1
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Zhang Y, Sui L, Du Q, Haataja L, Yin Y, Viola R, Xu S, Nielsson CU, Leibel RL, Barbetti F, Arvan P, Egli D. Permanent neonatal diabetes-causing insulin mutations have dominant negative effects on beta cell identity. Mol Metab 2024; 80:101879. [PMID: 38237895 PMCID: PMC10839447 DOI: 10.1016/j.molmet.2024.101879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Heterozygous coding sequence mutations of the INS gene are a cause of permanent neonatal diabetes (PNDM), requiring insulin therapy similar to T1D. While the negative effects on insulin processing and secretion are known, how dominant insulin mutations result in a continued decline of beta cell function after birth is not well understood. METHODS We explored the causes of beta cell failure in two PNDM patients with two distinct INS mutations using patient-derived iPSCs and mutated hESCs. RESULTS we detected accumulation of misfolded proinsulin and impaired proinsulin processing in vitro, and a dominant-negative effect of these mutations on beta-cell mass and function after transplantation into mice. In addition to anticipated ER stress, we found evidence of beta-cell dedifferentiation, characterized by an increase of cells expressing both Nkx6.1 and ALDH1A3, but negative for insulin and glucagon. CONCLUSIONS These results highlight a novel mechanism, the loss of beta cell identity, contributing to the loss and functional failure of human beta cells with specific insulin gene mutations.
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Affiliation(s)
- Yuwei Zhang
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States
| | - Lina Sui
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States
| | - Qian Du
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States
| | - Leena Haataja
- Metabolism Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI 48105, United States
| | - Yishu Yin
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States
| | - Ryan Viola
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States
| | - Shuangyi Xu
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States
| | - Christian Ulrik Nielsson
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States
| | - Rudolph L Leibel
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States
| | - Fabrizio Barbetti
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy; Monogenic Diabetes Clinic, Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, Rome 00164, Italy
| | - Peter Arvan
- Metabolism Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI 48105, United States
| | - Dieter Egli
- Naomi Berrie Diabetes Center & Department of Pediatrics, College of Physicians and Surgeons, Columbia Stem Cell Initiative, Columbia University, New York, NY, 10032, United States.
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2
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Regué L, Zhao L, Ji F, Wang H, Avruch J, Dai N. RNA m6A reader IMP2/IGF2BP2 promotes pancreatic β-cell proliferation and insulin secretion by enhancing PDX1 expression. Mol Metab 2021; 48:101209. [PMID: 33705986 PMCID: PMC8076713 DOI: 10.1016/j.molmet.2021.101209] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a common metabolic disease. Variants in human IGF2 mRNA binding protein 2 (IMP2/IGF2BP2) are associated with increased risk of T2D. IMP2 contributes to T2D susceptibility primarily through effects on insulin secretion. However, the underlying mechanism is not known. METHODS To understand the role of IMP2 in insulin secretion and T2D pathophysiology, we generated Imp2 pancreatic β-cell specific knockout mice (βIMP2KO) by recombining the Imp2flox allele with Cre recombinase driven by the rat insulin 2 promoter. We further characterized metabolic phenotypes of βIMP2KO mice and assessed their β-cell functions. RESULTS The deletion of IMP2 in pancreatic β-cells leads to reduced compensatory β-cell proliferation and function. Mechanically, IMP2 directly binds to Pdx1 mRNA and stimulates its translation in an m6A dependent manner. Moreover, IMP2 orchestrates IGF2-AKT-GSK3β-PDX1 signaling to stable PDX1 polypeptides. In human EndoC-βH1 cells, the over-expression of IMP2 is capable to enhance cell proliferation, PDX1 protein level and insulin secretion. CONCLUSION Our work therefore reveals IMP2 as a critical regulator of pancreatic β-cell proliferation and function; highlights the importance of posttranscriptional gene expression in T2D pathology.
