Day 2 :
Keynote Forum
Yousef Shahin
United Nations Relief and Works Agency, Jordan
Keynote: Diabetes care in refugee camps: The experience of UNRWA
Time : 09:30-10:10
Biography:
Yousef Shahin joined Jordan University of Science and Technology after graduating in Medicine from Zaporozhe Medical University where he obtained his Master degree in Public Health in 1995. Since 2005 he is at senior position in United Nations and Relief Agency for Palestine refuges (UNRWA), Manager of communicable and non-communicable diseases program. He joined World Health Organization from July-December 2011 as Technical Officer on Non communicable Diseases. He joined Aetna, Qatar as Director of disease Management from August 2015 to April 2016. He has 12 publications in medical journals including the Lancet on health topics targeting communicable and non-communicable diseases.
Abstract:
United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was established in 1949 and has delivered health care services for around 67 years. The epidemiological transition in disease burden is changing the context in which UNRWA’s health program operates and poses new challenges that require new ways of providing health services. Hypertension and diabetes are two major health problems for Palestine refugees. Among NCDs, hypertension and diabetes are two major health problems for Palestine refugees. UNRWA has been providing diabetes and hypertension care since 1992 in its primary health care centers. Around 11.0% and 16.2% of people ≥40 years attending UNRWA health facilities in 2015 had diabetes and hypertension respectively, with almost 250,000 people with diabetes and/or hypertension being cared for at UNRWA clinics in the region. The number of people with diabetes has been steadily increasing by 5% each year. The UNRWA NCD strategy is primarily directed at reducing risk factors and providing services for common conditions such as hypertension and diabetes. The current strategy has three main elements namely, healthy life style promotion, early detection of diabetes and hypertension - achieved by active screening of at risk individuals and implementation of treatment protocols and effective case management. Through a structured process of care delivery the UNRWA health system is making significant strides in addressing diabetes and hypertension and consequently the nine voluntary global targets as envisaged in the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020
Keynote Forum
David Naor
The Hebrew University-Hadassah Medical School, Israel
Keynote: Cell surface CD44 of β cell, a mediator of β cell destruction in autoimmune diabetes
Time : 10:10-10:50
Biography:
Professor David Naor is a professor of immunology in the Hebrew University, faculty of Medicine and was the head of Milton Winograd Chair of Cancer Studies. He received his Ph.D from the Hebrew University. He served as visiting professor in leading universities (e.g., UCLA, Harvard). He published 152 articles, including in leading journals like Nature, PNAS , J Clin Invest, J immunol , J Exp Med etc. His current research. has been focused on the role of CD44 and other hyaluronan-binding molecules (e.g., RHAMM) in autoimmune and cancer diseases. This CD44 research yielded 34 articles, which were cited thousands of times. He was invited to speak on CD44 at 8 plenary sessions of international conferences. He has been a member in editorial boards of several international scientific journals and he is on the scientific board of International Congress on Autoimmunity. He received awards from Johnson & Johnson "In recognition of outstanding research towards the advances of science and technology in health care” and from the Hebrew University for his “outstanding achievements in research and teaching
Abstract:
CD44 is a multi-functional receptor with multiple of isoforms engaged in modulation of cell trafficking and transmission of apoptotic signals. We have previously shown that injection of anti-CD44 antibody into NOD mice induced resistance to type 1 diabetes (T1D). In this communication we describe the mechanism underlying this effect. We found that CD44-deficient NOD mice develop stronger resistance to T1D than wild-type littermates. This effect is not explained by the involvement of CD44 in cell migration, because CD44-deficient inflammatory cells surprisingly had greater invasive potential than the corresponding wild type cells, probably owing to molecular redundancy. We describe here a mechanism underlying the T1D enhancement that has not yet been previously reported. CD44 expression and hyaluronic acid (HA, the principal ligand for CD44) accumulation were detected in pancreatic islets of diabetic NOD mice, but not of non-diabetic DBA/1 mice. Expression of CD44 on insulin-secreting β cells renders them susceptible to autoimmune attack, leading to β cell apoptotic destruction as indicated by TUNEL assay as well as by functional assays exhibiting increased nitric oxide release, reduced insulin secretion after glucose stimulation and decreased insulin content in β cells. All these parameters could not be detected in CD44-deficient islets. We further suggest that HA-binding to CD44-expressing β cells is implicated in β-cell demise. Altogether, these data demonstrate that CD44 is a receptor capable of modulating cell fate. This finding is important for other pathologies (e.g., cancer, neurodegenerative diseases) in which CD44 and HA appear to be implicated.
