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The exact mechanisms behind favorable metabolic and cardioprotective effects of SGLT-2 inhibitors (SGLT-2i) are still not fully understood. We performed a complex metabolomic analysis of subcutaneous (SAT) and epicardial (EAT) adipose tissue of heart failure subjects treated with SGLT-2i in order to assess their impact on different fat depots and identify potential cardioprotective factors. Nine subjects with severe heart failure with reduced ejection fraction (NYHA class III-IV) treated with SGLT-2i and 8 age-, BMI- and left ventricular ejection fraction-matched control subjects scheduled for heart transplantation or mechanical support implantation were included into the study. Eight SGLT-2i subjects and 5 control subjects had type 2 diabetes mellitus. A complex metabolomic analysis of SAT and EAT obtained during surgery was performed using liquid chromatography and mass spectrometry. SAT of SGLT-2i subjects showed marked increase in ketone bodies and a corresponding decrease of ketogenic triacylglycerols with medium-chain fatty acids suggesting enhanced ketogenesis typical for SGLT-2i use. In contrast, no such change was seen in EAT which, conversely, contained increased amount of long-chain triacylglycerols indicating significant differences in response to SGLT-2i treatment between these depots and a tendency to preserve EAT lipid content. Compared with control group, both SAT and EAT of SGLT-2i subjects consistently exerted surprisingly high levels of sphingolipids, especially sphingomyelins and ceramides, and ether-linked lipid species. In conclusion, SGLT-2i treatment leads to different metabolic responses in SAT and EAT with SAT showing mainly accented ketogenesis, while the preservation of EAT suggests other functions including potential cardioprotection. The exact role of increased sphingolipids and ether-linked lipids in both adipose tissue depots remains to be elucidated. Disclosure B.Kasperova: None. I.Pleyerova: None. K.Rosolová: None. P.Svoboda: None. J.Trnovska: None. P.Novodvorsky: Advisory Panel; Novo Nordisk, Sanofi, Other Relationship; Eli Lilly and Company, Sanofi, Research Support; Dexcom, Inc., Speaker's Bureau; Eli Lilly and Company, KRKA, Mundipharma, Novo Nordisk, Sanofi. P.Ivak: Consultant; Abbott, CARMAT SA. V.Melenovsky: Consultant; Bayer AG, Merck Sharp & Dohme Corp., Novo Nordisk, Research Support; Regeneron Pharmaceuticals Inc. I.Netuka: Board Member; LeviticusCardio Ltd., Consultant; Abbott, CARMAT SA. M.Haluzik: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Lilly Diabetes, Novartis AG. M.Mraz: None. O.Kuda: None. T.Cajka: None. D.Hlavácek: None. J.Mahrík: None. L.Tomanová: None. I.Lankova: n/a. S.Stemberkova hubackova: None. Funding Ministry of Health, Czech Republic - conceptual development of research organization („Institute for Clinical and Experimental Medicine – IKEM, IN 00023001“) NV19-02-00118

Cellular senescence is a novel mechanism suggested to contribute to the development of type 2 diabetes mellitus (T2DM) and cardiovascular diseases. Here, we analyzed the expression of senescent markers in myocardium and adjacent adipose tissue of subjects with and without coronary artery disease (CAD) and T2DM undergoing elective cardiac surgery. Eleven subjects with CAD and T2DM (DM group), 13 subjects with CAD without T2DM (CAD group) and 8 subjects without both CAD and T2DM (C - control) group undergoing elective cardiac surgery (CABG and/or valvular surgery) were included into the study. Samples of subcutaneous (SAT) and epicardial (EAT) adipose tissue and myocardium form right atrial wall were taken along with standard biochemical and anthropometric parameters at the beginning and end of surgery. mRNA expression of senescent markers p21 and p16 was assessed using qRT PCR. All 3 groups did not differ with respect to age (65.2 ± 6.9 vs. 61.7 ± 9.8 vs. 57.9 ± 12.3 years for DM vs. CAD vs. C, n.s.) or BMI (30.8 ± 3.9 vs. 28.5 ± 3.9 vs. 30.2 ± 3.4 kg/m2, n.s.), while DM group showed higher levels of fasting glucose (8.4 ± 1.6 vs. 5.9 ± 1.1 vs. 5.9 ± 0.9 mmol/, p=0.005) and HbA1C (52.5 ± 8.9 vs. 38.9 ± 4.2 vs. 31.5 ± 8.9 mmol/mol, p Disclosure M. Mraz: None. M. Haluzik: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk, Consultant; Self; Sanofi. J. Trnovska: None. B. Kasperova: None. I. Dvorakova: None. Z. Lacinova: None. D. Hlavacek: None. J. Mahrik: None. P. Ivak: None. I. Netuka: None. Funding Ministry of Health of the Czech Republic (RVO-VFN64165, NV19-0200118); IKEM (IN00023001)

