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Genetics and Epigenetics

The rs2341471-G/G genotype of activating transcription factor 6 (ATF6) is the risk factor of type 2 diabetes in subjects with obesity or overweight

Abstract

Background

Numerous studies have demonstrated that the onset of type 2 diabetes (T2D) is linked to the reduction in ß-cell mass caused by apoptosis, a process initiated by endoplasmic reticulum (ER) stress. The aim of this study was to investigate the associations between single nucleotide polymorphisms (SNPs) in the ATF6 gene (activating transcription factor 6), a key sensor of ER stress, and T2D susceptibility.

Methods

The study involved 3229 unrelated individuals, including 1569 patients with T2D and 1660 healthy controls from Central Russia. Four functionally significant intronic SNPs, namely rs931778, rs90559, rs2341471, and rs7517862, were genotyped using the MassARRAY-4 system.

Results

The rs2341471-G/G genotype of ATF6 was found to be associated with an increased risk of T2D (OR = 1.61, 95% CI 1.37–1.90, PFDR < 0.0001). However, a BMI-stratified analysis showed that this genotype and haplotypes CGGA and TAGA are associated with T2D risk exclusively in subjects with obesity or overweight (PFDR < 0.05). Despite these patients being found to have higher consumption of high-carbohydrate and high-calorie diets compared to normal-weight individuals (P < 0.0001), the influence of the rs7517862 polymorphism on T2D risk was observed independently of these dietary habits. Functional SNP annotation revealed the following: (1) the rs2341471-G allele is associated with increased ATF6 expression; (2) the SNP is located in a region exhibiting enhancer activity epigenetically regulated in pancreatic islets; (3) the rs2341471-G was predicted to create binding sites for 18 activating transcription factors that are part of gene-regulatory networks controlling glucose metabolism and maintaining proteostasis.

Conclusions

The present study revealed, for the first time, a strong association between the rs2341471-G/G ATF6 genotype and an increased risk of type 2 diabetes in people with obesity or overweight, regardless of known dietary risk factors. Further research is needed to support the potential of silencing the ATF6 gene as a means for the treatment and prevention of type 2 diabetes.

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Data availability

Data supporting reported results are available upon request.

References

  1. Klein S, Gastaldelli A, Yki-Järvinen H, Scherer PE. Why does obesity cause diabetes? Cell Metab. 2022;34:11–20. https://doi.org/10.1016/j.cmet.2021.12.012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Chew NWS, Ng CH, Tan DJH, Kong G, Lin C, Chin YH, et al. The global burden of metabolic disease: data from 2000 to 2019. Cell Metab. 2023;35:414–428.e3. https://doi.org/10.1016/j.cmet.2023.02.003

    Article  CAS  PubMed  Google Scholar 

  3. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32:1431–7. https://doi.org/10.1038/ijo.2008.102

    Article  CAS  Google Scholar 

  4. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pr. 2019;157:107843. https://doi.org/10.1016/j.diabres.2019.107843

    Article  Google Scholar 

  5. Ampofo AG, Boateng EB. Beyond 2020: modelling obesity and diabetes prevalence. Diabetes Res Clin Pr. 2020;167:108362. https://doi.org/10.1016/j.diabres.2020.108362

    Article  Google Scholar 

  6. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pr. 2022;183:109119. https://doi.org/10.1016/j.diabres.2021.109119

    Article  Google Scholar 

  7. Wysham C, Shubrook J. Beta-cell failure in type 2 diabetes: mechanisms, markers, and clinical implications. Postgrad Med. 2020;132:676–86. https://doi.org/10.1080/00325481.2020.1771047

    Article  CAS  PubMed  Google Scholar 

  8. Lima JEBF, Moreira NCS, Sakamoto-Hojo ET. Mechanisms underlying the pathophysiology of type 2 diabetes: From risk factors to oxidative stress, metabolic dysfunction, and hyperglycemia. Mutat Res Genet Toxicol Environ Mutagen. 2022;874-875:503437. https://doi.org/10.1016/j.mrgentox.2021.503437