Keynote Forum
Muhammad Abul Hasanat
Bangabandhu Sheikh Mujib Medical University, Bangladesh
Keynote: Gestational diabetes mellitus- experience in BSMMU, Bangladesh
Time : 11:10-11:50
Biography:
M A Hasanat has completed his MPhil on 1990 and MD (Endocrinology and Metabolism) in 1997 from Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh. He is the Chairman of Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. He has published more than 45 papers in reputed journals at international and national level. He is very keen to teaching and academic research all thorough.
Abstract:
South-East Asia has the highest prevalence of hyperglycemia in pregnancy (24.2%). Screening for gestational diabetes mellitus (GDM) is important owing to adverse fetal and maternal outcomes and risk of developing diabetes in future. Different methods of screening has hindered the development of a universal diagnostic criterion for GDM. An alarming frequency of GDM in Bangladeshi population following World Health Organization (WHO) 1999 and WHO 2013 diagnostic criteria respectively (36.6% and 40.9%) was observed. Comparison of WHO 1999, modified O’Sullivan and WHO 2013 criteria for GDM revealed discrepancy among these criteria despite good agreement. We observed higher frequency of risk allele, TCF7L2 rs7903146 in Bangladeshi GDM mothers under pilot study. Association was stronger in women having lower age and body mass index (BMI). Postpartum persistence of abnormal glucose tolerance (AGT) in GDM was also higher (50%); AGT in early gestation, use of insulin during pregnancy, higher maternal age and BMI were predictors for it. Adverse events were relatively higher in mothers with AGT than those with normal glucose tolerance (NGT) despite treatment (not significant). Implementation of 03-sample OGTT in resource poor setting is difficult. We are comparing diagnostic efficiency of simpler Diabetes in Pregnancy Study Group India (DIPSI) criterion with intention to implement for screening of GDM in community level. The extent of thyroid dysfunction in mothers with GDM is also being evaluated by our group. Multinational broad-based comparative studies are needed to explore the genetic predisposition and risk factors for GDM among the ethnic groups of different countries in Asia.
- Genetics of Diabetes|Diabetes Research in Clinical Practice|Cell Therapy for Diabetes and its Complications|Endocrinology Disorders and Treatment
Location: Kiel 1-3
Chair
David Naor
The Hebrew University-Hadassah Medical School, Israel
Co-Chair
Hidekatsu Yanai
National Center for Global Health and Medicine Kohnodai Hospital, Japan
Session Introduction
Haipeng Xiao
Sun Yat-sen University, China
Title: Down-regulation of miR-139-5p contributes to the anti-apoptotic effect on diabetic rat islets and INS1 cells induced by Liraglutide via targeting Irs1
Time : 11:55-12:30
Biography:
Haipeng Xiao, MD, PhD is the Professor of Endocrine, Chief Expert President, at the First Affiliated Hospital of Sun Yat-sen University. He is the Member of American Thyroid Association (ATA), member of Continuing Medical Education (CME) Committee, American Endocrine Society, member of Association for Medical Education in Europe (AMEE), and the Vice Secretary General, Clinical Teaching Committee of Medical Education, Ministry of Education, P. R. China. He is the Editorial Board Member of, Chinese Medical Journal, Chinese Journal of Endocrinology and Metabolism, Chinese Journal of Diabetes and Cardiovascular Endocrinology. As a long-term researcher in endocrine and metabolic diseases, he has published over 50 papers in core Chinese and foreign periodicals such as Journal of Clinical Endocrinology & Metabolism (JCEM), Brain Research, etc. Moreover, he took the lead in treating Graves’ diseases by introducing thyroid arterial embolization, and for the first time ever, he reported relevant findings of using innovative methods to treat Graves’ diseases in the prestigious Journal of JCEM. In June of 2012, he published another academic thesis “Circulating MicroRNA Profiles as Potential Biomarkers for Diagnosis of Papillary Thyroid Carcinoma” in JCEM which has received high attention and positive response among medical scientists home and abroad.
