[Show abstract][Hide abstract] ABSTRACT: Objective: Obesity is thought to be a major risk factor for the development of insulin resistance and type 2 diabetes mellitus. However, not all obese or insulin resistant individuals develop T2DM suggesting additional factors are required to cause disease. In order to identify additional mechanisms leading to insulin resistance and T2DM, we measured plasma adipokines as well as established biochemical risk factors for developing T2DM in a large indigenous Australian family. Results: We found T2DM individuals had higher insulin resistance (as measured by HOMA-IR) (p< 0.001), triglyceride (p= 0.003), cholesterol (p=0.02) and TNFα (p=0.03) levels than normoglycaemic controls, independent of age, gender and BMI. The alterations in insulin resistance could not be attributed to TNFα, as we did not find a correlation between TNFα and HOMA-IR in either normoglycaemic or T2DM individuals. In contrast, resistin correlated strongly to HOMA-IR in T2DM (p<0.001) but not normoglycaemic individuals despite the lack of significant differences in circulating levels. We also showed obese T2DM individuals had significantly lower leptin levels (p<0.001) and β cell function (as measured by HOMA-%B) (p<0.001) compared to obese normoglycaemic family members. Conclusion: These results suggest that events downstream of resistin signalling warrant further investigation to identify the cause for increased susceptibility to insulin resistance in this family. The lower leptin levels in obese T2DM individuals may be explained by a reduced β cell function. Longitudinal studies are required to assess the utility of TNFα and leptin levels in relation to BMI as risk factors for T2DM.
International Journal of Diabetes and Metabolism 01/2008; 16(1).
[Show abstract][Hide abstract] ABSTRACT: Indigenous Australians have a high prevalence of obesity and an unacceptably high rate of cardiovascular disease.
We conducted a cross-sectional analysis of 93 high-risk indigenous Australians to assess how strongly three anthropometric measures correlated with known cardiovascular risk factors.
Both waist circumference and body mass index were strongly associated with important risk factors. The waist : hip ratio was less useful. Waist circumference was the only measure that significantly correlated with the urine albumin creatinine ratio (rho=0.14; P=0.04).
Measuring the waist circumference is a cheap, effective way of monitoring cardiovascular risk.
European Journal of Cardiovascular Prevention and Rehabilitation 09/2007; 14(4):515-7. DOI:10.1097/HJR.0b013e3280117257 · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Anthropometric markers of obesity are simple means that may be used as markers of cardiovascular risk and insulin resistance. We compare body mass index, waist circumference and waist hip ratio as tools to screen for insulin resistance in 81 overweight Indigenous Australians using ROC curve analysis. Body mass index and waist circumference emerged as better predictors of insulin resistance compared with waist hip ratio.
[Show abstract][Hide abstract] ABSTRACT: We aim to examine the short-term efficacy of a lifestyle intervention programme on cardiovascular risk factors in overweight urban Indigenous Australians with and without type 2 diabetes mellitus. One hundred and one urban Indigenous Australians in Queensland voluntarily participated in a culturally appropriate lifestyle intervention programme based on improving physical activity and dietary intake; 44 had type 2 diabetes, 11 had impaired fasting glucose and 46 were euglycaemic. Efficacy of the intervention on biochemical and physical markers of cardiovascular outcome will be monitored over 2 years. Diabetic subjects were overweight with good but suboptimal control of cardiovascular risk factors (mean systolic blood pressure 132 mmHg, diastolic blood pressure 85 mmHg, LDL cholesterol 2.8mM and urine albumin to creatinine ratio 10.8) at baseline. At the 6 months follow up, there were significant reductions in waist circumference (3.1cm, P=0.01) and diastolic blood pressure (4.6 mmHg, P=0.01). Although modest, these changes may improve clinical outcome if sustained.
Diabetes Research and Clinical Practice 02/2007; 75(1):65-71. DOI:10.1016/j.diabres.2006.04.012 · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Indigenous Australians are at high risk for cardiovascular disease and type 2 diabetes. Carotid artery intimal medial thickness (CIMT) and brachial artery flow-mediated vasodilation (FMD) are ultrasound imaging based surrogate markers of cardiovascular risk. This study examines the relative contributions of traditional cardiovascular risk factors on CIMT and FMD in adult Indigenous Australians with and without type 2 diabetes mellitus.
