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Methods
Subjects
The 321 non-diabetic subjects (subject characteristics shown in [Table 1]) at an increased risk for type 2 diabetes, due to family history of diabetes (at least one second-degree relative with type 2 diabetes mellitus), history of gestational diabetes, overweight, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT), were recruited from an ongoing study on the pathophysiology of type 2 diabetes (Stefan et al., 2008). 80.9% of the subjects had a family history of diabetes. Relatedness among subjects was less than 1%. All subjects were anthropometrically characterized by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) and metabolically characterized by an oral glucose tolerance test (OGTT). A subgroup of 227 subjects was additionally characterized by a hyperinsulinemic-euglycemic clamp. The participants gave informed written consent to the study. The protocol was approved by the Ethics Committee of the University of Tübingen.
Analysis of the AHSG gene and selection of single nucleotide polymorphisms (SNPs) for genotyping
Using the publically available phase II data of the International HapMap Project derived from a population of Utah residents with ancestry from northern and western Europe (release #22, April 2007, www.hapmap.org/index.html.en, (The International HapMap Project, 2003)), we screened in silico the complete AHSG gene spanning 8.24 kb (7 exons, 6 introns, located on human chromosome 3q27.3), as well as 3 kb of its 5’- and 3 kb of its 3’-flanking regions. Among 33 informative SNPs, five SNPs were manually chosen as representative covering 100% of the common genetic variation (MAF≥0.05) of the locus with D’=1.0 and r2≥0.8. The five genotyped SNPs were: rs2248690 A/T (located in the 5’ flanking region), rs4831 C/G (located in exon 1, leading to the silent mutation Leu13Leu), rs2070635 A/G (located in intron 4), rs4917 C/T (located in exon 6, leading to the missense mutation Thr248Met), and rs1071592 C/A (located in exon 7, leading to the silent mutation Thr270Thr).
Genotyping of the study population
For genotyping, DNA was isolated from whole blood using a commercial DNA isolation kit (NucleoSpin, Macherey & Nagel, Düren, Germany). SNPs were genotyped using the TaqMan assay (Applied Biosystems, Foster City, CA, USA). The TaqMan genotyping reaction was amplified on a GeneAmp PCR system 7000 (50°C for 2 min, 95°C for 10 min, followed by 40 cycles of 95°C for 15 s and 60°C for 1 min), and fluorescence was detected on an ABI Prism sequence detector (Applied Biosystems, Foster City, CA, USA). Quality control was performed in the manner reported earlier (Stefan et al., 2005). The overall genotyping success rate was 99.1% (rs2248690: 98.8%, rs4831: 99.7%, rs2070635: 99.1%, rs4917: 98.8%, and rs1071592: 99.1%), and rescreening of 4.0% of subjects gave 100% identical results.
OGTT and hyperinsulinaemic-euglycaemic clamp
Both assays were performed as formerly described in detail ([Stefan et al., 2005]).
Determination of blood parameters
Plasma glucose, insulin, and C-peptide concentrations were measured as described earlier (Stefan et al., 2005). For determination of AHSG an immunoturbidimetric method was used with specific polyclonal goat anti-human fetuin-A antibodies to human fetuin-A (BioVendor Laboratory Medicine, Modreci, Czech Republic). This method was evaluated in a side-by-side comparison with an enzyme-linked immunosorbent assay (intra-assay coefficient of variation 3.5% and inter-assay coefficient of variation 5.4%, BioVendor Laboratory Medicine, Modreci, Czech Republic) (Stefan et al., 2006) showing a r2 of 0.88.
Body composition and body fat distribution
Percentage of body fat, body mass index (BMI), and waist circumference were measured as described earlier (Stefan et al., 2005).
Body fat depots were quantified using magnetic resonance imaging as described earlier (Machann et al., 2005).
Determination of IMCL by magnetic resonance spectroscopy
Neutral lipids within the muscle cell (IMCL) and those interlaced between the muscle fibers were measured by magnetic resonance spectroscopy as described earlier (Machann et al., 2005).