Abstract:
Diabetes is a chronic metabolic disease characterized with elevated glucose and lipid disturbance, which pathogenesis involves beta cell dysfunction and insulin resistance. Liraglutide is administered as GLP-1 receptor agonist on patient with diabetes mellitus and shows protective effect on beta cell function by inhibiting its apoptosis and promoting its proliferation and regeneration. MicroRNAs (miRNAs) are a category of endogenous non-coding small RNA, which inhibit the translation by binding to the 3’ untranslated region (3’ UTR) of their target mRNAs. It has become increasingly clear that miRNAs are not only involved in regulation of cell differentiation and apoptosis, but also in the pathogenesis of a variety of diseases. In our study, we aim to investigate the miRNA level differentially expressed in the pancreatic tissues of normal or diabetic SD rats without or with administration of Liraglutide, screen intended miRNA and predict its target gene，and explore the mechanism by which miRNA contributes to the anti-apoptotic effect of Liraglutide on pancreatic beta cells. We revealed differential expression of miRNAs and validated the increased expression of miR-139-5p in diabetic rats, while which decreased in diabetic rats with administration of liraglutide. We verified the direct regulatory effect of miR-139-5p on insulin receptor substrate 1(Irs1), a key player in insulin signal transduction pathway, through the target sequence ACTGTAG by using double luciferase report experiments. We also found palmitic acid can increase the expression of miR-139-5p and reduce IRS1 expression at both mRNA level and protein level in INS1 cells. Furthermore, administration of Liraglutide decreased the expression of miR-139-5p and enhanced the expression of IRS1, which protected both pancreatic tissues of SD rats and INS1 cells from apoptosis. Our data demonstrates that increased expression of miR-139-5p, which targets Irs1, prompts apoptosis in both pancreatic tissue of diabetic SD rats and INS1 cells treated with palmitic acid, down-regulation of miR-139-5p contributes to the anti-apoptotic effect induced by Liraglutide via targeting Irs1.
Cong-Yi Wang
Huazhong University of Science & Technology, China
Title: DNA methylation, an epigenetic wrestler, links environmental insults to the pathogenesis of autoimmune diabetes
Time : 12:30-13:05
Biography:
Cong-Yi Wang, MD, PhD, Professor and Director, the Center for Biomedical Research, Vice Director, Department of Sponsored Program Administration, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Before 2014, he served as a tenured Associate Professor at the Department of Pathology, and the Director of Georgia Esoteric & Molecular Laboratories, LLC, Georgia Regents University, USA. The major focus for his research is to dissect the role of genetic and epigenetic factors in the pathogenesis of diabetes and diabetic complications. Particularly, he employs animal models and human subjects to address how environmental insults interact with genetic factors to modulate disease susceptibility, and through which to develop effective therapeutic approaches for prevention/intervention of these devastating disorders.
Abstract:
Type 1 diabetes (T1D) is resulted from the interaction of susceptible genes and environmental factors. DNA methylation acts as a footprint to link susceptible genes and environmental factors, and encodes information beyond DNA to record the impact of environmental insults on DNA, which is interpreted by the methyl-CpG binding domain (MBD) proteins in a cell and gene-dependent manner. Particularly, MBD2, one of the MBD proteins, is preferentially induced upon pathological insults, which then deciphers DNA methylome-encoded information to modulate disease susceptibility. MBD2 was found to regulate the homeostasis of CD4 T cell differentiation and functionality, and mice deficient in MBD2 were completely protected from MOG35-55 induced experimental autoimmune encephalomyelitis (EAE). On the other hand, NOD mice deficient in MBD2 showed exacerbated T1D. Mechanistic studies revealed that MBD2 selectively binds to the methylated CpG sites at the T-bet and Hlx promoter, and by which it suppresses the transcription of IFN-γ. As a result, loss of MBD2 leads to altered IFN-γ expression, which then renders naïve T cells preferentially differentiating to Th1 cells along with impaired Th17 development. Moreover, elevated Hlx transcriptional activity resulted from MBD2 deficiency synergizes with T-bet to mediate IFN-γ expression in IL-4 producing Th2 cells. In patients with fulminant T1D, environmental insults in genetic predisposed subjects triggered Foxp3 promoter hypermethylation, which then prevented IRF-7 binding to the Foxp3 promoter, thereby impairing the development and functionality of regulatory T cells (Tregs). Collectively, these discoveries demonstrate how environmental factors trigger autoimmune responses during T1D development.