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MESH Headings
- Adenosine/analogs & derivatives
- Adenosine/metabolism
- Animals
- Cell Line
- Cell Proliferation/genetics
- Diabetes Mellitus, Type 2/genetics
- Diabetes Mellitus, Type 2/metabolism
- Diet, High-Fat/adverse effects
- Disease Models, Animal
- Gene Knockout Techniques
- Homeodomain Proteins/metabolism
- Humans
- Insulin Secretion/genetics
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/metabolism
- Insulin-Secreting Cells/metabolism
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Middle Aged
- Promoter Regions, Genetic
- RNA, Messenger/metabolism
- RNA-Binding Proteins/genetics
- RNA-Binding Proteins/metabolism
- Rats
- Signal Transduction/genetics
- Trans-Activators/metabolism
- Transfection
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Affiliation(s)
- Laura Regué
- Department of Molecular Biology and Diabetes Unit of the Medical Services, Massachusetts General Hospital, Boston, 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Liping Zhao
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Fei Ji
- Department of Molecular Biology and Diabetes Unit of the Medical Services, Massachusetts General Hospital, Boston, 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Hua Wang
- The Lundquist Institute, Harbor-UCLA, Torrance, CA, 90502, USA
| | - Joseph Avruch
- Department of Molecular Biology and Diabetes Unit of the Medical Services, Massachusetts General Hospital, Boston, 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Ning Dai
- Department of Molecular Biology and Diabetes Unit of the Medical Services, Massachusetts General Hospital, Boston, 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA.
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3
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Jeong EB, Jeong SS, Cho E, Kim EY. Makorin 1 is required for Drosophila oogenesis by regulating insulin/Tor signaling. PLoS One 2019; 14:e0215688. [PMID: 31009498 PMCID: PMC6476528 DOI: 10.1371/journal.pone.0215688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/05/2019] [Indexed: 01/02/2023] Open
Abstract
Reproduction is a process that is extremely sensitive to changes in nutritional status. The nutritional control of oogenesis via insulin signaling has been reported; however, the mechanism underlying its sensitivity and tissue specificity has not been elucidated. Here, we determined that Drosophila Makorin RING finger protein 1 gene (Mkrn1) functions in the metabolic regulation of oogenesis. Mkrn1 was endogenously expressed at high levels in ovaries and Mkrn1 knockout resulted in female sterility. Mkrn1-null egg chambers were previtellogenic without egg production. FLP-FRT mosaic analysis revealed that Mkrn1 is essential in germline cells, but not follicle cells, for ovarian function. As well, AKT phosphorylation via insulin signaling was greatly reduced in the germline cells, but not the follicle cells, of the mutant clones in the ovaries. Furthermore, protein-rich diet elevated Mkrn1 protein levels, without increased mRNA levels. The p-AKT and p-S6K levels, downstream targets of insulin/Tor signaling, were significantly increased by a nutrient-rich diet in wild-type ovaries whereas those were low in Mkrn1exS compared to wild-type ovaries. Taken together, our results suggest that nutrient availability upregulates the Mkrn1 protein, which acts as a positive regulator of insulin signaling to confer sensitivity and tissue specificity in the ovaries for proper oogenesis based on nutritional status.
