Indolepropionic acid and novel lipid metabolites are associated with a lower. risk of type 2 diabetes in the Finnish Diabetes Prevention Study

Transcription

1 1 Supplementary Material Indolepropionic acid and novel lipid metabolites are associated with a lower risk of type 2 diabetes in the Finnish Diabetes Prevention Study Vanessa D de Mello, Jussi Paananen, Jaana Lindström, Maria A Lankinen, Lin Shi, Johanna Kuusisto, Jussi Pihlajamäki, Seppo Auriola, Marko Lehtonen, Olov Rolandsson, Ingvar A Bergdahl, Elise Nordin, Pirjo Ilanne-Parikka, Sirkka Keinänen-Kiukaanniemi, Rikard Landberg, Johan G Eriksson, Jaakko Tuomilehto, Kati Hanhineva, Matti Uusitupa

2 2 Supplementary Methods Diabetes Prevention Study (DPS) original design The main inclusion criteria in the DPS were as follows: BMI>25 kg/m2, age years, and impaired glucose tolerance (IGT) based on the mean values of two 75 g of glucose oral glucose tolerance tests (OGTT) based on the WHO 1985 criteria. People with previous diagnosis of type 2 diabetes (T2D), severe chronic disease or unstable clinical conditions related to glucose metabolism were excluded from the study. The study protocol was approved by the Ethics Committee of the National Public Health Institute of Helsinki, Finland, and all of the study individuals gave written informed consent. The individuals in the intervention group received dietary tailored advice aiming at reducing weight and the intake of total and saturated fat and increasing the intake of dietary fiber, and instructions to increase their levels of physical activity. The main goals of the intervention group were weight reduction 5 %, moderate intensity physical activity 30 min/d, dietary fat < 30 % of total energy (E %), saturated fat < 10 E % and fiber 15 g/1000 kcal. The control group received general advice on the benefits of weight reduction, physical activity and healthy diet. The completeness of the food records was checked by the study nutritionist during each of the study visit. The mean daily nutrient intakes and food group/product intake were calculated with a dietary analysis program developed at the National Public Health Institute, Helsinki, Finland (3). In the DPS the main end-point was diagnosis of diabetes defined by the WHO 1985 criteria (plasma fasting glucose 7.8 or 2-h glucose 11.1) to be confirmed by a repeated positive OGTT and verified by a physician. As explained in detail elsewhere (2, 3) after a median follow-up of four years as suggested by the independent endpoint committee the intervention phase of the study was discontinued. After the intervention (active study) period, the post-

3 3 intervention follow-up was carried out with annual examinations. As previously reported (3), of the original 522 participants, 366 individuals free of T2D participated in the post-intervention follow-up study at least once. They were further followed until diabetes diagnosis, dropout or the end of 2009 (median total follow-up of nine years and time span of 13 years from baseline). Of these, 62 new cases of diabetes out of 200 in the intervention group and 68 out of 166 in the control group were diagnosed. During this period, 36 participants withdrew and ten died without a verified diabetes diagnosis (3). Reversed phase (RP) and hydrophilic interaction (HILIC) chromatography techniques in non-targeted LC-MS metabolite profiling analysis In the RP technique, four microliters of the sample solution was injected onto the column (Zorbax Eclipse XDB-C18, mm, 1.8 µm, Agilent Technologies, Palo Alto, CA, USA) kept at 50 C. The mobile phases, delivered at 0.4 mll/min, consisted of water (eluent A, Milli- Q purified, Millipore, Milford, MA) and methanol (eluent B; Sigma-Aldrich, St. Louis, MO), both containing 0.1 % (v/v) of formic acid (Sigma-Aldrich, St. Louis, MO). The following gradient profile was employed: 0 10 min: 2% 100% B,; min: 100% B,; min: 100% 2% B; min: 2% B. In the HILIC technique, three µl of the sample solution was injected onto the column (Acquity UPLC BEH Amide column, mm, 1.7 μm) (Waters Corporation, Milford, MA) kept at 45 C. The mobile phases, delivered at 0.6 mll/min, consisted of 50% ACN (v/v)(eluent A) and 90% ACN (v/v)(eluent B) acetonitrile, respectively, both containing 20 mm ammonium formate, ph 3 (Sigma-Aldrich, St. Louis, MO). The following gradient profile was as employed: min: 100% B, min: 100% B 0% B, min: 0% B 100% B; min: 100% B.