One hundred and nineteen Indigenous Australians were recruited. Physical and biochemical markers of cardiovascular risk, together with CIMT and FMD were measured for all subjects.
Fifty-three Indigenous Australians subjects (45%) had type 2 diabetes mellitus. There was a significantly greater mean CIMT in diabetic versus non-diabetic subjects (p=0.049). In the non-diabetic group with non-parametric analyses, there were significant correlations between CIMT and: age (r=0.64, p<0.001), systolic blood pressure (r=0.47, p<0.001) and non-smokers (r=-0.30, p=0.018). In the diabetic group, non-parametric analysis showed correlations between CIMT, age (r=0.36, p=0.009) and duration of diabetes (r=0.30, p=0.035) only. Adjusting for age, sex, smoking and history of cardiovascular disease, Hb(A1c) became the sole significant correlate of CIMT (r=0.35, p=0.01) in the diabetic group. In non-parametric analysis, age was the sole significant correlate of FMD (r=-0.31, p=0.013), and only in non-diabetic subjects. Linear regression analysis showed significant associations between CIMT and age (t=4.6, p<0.001), systolic blood pressure (t=2.6, p=0.010) and Hb(A1c) (t=2.6, p=0.012), smoking (t=2.1, p=0.04) and fasting LDL-cholesterol (t=2.1, p=0.04). There were no significant associations between FMD and examined cardiovascular risk factors with linear regression analysis
CIMT appears to be a useful surrogate marker of cardiovascular risk in this sample of Indigenous Australian subjects, correlating better than FMD with established cardiovascular risk factors. A lifestyle intervention programme may alleviate the burden of cardiovascular disease in Indigenous Australians by reducing central obesity, lowering blood pressure, correcting dyslipidaemia and improving glycaemic control. CIMT may prove to be a useful tool to assess efficacy of such an intervention programme.
[Show abstract][Hide abstract] ABSTRACT: We have conducted a genome-wide scan on a pedigree containing 372 adult members, of whom 49 have PDB. In the present study, we report linkage of a large pedigree to the PDB3 region on chromosome 5q35-qter with a peak multipoint LOD score of 6.77. Sequestosome 1 (SQSTM/p62) has been identified as the causative PDB gene in this region. Six sequestosome 1 mutations have been described to date. Four mutations have been identified in exon 8, 1210delT and 1215delC both resulting in premature stop codon at amino acid 394, 1215C to T (P392L), 1224insT (E396X), one mutation in exon 7, 1200C to T (P387L) and a G to A splice junction mutation at IVS7+1. These mutations cluster in the C terminus of the protein and are predicted to disrupt the ubiquitin binding properties of sequestosome 1. Sequence analysis of the gene encoding sequestosome 1 revealed a single base pair deletion (1215delC) segregating with the majority of affected members in the pedigree. This deletion introduces a stop codon at position 394, resulting in premature termination of the protein (L394X) and loss of the ubiquitin-associated binding domain. Screening of affected members from 10 further PDB families identified the previously reported P392L mutation in one family. No SQSTM1/p62 coding mutations were found in the remaining 9 families or in 113 age-matched controls.
