Singh, Prachi

Background Expression of adiponectin, an anti‐atherogenic and insulin‐sensitizing adipokine, is decreased in obesity. Mechanisms underlying this reduction are not well understood. Increased adiponectin in obesity may protect against development of cardiac and metabolic disorders. Objective To investigate the role of leptin in regulating adiponectin expression in humans. Design 1) determining the relationship between leptin and adiponectin in healthy humans during modest weight gain; 2) in‐vitro validation of the role of leptin in adiponectin expression. Results Modest weight gain of 3.8 ± 1.2 kg over 8 weeks of overfeeding in normal weight healthy subjects (n=33, 22 men, 30±7 years) increased both leptin and adiponectin. Changes in leptin during weight gain correlated with changes in adiponectin (rho=0.35, p=0.045), suggesting that leptin may regulate adiponectin expression. In cultured differentiated human white preadipocytes, leptin increased adiponectin mRNA and protein expression. Conclusions Leptin induces adiponectin expression. In obesity, adipose tissue may be resistant to leptin signaling thus preventing increases in adiponectin. Therefore, impaired leptin signaling may contribute to low adiponectin in obesity. Targeting leptin resistance may be beneficial in preventing obesity‐associated cardiac and metabolic disorders. Support : AHA 11SDG7260046, R21 DK81014

Background: Decreased testosterone (TTST) and sex hormone binding globin (SHBG) contribute to development of cardiometabolic disorders in obese men. We aimed to determine the effect of weight gain and weight loss on TTST and SHBG in healthy men and to examine their relationship with endothelial function. Method: 25 normal weight healthy men underwent an overfeeding protocol to gain 5% body weight over 8 weeks. Following weight gain, they underwent 8 weeks of weight loss. TTST, SHBG and endothelial function (brachial artery flow‐mediated dilation, FMD) were measured at baseline (T1), after weight gain (T2) and after weight loss (T3). Results: Volunteers gained 4 ± 1.3 kg and subsequently lost 3.2 ± 1.5 kg of body weight. TTST levels did not change (T1: 18.85 ± 6.2 nmol/L, T2: 19.3 ± 6.9 nmol/L, T3: 20.3 ± 7.6 nmol/L). However, SHBG decreased during weight gain (p=0.04) and increased during weight loss (p=0.0005) (T1: 22.8 ± 10.5 nmol/L, T2: 20.8 ± 11.1 nmol/L, T3: 25.58 ± 11.5 nmol/L). Furthermore, SHBG reduction during weight gain tended to correlate with decreases in FMD (p=0.06; R 2 =0.15). During weight loss, increases in SHBG correlate negatively with changes in FMD (p=0.008; R 2 =0.32). Conclusion : In normal weight healthy men, SHBG decreases with modest weight gain and increases with weight loss. TTST does not change. Changes in SHBG partly predict improvements in endothelial function with weight loss. Grant Funding Source : Supported by AHA 11SDG7260046, R21 DK81014, AHA 13POST16420009

Traditionally regarded as a consequence of sleep‐disordered breathing, excessive daytime sleepiness (EDS) is now recognized as an independent risk factor for cardiovascular disease. Evidence also links the shortening of telomeres, responsible for protecting DNA, with increased cardiovascular disease risk. Interestingly, recent data illustrate telomere lengthening in patients with obstructive sleep apnea (OSA); however, whether EDS is associated with telomere length independently of OSA remains unknown. To examine this potential relationship, we studied 169 subjects with polysomnography assessment who answered “yes” or “no” to experiencing EDS; 70 subjects (41%) reported EDS (59M, 44±12yrs, 30.3±5.5kg/m 2 ) whereas 99 did not (59%, 71M, 40±15yrs, 28.6±7.5kg/m 2 ). Telomere length was quantified via qPCR of genomic DNA isolated from peripheral blood samples and did not differ between individuals reporting EDS compared to those who did not (4,856±280 vs. 4,880±340bp, respectively, P =0.31). However, 50% of subjects reporting EDS had moderate‐to‐severe OSA (apnea‐hypopnea index ≥15events/hr) compared to 28% of the non‐EDS group ( P <0.01). To account for the confounding effects of OSA on telomere length, we conducted a series of subgroup analyses. Subjects without OSA who reported EDS (n=35, 27M, 39±11yrs, 27.4±5.0kg/m 2 ) had shorter telomeres (4,805±165 vs. 4,875±231bp, P =0.05) than those not reporting EDS (n=71, 47M, 35±11yrs, 26.8±5.4kg/m 2 ). Interestingly, within the OSA subgroup, there were no differences in telomere length (4,897±235 vs. 4,858±251bp, P =0.45) between those with (n=35, 32M, 48±11yrs, 33.2±4.5kg/m 2 ) and without EDS (n=28, 24M, 53±16yrs, 33.1±9.7kg/m 2 ). These effects do not appear to be influenced by subject demographics as no differences were found between compared groups (EDS‐OSA vs. nEDS‐OSA and OSA+EDS vs. OSA‐EDS). Collectively, our data suggest individuals reporting EDS may be at greater risk of developing cardiovascular disease due to accelerated telomere shortening. It also appears OSA and EDS exert differential effects on telomere length.

