many pathophysiological features of these vascular complications (e.g., inflammation, fibrosis, and oxidative stress) can be regulated by epigenetic mechanisms involving histone posttranslational modifications, DNA methylation, changes in chromatin structure/remodeling, and noncoding RNAs. Intriguingly, these epigenetic changes triggered during early periods of hyperglycemic exposure and uncontrolled diabetes are not immediately corrected even after restoration of normoglycemia and metabolic balance. This latency in effect across time and conditions is associated with persistent development of complications in diabetes with prior history of poor glycemic control, termed as metabolic memory or legacy effect. Epigenetic modifications are generally reversible and provide a window of therapeutic opportunity to ameliorate cellular dysfunction and mitigate or "erase" metabolic memory. Notably, trained immunity and related epigenetic changes transmitted from hematopoietic stem cells to innate immune cells have also been implicated in metabolic memory. Hence, identification of epigenetic variations at candidate genes, or epigenetic signatures genome-wide by epigenome-wide association studies can aid in prompt diagnosis to prevent progression of complications and identification of much-needed new therapeutic targets. Herein, we provide a review of epigenetics and epigenomics in metabolic memory of diabetic complications covering the current basic research, clinical data, and translational implications. [ABSTRACT FROM AUTHOR]

The prevalence of diabetes mellitus is increasing worldwide. Endothelial dysfunction plays a critical role in the pathophysiology of diabetes-related vascular complications. Several studies have shown that restoring blood glucose levels failed to reduce the incidence of major cardiovascular events in diabetic population, hence confirming the idea of “metabolic/hyperglycemic memory”. The major pathomechanism is, most likely, represented by the overproduction of reactive oxygen species (ROS). The purpose of this minireview is to summarize current knowledge about the mechanisms of metabolic memory and the impact of cardiovascular medication on this phenomenon, respectively.

Type 2 diabetes mellitus (T2DM) is a chronic disease with high global prevalence characterized by persistent hyperglycemia. Elevated blood glucose levels are associated with constant oxidative stress and increased protein glycation, establishing a metabolic memory state. Therefore, the efficacy of the Okra (Abelmoschus esculentus L. moench) Fruit Powder Standardized in Flavonoids (OFP-SF) was evaluated in glucose homeostasis, oxidative stress, and metabolic memory, using zebrafish models of acute and chronic hyperglycemia. The OFP-SF was produced from dried fresh fruits and subsequently subjected to characterization regarding its antioxidant potential and chemical composition. Finally, the product was standardized to contain 1.6% flavonoids. In acute hyperglycemia, OFP-SF at doses of 125 μg and 250 μg demonstrated the ability to normalize blood glucose levels, reaching levels of 94.56 ± 5.9 mg/dL and 76.88 ± 8.9 mg/dL, respectively, when administered prior to glucose overload. The same doses were tested in a chronic hyperglycemia model, where after a seven-day treatment, animals receiving 125 and 250 μg of OFP-SF exhibited glycemic values of 73.45 ± 15.67 mg/dL and 33.96 ± 5.31 mg/dL, respectively, comparable to those observed in the Control group (49.48 ± 2.77 mg/dL). Furthermore, OFP-SF was able to mitigate metabolic memory by reducing oxidative stress and protein glycation in the brain, liver, and eye tissues of hyperglycemic zebrafish. These findings provide a basis for developing new products that utilize the phytochemical potential of A. esculentus fruits for the prevention and adjunctive treatment of T2DM. [ABSTRACT FROM AUTHOR]

• Studied 2.5 vs 4 kg DM/kg BW herbage allowance in spring-calving primiparous beef cows. • High allowance improved nutrition and metabolic status in 2nd trimester of gestation. • Last trimester gestation IGF-I was greater in High allowance due to a carry-over effect. • Ovulation probability is positively associated with prepartum IGF-I but not postpartum. • Management plans must consider herbage allowance during the 2nd−trimester gestation. Grazing management significantly contributes to low beef production in cow-calf systems within the Rio de la Plata native grasslands. An herbage allowance (HA) of 4 kg DM/kg BW increased the productive response of primiparous cows grazing shallow soils compared to 2.5. However, the impact of HA on metabolic changes and its association with productive response were not studied. We studied two levels of native grassland HA from −150 days relative to calving (DC) to weaning (195 DC) in spring-calving primiparous beef cows undergoing temporary weaning (TW) and flushing at 86 ± 12 DC on herbage intake (HI), body condition score (BCS), BW, milk yield, calf weight, concentrations of metabolic hormones, and the probability of ovulation and pregnancy. Thirty-one heifers were assigned to HA treatments that fluctuated throughout seasons: autumn (−150 to −90 DC) at 5 and 3 kg DM/kg BW, winter (−90 to 0 DC) at 3 and 3 kg DM/kg BW, and spring-summer (0 to 195 DC) at 4 and 2 kg DM/kg BW for High and Low HA, respectively. Data were analysed using linear models and generalised linear models for continuous and categorical variables, respectively. During the autumn period, HI, insulin, IGF-I, BCS, and BW were higher in High HA than Low, despite small differences in herbage mass between HA. Throughout the winter, spring, and summer, HI, insulin, leptin, and BCS changes did not differ between HA. However, IGF-I concentrations were greater at −65 and −40 DC (84 vs 55 ± 8.6 ng/mL; P < 0.05) and tended to be greater after TW in High HA than Low. The probability of ovulation did not reach significance (0.94 vs 0.75 ± 0.11 for High and Low HA, respectively; P = 0.125), while the probability of pregnancy was greater in High HA than in Low HA (0.9 vs 0.61 ± 0.10; P = 0.07). Ovulation probability exhibited a positive association with IGF-I concentrations at −90 and −40 DC (P < 0.05), but not postpartum. Milk yield did not differ between treatments, while calf weight was heavier at weaning in High HA cows (194 vs 178 ± 3.3 kg; P < 0.05). High HA enhances autumn HI and BCS and generates a carry-over effect on IGF-I concentrations throughout winter and after TW ("metabolic memory"), explaining the better reproductive response. Moderate changes in cows' nutrition during autumn contribute to changes in metabolic status and reproductive outcomes in primiparous cows grazing moderate herbage production native grasslands. [ABSTRACT FROM AUTHOR]

