title: Genotype-based treatment of type 2 diabetes with an α2A-adrenergic receptor antagonist.
abstract: The feasibility of exploiting genomic information for individualized treatment of polygenic diseases remains uncertain. A genetic variant in ADRA2A, which encodes the α(2A)-adrenergic receptor (α(2A)AR), was recently associated with type 2 diabetes. This variant causes receptor overexpression and impaired insulin secretion; thus, we hypothesized that blocking α(2A)AR 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 α(2A)AR 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 α(2A)AR 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.
authors.affiliation: Department of Clinical Sciences, Lund University, SE-20502 Malmö, Sweden. 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics (Ministry of Health), Key Laboratory of Hormones and Development, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China.
authors.forename: Yunzhao
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Department of Clinical Sciences, Lund University, SE-20502 Malmö, Sweden.
authors.forename: Annika S
authors.initials: AS
authors.lastname: Axelsson
authors.affiliation: Department of Clinical Sciences, Lund University, SE-20502 Malmö, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Spégel
authors.affiliation: Department of Clinical Sciences, Lund University, SE-20502 Malmö, Sweden.
authors.forename: Lotta E
authors.initials: LE
authors.lastname: Andersson
authors.affiliation: Department of Clinical Sciences, Lund University, SE-20502 Malmö, Sweden.
authors.forename: Hindrik
authors.initials: H
authors.lastname: Mulder
authors.affiliation: Department of Clinical Sciences, Lund University, SE-20502 Malmö, Sweden.
authors.forename: Leif C
authors.initials: LC
authors.lastname: Groop
authors.affiliation: Department of Clinical Sciences, Lund University, SE-20502 Malmö, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Renström
authors.affiliation: Department of Clinical Sciences, Lund University, SE-20502 Malmö, Sweden. anders.rosengren@med.lu.se.
authors.forename: Anders H
authors.initials: AH
authors.lastname: Rosengren
mesh_terms: D058669:Adrenergic alpha-2 Receptor Antagonists / Q000627:therapeutic use*; D000368:Aged; D000483:Alleles; D001794:Blood Pressure / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000235:genetics* / Q000503:physiopathology; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D015870:Gene Expression; D014644:Genetic Variation; D005838:Genotype; D005934:Glucagon / Q000097:blood; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D018341:Receptors, Adrenergic, alpha-2 / Q000235:genetics*; D057170:Translational Research, Biomedical; D015016:Yohimbine / Q000627:therapeutic use
chemical_list: C547768:ADRA2A protein, human; D058669:Adrenergic alpha-2 Receptor Antagonists; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D018341:Receptors, Adrenergic, alpha-2; D015016:Yohimbine; D005934:Glucagon; D009638:Norepinephrine