Association of APOE polymorphisms and insulin resistance with TCM syndromes in type 2 diabetes patients with macroangiopathy

Abstract

Abstract.To investigate the association between apolipoprotein E (APOE) polymorphisms and insulin resistance and Traditional Chinese Medicine (TCM) syndromes in type 2 diabetes mellitus (T2DM) with macroangiopathy, 60 patients with T2DM macroangiopathy were enrolled and divided into three groups: dryness-heat due to deficiency of yin, Qi-Yin deficiency, and Yin-Yang deficiency, according to the TCM syndromes, with a control group of 20 healthy individuals. APOE genotype analysis was performed with polymerase chain reaction amplification and restriction fragment length polymorphism, and the results showed that the proportion of the ε4/4 and ε3/4 genotypes and frequencies of the ε4 and ε3 alleles were higher in the Qi-Yin deficiency group (P<0.05). Among the T2DM macroangiopathy patients, the E4 group had the largest number of cases, as well as a significantly longer disease course compared to the E2 group (P<0.05). The insulin resistance index (IRI), insulin action index and body mass index (BMI) of patients in the Yin-Yang deficiency group were significantly different from those of patients with dryness-heat due to deficiency of yin and Qi-Yin deficiency. Furthermore, correlation analysis of the BMI and IRI of patients in the Yin-Yang deficiency group revealed a correlation coefficient r= 0.696 (P<0.01) and a typical correlation between them. In conclusion, the Qi-Yin deficiency in T2DM patients with macroangiopathy is associated with the APOE E4 and E3 genotypes. Thus, the APOE gene polymorphism can, to some degree, reflect the TCM syndrome types of T2DM patients with macroangiopathy. Insulin resistance plays an important role in the occurrence of T2DM macroangiopathy and is closely associated with the Yin-Yang deficiency according to the TCM differentiating types.

Syndrome differentiation in modern research of traditional Chinese medicine

“…The observations include: the linkage between sex hormones and Shen deficiency syndrome was identified in chronic nephritis (Zhang et al, 1990); between C-reactive protein and Han/Re (cold/hot) syndrome in rheumatoid arthritis (RA) (Zhao et al, 2006); between Qi-Yin deficiency syndrome in type 2 diabetes mellitus patients (Xie et al, 2011); between carotid intima-media thickness (IMT), triglyceride (TG) and blood rheology with certain TCM syndrome (Lei et al, 2009); between blood stasis syndrome score with 24-h urine protein ration, cholesterol, estimation of glomerular filtration rate (eGFR) in the primary glomerular diseases ; between the bone mineral density and Shen deficiency syndrome in chronic obstructive pulmonary disease (COPD) ; between serum level of eosinophil cationic protein in asthmatic patients and the development of "heat" syndrome manifestations (Hsu et al, 2003); between the decrease in skin electrical conductance and the severity of Qi deficiency syndrome (Yu et al, 1998). More studies are in progress to explore the correlations between TCM syndrome and the biological indexes.…”

Clinical Applications of Omics Technologies on ZHENG Differentiation Research in Traditional Chinese Medicine

“…For example, previous genomics studies have found the relationships between interleukin-10 genotype and deficiency ZHENG in hepatitis B cirrhosis [29, 30] and between apolipoprotein polymorphisms and ZHENGs in type 2 diabetes mellitus [55]. Using transcriptomics, Ma et al [22] have indicated that interleukin-8 might be related to the pathobiology of blood stasis ZHENG in cornary heart, and Chen et al [64] have concluded that inflammatory-gene expression (ALOX5AP, S100A8 and S100A12) might be related to Cold ZHENG in hemodialysis.…”

“…In hyperlipidemia, it was found that polymorphism of ApoE gene is related in a certain degree to liver-kidney Yin deficiency ZHENG, spleen-kidney Yang deficiency ZHENG, Qi-stagnation-caused blood-stasis ZHENG, and so forth [50]. In diabetes mellitus, ApoE gene polymorphism was also explored, and it has proved that the Qi-Yin deficiency ZHENG in type 2 diabetes mellitus patients with macroangiopathy is associated with the ApoE E4 and E3 genotypes [55]. …”

ZHENG-Omics Application in ZHENG Classification and Treatment: Chinese Personalized Medicine

“…Actually, researchers and scientists of TCM have done some work with a lot of beneficial methods, such as physiology and biochemistry [7], molecular biology [8], and tongue image digitization [9, 10], to classify ZHENGs and evaluate the treatment based on ZHENG classification. Though the researches are beneficial, they are far from satisfactory.…”