Metabolomics has emerged as a powerful new tool in precision medicine. No studies have yet been published on the metabolomic changes in cerebrospinal fluid (CSF) produced by acute endurance exercise. CSF and plasma were collected from 19 young active adults (13 males and 6 females) before and 60 min after a 90‐min monitored outdoor run. The median age, BMI, and VO2 max of subjects was 25 years (IQR 22–31), 23.2 kg/m2 (IQR 21.7–24.5), and 47 ml/kg/min (IQR 38–51), respectively. Targeted, broad‐spectrum metabolomics was performed by liquid chromatography, tandem mass spectrometry (LC–MS/MS). In the CSF, purines and pyrimidines accounted for 32% of the metabolic impact after acute endurance exercise. Branch chain amino acids, amino acid neurotransmitters, fatty acid oxidation, phospholipids, and Krebs cycle metabolites traceable to mitochondrial function accounted for another 52% of the changes. A narrow but important channel of metabolic communication was identified between the brain and body by correlation network analysis. By comparing these results to previous work in experimental animal models, we found that over 80% of the changes in the CSF correlated with a cascade of mitochondrial and metabolic changes produced by ATP signaling. ATP is released as a co‐neurotransmitter and neuromodulator at every synapse studied to date. By regulating brain mitochondrial function, ATP release was identified as an early step in the kinetic cascade of layered benefits produced by endurance exercise. [ABSTRACT FROM AUTHOR]

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Aims/hypothesis: Attenuated counterregulation after recurrent hypoglycaemia is a major complication of diabetes treatment. As there is previous evidence for the relevance of sleep in metabolic control, we assessed the acute contribution of sleep to the counterregulatory adaptation to recurrent hypoglycaemia. Methods: Within a balanced crossover design, 15 healthy, normal-weight male participants aged 18–35 years underwent three hyperinsulinaemic–hypoglycaemic clamps with a glucose nadir of 2.5 mmol/l, under two experimental conditions, sleep and sleep deprivation. Participants were exposed to two hypoglycaemic episodes, followed by a third hypoglycaemic clamp after one night of regular 8 h sleep vs sleep deprivation. The counterregulatory response of relevant hormones (glucagon, growth hormone [GH], ACTH, cortisol, adrenaline [epinephrine] and noradrenaline [norepinephrine]) was measured, and autonomic and neuroglycopenic symptoms were assessed. Results: Sleep deprivation compared with sleep dampened the adaptation to recurrent hypoglycaemia for adrenaline (p=0.004), and this pattern also emerged in an overall analysis including adrenaline, GH and glucagon (p=0.064). After regular sleep, the counterregulatory responses of adrenaline (p=0.005), GH (p=0.029) and glucagon (p=0.009) were attenuated during the 3rd clamp compared with the 1st clamp, but were preserved after sleep deprivation (all p>0.225). Neuroglycopenic and autonomic symptoms during the 3rd clamp compared with the 1st clamp were likewise reduced after sleep (p=0.005 and p=0.019, respectively). In sleep deprivation, neuroglycopenic symptoms increased (p=0.014) and autonomic symptoms were unchanged (p=0.859). Conclusions/interpretation: The counterregulatory adaptation to recurrent hypoglycaemia is compromised by sleep deprivation between hypoglycaemic episodes, indicating that sleep is essential for the formation of a neurometabolic memory, and may be a potential target of interventions to treat hypoglycaemia unawareness syndrome. [ABSTRACT FROM AUTHOR]

We examined whether persistence of epigenetic DNA methylation (DNA-me) alterations at specific loci over two different time points in people with diabetes are associated with metabolic memory, the prolonged beneficial effects of intensive vs. conventional therapy during the Diabetes Control and Complications Trial (DCCT) on the progression of microvascular outcomes in the long-term follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) Study. We compared DNA-me profiles in genomic DNA of whole blood (WB) isolated at EDIC Study baseline from 32 cases (DCCT conventional therapy group subjects showing retinopathy or albuminuria progression by EDIC Study year 10) vs. 31 controls (DCCT intensive therapy group subjects without complication progression by EDIC year 10). DNA-me was also profiled in blood monocytes (Monos) of the same patients obtained during EDIC Study years 16-17. In WB, 153 loci depicted hypomethylation, and 225 depicted hypermethylation, whereas in Monos, 155 hypomethylated loci and 247 hypermethylated loci were found (fold change ≥1.3; P < 0.005; cases vs. controls). Twelve annotated differentially methylated loci were common in both WB and Monos, including thioredoxin-interacting protein (TXNIP), known to be associated with hyperglycemia and related complications. A set of differentially methylated loci depicted similar trends of associations with prior HbA1c in both WB and Monos. In vitro, high glucose induced similar persistent hypomethylation at TXNIP in cultured THP1 Monos. These results show that DNA-me differences during the DCCT persist at certain loci associated with glycemia for several years during the EDIC Study and support an epigenetic explanation for metabolic memory.