Obesity and associated metabolic complications are established risk factors for the development and progression of chronic kidney disease; however, BMI (body mass index)>35 kg/m2 is a contraindication for kidney transplantation. The aim of our study was to reduce excess body weight via laparoscopic sleeve gastrectomy (LSG) in obese patients with end-stage renal disease (ESRD) in order for them to become eligible for the transplantation program. Subjects with ESRD undergoing hemodialysis or peritoneal dialysis and BMI>35kg/m2 without serious comorbidities were included into the study. Anthropometric and biochemical parameters were measured before and 1, 3 and 6 months after LSG. In the thus far enrolled 7 subjects (6 females, aged 47.6 ± 9.6 years) LSG resulted in improved body weight (118.0 ± 17.6 vs. 107.5 ± 14.5 vs. 105.5 ± 14.4 vs. 99.5 ± 10.7 kg for baseline vs. 1 vs. 3 vs. 6 months, p To conclude, our pilot data suggest LSG to be an efficient and safe method to achieve the necessary weight reduction enabling renal transplantation in subjects with renal failure and higher degrees of obesity. Disclosure V. Hrádková: None. M. Kasalicky: None. S. Rajnochova-Bloudickova: None. I. Lankova: None. H. Kratochvilova: None. M. Mraz: None. K. Dvorakova: None. S. Slaba: None. J. Mendl: None. O. Viklicky: None. J. Fronek: None. M. Haluzik: Advisory Panel; Self; Lilly Diabetes, Sanofi. Consultant; Self; Ethicon US, LLC. Speaker’s Bureau; Self; AstraZeneca, Mundipharma International, Novartis AG, Novo Nordisk A/S. Funding Institute for Clinical and Experimental Medicine (00023001)

Diabetes and ageing are mutually linked and senescent cells might be involved in the development of obesity and type 2 diabetes mellitus (T2DM). Recent studies have shown that senolytic agents may improve diabetes-related pathologies. To this end we have tested our novel anti-cancer agent with senolytic properties, mitochondrially targeted tamoxifen (MitoTam), in a mouse model of T2DM. Obesity and diabetic metabolic profile were induced by high fat diet (HFD) feeding in 20 C57BL/6J male mice for 6 months with another group fed a standard diet (SD) serving as controls. Subsequently, both groups were divided into 2 subgroups (n=10 each) treated either with MitoTam (2µg/1g of body weight dissolved in 4% ethanol in corn oil) or the excipient given i.p. twice a week for a period of 4 weeks. In HFD animals, MitoTam decreased body weight already after 2 weeks of treatment, with most pronounced reduction of visceral adipose tissue (VAT, P In conclusion, our results suggest that MitoTam significantly improves HFD-induced obesity and diabetes in mice and that this effect might be in part mediated by alleviated senescence in adipose tissue. Disclosure J. Trnovska: None. E. Davidova: None. P. Svoboda: None. H. Kratochvilova: None. M. Mraz: None. S. Hubackova: None. J. Neuzil: None. M. Haluzik: Advisory Panel; Self; Lilly Diabetes, Sanofi. Consultant; Self; Ethicon US, LLC. Speaker’s Bureau; Self; AstraZeneca, Mundipharma International, Novartis AG, Novo Nordisk A/S. Funding Institute for Clinical and Experimental Medicine (00023001); Czech Science Foundation (GA 18-02550S)

