Page 1 of 47 Diabetes Skin Advanced Glycation Endproducts (AGEs) Glucosepane and Methylglyoxal Hydroimidazolone are Independently Associated with Long- term Microvascular Complication Progression of Type I diabetes Saul Genuth1*, Wanjie Sun2, Patricia Cleary2, Xiaoyu Gao2, David R Sell3, John Lachin2, the DCCT/EDIC Research Group, Vincent M. Monnier3,4* Short Title: Collagen AGEs and Microvascular Complications Departments: From the 1Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; the 2Biostatistics Center, George Washington University, Rockville, Maryland; the 3Departments of Pathology and 4Biochemistry, and Case Western Reserve University School of Medicine, Cleveland, Ohio. *Co-corresponding authors: Vincent Monnier MD, 216-368-6613 [phone]; 216-368-1357[fax], email:
[email protected], and Saul Genuth MD, email:
[email protected]; 216-368-5032[phone]; 216-844-8900[fax] 1 Diabetes Publish Ahead of Print, published online September 3, 2014 Diabetes Page 2 of 47 Abbreviations: AER, albumin excretion rate; AGE, advanced glycation end product; CML, Nε- (carboxymethyl)-lysine; DCCT, Diabetes Control and Complications Trial; EDIC, Epidemiology of Diabetes Interventions and Complications; GSPNE, glucosepane; CEL, carboxyethyl-lysine; G-H1, glyoxal hydroimidazolone; MG-H1, methylglyoxal hydroimidazolone. EDTRS, Early Treatment of Diabetic Retinopathy Scale; LRT, likelihood ratio test. 2 Page 3 of 47 Diabetes ABSTRACT Six skin collagen AGEs originally measured near Diabetes Control and Complications Trial (DCCT) closeout in 1993 may contribute to the “metabolic memory” phenomenon reported in the follow-up EDIC complications study. We now investigated whether addition of 4 originally unavailable AGEs, i.e. glucosepane (GSPNE), hydroimidazolones of methylglyoxal (MG-H1) and glyoxal (G-H1), and carboxyethyl-lysine (CEL), improves associations with incident retinopathy , nephropathy , and neuropathy events during 13-17 years post DCCT.