Elevated circulating follistatin associates with an increased risk of type 2 diabetes

Chuanyan Wu, Yan Borné, Rui Gao, Maykel López Rodriguez, William C. Roell, Jonathan M. Wilson, Ajit Regmi, Cheng Luan, Dina Mansour Aly, Andreas Peter, Jürgen Machann, Harald Staiger, Andreas Fritsche, Andreas L. Birkenfeld, Rongya Tao, Robert Wagner, Mickaël Canouil, Mun Gwan Hong, Jochen M. Schwenk, Emma AhlqvistMinna U. Kaikkonen, Peter Nilsson, Angela C. Shore, Faisel Khan, Andrea Natali, Olle Melander, Marju Orho-Melander, Jan Nilsson, Hans Ulrich Häring, Erik Renström, Claes B. Wollheim, Gunnar Engström, Jianping Weng, Ewan R. Pearson, Paul W. Franks, Morris F. White, Kevin L. Duffin, Allan Arthur Vaag, Markku Laakso, Norbert Stefan, Leif Groop, Yang De Marinis (Lead / Corresponding author)

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27 Citations (Scopus)
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The hepatokine follistatin is elevated in patients with type 2 diabetes (T2D) and promotes hyperglycemia in mice. Here we explore the relationship of plasma follistatin levels with incident T2D and mechanisms involved. Adjusted hazard ratio (HR) per standard deviation (SD) increase in follistatin levels for T2D is 1.24 (CI: 1.04–1.47, p < 0.05) during 19-year follow-up (n = 4060, Sweden); and 1.31 (CI: 1.09–1.58, p < 0.01) during 4-year follow-up (n = 883, Finland). High circulating follistatin associates with adipose tissue insulin resistance and non-alcoholic fatty liver disease (n = 210, Germany). In human adipocytes, follistatin dose-dependently increases free fatty acid release. In genome-wide association study (GWAS), variation in the glucokinase regulatory protein gene (GCKR) associates with plasma follistatin levels (n = 4239, Sweden; n = 885, UK, Italy and Sweden) and GCKR regulates follistatin secretion in hepatocytes in vitro. Our findings suggest that GCKR regulates follistatin secretion and that elevated circulating follistatin associates with an increased risk of T2D by inducing adipose tissue insulin resistance.

Original languageEnglish
Article number6486
Number of pages10
JournalNature Communications
Publication statusPublished - 10 Nov 2021


  • Genome-wide association studies
  • Type 2 diabetes

ASJC Scopus subject areas

  • Physics and Astronomy(all)
  • Chemistry(all)
  • Biochemistry, Genetics and Molecular Biology(all)


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