Expression of the gene encoding the high-Km glucose transporter 2 by the early postimplantation mouse embryo is essential for neural tube defects associated with diabetic embryopathy
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Excess glucose transport to embryos during diabetic pregnancy causes congenital malformations. The early postimplantation embryo expresses the gene encoding the high-Km GLUT2 (also known as SLC2A2) glucose transporter. The hypothesis tested here is that high-Km glucose transport by GLUT2 causes malformations resulting from maternal hyperglycaemia during diabetic pregnancy.
Materials and methods
Glut2 mRNA was assayed by RT-PCR. The Km of embryo glucose transport was determined by measuring 0.5–20 mmol/l 2-deoxy[3H]glucose transport. To test whether the GLUT2 transporter is required for neural tube defects resulting from maternal hyperglycaemia, Glut2+/− mice were crossed and transient hyperglycaemia was induced by glucose injection on day 7.5 of pregnancy. Embryos were recovered on day 10.5, and the incidence of neural tube defects in wild-type, Glut2+/− and Glut2−/− embryos was scored.
Early postimplantation embryos expressed Glut2, and expression was unaffected by maternal diabetes. Moreover, glucose transport by these embryos showed Michaelis–Menten kinetics of 16.19 mmol/l, consistent with transport mediated by GLUT2. In pregnancies made hyperglycaemic on day 7.5, neural tube defects were significantly increased in wild-type embryos, but Glut2+/− embryos were partially protected from neural tube defects, and Glut2−/− embryos were completely protected from these defects. The frequency of occurrence of wild-type, Glut2+/− and Glut2−/− embryos suggests that the presence of Glut2 alleles confers a survival advantage in embryos before day 10.5.
High-Km glucose transport by the GLUT2 glucose transporter during organogenesis is responsible for the embryopathic effects of maternal diabetes.
KeywordsNeural tube Diabetic pregnancy Diabetic embryopathy Embryo GLUT2 SLC2A2
neural tube defect
solute carrier 2
Maternal diabetes significantly increases the risk of congenital malformations: while rigorous glycaemic control in the periconception period reduces the incidence of congenital malformations, the incidence remains three to fivefold greater than that for non-diabetic pregnancy [1, 2, 3, 4, 5]. These malformations arise during the earliest stages of organogenesis, corresponding to approximately weeks 2–8 in human gestation . Both type 1 and type 2 diabetes increases the risk of congenital malformations [2, 7]. The metabolic profiles of type 1 and type 2 diabetes are different, except for episodic hyperglycaemia. Numerous studies have shown that the incidences of early miscarriage and congenital malformations are associated with poor glycaemic control [8, 9, 10]. These observations suggest that excess glucose, or a metabolic process activated by high glucose concentration in both type 1 and type 2 diabetes, is responsible for the teratogenic effect of diabetic pregnancy.
There are 14 known members of the solute carrier 2 (SLC2) family of facilitative hexose and polyol transporters, characterised by 12 transmembrane domains and the presence of several conserved amino acids [11, 12]. The different members of the SLC2 family differ in substrate specificity, affinity for cytochalasin B, inhibition by phloretin or phlorizin, and regulation by insulin . Of the 14 SLC2 gene family members, expression of Glut1, Glut2, Glut3, Glut8 and Glut12 (also known as Slc2a1, Slc2a2, Slc2a3, Slc2a8 and Slc2a12) is detected in preimplantation mouse embryos [13, 14, 15, 16, 17, 18]. GLUT12 protein is not detected in early postimplantation embryos, but it is detected later, during fetal development [17, 19]. Only expression of Glut1, Glut2 and Glut3 has been detected during the stage of postimplantation development that is susceptible to diabetic embryopathy (day 7.5) [12, 13, 20, 21, 22, 23]. Glut1 is expressed primarily in the ectoplacental cone, amnion, chorion and mesodermal layer of the yolk sac, and lower levels are expressed in the embryonic ectoderm. Northern blotting shows that Glut2 mRNA is expressed at high levels on days 7.5 and 8.5 but is barely detectable on day 9.5; most of the expression is in the endodermal layer of the visceral yolk sac. Glut3 expression is primarily in the amnion, chorion and endodermal layer of the yolk sac . Both GLUT1 and GLUT3 have affinities that approximate physiological glucose concentrations. GLUT2, however, has a Km that is two- to threefold higher than physiological glucose concentrations . Postnatally, GLUT2 is produced by pancreatic beta cells, hepatocytes, intestine and kidney—tissues that must transport glucose with high efficiency when its concentration is high, for example after intestinal absorption of nutrients following feeding [11, 25]. GLUT2 is essential for glucose-stimulated insulin release, and also regulates glucose sensing by extrapancreatic tissues [26, 27]. However, the early embryo is not normally exposed to glucose concentrations approaching the Km of the GLUT2 transporter. Thus, during normal, non-diabetic gestation, glucose transporters with a low Km (high affinity) would transport glucose into the embryo cells more efficiently than the GLUT2 transporter. There have been some reports that GLUT1 and GLUT3, which are produced in the postimplantation embryo during early organogenesis, are not downregulated during exposure to a hyperglycaemic environment, and so could continue to transport glucose even during maternal hyperglycaemia [21, 22]. However, the rate of glucose transport by GLUT1 and GLUT3 would saturate during hyperglycaemia. In contrast, transport by the high-Km GLUT2 transporter would become more efficient during hyperglycaemia and might allow the rate of glucose transport into embryo cells to increase two to threefold.