    Article  CAS  PubMed  Google Scholar 

  9. Campbell JE, Newgard CB. Mechanisms controlling pancreatic islet cell function in insulin secretion. Nat Rev Mol Cell Biol. 2021;22:142–58. https://doi.org/10.1038/s41580-020-00317-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Eizirik L, Cardozo AK, Cnop M. The role for endoplasmic reticulum stress in diabetes mellitus. Endocr Rev. 2008;29:42–61. https://doi.org/10.1210/er.2007-0015

    Article  CAS  PubMed  Google Scholar 

  11. Yong J, Johnson JD, Arvan P, Han J, Kaufman RJ. Therapeutic opportunities for pancreatic β-cell ER stress in diabetes mellitus. Nat Rev Endocrinol. 2021;17:455–67. https://doi.org/10.1038/s41574-021-00510-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ajoolabady A, Liu S, Klionsky DJ, Lip GYH, Tuomilehto J, Kavalakatt S, et al. ER stress in obesity pathogenesis and management. Trends Pharm Sci. 2022;43:97–109. https://doi.org/10.1016/j.tips.2021.11.011

    Article  CAS  PubMed  Google Scholar 

  13. Arunagiri A, Haataja L, Cunningham CN, Shrestha N, Tsai B, Qi L, et al. Misfolded proinsulin in the endoplasmic reticulum during development of beta cell failure in diabetes. Ann N. Y Acad Sci. 2018;1418:5–19. https://doi.org/10.1111/nyas.13531

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Scheuner D, Kaufman RJ. The unfolded protein response: a pathway that links insulin demand with beta-cell failure and diabetes. Endocr Rev. 2008;29:317–33. https://doi.org/10.1210/er.2007-0039

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Shrestha N, De Franco E, Arvan P, Cnop M Pathological β-cell endoplasmic reticulum stress in Type 2 diabetes: current evidence. Front Endocrinol. 2021;12. https://doi.org/10.3389/fendo.2021.650158.

  16. Engin F, Nguyen T, Yermalovich A, Hotamisligil GS. Aberrant islet unfolded protein response in type 2 diabetes. Sci Rep. 2014;4:4054. https://doi.org/10.1038/srep04054

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hetz C, Zhang K, Kaufman RJ. Mechanisms, regulation and functions of the unfolded protein response. Nat Rev Mol Cell Biol. 2020;21:421–38. https://doi.org/10.1038/s41580-020-0250-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Read A, Schröder M. The unfolded protein response: an overview. Biology. 2021;10. https://doi.org/10.3390/biology10050384.

  19. Klyosova EY, Azarova YE, Ilyina EA, Goryainova NV, Polonikov AV. Association between polymorphisms of heat shock protein HSPA5 and risk of Type 2 diabetes mellitus. Bull Exp Biol Med. 2024;176:599–602. https://doi.org/10.1007/s10517-024-06075-2

    Article  CAS  PubMed  Google Scholar 

  20. Pandey VK, Mathur A, Kakkar P. Emerging role of unfolded protein response (UPR) mediated proteotoxic apoptosis in diabetes. Life Sci. 2019;216:246–58. https://doi.org/10.1016/j.lfs.2018.11.041

    Article  CAS  PubMed  Google Scholar 

  21. Galicia-Garcia U, Benito-Vicente A, Jebari S, Larrea-Sebal A, Siddiqi H, Uribe KB, et al. Pathophysiology of Type 2 diabetes mellitus. Int J Mol Sci. 2020;21:6275. https://doi.org/10.3390/ijms21176275

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Adachi Y, Yamamoto K, Okada T, Yoshida H, Harada A, Mori K. ATF6 is a transcription factor specializing in the regulation of quality control proteins in the endoplasmic reticulum. Cell Struct Funct. 2008;33:75–89. https://doi.org/10.1247/csf.07044

    Article  CAS  PubMed  Google Scholar 

  23. Klyosova, EY EYu. Genetic variation of ERN1 and susceptibility to type 2 diabetes. Research Results in Biomedicine. 2022, 8; https://doi.org/10.18413/2658-6533-2022-8-3-0-1.

  24. Yu R, Chen X, Zhu X, He B, Lu C, Liu Y, et al. ATF6 deficiency damages the development of spermatogenesis in male Atf6 knockout mice. Andrologia. 2022, 54; https://doi.org/10.1111/and.14350.