Cardiovascular diseases (CVD) are the most common cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). C1q TNF-related protein 3 (CTRP3) is a novel adipokine that reduces inflammation and acts cardioprotectively. The aim of our study was to analyze serum levels and gene expression of CTRP3 in subcutaneous and epicardial adipose tissue in patients with CVD and T2DM undergoing elective cardiac surgery. 38 patients with coronary artery disease (CAD) without T2DM (CAD group), 21 subjects with CAD and T2DM (T2DM group) and 18 patients with a valvular defect without CAD or T2DM (nonCAD group) were included into the study. Peripheral blood, subcutaneous (SAT) and epicardial adipose tissue (EAT) were examined at the start and end of elective cardiac surgery. mRNA expression was determined using qRT-PCR. 21 healthy subjects served as controls for serum CTRP3 (C group). Baseline anthropometric and biochemical parameters were comparable in all groups except of higher fasting blood glucose (6.0±1.2 vs. 5.5±0.2 vs. 6.0±0.9 vs. 8.5±0.4 mmol/l for CAD vs. nonCAD vs. C vs. T2DM, p To conclude, decreased serum levels of CTRP3 in patients with CVD together with reduced mRNA expression in EAT in T2DM subjects with CAD indicate a possible role of CTRP3 in the pathogenesis of cardiovascular complications of type 2 diabetes mellitus. Disclosure H. Kratochvilova: None. B. Kasperova: None. Z. Lacinova: None. I. Lankova: None. J. Trnovska: None. I. Netuka: None. P. Ivak: None. J. Mahrík: None. D. Hlavácek: None. M. Mraz: None. M. Haluzik: Advisory Panel; Self; Lilly Diabetes, Sanofi. Consultant; Self; Ethicon US, LLC. Speaker’s Bureau; Self; AstraZeneca, Mundipharma International, Novartis AG, Novo Nordisk A/S. Funding Institute for Clinical and Experimental Medicine (00023001); RVOVFN64165; Ministry of Health of the Czech Republic (NV19-02-00118)

Metformin is considered the first-line treatment in all subjects with type 2 diabetes mellitus (T2DM) not having a contraindication for its use. Patient compliance with metformin is not optimal; however, objective compliance data are scarce. The aim of our study was to analyse the adherence to metformin treatment by determining its plasma levels and to identify its determinants in a broad spectrum of T2DM patients. In total, 309 patients with T2DM from a single tertiary diabetes centre (mean age 66.5 ± 9.0 years, HbA1C 57.2 ± 13.1 mmol/mol, BMI 30.8 ± 4.9 kg/m2) using standard or XR (sustained release) form of metformin were included in the study. Blood sampling for metformin together with a short questionnaire were performed during a regular outpatient visit. Hydrophilic interaction chromatography and high-resolution mass spectrometry (Q Exactive Plus instrumentation) were used to quantify metformin levels. Values ​​below 100 ng/ml were deemed sub-therapeutic. Out of 309 patients, sub-therapeutic values were measured in 4.2% and zero levels in 1.9% of subjects. The use of XR form did not increase compliance (16.7 vs. 15.4 vs. 13.8% of subjects for zero vs. sub-therapeutic vs. therapeutic range, n.s.), while all subjects using combination preparation with another antidiabetic agent (11.0%) were in therapeutic range. Zero levels of metformin were associated with a trend to increased HbA1C, higher number of other antidiabetic drugs and more frequent insulin use, whereas age, BMI and diabetes duration had no effect on metformin compliance. Adherence to metformin also increased with education status while not being affected by smoking or alcohol use. In conclusion, in a tertiary diabetes centre the compliance with metformin treatment was greater than 93% and increased with the use of combination preparations, lower number of antidiabetic drugs and higher education status. The XR form was not associated with increased adherence rate. Disclosure I. Lankova: None. I. Miskova: None. S. Frankova: None. D. Kobrova: None. T. Cajka: None. J. Hricko: None. M. Paucova: None. V. Hrádková: None. Z. Vlasakova: None. T. Pelikanova: None. M. Mraz: None. M. Haluzik: Advisory Panel; Self; Lilly Diabetes, Sanofi. Consultant; Self; Ethicon US, LLC. Speaker’s Bureau; Self; AstraZeneca, Mundipharma International, Novartis AG, Novo Nordisk A/S. Funding Institute for Clinical and Experimental Medicine (00023001); RVOVFN64165