In the rat, the intracellular glucose concentration in the embryo neuroepithelium is at equilibrium with maternal serum, even when the mother is hyperglycaemic . This indicates that glucose is freely transportable into embryo cells, even when maternal glucose concentrations are above the Km for low-Km glucose transporters.
Neural tube defects (NTD), which are among the most common malformations that occur in the offspring of diabetic human mothers [29, 30], are significantly increased in the embryos of diabetic mice and rats [31, 32, 33]. That high glucose concentration is responsible for the teratogenic effects of diabetic pregnancy has been demonstrated using three approaches: (1) inducing hyperglycaemia in pregnant non-diabetic mice by glucose injection causes NTD; (2) lowering blood glucose concentrations in pregnant diabetic animals with phlorizin to cause renal glucose clearance reduces NTD; and (3) culturing fragments of neurulating embryos in media containing concentrations of glucose that are equivalent to those in serum during diabetes (15 mmol/l) inhibits expression of Pax3, a gene required for neural tube closure, compared with culture in media containing 5 mmol/l glucose . It was noteworthy that in glucose-injected and phlorizin-treated animals, the incidence of NTD was not linearly correlated with maternal blood glucose concentration. Rather, the increase in NTD was not statistically significant until maternal blood glucose concentrations were ≥250 mg/dl (13.89 mmol/l) on the day before the onset of Pax3 expression . This indicates that the threshold of maternal glycaemia above which there is a significant increase in NTD corresponds to the Km for the GLUT2 glucose transporter. Similarly, in human diabetic pregnancy, the relationship of adverse pregnancy outcome (spontaneous abortion and major malformation) with HbA1 is not linear but sigmoidal . Although high HbA1 levels do not distinguish between episodic glycaemic excursions and chronic hyperglycaemia, they do indicate the steady-state exposure of maternal and embryo tissues to glucose during the preceding several weeks. A sigmoidal, rather than linear, association of poor glycaemic control with adverse pregnancy outcome is consistent with a model in which there is a threshold of maternal glycaemia above which damage to embryo development occurs.
In this study, we tested the hypothesis that the high-Km GLUT2 glucose transporter is essential for the embryopathic effects of maternal hyperglycaemia.
Materials and methods
ICR mice (Taconic, Germantown, NY, USA) were obtained at 5–6 weeks of age and were used to generate embryos for the assay of Glut2 mRNA and 2-deoxy[3H]glucose transport. For the assay of Glut2 mRNA, mice were made diabetic with streptozotocin (STZ) (Sigma Chemicals, St Louis, MO, USA) as described . Briefly, female mice to be made diabetic were injected intraperitoneally with STZ to destroy pancreatic beta cells. Hyperglycaemia before pregnancy was controlled with subcutaneously implanted insulin pellets (Linshin, Inc., Scarborough, ON, Canada). Diabetic and age-matched non-diabetic female mice were mated with non-diabetic ICR male mice about 3 weeks after insertion of insulin pellets and checked daily for copulation plugs. Day 0.5 of pregnancy was determined to be at 12.00 h on the day in which a copulation plug was found. The STZ-diabetic female mice became hyperglycaemic beginning on day 4.5 of pregnancy because of insufficiency of the insulin pellets during pregnancy . Pregnant mice were killed by cervical dislocation to recover embryos on day 7.5 for the assay of Glut2 mRNA or 2-deoxy-d-[3H]glucose transport.
