Ca2+ oscillations in pancreatic beta-cells exposed to leucine and arginine

Dual-wavelength microfluorometry with the fura-2 indicator was employed for continuous recordings of cytoplasmic Ca2+ (Ca2+i) in individual pancreatic beta-cells isolated from ob/ob-mice. When added to a medium containing 3 mmol l-1 glucose, both 10 mmol l-1 leucine and 20 mmol l-1 arginine induced rises in Ca2+i with periodic fluctuations. In the case of leucine, this increase was preceded by initial lowering followed by high-amplitude oscillations with a periodicity of 2-6 min. In a glucose-free medium arginine had no effect, and leucine was unable to induce more than a single peak of Ca2+i increase. When present at a concentration of 1 mmol l-1, leucine sometimes induced a couple of high-amplitude oscillations at 3 mmol l-1 glucose but lowered Ca2+i permanently in a glucose-free medium. It is likely that the high-amplitude oscillations of Ca2+i are related to the electrical activity of the beta-cells. Provided that some glucose was present, leucine initiated a similar type of Ca2+i response as obtained during glucose-induced insulin release. The observed leucine effect is therefore compatible with a role of glycolysis in generating high-amplitude Ca2+ oscillations and pulsatile insulin release.     

Physiological regulation of the pancreatic {beta}-cell: functional insights for understanding and therapy of diabetes

Knowledge about the sites and actions of the numerous physiological and pharmacological factors affecting insulin secretion and pancreatic beta-cell function has been derived from the use of bioengineered insulin-producing cell lines. Application of an innovative electrofusion approach has generated novel glucose-responsive insulin-secreting cells for pharmaceutical and experimental research, including popular BRIN-BD11 beta-cells. This review gives an overview of the establishment and core characteristics of clonal electrofusion-derived BRIN-BD11 beta-cells. As discussed, BRIN-BD11 cells have facilitated studies aimed at dissecting important pathways by which nutrients and other bioactive molecules regulate the complex mechanisms regulating insulin secretion, and highlight the future potential of novel and diverse bioengineering approaches to provide a cell-based insulin-replacement therapy for diabetes. Clonal BRIN-BD11 beta-cells have been instrumental in: (a) characterization of K(ATP) channel-dependent and -independent actions of nutrients and established and emerging insulinotropic antidiabetic drugs, and the understanding of drug-induced beta-cell desensitization; (b) tracing novel metabolic and beta-cell secretory pathways, including use of state-of-the-art NMR approaches to provide new insights into the relationships between glucose and amino acid handling and insulin secretion; and (c) determination of the chronic detrimental actions of nutrients and the diabetic environment on pancreatic beta-cells, including the recent discovery that homocysteine, a risk factor for metabolic syndrome, may play a role in the progressive demise of insulin secretion and pancreatic beta-cell function in diabetes. Collectively, the studies discussed in this review highlight the importance of innovative experimental beta-cell physiology in the discovery and characterization of new and improved drugs and therapeutic strategies to help tackle the emerging diabetes epidemic.     

肾上腺髓质素加强高糖对自发性高血压大鼠胰岛β细胞的毒性作用

探讨高糖是否对自发性高血压大鼠 (SHR)和 Wistar- Kyoto(WKY)鼠胰岛 β细胞分泌功能具有抑制作用 ,肾上腺髓质素 (adrenomedullin,AM)能否加强此抑制作用。选取 6周龄 SHR鼠及 10周龄 WKY鼠各 10只 ,分离胰岛放入 12孔培养板内 (90个胰岛 /孔 )培养。先以含 5 .6 m mol/ L(m M)葡萄糖的 RPMI16 4 0培养基培养 1h,取出培养液。然后用含 2 0 m M葡萄糖及不同浓度 AM(分别是 0 ,10 - 8,10 - 7,10 - 6 M)的 RPMI 16 4 0培养基培养 1小时 ,取出培养液 ,放射免疫分析 (RIA)方法测定两次培养液的胰岛素含量。 SHR鼠的胰岛细胞经用不加 AM含 2 0m M葡萄糖的 16 4 0培养基培养 1h后 ,与用含 5 .6 m M葡萄糖的 16 4 0培养基培养 1h相比 ,其培养液中胰岛素含量明显降低 (分别是 19.9± 6 .6 vs6 0 .9± 33.6 m U/ L,P<0 .0 5 )。当用含 2 0 m M葡萄糖及不同浓度 AM的 16 4 0培养基培养时 ,随着 AM浓度的增加 ,培养液中的胰岛素含量进一步减少 (19.9± 6 .6 vs2 2 .2± 8.0 vs2 1.5± 5 .6 vs17.9± 3.6 m U/ L)。对照组 WKY鼠的胰岛细胞经上述相同方法处理后得出相似的结果。但 WKY鼠与 SHR鼠相比 ,其胰岛细胞经用含 5 .6 m M及 2 0 m M葡萄糖培养基培养后培养液中的胰岛素含量较高 (P<0 .0 1)。用高糖培养基培养     