Type 2 diabetes represents one of the most significant global health threats of the 21st century owing to its constantly increasing prevalence and long-term debilitating complications (1). In addition to accelerated macrovascular disease in poorly controlled diabetes that is responsible for increased cardiovascular morbidity and mortality, microvascular complications, such as diabetic nephropathy, neuropathy, and retinopathy, cause a significant burden and may markedly impair not only life expectancy but also quality of life of patients with diabetes (2). Diabetic retinopathy is the most common cause of blindness in developed countries and one of the most feared diabetes complications (3). Significant progress has been made in our understanding of the etiopathogenesis of type 2 diabetes with numerous novel contributing mechanisms identified in the past couple of years (4). Both experimental and clinical studies have demonstrated that gut represents a vital organ with respect to regulation of glucose metabolism and modulation of the risk of type 2 diabetes development (5). Multiple facets of the gut–glucose metabolism interconnection have been uncovered in particular by studying the changes induced by weight loss associated with bariatric surgery or endoscopic methods mimicking bariatric surgery. The possible mechanisms of gut-driven improvements in glucose metabolism after surgical or endoscopic interventions include restriction of food amount, enhanced passage of chymus into distal parts of small …

Duodenal-jejunal by-pass liner (DJBL) is an endoscopically implantable device designed to non-invasively mimic the effects of surgical gastric by-pass. However, the exact mechanisms responsible for improved glucose control associated with DJBL are still unclear. The aim of our study was to assess the effect of DJBL on insulin sensitivity and secretion in subjects with type 2 diabetes mellitus (T2DM) and obesity. Twenty-one obese subjects with T2DM (15 males, age 52.3 ± 11.2 years) underwent the implantation of the EndoBarrier DJBL (GI Dynamics, U.S.). Anthropometric, biochemical and hormonal parameters were measured before and 10 months after the implantation of DJBL. Insulin sensitivity was assessed using euglycemic-hyperinsulinemic clamp. Standard parameters including glucose disposal rate (M) and metabolic clearance rate of glucose (MCG) were calculated based on clamp results. Over 10 months the implantation of DJBL decreased body weight (body mass index 41.6 ± 6.1 vs. 37.5 ± 4.2 kg/m2, p Disclosure M. Kudlackova: None. M. Mraz: None. M. Haluzik: None. T. Pelikanova: None. M. Benes: None. D. Lapesova: None. D. Kobrova: None. Z. Vlasakova: None. O. Brizova: None. Z. Lacinova: None. Funding Institute for Clinical and Experimental Medicine (IN00023001)

The duodenum has recently emerged as a key regulator in glucose metabolism via modulation of a complex network of neural and hormonal signals in response to ingested food. DiaGone™ is an endoscopic device which utilizes precisely controlled laser technology to target the duodenal submucosal neural plexi with the aim of improving glucose control by modulating the gastrointestinal neurohumoral axis. Nine subjects (5 males) with obesity (BMI 34.0 ± 4.6 kg/m2) and type 2 diabetes mellitus (T2DM) insufficiently controlled on metformin were included in this first-in-human trial in order to assess the efficacy and safety of DiaGone™. Subjects were instructed to continue with regular diet 24h after the procedure and metformin dose was not changed during the study period. Biochemical and anthropometric parameters were assessed at baseline and 3 and 6 months after the procedure and continuous glucose monitoring (CGM) and a standard liquid meal test were performed at baseline and 3 months after the procedure. DiaGone™ significantly decreased HbA1C from 78.3 ± 13.3 mmol/mol at baseline to 64.9 ± 6.4 mmol/mol and 64.8 ± 7.1 mmol/mol at 3 and 6 months, respectively (p In conclusion, these pilot results suggest that endoscopic duodenal submucosal laser ablation using the DiaGone™ device is associated with improvements in both baseline and postprandial glycemia as well as HbA1C with no significant changes in insulin levels or body weight while having a favorable safety and tolerability profile. Disclosure M. Mraz: None. I. Marcovitch: Employee; Self; Digma Medical. I. Lankova: None. H. Kratochvilova: None. A. Cinkajzlova: None. M. Benes: None. J. Korner: Board Member; Self; Digma Medical. Stock/Shareholder; Self; Digma Medical. Z. Vlasakova: None. J. Spicak: None. T. Pelikanova: None. M. Haluzik: None. Funding MH CZ - DRO; Institute for Clinical and Experimental Medicine (IN00023001); RVO (VFN64165)