Abstract Introduction Voluntary sleep curtailment decreases insulin sensitivity. However, molecular mechanisms underlying impaired insulin signaling are not completely understood. To gain molecular insights, we examined the transcription of known cellular insulin-signaling regulators in adipose tissue obtained from subjects undergoing experimental sleep restriction. Methods Nineteen healthy subjects (males: 11; age: 19 - 36 years; BMI: 24.5 ± 3.6 kg/m2) underwent a normal (9 hours/night) and a restricted sleep (4 hours/night) sequence in a random order. Each inpatient stay included a screen visit followed by 4 days of acclimation and 9 days of experimental phase consisting of a controlled sleep opportunity. Eucaloric diet was provided to ensure weight maintenance. Abdominal fat sample was obtained at the screen and end of the experimental phase. mRNA was quantified by RT-PCR. Fasting morning blood draws were obtained at the end of acclimation and experimental phases. Mixed models were used for analysis. Results mRNA expression did not differ in normal and restricted sleep condition for SOCS3 [changes in normal Vs. restricted sleep, 0.02 (0.11, -0.01) Vs. 0.01 (0.12, -0.07), p=0.33], PTEN [-0.22 (0.18, -0.39) Vs. -0.10 (0.21, -0.20), p=0.22], PTB1B [-0.003 (0.04, -0.07) Vs. -0.01 (0.06, -0.06), p=0.74] and Cav-1 [-2.45 (0.78, -8.39) Vs. -6.31 (1.68, -8.29), p=0.34]. Further, transcription of insulin-receptor also did not change [0.01 (0.07, -0.06) Vs. -0.03 (0.09, -0.07), p=0.92]. However, within group analysis show significant decreases in Cav-1 mRNA only during sleep restriction (normal: p=0.09; restricted: p=0.003). Importantly, restricting sleep duration was associated with lowering of insulin (0.6 ± 1.9 Vs. -1.6 ± 1.7 uIU/ml; p=0.003), no change in glucose (-1.5 ± 3.8 Vs. -3.7 ± 4.12 mg/dl, p=0.06) and improvement in HOMA-IR index (0.12 ± 0.44 Vs -0.42 ± 0.43, p=0.002). Conclusion Chronic sleep restriction does not alter the transcription of cell-signaling regulators in abdominal adipose tissue. Moreover, restricting sleep duration without increasing calorie intake did not seem to decrease insulin sensitivity as determined by HOMA-IR. Support NIH grants HL114676, Mayo Clinic CCaTS UL1 TR002377; AHA grant 13POST16420009 to NC