  25. Thameem F, Farook VS, Bogardus C, Prochazka M. Association of amino acid variants in the activating transcription factor 6 gene (ATF6) on 1q21-q23 with type 2. Diabetes Pima Indians Diabetes 2006;55:839–42. https://doi.org/10.2337/diabetes.55.03.06.db05-1002

    Article  CAS  PubMed  Google Scholar 

  26. Chu WS, Das SK, Wang H, Chan JC, Deloukas P, Froguel P, et al. Activating transcription factor 6 (ATF6) sequence polymorphisms in type 2 diabetes and pre-diabetic traits. Diabetes. 2007;56:856–62. https://doi.org/10.2337/db06-1305

    Article  CAS  PubMed  Google Scholar 

  27. Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, Araki E, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. J Diabetes Investig. 2010. https://doi.org/10.1111/j.2040-1124.2010.00074.x

    Article  PubMed  PubMed Central  Google Scholar 

  28. Azarova I, Klyosova E, Polonikov A Association between RAC1 gene variation, redox homeostasis and type 2 diabetes mellitus. Eur J Clin Invest. 2022;52. https://doi.org/10.1111/eci.13792.

  29. Azarova I, Klyosova E, Polonikov A. Single nucleotide polymorphisms of the RAC1 gene as novel susceptibility markers for neuropathy and microvascular complications in Type 2 diabetes. Biomedicines. 2023;11:981. https://doi.org/10.3390/biomedicines11030981

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Polonikov AV, Ivanov VP, Belugin DA, Khoroshaya IV, Kolchanova IO, Solodilova MA, et al. Analysis of common transforming growth factor beta-1 gene polymorphisms in gastric and duodenal ulcer disease: pilot study. J Gastroenterol Hepatol. 2007;22:555–64. https://doi.org/10.1111/j.1440-1746.2006.04542.x

    Article  CAS  PubMed  Google Scholar 

  31. Polonikov A, Vialykh E, Vasil’eva O, Bulgakova I, Bushueva O, Illig T, et al. Genetic variation in glutathione S-transferase genes and risk of nonfatal cerebral stroke in patients suffering from essential hypertension. J Mol Neurosci. 2012;47:511–3. https://doi.org/10.1007/s12031-012-9764-y

    Article  CAS  PubMed  Google Scholar 

  32. Polonikov AV, Bushueva OY, Bulgakova IV, Freidin MB, Churnosov MI, et al. A comprehensive contribution of genes for aryl hydrocarbon receptor signaling pathway to hypertension susceptibility. Pharmacogenet Genomics. 2017;27:57–69. https://doi.org/10.1097/FPC.0000000000000261

    Article  CAS  PubMed  Google Scholar 

  33. Azarova I, Bushueva O, Konoplya A, Polonikov A. Glutathione S-transferase genes and the risk of type 2 diabetes mellitus: role of sexual dimorphism, gene-gene and gene-smoking interactions in disease susceptibility. J Diabetes. 2018;10:398–407. https://doi.org/10.1111/1753-0407.12623

    Article  CAS  PubMed  Google Scholar 

  34. Klyosova EYU, Azarova IE, Sunyaykina OA, Polonikov AV Validity of a brief screener for environmental risk factors of age-related diseases using type 2 diabetes and coronary artery disease as examples. Res Results Biomed. 2022; https://doi.org/10.18413/2658-6533-2022-8-1-0-10.

  35. World Health Organization (2007). The world health report 2007: a safer future: global public health security in the 21st century. https://www.who.int/publications/i/item/9789241563444

  36. American Diabetes Association. Standards of medical care in diabetes--2007. Diabetes Care. 30: 4. https://doi.org/10.2337/dc07-S004.

  37. Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003;78:734–41. https://doi.org/10.1093/ajcn/78.4.734

    Article  CAS  PubMed  Google Scholar 

  38. Mazzocchi M, Brasili C, Sandri E. Trends in dietary patterns and compliance with World Health Organization recommendations: a cross-country analysis. Public Health Nutr. 2008;11:535–40. https://doi.org/10.1017/S1368980007000900

    Article  PubMed  Google Scholar 

  39. Gannon MC, Nuttall FQ. Amino acid ingestion and glucose metabolism-a review. IUBMB Life. 2010;62:660–8. https://doi.org/10.1002/iub.375

    Article  CAS  PubMed  Google Scholar 

  40. World Health Organization. (2003). The World Health Report: 2003: shaping the future. World Health Organization. https://iris.who.int/handle/10665/42789.