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Affiliation(s)
- Eui Beom Jeong
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Kyunggi-do, Republic of Korea
- Department of Brain Science, Ajou University School of Medicine, Suwon, Kyunggi-do, Republic of Korea
| | - Seong Su Jeong
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Kyunggi-do, Republic of Korea
- Department of Brain Science, Ajou University School of Medicine, Suwon, Kyunggi-do, Republic of Korea
| | - Eunjoo Cho
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Kyunggi-do, Republic of Korea
- Department of Brain Science, Ajou University School of Medicine, Suwon, Kyunggi-do, Republic of Korea
- * E-mail: (EYK); (EC)
| | - Eun Young Kim
- Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Kyunggi-do, Republic of Korea
- Department of Brain Science, Ajou University School of Medicine, Suwon, Kyunggi-do, Republic of Korea
- * E-mail: (EYK); (EC)
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4
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Abstract
BACKGROUND Hypoglycemic events in patients with type 1 diabetes (T1D) are associated with measurable electroencephalography (EEG) changes. Previous studies have, however, evaluated these changes on a single EEG channel level, whereas multivariate analysis of several EEG channels has been scarcely investigated. The aim of the present work is to use a coherence approach to quantitatively assess how hypoglycemia affects mutual connectivity of different brain areas. MATERIALS AND METHODS EEG multichannel data were obtained from 19 patients with T1D (58% males; mean age, 55 ± 2.4 years; diabetes duration, 28.5 ± 2.6 years; glycated hemoglobin, 8.0 ± 0.2%) who underwent a hyperinsulinemic-hypoglycemic clamp study. The information partial directed coherence (iPDC) function was computed through multivariate autoregressive models during eu- and hypoglycemia in the theta and alpha bands. RESULTS In passing from eu- to hypoglycemia, absolute values of the iPDC function tend to decrease in both bands in all combinations of the considered channels. In particular, the scalar indicator [Formula: see text], which summarizes iPDC information, significantly decreased (P < 0.01) in 17 of 19 subjects: from T5-A1A2 to C3-A1A2 from O1-A1A2 to C4-A1A2 and from O2-A1A2 to Cz-A1A2 in the theta band and from O1-A1A2 to T4-A1A2 and from O1-A1A2 to C4-A1A2 in the alpha band. CONCLUSIONS The coherence decrease measured by iPDC in passing from eu- to hypoglycemia is likely related to the progressive loss of cognitive function and altered cerebral activity in hypoglycemia. This result encourages further quantitative investigation of EEG changes in hypoglycemia and of how EEG acquisition and real-time processing can support hypoglycemia alert systems.
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Affiliation(s)
- Maria Rubega
- 1 Department of Information Engineering, University of Padova , Padova, Italy
| | - Giovanni Sparacino
- 1 Department of Information Engineering, University of Padova , Padova, Italy
| | - Anne S Sejling
- 2 Department of Cardiology, Nephrology and Endocrinology, Nordsjællands University Hospital , Hillerød, Denmark
| | - Claus B Juhl
- 3 Hyposafe , Lyngsby, Denmark
- 4 Hospital of South West Jutland , Department of Medicine, Esbjerg, Denmark
| | - Claudio Cobelli
- 1 Department of Information Engineering, University of Padova , Padova, Italy
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5
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Ilag LL, Deeg MA, Costigan T, Hollander P, Blevins TC, Edelman SV, Konrad RJ, Ortmann RA, Pollom RK, Huster WJ, Zielonka JS, Prince MJ. Evaluation of immunogenicity of LY2963016 insulin glargine compared with Lantus® insulin glargine in patients with type 1 or type 2 diabetes mellitus. Diabetes Obes Metab 2016; 18:159-68. [PMID: 26434665 PMCID: PMC4737399 DOI: 10.1111/dom.12584] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/17/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
Abstract
AIMS To compare the immunogenicity profiles and the potential effects on clinical outcomes of LY2963016 insulin glargine (LY IGlar) and Lantus® insulin glargine (IGlar), products with identical primary amino acid sequences, in patients with type 1 or type 2 diabetes mellitus (T1DM or T2DM). METHODS To assess immunogenicity, anti-insulin glargine antibodies (measured as percent binding) were compared between treatments in 52-week (open-label) and 24-week (double-blind) randomized studies in total study populations of patients with T1DM (N = 535) and T2DM (N = 756), respectively, and two subgroups of patients with T2DM: insulin-naïve patients and those reporting prestudy IGlar treatment (prior IGlar). Relationships between insulin antibody levels and clinical outcomes were assessed using analysis of covariance and partial correlations. Insulin antibody levels were assessed using Wilcoxon rank sum. Treatment comparisons for treatment-emergent antibody response (TEAR) and incidence of detectable antibodies were analysed using Fisher's exact test. RESULTS No significant treatment differences were observed for insulin antibody levels, incidence of detectable anti-insulin glargine antibodies, or incidence of TEAR [overall and endpoint, by last-observation-carried-forward (LOCF)] in patients with T1DM or patients with T2DM, including the insulin-naïve subgroup. A statistically significant difference was noted in the overall incidence of detectable antibodies but not at endpoint (LOCF) nor in TEAR for the prior IGlar subgroup of patients with T2DM. Insulin antibody levels were low (<5%) in both treatment groups. Insulin antibody levels or developing TEAR was not associated with clinical outcomes. CONCLUSIONS LY IGlar and IGlar have similar immunogenicity profiles; anti-insulin glargine antibody levels were low for both treatments, with no observed effect on efficacy and safety outcomes.