Determination of hepatic fat content
Hepatic fat content was determined by localized proton-magnetic resonance spectroscopy as described earlier (Machann et al., 2005).
Calculations
Insulin sensitivity from the OGTT (in arbitrary units), and clamp-derived insulin sensitivity (in arbitrary units) were calculated as reported earlier (Stefan et al., 2005).
Statistical analyses
Usually, data are given as means±SD. Distribution was tested for normality using the Shapiro-Wilk W test. Log-transformation of non-normally distributed variables, i.e., age, BMI, total adipose tissue (TAT), non-visceral adipose tissue (NVAT), visceral adipose tissue (VAT), hepatic lipids, IMCL tibialis, IMCL soleus, ISI (OGTT), ISI (clamp), and AHSG plasma levels, was performed prior to simple and multivariate linear regression analyses. In multivariate linear regression models, the trait was chosen as dependent variable, and gender, age, BMI, and genotype were tested as independent variables. Taking into account that 5 SNPs were tested in parallel, a Bonferroni corrected p-value<0.01 was considered statistically significant. The statistical software package JMP 7.0 (SAS Institue, Cary, NC, USA) was used. In the dominant model, the study was sufficiently powered (1-β>0.8) to detect effect sizes of 0.31≤d≤0.35 (two-tailed t-test) dependent on the SNP tested. Power calculation was performed using G*power software available at www.psycho.uni-duesseldorf.de/aap/projects/gpower. Analysis of linkage disequilibrium (LD) (D’, r2) was performed using the JLIN program provided by the Western Australian Institute for Medical Research (www.genepi.org.au/jlin (Carter et al., 2006)). Hardy-Weinberg equilibrium was tested using χ2 test.
References
[1] Carter KW, MacCaskie PA, Palmer LJ. JLIN: a java based linkage disequilibrium plotter. BMC Bioinformatics 2006; 7: 60
[2] Machann J, Thamer C, Schnoedt B, Stefan N, Stumvoll M, Häring HU,
Claussen CD, Fritsche A, Schick F. Age and gender related eff ects on adipose
tissue compartments of subjects with increased risk for type 2 diabetes: a whole body MRI/MRS study. MAGMA 2005; 18: 128 – 137
[3] Mori K, Emoto M, Yokoyama H, Araki T, Teramura M, Koyama H, Shoji T, Inaba M, Nishizawa Y. Association of serum fetuin-A with insulin resistance in type 2 diabetic and nondiabetic subjects. Diabetes Care 2006; 29: 468
[4] Stefan N, Machicao F, Staiger H, Machann J, Schick F, Tschritter O, Spieth
C, Weigert C, Fritsche A, Stumvoll M, Häring HU. Polymorphisms in the gene encoding adiponectin receptor 1 are associated with insulin resistance and high liver fat. Diabetologia 2005; 48: 2282 – 2291
[5] Stefan N, Hennige AM, Staiger H, Machann J, Schick F, Kröber SM, Machicao
F, Fritsche A, Häring HU. Alpha2-Heremans-Schmid glycoprotein/fetuin-A is associated with insulin resistance and fat accumulation in the liver in humans. Diabetes Care 2006; 29: 853 – 857
[6] Stefan N, Kantartzis K, Machann J, Schick F, Thamer C, Rittig K, Balletshofer
B, Machicao F, Fritsche A, Häring HU. Identifi cation and characterization of metabolically benign obesity in humans. Arch Intern Med 2008; 168: 1609 – 1616
[7] The International HapMap Project. Nature 2003; 426: 789 – 796
Correspondence
Prof. Dr. med. H.-U. Häring
Medizinische Klinik IV
Universitätsklinikum Tübingen
Otfried-Müller-Str. 10
72076 Tübingen
Germany
Phone: +49/7071/298 27 35
Fax: +49/7071/29 27 84
Email: hans-ulrich.haering@med.uni-tuebingen.de