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Genotype-based treatment of type 2 diabetes with an α2A-adrenergic receptor antagonist.

Tang, Yunzhao LU ; Axelsson, Annika LU ; Spégel, Peter LU ; Andersson, Lotta LU ; Mulder, Hindrik LU ; Groop, Leif LU ; Renström, Erik LU and Rosengren, Anders LU (2014) In Science Translational Medicine 6(257). p.139-257
Abstract
The feasibility of exploiting genomic information for individualized treatment of polygenic diseases remains uncertain. A genetic variant in ADRA2A, which encodes the α2A-adrenergic receptor (α2AAR), was recently associated with type 2 diabetes. This variant causes receptor overexpression and impaired insulin secretion; thus, we hypothesized that blocking α2AAR pharmacologically could improve insulin secretion in patients with the risk genotype. A total of 50 type 2 diabetes patients were recruited on the basis of ADRA2A genotype for a randomized placebo-controlled intervention study with the α2AAR antagonist yohimbine. The patients received 0, 10, or 20 mg of yohimbine at three separate visits. The primary endpoint was insulin secretion... (More)
The feasibility of exploiting genomic information for individualized treatment of polygenic diseases remains uncertain. A genetic variant in ADRA2A, which encodes the α2A-adrenergic receptor (α2AAR), was recently associated with type 2 diabetes. This variant causes receptor overexpression and impaired insulin secretion; thus, we hypothesized that blocking α2AAR pharmacologically could improve insulin secretion in patients with the risk genotype. A total of 50 type 2 diabetes patients were recruited on the basis of ADRA2A genotype for a randomized placebo-controlled intervention study with the α2AAR antagonist yohimbine. The patients received 0, 10, or 20 mg of yohimbine at three separate visits. The primary endpoint was insulin secretion at 30 min (Ins30) during an oral glucose tolerance test (OGTT). Patients with the risk variant had 25% lower Ins30 than those without risk genotype. After administration of 20 mg of yohimbine, Ins30 was enhanced by 29% in the risk group, making secretion similar to patients carrying the low-risk allele. The corrected insulin response and disposition index in individuals with the high-risk (but not low-risk) allele were improved by 59 ± 18% and 43 ± 14%, respectively. The beneficial effect of yohimbine was not a consequence of improved insulin sensitivity. In summary, the data show that the insulin secretion defect in patients carrying the ADRA2A risk genotype can be corrected by α2AAR antagonism. The findings show that knowledge of genetic risk variants can be used to guide therapeutic interventions that directly target the underlying pathophysiology and demonstrate the potential of individualized genotype-specific treatment of type 2 diabetes. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Science Translational Medicine
volume
6
issue
257
pages
139 - 257
publisher
American Association for the Advancement of Science (AAAS)
external identifiers
  • pmid:25298321
  • wos:000343317900007
  • scopus:84908374461
ISSN
1946-6242
DOI
10.1126/scitranslmed.3009934
language
English
LU publication?
yes
id
a8bcc143-a9bb-4d6c-91a1-615703157434 (old id 4737285)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25298321?dopt=Abstract
date added to LUP
2014-11-06 19:50:21
date last changed
2017-09-03 03:14:48
@article{a8bcc143-a9bb-4d6c-91a1-615703157434,
  abstract     = {The feasibility of exploiting genomic information for individualized treatment of polygenic diseases remains uncertain. A genetic variant in ADRA2A, which encodes the α2A-adrenergic receptor (α2AAR), was recently associated with type 2 diabetes. This variant causes receptor overexpression and impaired insulin secretion; thus, we hypothesized that blocking α2AAR pharmacologically could improve insulin secretion in patients with the risk genotype. A total of 50 type 2 diabetes patients were recruited on the basis of ADRA2A genotype for a randomized placebo-controlled intervention study with the α2AAR antagonist yohimbine. The patients received 0, 10, or 20 mg of yohimbine at three separate visits. The primary endpoint was insulin secretion at 30 min (Ins30) during an oral glucose tolerance test (OGTT). Patients with the risk variant had 25% lower Ins30 than those without risk genotype. After administration of 20 mg of yohimbine, Ins30 was enhanced by 29% in the risk group, making secretion similar to patients carrying the low-risk allele. The corrected insulin response and disposition index in individuals with the high-risk (but not low-risk) allele were improved by 59 ± 18% and 43 ± 14%, respectively. The beneficial effect of yohimbine was not a consequence of improved insulin sensitivity. In summary, the data show that the insulin secretion defect in patients carrying the ADRA2A risk genotype can be corrected by α2AAR antagonism. The findings show that knowledge of genetic risk variants can be used to guide therapeutic interventions that directly target the underlying pathophysiology and demonstrate the potential of individualized genotype-specific treatment of type 2 diabetes.},
  author       = {Tang, Yunzhao and Axelsson, Annika and Spégel, Peter and Andersson, Lotta and Mulder, Hindrik and Groop, Leif and Renström, Erik and Rosengren, Anders},
  issn         = {1946-6242},
  language     = {eng},
  number       = {257},
  pages        = {139--257},
  publisher    = {American Association for the Advancement of Science (AAAS)},
  series       = {Science Translational Medicine},
  title        = {Genotype-based treatment of type 2 diabetes with an α2A-adrenergic receptor antagonist.},
  url          = {http://dx.doi.org/10.1126/scitranslmed.3009934},
  volume       = {6},
  year         = {2014},
}