Mice carrying a Glut2 knockout allele  on a 129/SvJ background were used to generate embryos that were GLUT2-deficient. The Glut2 knockout strain was originally generated on a mixed C57Bl/6J × 129/Sv background. C57Bl/6J embryos are resistant to diabetic embryopathy . Therefore, a congenic strain was generated to place the Glut2+/− allele on a 129/SvJ background . Offspring at each generation with the least residual donor background (C57Bl/6J) were identified by marker-assisted gene analysis  performed by the Speed Congenics facility of the Jackson Laboratory (Bar Harbor, ME, USA). The strain was considered to be congenic once it retained <0.2% C57Bl/6J DNA .
Non-diabetic Glut2+/− male and female mice were mated and hyperglycaemia or oxidative stress was induced on day 7.5 as described previously [34, 39]. Briefly, transient hyperglycaemia was induced by injecting 2 ml of 12.5% glucose–PBS solution subcutaneously approximately every 1–2 h between 09.00 and 17.00 h. Blood glucose concentrations were checked hourly, and animals were re-injected as needed to maintain the blood glucose concentration ≥300 mg/dl (16.65 mmol/l). Oxidative stress was induced with a single injection of 3 mg/kg antimycin A (Sigma Chemicals), a mitochondrial complex III inhibitor [40, 41], dissolved in 25% (v/v) propylene glycol. Control mice were injected with PBS or propylene glycol. Embryos were dissected from uteri and removed from surrounding membranes on day 10.5 as described  under a Nikon SMZ stereo microscope. Embryos were inspected externally for NTD as defined by an open or malformed cranium or spinal neural tube. Embryos were photographed with a Spot colour digital camera mounted on the stereo microscope using Spot 3.5 software (Micro Video Instruments, Avon, MA, USA).
All procedures performed using animals followed the National Institutes of Health’s Principles of laboratory animal care and were approved by the Institutional Animal Care and Use Committee of the Joslin Diabetes Center.
RT-PCR assay of Glut2 mRNA
Day-7.5 embryos from individual diabetic or non-diabetic pregnancies were pooled. RNA was isolated and reverse-transcribed, and serial dilutions of the reverse transcription products were amplified by PCR as described previously . The cDNA products were amplified using primers complementary to the Glut2 amplicon  and the PCR conditions described below, or to constitutively expressed 36B4 (also known as Arbp), which was used as a normalisation control, as described [35, 44]. Autoradiographs of the electrophoresed PCR products were scanned, and unsaturated bands were quantified using Adobe Photoshop (version 9.0.1, Adobe Systems, Inc., San Jose, CA). The amount of Glut2 RT-PCR product was expressed relative to that of the 36B4 RT-PCR product.
Measurement of glucose transport kinetics
Uptake of 2-deoxy-d-[3H]glucose by day-7.5 embryos was assayed using a procedure modified after that of Cheatham et al. . Briefly, embryos with surrounding amniotic and yolk sac membranes were dissected in cold DMEM containing 5 mmol/l glucose (Invitrogen, Carlsbad, CA, USA) with 10% FCS. Pooled embryos were washed with KRH buffer , and incubated for 5 min with collagenase, while passing up and down with a 1 ml micropipette tip. The embryo fragments were rinsed with KRH buffer, and the equivalent of three or four embryos was distributed into individual tubes. Tissues were incubated for 30 s with 0.5–20 mmol/l 2-deoxy-d-[3H]glucose (2-deoxy-d-[1,2-3H]glucose, specific activity 969 GBq/mmol; Perkin Elmer–New England Nuclear, Boston, MA, USA) at a constant specific activity of 185 Bq/mmol. Samples were incubated without or with cytochalasin B (Sigma), added at 0.4 or 4.0 μmol/l. Samples incubated with 0.5–20 mmol/l l-[3H]glucose (l-[1-3H] glucose; Perkin Elmer–New England Nuclear) were used as controls for non-specific glucose uptake. The specific activity of l-[3H]glucose was comparable with that of 2-deoxy-d-[3H]glucose, and was added to the l-glucose incubation solution to give a constant specific activity of 185 Bq/mmol. Reactions were terminated by adding 1 ml cold PBS, followed by centrifugation and three washes with PBS. Pellets were solubilised with 0.5 ml of 0.05% SDS. Four-hundred microlitres of the solubilised pellet was counted for radioactivity and 100 μl was used for protein measurement (Bio-Rad, Hercules, CA, USA). The Km and Vmax of 2-deoxy-d-glucose uptake were determined using non-linear curve fitting analysis with the Michaelis–Menten equation (Prism, version 4.0; GraphPad Software, Inc., San Diego, CA, USA).