Neudesin has recently been identified as a negative regulator of energy expenditure in experimental animals; however, its role in humans remains unexplored. The aim of our study was to assess the effects of obesity and type 2 diabetes mellitus along with selected interventions including acute fasting and endoscopic duodenal-jejunal by-pass liner implantation (DJBL) on its serum levels and adipose tissue mRNA expression. Fifteen obese T2DM subjects undergoing DJBL implantation, 15 subjects with functional hypoglycemia subjected to 72-hour fasting (Fast) and 12 healthy controls (C) were included in the study. Samples were taken at baseline and 6 and 10 months after DJBL and after 78 hours of fasting and 2 hours after realimentation, respectively. Serum neudesin was measured using ELISA kit (Neudesin Human ELISA, Biovendor, CR). qRT PCR was used to detect mRNA expression of neudesin in white adipose tissue (WAT). Baseline serum neudesin levels were comparable between all groups (1.77 ± 0.86 vs. 1.74 ± 0.54 vs. 1.88 ± 0.70 ng/ml, n.s. for DJBL vs. Fast vs. C). Along with reduction in body weight (BMI 42.8 ± 6.53 vs. 36.6 ± 4.91 kg/m2, p=0.038) and improvement of HbA1c (73.5 ± 17.2 vs. 50.0 ± 12.6 mmol/mol, p=0.001) DJBL increased serum neudesin at 6 and 10 months after procedure (1.77 ± 0.86 vs. 2.28 ± 1.27 vs. 2.13 ± 1.02 ng/ml, p=0.001 for baseline vs. 6 vs. 10 months), while having no effect on neudesin mRNA expression in WAT. In contrast, acute fasting decreased serum neudesin during the whole period (1.74 ± 0.54 vs. 1.46 ± 0.48 ng/ml, p=0.001 for baseline vs. 72 hours) with no impact of subsequent realimentation (1.37 ± 0.44 ng/ml, n.s. 2 h postprandially).To conclude, serum neudesin levels are regulated differently during acute fasting and chronic weight reduction induced by DJBL. Further studies are needed to assess its potential in the treatment of obesity and T2DM. Disclosure H. Kratochvilova: None. Z. Lacinová: None. J. Klouckova: None. P. Kaválková: None. A. Cinkajzlova: None. P. Trachta: None. J. Krizova: None. M. Benes: None. Z. Vlasakova: None. T. Pelikanova: None. M. Mraz: None. M. Haluzik: None.

Obesity and type 2 diabetes mellitus are accompanied by low-grade inflammation and changed immune cell composition in adipose tissue. However, little is known about subclinical inflammation in gestational diabetes mellitus (GDM). The aim of our study was to analyse lymphocyte populations in subcutaneous (SAT) and visceral adipose tissue (VAT) together with systemic levels and mRNA expression of selected inflammatory markers in these depots and placenta. Thirty-seven pregnant females - 21 with GDM (GDM group) and 16 without GDM (P group) - were included into the study. Blood samples were taken in 28th-32th and 36th-38th gestational week and 6-12 months after delivery and SAT, VAT and placental samples were obtained during delivery. Lymphocytes were assessed as percent of CD45+ cells measured by flow cytometry. In both groups CD45+ lymphocytes were higher in VAT compared to SAT (19.2 ± 2.2 vs. 6.5 ± 0.7%, p Disclosure A. Cinkajzlova: None. K. Anderlová: None. P. Simjak: None. Z. Lacinová: None. J. Klouckova: None. H. Kratochvilova: None. H. Krejci: None. M. Mraz: None. M. Haluzik: None. M. Krsek: None.

