Non-insulin-dependent diabetes mellitus (NIDDM) is a genetically heterogeneous disorder. Maturity-onset diabetes of the young, a form of NIDDM with an early age of onset and autosomal dominant inheritance, can result from mutations in glucokinase, a key enzyme of glucose metabolism in beta cells and the liver. We studied 32 French families with maturity-onset diabetes of the young as well as 21 families with late-onset NIDDM to determine the frequency and clinical features of mutations of glucokinase. Fasting plasma glucose concentrations and oral glucose-tolerance tests were used to determine metabolic status. DNA was isolated from lymphocytes, and DNA polymorphisms in the glucokinase gene were tested for linkage with diabetes. Individual exons of the glucokinase gene from one affected member in each family were amplified by the polymerase chain reaction and screened for mutations by analysis of the conformation-dependent polymorphisms of single-stranded DNA and by DNA sequencing.
The insulin and IGF signaling pathways are critical for development and maintenance of pancreatic β cell mass and function. The serine-threonine kinase Akt is one of several mediators regulated by these pathways. We have studied the role of Akt in pancreatic β cell physiology by generating transgenic mice expressing a kinase-dead mutant of this enzyme in β cells. Reduction of Akt activity in transgenic animals resulted in impaired glucose tolerance due to defective insulin secretion. The mechanisms involved in dysregulation of secretion in these mice lie at the level of insulin exocytosis and are not the result of abnormalities in glucose signaling or function of voltage-gated Ca2+ channels. Therefore, transgenic mice showed increased susceptibility to developing glucose intolerance and diabetes following fat feeding. These observations suggest that Akt plays a novel and important role in the regulation of distal components of the secretory pathway and that this enzyme represents a therapeutic target for improvement of β cell function in diabetes.
The insulin and IGF signaling pathways are critical for development and maintenance of pancreatic β cell mass and function. The serine-threonine kinase Akt is one of several mediators regulated by these pathways. We have studied the role of Akt in pancreatic β cell physiology by generating transgenic mice expressing a kinase-dead mutant of this enzyme in β cells. Reduction of Akt activity in transgenic animals resulted in impaired glucose tolerance due to defective insulin secretion. The mechanisms involved in dysregulation of secretion in these mice lie at the level of insulin exocytosis and are not the result of abnormalities in glucose signaling or function of voltage-gated Ca2+ channels. Therefore, transgenic mice showed increased susceptibility to developing glucose intolerance and diabetes following fat feeding. These observations suggest that Akt plays a novel and important role in the regulation of distal components of the secretory pathway and that this enzyme represents a therapeutic target for improvement of β cell function in diabetes.
Glut2, the facilitative glucose transporter isoform expressed in pancreatic p cells, is believed to play a role in glucose-stimulated insulin secretion.
Persistent hypoglycaemia in infancy is most commonly caused by hyperinsulinism. A case is reported of the somatic loss of the maternal 11p in an insulin secreting focal adenoma in association with a germline SUR-1 mutation on the paternal allele in a baby boy with hyperinsulinism diagnosed at 49 days old. A reduction to homozygosity of an SUR-1 mutation is proposed as a critical part of the cause of focal hyperinsulinism.