4 4 The MS conditions after both chromatographic separations were as follows: Jetstream ESI source, operated in positive and negative ionization mode, drying gas temperature 325 C and flow 10 L/min, sheath gas temperature 350 C and flow 11 L/min, nebulizer pressure 45 psi, capillary voltage 3500 V, nozzle voltage 1000 V, fragmentor voltage 100 V, and skimmer 45 V. For data acquisition, 2 GHz extended dynamic range mode was used and the instrument was set to acquire over the m/z The data were collected in the centroid mode at the acquisition rate of 2.5 spectra/s (i.e. 400 ms/spectrum) with an abundance threshold 150. For the automatic data dependent MS/MS analyses performed on the QC samples four most abundant ions were selected for fragmentation from every precursor scan cycle. These ions were excluded after two product ion spectra and released again for fragmentation after a min hold. The precursor scan time was based on ion intensity, ending at counts or after 300 ms. The product ion scan time was 300 ms. The collision energies were 10, 20 and 40 V in subsequent runs. The continuous mass axis calibration was performed by monitoring two reference ions from an infusion solution throughout the runs. The reference ions were m/z and m/z in positive mode and m/z and m/z in negative mode. Calculations Matsuda index of insulin sensitivity (ISI) was calculated as: 10,000 / square root of (fasting glucose x fasting insulin x [arithmetic mean of glucose x arithmetic mean insulin both during an OGTT at 0, 30, and 120 min]). Disposition index (DI30) was calculated as the product of the ratio of total insulin area under the curve (AUC) and total glucose AUC during the 0-30min OGTT multiplied by the Matsuda ISI, as previously (4,5). METSIM study

5 5 In the prospective population-based METSIM cohort the average follow-up time was 5.9 years and the diagnoses of T2D were based on an OGTT, HbA1c measurements and National Drug Reimbursement registry data. Indolepropionic acid data derived from the non-targeted metabolomics analyses were available from baseline and follow-up from 55 men who developed diabetes and 55 non-diabetic controls. At baseline, the means ± SD for BMI and fasting plasma glucose, respectively, were 59 ± 6 years, 29.5 ± 3.8 kg/m2 and 6.2 ± 0.5 mmol/l in cases and 59 ± 5 years, 26.0 ± 2.7 kg/m2 and 5.2 ± 0.2 mmol/l in controls.

6 6 Supplementary References 1. Eriksson J, Lindström J, Valle T, et al. (1999) Prevention of type II diabetes in subjects with impaired glucose tolerance: The diabetes prevention study (DPS) in Finland. Study design and 1-year interim report on the feasibility of the lifestyle intervention programme. Diabetologia 42: , Tuomilehto J, Lindström J, Eriksson JG, et al. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344: Lindström J, Peltonen M, Eriksson JG, et al. (2013) Improved lifestyle and decreased diabetes risk over 13 years: Long-term follow-up of the randomised finnish diabetes prevention study (DPS). Diabetologia 56: de Mello VD, Lindström J, Eriksson J, et al. (2012) Insulin secretion and its determinants in the progression of impaired glucose tolerance to type 2 diabetes in impaired glucosetolerant individuals: the Finnish Diabetes Prevention Study. Diabetes Care 35: de Mello VD, Lindstrom J, Eriksson JG, et al. (2015) Markers of cholesterol metabolism as biomarkers in predicting diabetes in the Finnish Diabetes Prevention Study. Nutr Metab Cardiovasc Dis 25:

7 7 Supplementary Figure S1. Flowchart of metabolomics study in the Finnish Diabetes Prevention Study

8 8 Supplementary Table S1. Metabolites associated with T2D including statistically significantly unknown compounds and information on their compound class, analytical mode, retention time, molecular mass, and LC-MS/MS fragment ions used for structural assignment listed Metabolite Class Mass ms/ms Mode rt OR Lower Higher P* FDR- P Indolepropionic acid S other ESI(+) , , RP x Betaine S other ESI(+) , , hilic LPC(17:0) lipid ESI(+) , , ; ESI(-) , , RP x LPC(19:0) lipid ESI(-) , , RP x LPC(20:1) lipid ESI(+) , , ; ESI(-) , , RP x PC(22:6/18:2) lipid ESI(+) , ; ESI(-) , , , RP x , PC(18:1/22:6) lipid ESI(+) , ; ESI(-) , , , RP x LPC(15:1) lipid ESI(+) , , ; ESI(-) , , RP x , , PC(20:4/17:0) lipid ESI(+) , ; ESI(-) , , RP x