The insulin-like growth factor (IGF) axis is involved in the regulation of growth and metabolism; however, little is known about its role in the development of gestational diabetes mellitus (GDM). The aim of our study was to determine serum IGF-1, IGF-2 and selected IGF binding protein (IGFBP) levels and their mRNA expression in subcutaneous (SAT) and visceral adipose tissue (VAT) and placenta in the context of pregnancy and GDM. Thirty-seven pregnant females - 21 with GDM (GDM group) and 16 without GDM (P group) - and 15 age-matched non-pregnant control females (NP group) were included into the study. Blood samples were taken in 28th-32th and 36th-38th gestational week and 6-12 months after delivery (GDM and P group) or before diagnostic laparoscopy (NP group). SAT, VAT and placental samples were obtained during delivery or surgery, respectively. Compared with NP group serum IGF-1, IGFBP-1 and 3 were increased in both GDM and P subjects reaching maximum levels in 38th-39th gestational week. IGF-2 was elevated only in GDM group culminating 6 months after delivery (745.1±24.7 vs. 909.2±62.8 vs. 998.7±92.7 ng/ml, p=0.017 for GDM and 726.9±28.4 vs. 791.2±44.2 vs. 748.9±58.4 ng/ml, p=0.341 for P group, respectively). IGFBP-3 was higher and IGFBP-4 was decreased in GDM vs. P group during the whole study (IGFBP3: 631.0±22.9 vs. 536.9±15.4 ng/ml, p=0.003 for GDM vs. P group; IGFBP4: 14.79±2.71 vs. 22.78±2.94 ng/ml, p In conclusion, females with GDM had increased serum IGF-2, IGFBP-3 and reduced IGFBP-4 levels and elevated placental mRNA expression of several components of IGF axis compared with pregnant women without GDM. These changes might play a role in the development of GDM. Disclosure K. Anderlová: None. P. Simjak: None. A. Cinkajzlova: None. J. Klouckova: None. H. Kratochvilova: None. Z. Lacinová: None. P. Kaválková: None. H. Krejci: None. M. Mraz: None. M. Haluzik: None. M. Krsek: None.

Lymphocytes play a role in the development of adipose tissue inflammation. Epicardial adipose tissue was shown to be a potential source of inflammatory mediators contributing to coronary atherosclerosis. The aim of the study was to assess lymphocyte content in peripheral blood, subcutaneous (SAT) and epicardial adipose tissue (EAT) in subjects with coronary artery disease (CAD) along with the effects of elective cardiac surgery. Twelve subjects without CAD (non-CAD group) and 24 age-, BMI- and HbA1C-matched subjects with CAD were included into the study. Blood, SAT and EAT samples were obtained before and at the end of elective cardiac surgery. Lymphocyte populations were quantified as percent of CD45+ cells using flow cytometry. Subjects with CAD had higher total lymphocyte (CD45+) amount in EAT compared to SAT (32.24±7.45 vs. 11.22±1.34%, p=0.025) with a similar trend observed in non-CAD subjects (29.68±7.61 vs. 10.13±2.01%, p=0.067). CD3+ cells were increased and CD3- cells decreased in EAT of CAD relative to non-CAD group with no difference between EAT and SAT. In both groups EAT showed reduced percentage of NK cells (CD15/56+CD3-) and elevated B cells (CD19+) relative to SAT (NK cells: 5.96±1.32 vs. 13.22±2.10%, p=0.012 for CAD and 5.32±1.97 vs. 13.81±2.72%, p=0.022 for non-CAD; B cells: 5.22±2.43 vs. 0.96±0.21%, p=0.039 for CAD and 12.49±5.83 vs. 1.16±0.19%, p=0.016 for non-CAD). CD8+ and NKT (CD16/56+CD3+) cells in EAT correlated positively with fasting glucose and HbA1C, while showing no association in SAT. Cardiac surgery decreased total lymphocytes in peripheral blood, SAT and EAT of both groups, while having only minor effects on lymphocyte subpopulations. To conclude, epicardial adipose tissue in subjects with CAD shows increased amount of total and CD3+ lymphocytes as compared with SAT or non-CAD subjects. These changes could contribute to the development of local inflammation and coronary atherosclerosis. Disclosure M. Mraz: None. A. Cinkajzlova: None. Z. Lacinov : None. J. Klouckova: None. H. Kratochvilova: None. M. Lips: None. P. Kopecky: None. M. Porizka: None. J. Lindner: None. M. Haluzik: None.