In three patients who had repeated episodes of symptomatic postprandial hypoglycemia, oral glucose tolerance testing demonstrated normal initial insulin response but subsequent hyperinsulinemia and hypoglycemia. Intravenous glucose and tolbutamide provoked normal glucose and insulin responses, suggesting normal beta-cell function. Evidence that the hyperinsulinism and hypoglycemia provoked by oral glucose was due to alimentary factors included hyperglycemia, hyperinsulinism, and subsequent hypoglycemia after duodenal glucose infusions, normal gastric emptying as measured by a radioisotopic method, and control of the hyperglycemic, hyperinsulinemic responses and of hypoglycemic symptoms in these patients by phenformin, a drug reported to impede glucose absorption from the gut. We conclude that alimentary hypoglycemia may occur in the absence of gastrointestinal surgery, and can be distinguished from the hypoglycemia of early diabetes by normal to increased initial insulin secretion after the ingestion of glucose. (N Engl J Med 288:1206–1210, 1973)
These studies of a rat model for non-insulin-dependent diabetes mellitus (NIDDM) were performed to determine whether hyperglycemia occurs when capacity to synthesize insulin is exceeded. The neonatal streptozocin (STZ)-treated rat has acute hyperglycemia with marked destruction of pancreatic β-cells, followed by gradual regeneration to 50–70% normal (β-cell number. At age 4 wk, fed serum glucose concentration is only mildly elevated relative to controls. With age, the rats become progressively hyperglycemic, and by 12 wk they have marked impairment of glucose-stimulated insulin release. In these studies, dexamethasone (0.125 mg/kg/day for 4 days) was administered to control and to STZ-treated animals to produce insulin resistance. The relationship between insulin biosynthesis and serum glucose concentrations was assessed. In control rats, response to dexamethasone was similar at both 4 and 12 wk. Serum glucose levels and pancreatic insulin concentration remained unchanged. Both insulin biosynthetic rates (as measured by 3Hleucine incorporation into proinsulin) and proinsulin mRNA levels increased twofold. STZ-treated rats at age 4 wk demonstrated mild hyperglycemia. Dexamethasone injection resulted in an increase in insulin biosynthesis and proinsulin mRNA in these animals, while serum glucose did not increase. STZ-treated rats at 12 wk showed more profound hyperglycemia (serum glucose 315 ± 38 mg/dl versus control, 187 ± 12 mg/dl). A marked rise in serum glucose (to 519 ± 42 mg/dl) was observed after4 days of dexamethasone injection. Pancreatic insulin content became severely depleted relative to salineinjected, STZ-treated animals, and there was no response of levels of proinsulin mRNA. These studies demonstrate a significant correlation between mean insulin biosynthetic rates and mean proinsulin mRNA levels in 4-wk-old rats. In these rats with mild glucose intolerance related to a decrease in insulin synthesis, the rate of biosynthesis can still increase if demand for insulin is acutely increased by induction of an insulin-resistant state. If the correlation between proinsulin mRNA and biosynthesis exists in 12-wk-old animals, the data suggest that older, more hyperglycemic animals lose the capacity to increase rates of insulin biosynthesis and secretion; severe hyperglycemia ensues when capacity to synthesize insulin is exceeded.
SUMMARY this report describes the development of a rapid method for detection of nanogram quantities of insulin in tissue extracts after electrophoresis. Following electrophoresis the proteins are transferred to nitrocellulose filters and treated with a photoreactive crosslinking agent. Filter bound insulin is detected by antiinsulin antibody and 125 l-protein A, followed by autoradiography. The photoaffinity crosslinking is simple, rapid, and stable, and does not require reactive binding sites on derivatized paper. Under these conditions insulin maintains its immunoreactivity yet can be washed extensively to reduce nonspecific background; as little as 10 ng can be visualized. The method has proven to be useful for rapid analysis of qualitative as well as quantitative differences in immunoreactive insulin in tissue extracts. DIABETES 37: 648-652, July 1982.
The sulfonylurea receptor (SUR) is a key component in glucose-stimulated insulin secretion. Obesity and NIDDM are frequently associated and share some metabolic abnormalities, suggesting that they might also share some susceptibility genes. Thus, the SUR encoding gene is a plausible candidate for a primary pancreatic β-cell defect and thus for hyperglycemia and weight gain. Through association and linkage studies, we have investigated the potential role of the SUR gene in families with NIDDM and in two independent sets of morbidly obese families. The exon 22 T-allele at codon 761 was more common in patients with NIDDM (7.7%) and morbid obesity (7.8%) than in control subjects (1.8%, P = 0.030 and P = 0.023, respectively). This variant was associated with morbid obesity (odds ratio 3.71, P = 0.017) and NIDDM (odds ratio 2.20, P = 0.04; association dependent on BMI). Although the frequencies for intron 24 variant were similar in all groups, morbidly obese patients homozygous for the c-allele had a more deleterious form of obesity. Sib-pair linkage studies with NIDDM in French Caucasian families gave no evidence for linkage to the SUR locus. However, in one set of the obese families, we found an indication for linkage with a SUR-linked microsatellite marker (D11S419, P = 0.0032). We conclude that in Caucasians, the SUR locus may contribute to the genetic susceptibility to NIDDM and obesity.
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