Zehra Gok Metin
Hacettepe University, Turkey
Title: Effects of aromatherapy massage on neuropathic pain and quality of life in patients with diabetes: A randomized controlled study
Time : 14:10-14:45
Biography:
Zehra Gok Metin has completed her PhD in 2015 from Hacettepe University and stayed for one year at University of Alabama at Birmingham for Post-doctoral studies. She is an Instructor at Hacettepe University Faculty of Nursing. She is working on Symptom Management especially for pain for five years. She has several publications in reputed journals and has been serving as a reviewer for reputed journals.
Abstract:
Purpose: This study aimed to examine the effects of aromatherapy massage on neuropathic pain severity and quality of life in patients suffering from painful diabetic neuropathy.
Design & Methods: This randomized controlled clinical study was conducted in a university hospital endocrine outpatient clinic in Turkey. The sample of the study consisted of totally 46 patients, randomly allocated to the intervention group (n=21) and the control group (n=25). The intervention group received aromatherapy massage three times in a week during a duration of four weeks. Control group did not receive any intervention without usual care. Data were collected using the patient questionnaire, Douleur Neuropathique Questionnaire, Visual Analog Scale and Neuropathic Pain Impact on Quality of Life Questionnaire.
Findings: Neuropathic pain scores significantly decreased in the intervention group compared with the control group in the 4th week of the study. Similarly, quality of life scores significantly improved in the intervention group in the 4th week of the study.
Conclusions: Aromatherapy massage is a simple and effective nonpharmacological nursing intervention that can be used to manage neuropathic pain and improve quality of life in patients with painful neuropathy.
Clinical Relevance: Aromatherapy massage was a well-tolerated, feasible, and safe nonpharmacological method that could easily be integrated into clinical settings by nurses. However, long-term effects and follow-up procedures should be added in clinical study designs to support clinical usage of aromatherapy massage.
Soha M Abd El Dayem
National Research Centre, Egypt
Title: Leptin and lipid profile in overweight type 1 diabetic patient
Time : 14:45-15:20
Biography:
Soha M Abd El Dayem has international experience in various programs, contributions and participation in different countries for diverse fields of study. Her research interests reflect in her wide range of publications in various national and international journals.
Abstract:
Objective: To evaluate leptin and lipid profile in overweight type 1 diabetic patient.
Patients & Methods: The study included 50 overweight type 1 diabetic patients and 50 age and sex matched healthy controls. Blood sample was taken for evaluation of glycosylated hemoglobin, lipid profile and leptin. Also, urine sample was taken for evaluation of albumin/ creatinine ratio.
Results: Leptin level was significantly lower in overweight diabetic patients and had a significant positive correlation with hip circumference and body mass index and negative correlation with HbA1c. Leptin level was significantly lower in overweight diabetic patients with HbA1c > 7.5 %. The best cut off point between overweight diabetic group and control group regarding level of leptin was found 16.9 with sensitivity 68% and specificity 56% and also area under curve 0.623.
Conclusion: leptin level is low in overweight diabetic patients and it is related to body mass index and hip circumference. LDL-c level was significantly increased while HDL-c level was significantly decreased in the diabetic overweight group indicating increased risk of cardiovascular disease. Leptin level in overweight diabetic patients is related to metabolic control.
Ahmed A Battah
Cairo University, Egypt
Title: Relationship of plasma level of nesfatin, chemerin and vaspin to early atherosclerotic changes and its genetic study in adolescent type 1 diabetic patients
Time : 15:20-15:55
Biography:
Abstract:
Objective: To evaluate the relationship of plasma level of nesfatin, chemerin and vaspin to early atherosclerotic changes. Also to evaluate chemerin and vaspin genotype and to detect its relation to glycemic control and atherosclerosis in adolescent type 1 diabetic patients.