9 9 PC(22:6/17:0) lipid ESI(+) , ; ESI(-) , , RP x PC(15:1/18:2) lipid ESI(+) , ; ESI(-) , , , RP x LPE(16:0) lipid ESI(-) , , RP x PC(18:2/15:0) lipid ESI(+) , ; ESI(-) , , RP x LPC(18:1) lipid ESI(+) , , ; ESI(-) , , RP x LPC(15:0) lipid ESI(+) , , , , ; ESI(-) RP , , PC(18:2/17:0) lipid ESI(+) , ; ESI(-) , , , RP PC(22:6/16:0) lipid ESI(+) , ; ESI(-) , , , RP , PC(20:3/18:0) lipid ESI(+) , ; ESI(-) , , , RP LPE(18:0) lipid ESI(+) , , ; ESI(-) , , RP LPC(18:2) lipid ESI(+) , , ; ESI(-) , , RP

10 10 PC(14:0/18:1) lipid ESI(+) , ; ESI(-) , , , RP L-Phenylalanine S AA ESI(-) , , , , , hilic x Alanine S AA ESI(+) , hilic x Tyrosine S AA ESI(+) , , , , hilic x Proline S AA ESI(+) , hilic x Isoleucine S AA ESI(+) , , , hilic Leucine S AA ESI(+) , , , , hilic Phe-Phe AA ESI(+) , , hilic GCA S BA ESI(-) , ; ESI(+) , , , RP x , TCDC S BA ESI(-) ; ESI(+) , RP GCDC S BA ESI(+) , ; ESI(-) , , , RP GDC S BA ESI(+) , , , ; ESI(-) RP DC S BA ESI(-) , ; ESI(+) , RP CA S BA ESI(-) , , ; ESI(+) , , RP

11 11 Unknown lipid Hilic x10-6 4x10-4 Unknown lipid Hilic x Unknown lipid Hilic x Unknown lipid Hilic x Unknown lipid Hilic Unknown lipid Hilic Unknown lipid RP x Unknown lipid RP x Unknown lipid RP x Unknown lipid RP x Unknown lipid RP x Unknown lipid RP x * Logistic regression adjusted for study group (lifestyle or control) for the association of each metabolite with type 2 diabetes (cases and non-cases). FDR: correction for multiple comparisons was applied within each analytical mode including all the detected metabolite signals. AA: amino acid BA: bile acid Phe: phenylalanine rt: retention time GCA: Glycocholic acid TCDC: Taurochenodeoxycholic acid GCDC: Glycochenodeoxycholic acid GDC: Glycodeoxycholic DC: Deoxycholic acid CA: Cholic acid; upperscript S denotes compounds identified based on comparison with pure chemical standard.

12 14 Supplementary Table S2. Identified metabolites and their association with the development of type 2 diabetes in the Finnish Diabetes Prevention Study after excluding participants with diabetes at metabolomics sampling Metabolite Class OR Lower Higher P * FDR-P * Indolepropionic acid other x Betaine other LPC(17:0) lipid x LPC(19:0) lipid x LPC(20:1) lipid x PC(22:6/18:2) lipid x PC(18:1/22:6) lipid x LPC(15:1) lipid x PC(20:4/17:0) lipid x PC(22:6/17:0) lipid x PC(15:1/18:2) lipid x LPE(16:0) lipid x PC(18:2/15:0) lipid x LPC(18:1) lipid x LPC(15:0) lipid x PC(18:2/17:0) lipid x PC(22:6/16:0) lipid x PC(20:3/18:0) lipid LPE(18:0) lipid LPC(18:2) lipid

13 15 PC(14:0/18:1) lipid x L-Phenylalanine amino acid x Tyrosine amino acid x Alanine amino acid x Proline amino acid x Isoleucine amino acid Phe-phe amino acid Leucine amino acid GCA bile acid x TCDC bile acid x GCDC bile acid x GDC bile acid DC bile acid x CA bile acid * Logistic regression adjusted for study group (lifestyle or control) for the association of each metabolite with type 2 diabetes (cases and non-cases). FDR: correction for multiple comparisons was applied within each analytical mode including all the detected metabolite signals. Phe: phenylalanine GCA: Glycocholic acid TCDC: Taurochenodeoxycholic acid GCDC: Glycochenodeoxycholic acid GDC: Glycodeoxycholic DC: Deoxycholic acid CA: Cholic acid