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MESH Headings
- Asymptomatic Diseases/epidemiology
- Biosimilar Pharmaceuticals/adverse effects
- Biosimilar Pharmaceuticals/therapeutic use
- Cross Reactions
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/immunology
- Double-Blind Method
- Drug Hypersensitivity/complications
- Drug Hypersensitivity/epidemiology
- Drug Hypersensitivity/etiology
- Drug Hypersensitivity/immunology
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemia/prevention & control
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Immunogenetic Phenomena/drug effects
- Incidence
- Insulin Antibodies/analysis
- Insulin Glargine/adverse effects
- Insulin Glargine/analogs & derivatives
- Insulin Glargine/therapeutic use
- Insulin, Regular, Human/adverse effects
- Insulin, Regular, Human/analogs & derivatives
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/therapeutic use
- Recombinant Proteins/adverse effects
- Recombinant Proteins/therapeutic use
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Affiliation(s)
- L L Ilag
- Eli Lilly and Company, Indianapolis, IN, USA
| | - M A Deeg
- Eli Lilly and Company, Indianapolis, IN, USA
| | - T Costigan
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - T C Blevins
- Texas Diabetes and Endocrinology, Austin, TX, USA
| | - S V Edelman
- University of California, San Diego, San Diego, CA, USA
| | - R J Konrad
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R A Ortmann
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R K Pollom
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W J Huster
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - M J Prince
- Eli Lilly and Company, Indianapolis, IN, USA
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6
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Owens DR, Matfin G, Monnier L. Basal insulin analogues in the management of diabetes mellitus: What progress have we made? Diabetes Metab Res Rev 2014; 30:104-19. [PMID: 24026961 DOI: 10.1002/dmrr.2469] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/15/2013] [Accepted: 09/08/2013] [Indexed: 02/06/2023]
Abstract
Insulin remains the most effective and consistent means of controlling blood glucose levels in diabetes. Since 1946, neutral protamine Hagedorn (NPH) has been the predominant basal insulin in clinical use. However, absorption is variable due to the need for resuspension and the time-action profile (peak activity 4-6 h after subcutaneous administration) confers an increased propensity for between-meal and nocturnal hypoglycaemia. In the 1980s, recombinant DNA technology enabled modifications to the insulin molecule resulting in the soluble long-acting insulin analogues, glargine and detemir. Both exhibit a lower risk of hypoglycaemia compared with neutral protamine Hagedorn due to improved time-action profiles and reduced day-to-day glucose variability. Glargine is indicated for administration once daily and detemir once or twice daily. Degludec is the latest prolonged-acting insulin which forms long subcutaneous multi-hexamers that delay absorption. Recent phase III trials in type 1 and type 2 diabetes show that degludec was non-inferior to comparators (predominantly glargine) with a minimal although inconsistent reduction in overall hypoglycaemia and a small absolute difference in nocturnal hypoglycaemia. Newer developmental agents include LY2605541 and glargine U300. LY2605541 comprises insulin lispro combined with polyethylene glycol, thereby increasing its hydrodynamic size and retarding absorption from the subcutaneous tissue. Glargine U300 is a new formulation of glargine resulting in a flatter and more prolonged time-action profile than its predecessor. This article reviews recent advances in basal insulin analogues, including a critical appraisal of the degludec trials.