  41. World Health Organization (2010) Global recommendations on physical activity for health. https://www.who.int/publications/i/item/9789241599979.

  42. Armstrong T, Bull F. Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ). J Public Health. 2006;14:66–70. https://doi.org/10.1007/s10389-006-0024-x

    Article  Google Scholar 

  43. Weir CB, Jan A BMI Classification Percentile And Cut Off Points. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/

  44. Solé X, Guinó E, Valls J, Iniesta R, Moreno V. SNPStats: a web tool for the analysis of association studies. Bioinformatics. 2006;22:1928–9. https://doi.org/10.1093/bioinformatics/btl268

    Article  CAS  PubMed  Google Scholar 

  45. Oba S, Suzuki E, Yamamoto M, Horikawa Y, Nagata C, Takeda J.Gifu Diabetes Study Group Active and passive exposure to tobacco smoke in relation to insulin sensitivity and pancreatic β-cell function in Japanese subjects. Diabetes Metab. 2015;41:160–7. https://doi.org/10.1016/j.diabet.2014.09.002.

    Article  CAS  PubMed  Google Scholar 

  46. Topsakal S, Ozmen O, Aslankoc R, Aydemir DH. Pancreatic damage induced by cigarette smoke: the specific pathological effects of cigarette smoke in the rat model. Toxicol Res. 2016;5:938–45. https://doi.org/10.1039/c5tx00496a

    Article  CAS  Google Scholar 

  47. Cho YS, Chen CH, Hu C, Long J, Ong RT, Sim X, et al. Meta-analysis of genome-wide association studies identifies eight new loci for type 2 diabetes in east Asians. Nat Genet. 2011;44:67–72. https://doi.org/10.1038/ng.1019

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Oyadomari S, Araki E, Mori M. Endoplasmic reticulum stress-mediated. apoptosis Pancreat beta-cells Apoptosis 2002;7:335–45. https://doi.org/10.1023/a:1016175429877

    Article  CAS  Google Scholar 

  49. Back SH, Kaufman RJ. Endoplasmic reticulum stress and type 2 diabetes. Annu Rev Biochem. 2012;81:767–93. https://doi.org/10.1146/annurev-biochem-072909-095555

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Gusev A, Ko A, Shi H, Bhatia G, Chung W, Penninx BWJH, et al. Integrative approaches for large-scale transcriptome-wide association studies. Nat Genet. 2016;48:245–52. https://doi.org/10.1038/ng.3506

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Klyosova E, Azarova I, Buikin S, Polonikov A. Differentially expressed genes regulating glutathione metabolism, protein-folding, and unfolded protein response in pancreatic β-cells in Type 2 diabetes mellitus. Int J Mol Sci. 2023;24:12059. https://doi.org/10.3390/ijms241512059

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Local A, Huang H, Albuquerque CP, Singh N, Lee AY, Wang W, et al. Identification of H3K4me1-associated proteins at mammalian enhancers. Nat Genet. 2018;50: 73–82. https://doi.org/10.1038/s41588-017-0015-6.

  53. Werner H BRCA1: an endocrine and metabolic regulator. Front Endocrinol. 2022;13. https://doi.org/10.3389/fendo.2022.844575.

  54. Bourouh C, Courty E, Rolland L, Pasquetti G, Gromada X, Rabhi N, et al. The transcription factor E2F1 controls the GLP-1 receptor pathway in pancreatic β cells. Cell Rep. 2022;40:111170. https://doi.org/10.1016/j.celrep.2022.111170

    Article  CAS  PubMed  Google Scholar 

  55. Shirakawa J, Togashi Y, Basile G, Okuyama T, Inoue R, Fernandez M, et al. E2F1 transcription factor mediates a link between fat and islets to promote β cell proliferation in response to acute insulin resistance. Cell Rep. 2022;41:111436. https://doi.org/10.1016/j.celrep.2022.111436

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Oger F, Bourouh C, Friano ME, Courty E, Rolland L, Gromada X, et al. β-cell-specific E2f1 deficiency impairs glucose homeostasis, β-cell identity, and insulin secretion. Diabetes. 2023;72:1112–26. https://doi.org/10.2337/db22-0604

    Article  CAS  PubMed  Google Scholar 

  57. Meriin AB, Zaarur N, Roy D, Kandror KV Egr1 plays a major role in the transcriptional response of white adipocytes to insulin and environmental cues. Front Cell Dev Biol. 2022;10. https://doi.org/10.3389/fcell.2022.1003030.