Bone 08/2004; 35(1):277-82. DOI:10.1016/j.bone.2004.01.010 · 3.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Paget disease of bone (PDB) is characterized by increased osteoclast activity and localized abnormal bone remodeling. PDB has a significant genetic component, with evidence of linkage to chromosomes 6p21.3 (PDB1) and 18q21-22 (PDB2) in some pedigrees. There is evidence of genetic heterogeneity, with other pedigrees showing negative linkage to these regions. TNFRSF11A, a gene that is essential for osteoclast formation and that encodes receptor activator of nuclear factor-kappa B (RANK), has been mapped to the PDB2 region. TNFRSF11A mutations that segregate in pedigrees with either familial expansile osteolysis or familial PDB have been identified; however, linkage studies and mutation screening have excluded the involvement of RANK in the majority of patients with PDB. We have excluded linkage, both to PDB1 and to PDB2, in a large multigenerational pedigree with multiple family members affected by PDB. We have conducted a genomewide scan of this pedigree, followed by fine mapping and multipoint analysis in regions of interest. The peak two-point LOD scores from the genomewide scan were 2.75, at D7S507, and 1.76, at D18S70. Multipoint and haplotype analysis of markers flanking D7S507 did not support linkage to this region. Haplotype analysis of markers flanking D18S70 demonstrated a haplotype segregating with PDB in a large subpedigree. This subpedigree had a significantly lower age at diagnosis than the rest of the pedigree (51.2+/-8.5 vs. 64.2+/-9.7 years; P=.0012). Linkage analysis of this subpedigree demonstrated a peak two-point LOD score of 4.23, at marker D18S1390 (straight theta=0), and a peak multipoint LOD score of 4.71, at marker D18S70. Our data are consistent with genetic heterogeneity within the pedigree and indicate that 18q23 harbors a novel susceptibility gene for PDB.
The American Journal of Human Genetics 03/2002; 70(2):517-25. DOI:10.1086/338658 · 10.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prevalence of type 2 diabetes among Australian residents is 7.5%; however, prevalence rates up to six times higher have been reported for indigenous Australian communities. Epidemiological evidence implicates genetic factors in the susceptibility of indigenous Australians to type 2 diabetes and supports the hypothesis of the "thrifty genotype," but, to date, the nature of the genetic predisposition is unknown. We have ascertained clinical details from a community of indigenous Australian descent in North Stradbroke Island, Queensland. In this population, the phenotype is characterized by severe insulin resistance. We have conducted a genomewide scan, at an average resolution of 10 cM, for type 2 diabetes-susceptibility genes in a large multigeneration pedigree from this community. Parametric linkage analysis undertaken using FASTLINK version 4.1p yielded a maximum two-point LOD score of +2.97 at marker D2S2345. Multipoint analysis yielded a peak LOD score of +3.9 <1 cM from marker D2S2345, with an 18-cM 3-LOD support interval. Secondary peak LOD scores were noted on chromosome 3 (+1.8 at recombination fraction [theta] 0.05, at marker D3S1311) and chromosome 8 (+1.77 at theta=0.0, at marker D8S549). These chromosomal regions are likely to harbor novel susceptibility genes for type 2 diabetes in the indigenous Australian population.
The American Journal of Human Genetics 02/2002; 70(2):349-57. DOI:10.1086/338626 · 10.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Paget's disease of bone is a common condition characterized by bone pain, deformity, pathological fracture, and an increased incidence of osteosarcoma. Genetic factors play a role in the pathogenesis of Paget's disease but the molecular basis remains largely unknown. Susceptibility loci for Paget's disease of bone have been mapped to chromosome 6p21.3 (PDB1) and 18q21.1-q22 (PDB2) in different pedigrees. We have identified a large pedigree of over 250 individuals with 49 informative individuals affected with Paget's disease of bone; 31 of whom are available for genotypic analysis. The disease is inherited as an autosomal dominant trait in the pedigree with high penetrance by the sixth decade. Linkage analysis has been performed with markers at PDB1; these data show significant exclusion of linkage with log10 of the odds ratio (LOD) scores < -2 in this region. Linkage analysis of microsatellite markers from the PDB2 region has excluded linkage with this region, with a 30 cM exclusion region (LOD score < -2.0) centered on D18S42. These data confirm the genetic heterogeneity of Paget's disease of bone. Our hypothesis is that a novel susceptibility gene relevant to the pathogenesis of Paget's disease of bone lies elsewhere in the genome in the affected members of this pedigree and will be identified using a microsatellite genomewide scan followed by positional cloning.
Journal of Bone and Mineral Research 01/2001; 16(1):33-8. DOI:10.1359/jbmr.2001.16.1.33 · 6.83 Impact Factor