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MESH Headings
- Animals
- Chemistry, Pharmaceutical/trends
- Clinical Trials as Topic
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 2/drug therapy
- Drugs, Investigational/adverse effects
- Drugs, Investigational/chemistry
- Drugs, Investigational/therapeutic use
- Humans
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/chemistry
- Hypoglycemic Agents/therapeutic use
- Insulin, Long-Acting/adverse effects
- Insulin, Long-Acting/chemistry
- Insulin, Long-Acting/genetics
- Insulin, Long-Acting/therapeutic use
- Insulin, Regular, Human/analogs & derivatives
- Insulin, Regular, Human/chemistry
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/therapeutic use
- Recombinant Proteins/adverse effects
- Recombinant Proteins/chemistry
- Recombinant Proteins/therapeutic use
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Affiliation(s)
- David R Owens
- Diabetes Research Group, Swansea University, Swansea, Wales, UK
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7
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Kubota M, Sato Y, Khookhor O, Ekberg K, Chibalin AV, Wahren J. Enhanced insulin action following subcutaneous co-administration of insulin and C-peptide in rats. Diabetes Metab Res Rev 2014; 30:124-31. [PMID: 24027001 DOI: 10.1002/dmrr.2471] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/12/2013] [Accepted: 09/07/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study was undertaken to examine if C-peptide (C) may interact with hexameric insulin and facilitate its disaggregation into the physiologically active monomeric form. METHODS Regular insulin (I) or an insulin analogue (IA) were injected s.c. in rats together with C or its C-terminal pentapeptide (PP). I or IA and C or PP were administered either as a physical mixture or into two separate s.c. depots. Whole body glucose utilization was evaluated using the euglycemic clamp technique. Phosphorylation of Akt/PKB and GSK in liver and skeletal muscles and ⁸⁶Rb⁺ uptake by L6 cells were measured. RESULTS S.c. injection of a mixture of I and C or I and PP resulted in a 30-55% greater (P < 0.01-0.001) and 15-27% (P < 0.05-0.001) longer stimulation of whole body glucose utilization than after separate injections. Insulin-stimulated phosphorylation of Akt/PKB in liver increased 35% more after injection of I and C in mixture compared with after separate injections. Phosphorylation of GSK3 was augmented by 50% (P < 0.05) following the injection of I and C in mixture compared with separate injections. Stimulation of myotubes with premixed I and C (1 nM) elicited 20% additional increase in ouabain-sensitive ⁸⁶Rb⁺ uptake (P < 0.05) in comparison with the effect when I and C were added separately. CONCLUSIONS Subcutaneous co-administration of insulin and C results in augmented insulin bioactivity at the level of tissue glucose uptake, intracellular signalling, and enzyme activation. These effects may be attributed to augmented C mediated disaggregation of hexameric insulin into its physiologically active monomeric form.
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MESH Headings
- Animals
- C-Peptide/administration & dosage
- C-Peptide/chemistry
- C-Peptide/genetics
- C-Peptide/pharmacology
- Cell Line
- Drug Combinations
- Drug Implants
- Drug Therapy, Combination
- Enzyme Activation/drug effects
- Glycogen Synthase Kinase 3/chemistry
- Glycogen Synthase Kinase 3/metabolism
- Humans
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/chemistry
- Hypoglycemic Agents/pharmacology
- Insulin Lispro/administration & dosage
- Insulin Lispro/genetics
- Insulin Lispro/pharmacology
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/pharmacology
- Liver/drug effects
- Liver/enzymology
- Liver/metabolism
- Male
- Muscle, Skeletal/drug effects
- Muscle, Skeletal/enzymology
- Muscle, Skeletal/metabolism
- Oligopeptides/administration & dosage
- Oligopeptides/chemistry
- Oligopeptides/genetics
- Oligopeptides/pharmacology
- Peptide Fragments/administration & dosage
- Peptide Fragments/chemistry
- Peptide Fragments/genetics
- Peptide Fragments/pharmacology
- Phosphorylation/drug effects
- Protein Processing, Post-Translational/drug effects
- Proto-Oncogene Proteins c-akt/agonists
- Proto-Oncogene Proteins c-akt/metabolism
- Random Allocation
- Rats
- Rats, Wistar
- Recombinant Proteins/administration & dosage
- Recombinant Proteins/chemistry
- Recombinant Proteins/pharmacology
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Affiliation(s)
- M Kubota
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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8