Genotype analysis of Glut2 allele
Glut2+/− pups were identified by PCR analysis of tail DNA using the previously reported primer sequences [42, 43] and the following conditions: 94°C for 5 min, followed by 36 cycles of 94°C for 30 s, 53°C for 30 s, 72°C for 30 s and 72°C for 10 min. DNA was prepared using DNAzol (Molecular Research Center, Cincinnati, OH, USA) according to the manufacturer’s instructions. Genotypes of embryos of Glut2+/− × Glut2+/− matings were determined similarly using yolk sac DNA.
χ2 analyses were performed using Prism (version 4.0) software for Macintosh (GraphPad Software).
Mouse embryos produce a functional high-Km GLUT2 glucose transporter
Mouse embryos lacking a functional GLUT2 glucose transporter are resistant to hyperglycaemia-induced NTD
If glucose uptake by the GLUT2 glucose transporter is essential for diabetic embryopathy, then embryos in which only GLUT2-mediated glucose uptake is non-functional should be resistant to the teratogenic effects of hyperglycaemia. It is possible to test this using Glut2−/− embryos.
Female and male Glut2+/− mice were crossed to generate wild-type, Glut2+/− and Glut2−/− embryos. On day 7.5 of pregnancy, female mice were made hyperglycaemic by subcutaneous glucose injection at approximately hourly intervals. This is sufficient to induce NTD associated with diabetic embryopathy . Control pregnancies were injected with PBS. The mean blood glucose concentration was 18.91 ± 0.54 mmol/l, compared with 6.88 ± 0.18 mmol/l in PBS-injected controls.
To determine whether GLUT2-deficient embryos were susceptible to NTD caused by biochemical events distal to glucose transport, pregnant mice were given a single injection of antimycin A on day 7.5. Antimycin A is a mitochondrial complex III inhibitor that stimulates superoxide production [40, 41] and mimics the effects of maternal diabetes on Pax3 expression and NTD [39, 47]. As shown in Fig. 3c, antimycin A induced NTD in embryos of all genotypes. While the incidence of NTD in the Glut2−/− embryos was less than in Glut2+/+and Glut2+/− embryos (15 vs 44%), there was no significant difference in the incidence of NTD of embryos of any genotype.
Total number of embryos of each Glut2 genotype in each treatment group from matings of Glut2+/− with Glut2+/− mice
The data reported here confirm that the early postimplantation embryo, at the stage of development that is susceptible to NTDs induced by diabetic pregnancy, expresses the gene encoding the high Km GLUT2 glucose transporter. Expression of Glut1, Glut2 and Glut3 is suppressed in preimplantation embryos of diabetic mice , and expression of Glut1 has been found to be both unchanged or suppressed by maternal diabetes or high-glucose culture in postimplantation embryos [21, 22]. However, in the present study, expression of Glut2 was unaffected by maternal diabetes. Furthermore, the early embryo produces a functional high-Km transporter, as the Km of glucose uptake is 16.19 mmol/l, and it was not inhibited by 0.4 μmol/l cytochalasin B but it was inhibited by 4.0 μmol/l cytochalasin B. GLUT2-deficient embryos of hyperglycaemic mothers were resistant to hyperglycaemia-induced NTD, indicating that glucose transported into embryo cells by GLUT2, but not other glucose transporters, mediates the embryopathic effects of maternal hyperglycaemia.
It is interesting to note that in patients with diabetes, the tissues that suffer from the adverse effects of hyperglycaemia during the pathogenesis of diabetic complications, such as the vasculature and nerves, do not express GLUT2. However, if the rate of glucose phosphorylation by these tissues is sufficiently high, a concentration gradient driving sustained glucose uptake can be maintained. On the other hand, it may take years for the accumulated damage from hyperglycaemia to be clinically detectable, whereas the adverse effects of maternal hyperglycaemia on the embryo are apparent within hours. Therefore, the rate of glucose metabolism and ensuing adverse effects on embryo physiology may be far in excess of that which occurs in tissues producing only low-Km glucose transporters.