Background Dietary habits are critical determinants of health and especially of cardiometabolic risk status. Previous studies have examined the relationship between breakfast consumption and indices of obesity, with conflicting findings. Such discrepancy may be owed to the use of surrogate measures of adiposity such as body mass index. Furthermore, it is unknown whether frequency of breakfast consumption is associated with different patterns of regional body fat distribution. Objective In this study, we aimed at investigating the association between frequency of breakfast consumption and body fat distribution. Methods We compiled data from 184 individuals (64% males, mean age 35.8±12.6 years, ranging from 18 to 63 years old) who participated in research studies performed in the Mayo Clinic Cardiovascular/Sleep Laboratory from 2005 to 2019 and underwent whole body dual‐energy X‐ray absorptiometry (DXA) for body composition. Breakfast eating habits were assessed by questionnaire and frequency of consumption was determined as number of times per week (range 0 to 7). Responses were recoded as low frequency (0 to 2 times/week), middle frequency (3 to 4 times/week), and high frequency (5 to 7 times/week). Measures of height and weight were collected to compute body mass index (BMI, kg/m 2 ). Total body fat percentage, fat mass, and lean mass were obtained from DXA. Regions of interest were manually adjusted with the DXA software to quantify abdominal fat and lower body fat. Abdominal fat/total body fat and lower body fat/total body fat ratios were calculated. Results Low frequency of breakfast consumption was reported by 14% of the subjects (n=26), while 18% (n=34) reported middle‐frequency of consumption. The proportion of men/women (p=0.1) and BMI values (p=0.78) were similar across breakfast eating categories. Compared to those who had breakfast with high‐frequency, those who ate it less frequently were younger (p=0.038). In age, sex, and BMI‐adjusted analysis, low‐frequency of breakfast consumption was significantly associated with greater abdominal fat mass (standardized beta=0.11, 95% CI 0.09‐ 1.29, p=0.024) and higher abdominal fat/total body fat ratio (standardized beta=0.16, 95% CI 0.003–0.024, p=0.013). Total body fat percentage (p=0.26), fat mass (p=0.26), and lean mass (p=0.22) were not associated with frequency of breakfast consumption. Similarly, no relations were seen with lower body fat (p=0.85) or lower body fat/total body fat ratio (p=0.51). Conclusion Our study showed that infrequent breakfast consumption is selectively associated with greater abdominal fat mass. As accumulation of fat in the abdominal depot is a more robust predictor of adverse outcomes than total adiposity, these findings suggest that abdominal fat may mediate the increased cardiometabolic risk previously observed in conjunction with infrequent breakfast consumption.

Telomere length (TL) is associated with cardiovascular disease (CVD) and cancer. Obstructive sleep apnea (OSA) is also linked to higher risk of CVD and cancer, and to TL. We investigated the association between TL and risk of major adverse cardiac events (MACE) and cancer in OSA patients. We studied 210 individuals undergoing sleep-related studies between 2000 and 2007. Baseline characteristics and follow-up data (available in 164 subjects) were obtained from clinic records. Incidence rates were calculated for the entire group and by OSA status. Hazard ratios were calculated to estimate effects of OSA and TL on risk of MACE and cancer. In total, 32 individuals (20%) developed MACE and/or cancer during 12.7-year follow-up. The OSA group had a higher likelihood of cancer (16.0 vs. 4.9 events per 1000 person-years, P = 0.044) but no clear evidence of an elevated incidence of MACE (10.8 vs. 4.8 events per 1000 person-years, P = 0.293) compared to the non-OSA group. There was no association between TL and MACE- (HR = 1.01, 95% CI 0.78–1.28), or cancer-risk (HR = 1.18, 95% CI 0.96–1.43). Our study warrants further investigation of any modulating effect of OSA on TL and the risk of MACE and cancer.

Background: Leptin contributes to obesity-related cardiometabolic pathology. While the role of adipose tissue dysfunction in altering metabolic profile in obesity is recognized, the direct effects of leptin signaling in adipose tissue are not completely understood. Among factors impacting adipose tissue function in obesity, adipocyte death is associated with increased inflammation with consequent adipose tissue insulin-resistance. Furthermore, apoptosis of adipocyte progenitor cells (preadipocytes) is important as it lowers adipose tissue capacity to maintain and expand fat storage. Objective: To determine the effects of leptin on regulation of proteins important to apoptotic pathways in cultured human white preadipocytes (HWP) and differentiated HWP (dHWP). Methods: Cells were exposed to increasing concentrations of leptin to evaluate the role of leptin on regulation of anti-apoptotic Bcl2, and pro-apoptotic Bax and CD95 expression. Next, we examined if pre-exposure to leptin attenuated TNF-α and FasL induced apoptosis. Results: Leptin upregulated transcription of Bcl2 (p=0.02) and down-regulated transcription of Bax (p=0.02) and CD95 (p=0.04) in a leptin-concentration dependent manner in dHWP. Leptin dependent increases in Bcl2 (p=0.004) and decreases in Bax (p=0.003) and CD95 (P=0.03) protein expression were also observed. Furthermore, 24 hour pre-exposure to leptin protected cells from TNF-α (p=0.01; p=0.006) and FasL (p=0.03; p=0.007) induced apoptosis in dHWP and HWP respectively. Additionally, leptin attenuated TNF-mediated activation of the p53 pathway, suggesting another mechanism by which leptin mediates its inhibitory effects on TNF-induced apoptosis. Conclusion: Leptin regulates the expression of proteins involved in the apoptotic pathway such that it decreases the apoptotic potential of adipose tissue by increasing anti-apoptotic Bcl2 and decreasing pro-apoptotic Bax and CD95 protein expression. In contrast to our in-vitro findings, prior studies in adipose tissue from obese humans report decreased Bcl2 and increased Bax protein expression, along with high leptin expression. This suggests that increased adipose tissue apoptosis in obesity may at least in part be secondary to altered leptin signaling.

