Evidence for altered thiamine metabolism in diabetes: Is there a potential to oppose gluco- and lipotoxicity by rational supplementation?

Abstract

Growing prevalence of diabetes (type 2 as well as type 1) and its related morbidity due to vascular complications creates a large burden on medical care worldwide. Understanding the molecular pathogenesis of chronic micro-, macro-and avascular complications mediated by hyperglycemia is of crucial importance since novel therapeutic targets can be identified and tested. Thiamine (vitamin B1) is an essential cofactor of several enzymes involved in carbohydrate metabolism and published data suggest that thiamine metabolism in diabetes is deficient. This review aims to point out the physiological role of thiamine in metabolism of glucose and amino acids, to present overview of thiamine metabolism and to describe the consequences of thiamine deficiency (either clinically manifest or latent). Furthermore, we want to explain why thiamine demands are increased in diabetes and to summarise data indicating thiamine mishandling in diabetics (by review of the studies mapping the prevalence and the degree of thiamine deficiency in diabetics). Finally, we would like to summarise the evidence for the beneficial effect of thiamine supplementation in progression of hyperglycemia-related pathology and, therefore, to justify its importance in determining the harmful impact of hyperglycemia in diabetes. Based on the data presented it could be concluded that although experimental studies mostly resulted in beneficial effects, clinical studies of appropriate size and duration focusing on the effect of thiamine supplementation/therapy on hard endpoints are missing at present. Moreover, it is not currently clear which mechanisms contribute to the deficient action of thiamine in diabetes most. Experimental studies on the molecular mechanisms of thiamine deficiency in diabetes are critically needed before clear answer to diabetes community could be given. Key words: Diabetes; Thiamine; Vitamin B1; Transketolase; Benfotiamine; Hyperglycemia; Nephropathy; Metabolic syndrome; Cardiovascular disease; Chronic kidney disease Core tip: Published data suggest deficient action of thiamine in diabetes, however, it is not currently clear by which mechanisms. Plasma levels might be decreased in diabetics (although renal function has a prevailing effect), nevertheless, intracellular concentration of thiamine diphosphate is the crucial parameter and there is not a direct relationship with the plasma thiamine since the rate of transmembrane transport (via thiamine transporters) and intracellular activation by thiamine pyrophosphokinase might affected by hyperglycemia at first place. Experimental studies on the molecular mechanisms of thiamine deficiency in diabetes are critically needed before clear answer to diabetes community could be given.

Thiamine Deficiency and Neurodegeneration: the Interplay Among Oxidative Stress, Endoplasmic Reticulum Stress, and Autophagy

“…Thiamine was first discovered by two Dutch chemists, Dr. B. C. P. Jansen and his closest collaborator Dr. W. Donath in 1926, and it was isolated, purified and synthesized by Dr. R. R. Williams in 1936 [2]. Thiamine is an essential micronutrient for humans, which is supplied from a diet rich in thiamine [3]. Thiamine is enriched in lean pork, beef, wheat germ and whole grains, organ meats, eggs, fish, legumes, and nuts [4].…”

Sudden infant death syndrome and abnormal metabolism of thiamin

“…. This disease, known in the West as "dead-in-bed syndrome" mainly affects young type 1 diabetes patients [58], a disease in which thiamin metabolism is implicated [59] and in which autonomic neuropathy is common. Thiamin deficiency beriberi is a prototype for dysautonomia in its early stages [17].…”

Diabetic Cardiovascular Neuropathy

“…The deficiency of thiamine in clinical diabetes may increase the fragility of vascular cells to the adverse effects of hyperglycaemia and there by the increase of the risk of developing microvascular complications. A suppression of TKT activity, and subsequent down-regulation of the hexose monophosphate (HMP) shunt, resulting in accumulation of glyceraldehyde 3-phosphate (GA3P), fructose 6-phosphate (F6-P), and dihydroxyacetone phosphate (DHAP) may be at least one mechanism in the development of diabetes-induced vascular damage and other comorbidities [182][183][184][185]. It is hypothesized that genetic variability in TKT might contribute to susceptibility to early DPN [186,187].…”