During non-diabetic pregnancy, the embryo or fetus would not be exposed to glucose at concentrations approaching the Km of the GLUT2 transporter. Therefore, there does not appear to be an occasion when this transporter would mediate glucose uptake. Furthermore, since embryos also produce GLUT1 and GLUT3, which mediate low-Km (high-affinity) glucose transporters at normal, non-diabetic, circulating glucose concentrations, the need for a high-Km (low-affinity) transporter is not obvious.
Before we began this study, we considered that, because Glut2−/− pups are viable until weaning , GLUT2 is not necessary for embryonic or fetal development. Therefore, as explained above, its presence or absence would appear to have little consequence during non-diabetic pregnancy, and so the expression of Glut2 may be vestigial. For example, embryos of oviparous animals derive glucose that is stored as glycogen in egg yolk at quantities sufficient to provide energy until hatching. The concentration of glucose that is transported to the embryo from the egg yolk might approach the Km of GLUT2. Indeed, the concentration of glucose in the yolk of a neurulating chick embryo is approximately 11 mmol/l (Fine and Loeken, unpublished data). Thus, there might be no selective pressure to retain expression of Glut2, but also no selective pressure against its expression during normal mammalian gestation.
However, the frequency of occurrence of each Glut2 genotype in embryos recovered from Glut2+/− × Glut2+/− matings suggests that, although the expression of Glut2 is not absolutely required for embryonic life, GLUT2 sufficiency confers a significant survival advantage before embryonic day 10.5 over GLUT2 deficiency. It is not known when, before day 10.5, the GLUT2-deficient embryos are lost, but because there were no implantation sites containing reabsorbing embryos, and implantation sites of embryos that die at day 7.5 or later were still detectable on day 10.5, the embryos must have died before day 7.5. Glut2 mRNA is detected beginning at the eight-cell stage , so the embryos were probably lost between the eight-cell stage and very early postimplantation development.
The non-Mendelian occurrence of Glut2+/− and Glut2−/− embryos was not expected, because when the Glut2 knockout line was first generated the occurrence of each of the genotypes from Glut2+/− parents was Mendelian . However, the original Glut2 knockout line was generated on a mixed C57Bl/6J × 129/Sv background, whereas the mice used here were on a pure 129Sv/J background. This suggests that there are polymorphic modifier genes that can complement the function of GLUT2 on some strain backgrounds but not on others. It is possible that GLUT2 transports a solute other than glucose during normal embryogenesis. It was recently recognised that GLUT2 is a high-affinity (low-Km) transporter of glucosamine . Glucosamine can be a substrate for the intermediates of post-translational glycosylation. Carbohydrate modification of proteins is essential for the production of extracellular matrix, as well as secreted and intracellular glycoproteins. The principal site of serum glucosamine synthesis is the liver . Although glucosamine-6-phosphate is synthesised from the glycolytic intermediate, fructose-6-phosphate, and glutamine, it can also be generated by phosphorylation of glucosamine transported from extracellular sources. Because the early embryo derives its energy primarily through glycolytic (anaerobic) glucose metabolism , it is possible that in 129Sv/J embryos the rate of conversion of fructose-6-phosphate to fructose-1,6-biphosphate leaves a suboptimal concentration of fructose 6-phosphate to serve as a substrate for hexosamine biosynthesis, thereby increasing the need to derive glucosamine from maternal circulation.
In conclusion, production of a functional, high Km GLUT2 glucose transporter confers sensitivity of the early postimplantation embryo to hyperglycaemia-induced malformations. Embryos lacking GLUT2 glucose transporters are structurally normal, although GLUT2-haploinsufficient and -deficient embryos are less viable than embryos that express two wild-type Glut2 alleles. However, when maternal glucose concentrations approach the Km of GLUT2, excessive glucose transport into embryo cells will affect embryonic development adversely.
This work was supported by grants from the National Institutes of Health (DK52865 and DK58300) to M.R. Loeken. We are grateful for technical assistance from Rakhi Patel and Julie Adams, and to members of the Loeken laboratory for helpful discussions.
Duality of interest
The authors do not have any duality of interest.