Patients & Methods: The study included 70 type 1 diabetic patients and 30 age and sex matched healthy volunteers. The mean age of patients was 17.99±2.59, mean duration of diabetes was 10.91±3.54, mean onset of disease was 7.00±3.28. Blood samples were taken for assessment of chemerin, nesfatin, vaspin, and oxidized low-density lipoprotein (OxLDL) by enzyme linked immunosorbent assay (ELISA) technique. Also, blood samples were taken for analysis of glycosylated hemoglobin (HbA1); lipid profiles and urine samples were taken for assessment of albumin/creatinine ratio. Carotid (cIMT) and aortic (AIMT) intima-media thickness were also done.
Results: Nesfatin, chemerin, vaspin, OxLDL, and albumin/creatinine ratio, cIMT and AIMT were significantly higher in diabetic patients. HbA1 and cIMT were significantly higher in TT genotype of chemerin than GG genotype (9.50±1.99 vs. 8.34±1.62 and 0.54±0.06 vs. 0.50±0.04 respectively). Chemerin and vaspin had a significant positive correlation (r=0.2, P=0.05), nesfatin and LDL (r=0.3, P=0.05) and Vaspin and body mass index (r=0.3, P=0.01).
Conclusion: Diabetic patients had increased level of adipocytokines and are liable for early atherosclerosis. TT genotype in diabetic patients is associated with poor glycemic control and early atherosclerosis.
Eustache Paramithiotis
Caprion Biosciences Inc., Canada
Title: A personalized approach for assessing pancreatic function in diabetes using novel islet biomarkers
Time : 15:55-16:30
Biography:
Eustache Paramithiotis completed a PhD in Immunology from McGill University and Post-doctoral research at the Howard Hughes Medical Institute at the University of Alabama at Birmingham with an award from the Irvington Institute for Immunological Research. He has extensive experience in large scale biology and translational medicine, in particular biomarker discovery and validation, and has led several privately or publically funded multi-year projects. He is currently the Caprion’s Vice President of Biomarker discovery and Diagnostics, responsible for the advancement of Caprion’s diagnostics development pipeline and for discovery of biomarkers with diagnostic application potential.
Abstract:
Pancreatic islets play a critical role in diabetes disease development. Their status is currently approximated through measurements of basal and stimulated blood glucose, C-peptide, and insulin levels. Glycated hemoglobin (HbA1c) levels are used to estimate disease progression and response to therapy. These tests are either insufficient, or impractical to perform in a clinical setting. Therefore, an important unmet need remains for biomarkers that can accurately monitor the function and health of pancreatic islets. Such biomarkers may help predict disease progression, guide drug selection, monitor therapeutic efficacy and accelerate the development of disease-modifying therapies that aim at improving the function of ï¢-cells. We have identified candidate blood biomarkers associated with pancreatic islet function by proteomic analysis of secretory vesicles isolated from primary human pancreatic islets under steady state and following induced dysfunction. Candidate specificity was evaluated by comparing the pancreatic islet datasets to a library of secreted proteins produced by multiple major organs and selecting the proteins uniquely present in pancreatic islets. The performance of the biomarkers was assessed using targeted multiple reaction monitoring mass spectrometry (MRM-MS) or ELISA in plasma from patients that were either normoglycemic (n=47), had impaired glucose tolerance (n=17), or were Type 2 diabetics diagnosed for less than 1.5 years (n=19) or for over 5 years (n=28). A pool of 14 candidates was able to accurately classify patients into the disease progression groups when used in small combinations of 3-5 biomarkers. This performance was independent of and superior to the standard of care (SOC; glycated hemoglobin and fasting plasma glucose). This performance improvement was especially important for pre-diabetic patients where about 50% can be currently be correctly identified by the SOC. Most candidate biomarkers had functions related to metabolic homeostasis or regulation of islet secretion, tissue remodeling, and inflammation. We have thus identified candidate biomarkers derived from human pancreatic islets that appear able to distinguish between disease progression groups. Independent confirmatory studies are underway using cross-sectional groups from a different clinical site as well as longitudinal cohorts of patients with gestational diabetes or who underwent bariatric surgery.