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Abstract
Diabetes is a pandemic disease characterized by autoimmune, genetic and metabolic abnormalities. While insulin deficiency manifested as hyperglycemia is a common sequel of both Type-1 and Type-2 diabetes (T1DM and T2DM), it does not result from a single genetic defect--rather insulin deficiency results from the functional loss of pancreatic β cells due to multifactorial mechanisms. Since pancreatic β cells of patients with T1DM are destroyed by autoimmune reaction, these patients require daily insulin injections. Insulin resistance followed by β cell dysfunction and β cell loss is the characteristics of T2DM. Therefore, most patients with T2DM will require insulin treatment due to eventual loss of insulin secretion. Despite the evidence of early insulin treatment lowering macrovascular (coronary artery disease, peripheral arterial disease and stroke) and microvascular (diabetic nephropathy, neuropathy and retinopathy) complications of T2DM, controversy exists among physicians on how to initiate and intensify insulin therapy. The slow acting nature of regular human insulin makes its use ineffective in counteracting postprandial hyperglycemia. Instead, recombinant insulin analogs have been generated with a variable degree of specificity and action. Due to the metabolic variability among individuals, optimum blood glucose management is a formidable task to accomplish despite the presence of novel insulin analogs. In this article, we present a recent update on insulin analog structure and function with an overview of the evidence on the various insulin regimens clinically used to treat diabetes.
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MESH Headings
- Animals
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Diabetic Angiopathies/prevention & control
- Drug Monitoring
- Evidence-Based Medicine
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/chemistry
- Hypoglycemic Agents/metabolism
- Hypoglycemic Agents/therapeutic use
- Insulin/administration & dosage
- Insulin/analogs & derivatives
- Insulin/metabolism
- Insulin/therapeutic use
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/analogs & derivatives
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/therapeutic use
- Recombinant Proteins/administration & dosage
- Recombinant Proteins/chemistry
- Recombinant Proteins/therapeutic use
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Affiliation(s)
- Ahter D. Sanlioglu
- Human Gene and Cell Therapy Center; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Department of Medical Biology and Genetics; Akdeniz University Faculty of Medicine; Antalya, Turkey
| | - Hasan Ali Altunbas
- Human Gene and Cell Therapy Center; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Akdeniz University Faculty of Medicine; Antalya, Turkey
| | - Mustafa Kemal Balci
- Human Gene and Cell Therapy Center; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Akdeniz University Faculty of Medicine; Antalya, Turkey
| | | | - Salih Sanlioglu
- Human Gene and Cell Therapy Center; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Department of Medical Biology and Genetics; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Correspondence to: Salih Sanlioglu,
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9
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Wang X, Xu XL, Zhao XL, Ma XW, Yu H, Gong H, Zhang SR, Chen FL. Hypoglycemia due to insulin binding antibodies in a patient with insulin-treated type 2 diabetes and Graves' disease. Endocrine 2013; 43:236-7. [PMID: 22886314 DOI: 10.1007/s12020-012-9721-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
MESH Headings
- Aged, 80 and over
- Antithyroid Agents/therapeutic use
- Autoantibodies/analysis
- Autoimmune Diseases/complications
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/immunology
- Autoimmune Diseases/physiopathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/immunology
- Female
- Graves Disease/complications
- Graves Disease/drug therapy
- Graves Disease/physiopathology
- Graves Ophthalmopathy/etiology
- Graves Ophthalmopathy/prevention & control
- Humans
- Hypoglycemia/etiology
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Immunosuppressive Agents/therapeutic use
- Insulin, Regular, Human/adverse effects
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/therapeutic use
- Methimazole/therapeutic use
- Prednisone/therapeutic use
- Recombinant Proteins/adverse effects
- Recombinant Proteins/therapeutic use
- Treatment Outcome
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