Cardiorenal Diabetes

CARDIORENAL DIABETES

Daniel Gordin, M.D., Dr.Med.Sci., Associate Professor, PI
Rasmus Simonsen, M.D., Dr.Med.Sci., postdoc
Anniina Tynjälä, M.D.
Jussi Inkeri, M.D.
Fanny Jansson Sigfrids, M.D.
Aleksi Tarkkonen, M.D.
Anna Sandelin, M.Sc., Research nurse


Hypoxia in diabetic kidney disease

Renal disease is a major driver of cardiovascular morbidity and mortality and contributes greatly to a poor quality of life in diabetes. Preventing renal hypoxia, an early risk factor for diabetic kidney disease, may play an important role in delaying the onset of this grave complication.

Via cutting edge methodology (renal haemodynamics, renal and cardiac imaging by BOLD MRI and PET-CT), we aim to detect early haemodynamic, metabolic, and morphological changes that lead to relative tissue hypoxia in the kidney. Our recent establishment of a renal lab which includes capabilities of measuring renal function (GFR; glomerular filtration rate, and ERPF; effective renal plasma flow), will enable us to perform these studies. Various interventions, such as maneuvers affecting cardiac autonomic neuropathy as well as pharmacological compounds, will be employed to reverse tissue hypoxia.

Risk factors for cerebrovascular disease in patients with type 1 diabetes

Diabetes and ischemic stroke are two major causes of early morbidity and mortality. We recently reported a high risk of premature death in individuals with type 1 diabetes, compared to type 2 diabetes and non-diabetic controls, in a large cohort of young individuals who had suffered a first ever stroke. The strongest risk factor for mortality was renal disease.

The goal of this collaborative longitudinal study is to find early markers and causal risk factors for cerebrovascular disease in individuals with type 1 diabetes. All subjects underwent detailed clinical examination, clinical and biochemical profiling, genetic (GWAS, whole genome sequencing) and retinal evaluations (fundus photos, OCTA), and brain MRI. We aim to repeat these examinations in these individuals, to establish a longitudinal trajectory, and additionally include a cognitive examination to find structural-functional associations between brain anatomy and cognition.

The final aim of these two initiatives is to identify patients at risk for renal and cerebrovascular in order to plan their prevention and even find tools to improve their individual treatment to eventually delay or in best case halt these grim diseases.

Collaboration

Our group has developed a comprehensive collaborative network with high profile research groups nationally and internationally.


Contact info
Daniel Gordin, M.D., Dr.Med.Sci., Associate Professor, PI
E-mail: daniel.gordin@helsinki.fi


Selected Publications

Gordin D, Hiilesmaa V, Fagerudd J, Rönnback M, Forsblom C, Kaaja R, Teramo K, Groop P-H, Finn-Diane Study Group. Preeclampsia but not pregnancy induced hypertension is a risk factor for diabetic nephropathy in type 1 diabetes. Diabetologia 2007;50:516-22.

Gordin D, Rönnback M, Forsblom C, Heikkilä O, Saraheimo M, Groop P-H. Acute hyperglycaemia rapidly increases arterial stiffness in young patients with type 1 diabetes. Diabetologia 2007;50:516-22.

Gordin D, Wadén J, Forsblom C, Thorn L, Rosengård-Bärlund M, Tolonen N, Saraheimo M, Harjutsalo V, Groop PH; FinnDiane Study Group. Pulse pressure predicts incident cardiovascular disease but not diabetic nephropathy in patients with type 1 diabetes (The FinnDiane Study). Diabetes Care 2011;34:886-91.

Putaala J*, Liebkind R*, Gordin D, Thorn LM, Haapaniemi E, Forsblom C, Groop PH, Kaste M, Tatlisumak T. Diabetes mellitus and ischemic stroke in the young: clinical features and long-term prognosis. Neurology 2011; 24;76:1831-7.

Gordin D*, Soro-Paavonen A*, Thomas M, Bjerre M, Saraheimo M, Harjutsalo V, Flyvbjerg A, Forsblom C, Groop PH. Osteoprotegerin is an independent predictor of vascular events in finnish adults with type 1 diabetes. Diabetes Care 2013; 36:1827-1833.

Gordin, D*, Forsblom C*, Panduru NM, Thomas MC, Bjerre M, Soro-Paavonen M, Tolonen N, Sandholm N, Flyvbjerg A, Harjutsalo V, Groop PH; on behalf of the FinnDiane Study Group. Osteopontin is a strong predictor of incipient diabetic nephropathy, cardiovascular disease and all-cause mortality in patients with type 1 diabetes. Diabetes Care 2014;37:2593-600.

Bernardi L, Gordin D, Bordino M, Rosengård-Bärlund M, Sandelin A, Forsblom C, Groop PH. Oxygen-induced impairment in arterial function is corrected by slow breathing in patients with type 1 diabetes. Sci Rep 2017;7:6001.

Liebkind R*, Gordin D*, Strbian D, Meretoja A, Thorn LM, Hagg S, Forsblom C, Tatlisumak T Groop PH, Putaala J. Diabetes and intracerebral hemorrhage: Baseline characteristics and mortality. Eur J Neurol 2018;25:825-832.

Gordin D, Harjutsalo V, Tinsley L, Fickweiler W, Sun JK, Forsblom C, Amenta PS, Pober D, D’Eon S, Khatri M, Stillman IE, Groop P-H, Keenan HA, King GL. Differential association of microvascular attributions with cardiovascular disease in patients with long duration of type 1 diabetes. Diabetes Care 2018;41:815-822.

Niiranen TJ, Gordin D. Initial Treatment of Hypertension Letter to the Editor. N Engl J Med 2018;378:1952.

Thorn LM*, Shams S*, Gordin D, Liebkind R, Forsblom C, Summanen P, Hägg-Holmberg S, Tatlisumak T, Salonen O, Putaala J, Martola J, Groop PH on behalf of the FinnDiane Study Group. Clinical and magnetic resonance imaging features of cerebral small vessel disease in type 1 diabetes. Diabetes Care 2019;2:327-330.

Gordin D*, Shah H*, Shinjo T, St-Louis R, Qi W, Park K, Paniagua S, Pober DM,  Wu I, Bahnam V, Brissett MJ, Tinsley LJ, Dreyfuss JM, Pan H, Dong Y, Niewczas MA, Amenta A, Sadowski T, Kannt A, Keenan HA, King GL. Characterization of glycolytic enzymes and pyruvate kinase M2 in type 1 and 2 diabetic nephropathy. Diabetes Care 2019;42:1263-1273.

Tynjälä A, Forsblom C, Harjutsalo V, Groop PH, Gordin D. Arterial stiffness predicts mortality in individuals with type 1 diabetes. Diabetes Care 2020;43:2266-2271.

Inkeri J, Tynjälä A, Forsblom C, Liebkind R, Tatlisumak T, Thorn LM, Groop PH, Shams S, Putaala J, Martola J, Gordin D. Carotid intima-media thickness and arterial stiffdness in relation to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes. Acta Diabetologica;2021:58:929-937.

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