  58. Raychaudhuri S, Loew C, Körner R, Pinkert S, Theis M, Hayer-Hartl M, et al. Interplay of acetyltransferase EP300 and the proteasome system in regulating heat shock transcription factor 1. Cell. 2014;156:975–85. https://doi.org/10.1016/j.cell.2014.01.055

    Article  CAS  PubMed  Google Scholar 

  59. Eom YS, Gwon AR, Kwak KM, Youn JY, Park H, Kim KW, et al. Notch1 has an important role in β-cell mass determination and development of diabetes. Diabetes Metab J. 2021;45:86–96. https://doi.org/10.4093/dmj.2019.0160

    Article  PubMed  Google Scholar 

  60. Lum JJ, Bui T, Gruber M, Gordan JD, DeBerardinis RJ, Covello KL, et al. The transcription factor HIF-1alpha plays a critical role in the growth factor-dependent regulation of both aerobic and anaerobic glycolysis. Genes Dev. 2007;21:1037–49. https://doi.org/10.1101/gad.1529107

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Gunton JE. Hypoxia-inducible factors and diabetes. J Clin Invest. 2020;130:5063–73. https://doi.org/10.1172/JCI137556

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Nagarajan SR, Livingstone EJ, Monfeuga T, Lewis LC, Ali SHL, Chandran A, et al. MLX plays a key role in lipid and glucose metabolism in humans: evidence from in vitro and in vivo studies. Metabolism. 2023;144:155563. https://doi.org/10.1016/j.metabol.2023.155563

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Yang X, Graff SM, Heiser CN, Ho KH, Chen B, Simmons AJ, et al. Coregulator Sin3a promotes postnatal murine β-cell fitness by regulating genes in Ca2+ homeostasis, cell survival, vesicle biosynthesis, glucose metabolism, and stress response. Diabetes. 2020;69:1219–31. https://doi.org/10.2337/db19-0721

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Morishima N, Nakanishi K, Nakano A. Activating transcription factor-6 (ATF6) mediates apoptosis with reduction of myeloid cell leukemia sequence 1 (Mcl-1) protein via induction of WW domain binding protein 1. J Biol Chem. 2011;286:35227–35. https://doi.org/10.1074/jbc.M111.233502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Huang J, Wan L, Lu H, Li X High expression of active ATF6 aggravates endoplasmic reticulum stress‑induced vascular endothelial cell apoptosis through the mitochondrial apoptotic pathway. Mol Med Rep. 2018; https://doi.org/10.3892/mmr.2018.8658.

  66. Seo HY, Kim YD, Lee KM, Min AK, Kim MK, Kim HS, et al. Endoplasmic reticulum stress-induced activation of activating transcription factor 6 decreases insulin gene expression via up-regulation of orphan nuclear receptor small heterodimer partner. Endocrinology. 2008;149:3832–41. https://doi.org/10.1210/en.2008-0015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The study was supported by the Russian Science Foundation (project No. 22-25-00585).

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Conceptualization, A.P.; methodology, E.K., A.P., I.A., I.P., and R.K.; software, A.P. and R.K.; validation, E.K. and A.P.; formal analysis, E.K. and I.A.; investigation, E.K. and I.A.; resources, I.A.; data curation, I.P. and R.K.; writing—original draft preparation, E.K. and A.P.; writing—review and editing, A.P.; supervision, A.P.; project administration, A.P.

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Correspondence to Alexey Polonikov.

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Klyosova, E., Azarova, I., Petrukhina, I. et al. The rs2341471-G/G genotype of activating transcription factor 6 (ATF6) is the risk factor of type 2 diabetes in subjects with obesity or overweight. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01604-5

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