14 16 Supplementary Table S3. List of identified metabolites and their association with the development of type 2 diabetes in the Finnish Diabetes Prevention Study (N=200) in models further adjusted for BMI or sex Metabolite OR Lower Higher P * FDR-P * OR Lower Higher P FDR-P Indolepropionic acid x x Betaine LPC(17:0) x x x10-3 LPC(19:0) x x x10-3 LPC(20:1) x x x10-3 PC(22:6/18:2) x x10-5 8x10-3 PC(18:1/22:6) x x10-5 8x10-3 LPC(15:1) x x PC(20:4/17:0) x x PC(22:6/17:0) x x PC(15:1/18:2) x LPE(16:0) x x

15 17 PC(18:2/15:0) x x LPC(18:1) x LPC(15:0) x x PC(18:2/17:0) x x PC(22:6/16:0) x x PC(20:3/18:0) x LPE(18:0) x LPC(18:2) x PC(14:0/18:1) x L-Phenylalanine x x x10-4 Tyrosine x x x10-3 Alanine x x Proline x x Isoleucine x Leucine x Phe-phe x

16 18 GCA x x TCDC x GCDC x GDC DC CA * Logistic regression adjusted for study group (lifestyle or control) and body weight for the association of each metabolite with type 2 diabetes (cases and non-cases). Logistic regression adjusted for study group (lifestyle or control) and sex for the association of each metabolite with type 2 diabetes (cases and non-cases). FDR: correction for multiple comparisons was applied within each analytical mode including all the detected metabolite signals. Phe: phenylalanine GCA: Glycocholic acid TCDC: Taurochenodeoxycholic acid GCDC: Glycochenodeoxycholic acid GDC: Glycodeoxycholic DC: Deoxycholic acid CA: Cholic acid.

17 19 Supplementary Table S4. List of identified metabolites and their association with the development of type 2 diabetes in the Finnish Diabetes Prevention Study (N=200) in models further adjusted for fasting or 2-h glucose during an oral glucose tolerance test at metabolomics sampling Metabolite OR Lower Higher P * FDR-P * OR Lower Higher P FDR-P Indolepropionic acid x x Betaine LPC(17:0) x x LPC(19:0) x x LPC(20:1) x x PC(22:6/18:2) x x PC(18:1/22:6) x x LPC(15:1) x x PC(20:4/17:0) x x PC(22:6/17:0) x x PC(15:1/18:2) x

18 20 LPE(16:0) x PC(18:2/15:0) x LPC(18:1) LPC(15:0) PC(18:2/17:0) PC(22:6/16:0) x PC(20:3/18:0) LPE(18:0) LPC(18:2) x PC(14:0/18:1) L-Phenylalanine x Tyrosine x Alanine x Proline Isoleucine Leucine

19 21 Phe-phe GCA x TCDC GCDC GDC DC CA * Logistic regression adjusted for study group (lifestyle or control) and fasting glucose for the association of each metabolite with type 2 diabetes (cases and non-cases). Logistic regression adjusted for study group (lifestyle or control) and 2-h glucose for the association of each metabolite with type 2 diabetes (cases and non-cases). FDR: correction for multiple comparisons was applied within each analytical mode including all the detected metabolite signals. Phe: phenylalanine GCA: Glycocholic acid TCDC: Taurochenodeoxycholic acid GCDC: Glycochenodeoxycholic acid GDC: Glycodeoxycholic DC: Deoxycholic acid CA: Cholic acid.

20 22 Supplementary Table S5. List of identified metabolites and their association with the development of type 2 diabetes in the Finnish Diabetes Prevention Study (N=200) in models further adjusted for fasting or 2-h insulin during an oral glucose tolerance test at metabolomics sampling Metabolite OR Lower Higher P * FDR-P * OR Lower Higher P FDR-P Indolepropionic acid x x Betaine LPC(17:0) x x LPC(19:0) x x LPC(20:1) x x PC(22:6/18:2) x x PC(18:1/22:6) x x LPC(15:1) x x PC(20:4/17:0) x x PC(22:6/17:0) x x PC(15:1/18:2)