Background: Abdominal fat elevates while lower-body (LB) fat diminishes cardiovascular risk. However, molecular mechanisms differentiating the two fat depots are not completely understood. MicroRNA (miRNA) are important regulators of gene expression with widespread effects on several proteins. Objective: To explore miRNA differences between the two fat depots using unbiased next-generation sequencing (NGS) approach. Methods: Total RNA isolated from paired subcutaneous (sc) fat tissue obtained from abdomen (ABD) and LB (femoral) region of 12 healthy subjects (7 male; age: 27 ± 5 years; BMI: 23.5 ± 3.2 kg/m 2 ) was used to quantify miRNA expression. Body fat distribution was determined using dual-energy X-ray absorptiometry and abdominal computed tomography scans. RNA was prepped using the NEBNext small RNA library prep kit and sequenced using Illumina HiSeq 2000. Raw sequence data were processed using CAP-miRSeq pipeline. miRNA expression between the two depots was evaluated using EdgeR. Relationship between miRNA and regional fat depots were examined using Spearman’s correlation. Adjusted or unadjusted P value <0.05 was considered significant. Results: Using NGS, 383 ± 55 known miRNA with ≥5 raw reads were detected in the study samples. Principal component analysis including all miRNAs showed no any clear separation between ABD or LB fat tissue. However, 37 miRNAs were found to have altered expression in the two depots. miR-196a-5p (log2FC=1.138, p<0.001), miR-146b-5p ( log2FC=1.388, p<0.001), miR-1287 ( log2FC=1.059, p<0.001), miR-1247-5p (1.002, p<0.001), and miR-346 (log2FC =-1.240, p=0.002) were among the top five differentially expressed miRNA in ABD Vs. LB fat. Interestingly, ABD fat tissue expression of miR196a-5p (rho=-0.58, p=0.047) and miR146b-5p (rho=0.76, p=0.004) correlated with visceral fat while miR146b-5p (rho=0.66, p=0.02) and miR1287 (rho=0.79, p=0.002) correlated with ABD sc fat. Conclusions: Several miRNAs are differentially expressed between ABD and LB fat tissue which may partly contribute to depot specific alterations in adipose tissue function and consequent cardiometabolic risk. Furthermore, the associations between miRNA and regional fat depots suggest a functional role of these miRNA in fat distribution.

Background Excessive daytime sleepiness ( EDS ), a common symptom among patients with sleep‐disordered breathing, is closely associated with the development of cardiovascular diseases, but its long‐term prognostic value is not completely understood. The aim of this study was to investigate whether EDS would be an independent prognostic factor after myocardial infarction. Methods and Results We prospectively recruited 112 post–myocardial infarction patients. The Epworth Sleepiness Scale was completed before polysomnography, and EDS was defined as a score ≥11. After exclusion of 8 patients who accepted treatment with continuous positive airway pressure, 104 patients were followed up for 48 months. The primary composite end point was major adverse cardiac events. Patients with EDS had higher rates of major adverse cardiac events (48.4% versus 27.4%, χ 2 =5.27, P =0.022) and reinfarction (29.0% versus 5.5%, χ 2 =13.51, P =0.0002) compared with those without EDS . In the Cox proportional hazards model, patients with EDS had 2.15 times (95% confidence interval, 1.08–4.18; P =0.030) higher crude risk of major adverse cardiac events, with prognostic significance persisting after adjusting for age, diabetes mellitus, depression, left ventricular ejection fraction, apnea–hypopnea index, and nocturnal nadir oxygen saturation (hazard ratio: 2.13, 95% confidence interval, 1.04–4.26, P =0.039). Furthermore, among participants with moderate to severe sleep‐disordered breathing, the presence of EDS was associated with higher risk of major adverse cardiac events than those without EDS , after adjusting for age and nadir oxygen saturation (hazard ratio: 3.17, 95% confidence interval, 1.22–7.76, P =0.019). Conclusions EDS may be an independent prognostic factor of adverse outcome in post–myocardial infarction patients with moderate to severe sleep‐disordered breathing. Evaluation of EDS may shed new light on risk stratification and identify treatment responders for this patient population.