21 23 LPE(16:0) x PC(18:2/15:0) x x LPC(18:1) x x LPC(15:0) x x PC(18:2/17:0) x x PC(22:6/16:0) x PC(20:3/18:0) LPE(18:0) LPC(18:2) PC(14:0/18:1) L-Phenylalanine x x Tyrosine x x Alanine x x Proline x Isoleucine Leucine

22 24 Phe-phe GCA x x TCDC GCDC GDC DC CA * Logistic regression adjusted for study group (lifestyle or control) and fasting insulin for the association of each metabolite with type 2 diabetes (cases and non-cases). Logistic regression adjusted for study group (lifestyle or control) and 2-h insulin for the association of each metabolite with type 2 diabetes (cases and non-cases). FDR: correction for multiple comparisons was applied within each analytical mode including all the detected metabolite signals. Phe: phenylalanine. GCA: Glycocholic acid TCDC: Taurochenodeoxycholic acid GCDC: Glycochenodeoxycholic acid GDC: Glycodeoxycholic DC: Deoxycholic acid CA: Cholic acid.

23 25 Supplementary Table S6. Associations of lipid metabolites related to lower chance of developing T2D with circulating high sensitive C-reactive protein (hscrp) at metabolomics sampling adjusted for confounding factors Metabolite Model 1 Model 2 Model 3 Model 4 LPC(17:0) LPC(15:1) LPC(20:1) PC(22:6/18:2) PC(15:1/18:2) β p 3.1x x x x10-7 β p 6.3x x x x10-6 β p 7.5x x x x10-8 β p 4.8x x10-4 β p * Linear regression models testing the association of each lipid metabolite with hscrp (dependent variable). adjusted for either one of the confounding factors: fasting glucose (Model 1). 2-h glucose (Model 2). BMI (Model 3) or study group (Model 4).

24 26 Supplementary Table S7. Correlations of identified top ranking metabolites with dietary intake * CHO Fiber Fat SAFA MUFA PUFA Protein Indolepropionic acid r P 9.1x LPC(17:0) r P LPC(19:0) r P x LPC(20:1) r P PC(22:6/18:2) r P PC(18:1/22:6) r P LPC(15:1) r P PC(20:4/17:0) r P PC(22:6/17:0) r P PC(15:1/18:2) r P

25 27 LPE(16:0) r P PC(18:2/15:0) r P L_Phenylalanine r P Tyrosine r P Alanine r P Proline r P Isoleucine r P * Energy adjusted nutrient intake Total fiber (g) per 1000 kcal energy intake CHO: carbohydrates SAFA: saturated fat MUFA: monounsaturated fat PUFA: polyunsaturated fat.

26 28 Supplementary Table S8. Pearson correlation (r) of indolepropionic acid with the most significant metabolites associated with type 2 diabetes in the Finnish Diabetes Prevention Study (n=200) Indolepropionic acid LPC(17:0) r 0.24 P LPC(19:0) r 0.23 P LPC(20:1) r 0.14 P 0.06 PC(22:6/18:2) r 0.03 P 0.69 PC(18:1/22:6) r 0.06 P 0.39 LPC(15:1) r 0.17 P 0.01 PC(20:4/17:0) r 0.03 P 0.69 PC(22:6/17:0) r 0.05 P 0.46 PC(15:1/18:2) r 0.09 P 0.19 LPE(16:0) r 0.08

27 29 P 0.29 PC(18:2/15:0) r 0.18 P 0.01 L_Phenylalanine r P Tyrosine r 0.05 P 0.46 Alanine r P 0.29 Proline r P 0.62 Isoleucine r P 0.17

28 30 Supplementary Table S9. Pearson correlation (r) between bile acids and the most significant metabolites associated with type 2 diabetes in the Finnish Diabetes Prevention Study (n=200) GCA TCDC GCDC GDC DC CA Indolepropionic acid r P LPC(17:0) r P LPC(19:0) r P LPC(20:1) r P PC(22:6/18) r P PC(18:1/22:6) r P LPC(15:1) r P PC(20:4/17:0) r P PC(22:6/17:0) r P PC(15:1/18:2) r P

29 31 LPE(16:0) r P PC(18:2/15:0) r P x L-Phenylalanine r P Tyrosine r P x Alanine r P Proline r P 1.8x x Isoleucine r P IPA: Indolepropionicacid GCA: Glycocholic acid TCDC: Taurochenodeoxycholic acid GCDC: Glycochenodeoxycholic acid GDC: Glycodeoxycholic DC: Deoxycholic acid CA: Cholic acid.