Imaging beta-cell mass and function in situ and in vivo

Glucose-stimulated insulin secretion (GSIS) from pancreatic beta-cells is critical to the maintenance of blood glucose homeostasis in animals. Both decrease in pancreatic beta-cell mass and defects in beta-cell function contribute to the onset of diabetes, although the underlying mechanisms remain largely unknown. Molecular imaging techniques can help beta-cell study in a number of ways. High-resolution fluorescence imaging techniques provide novel insights into the fundamental mechanisms underlying GSIS in isolated beta-cells or in situ in pancreatic islets, and dynamic changes of beta-cell mass and function can be noninvasively monitored in vivo by imaging techniques such as positron emission tomography and single-photon emission computed tomography. All these techniques will contribute to the better understanding of the progression of diabetes and the search for the optimized therapeutic measures that reverse deficits in beta-cell mass and function.     

Association of a microsatellite in FASL to type II diabetes and of the FAS-670G>A genotype to insulin resistance

Type II diabetes is caused by a failure of the pancreatic beta-cells to compensate for insulin resistance leading to hyperglycaemia. There is evidence for an essential role of an increased beta-cell apoptosis in type II diabetes. High glucose concentrations induce IL-1beta production in human beta-cells, Fas expression and concomitant apoptosis owing to a constitutive expression of FasL. FASL and FAS map to loci linked to type II diabetes and estimates of insulin resistance, respectively. We have tested two functional promoter polymorphisms, FAS-670 G>A and FASL-844C>T as well as a microsatellite in the 3' UTR of FASL for association to type II diabetes in 549 type II diabetic patients and 525 normal-glucose-tolerant (NGT) control subjects. Furthermore, we have tested these polymorphisms for association to estimates of beta-cell function and insulin resistance in NGT subjects. We found significant association to type II diabetes for the allele distribution of the FASL microsatellite (P-value 0.02, Bonferroni corrected). The FAS-670G>A was associated with homeostasis model assessment insulin resistance index and body mass index (P-values 0.02 and 0.02). We conclude that polymorphisms of FASL and FAS associate with type II diabetes and estimates of insulin resistance in Danish white subjects.     

Cell-matrix interactions improve beta-cell survival and insulin secretion in three-dimensional culture

Controlled matrix interactions were presented to pancreatic beta-cells in three-dimensional culture within poly(ethylene glycol) hydrogels. Dispersed MIN6 beta-cells were encapsulated in gel environments containing the following entrapped extracellular matrix (ECM) proteins: collagen type I, collagen type IV, fibrinogen, fibronectin, laminin, and vitronectin. In ECM-containing gels, beta-cell survival was significantly better than in gels without ECM over 10 days. Correspondingly, apoptosis in encapsulated beta-cells was less in the presence of each matrix protein, suggesting the ability of individual matrix interactions to prevent matrix signaling-related apoptosis (anoikis). MIN6 beta-cells cultured in gels containing collagen type IV or laminin secreted more insulin in response to glucose stimulation than beta-cells in all other experimental conditions. Variations in collagen type IV or laminin concentration between 10 microg/mL and 250 microg/mL did not affect insulin secretion. Finally, beta-cell function in hydrogels presenting both collagen type IV and laminin revealed synergistic interactions. With a total protein concentration of 100 microg/mL, three gel compositions of varying ratios of collagen type IV to laminin (25:75, 50:50, and 75:25) were tested. In the presence of 25 microg/mL of collagen type IV and 75 microg/mL of laminin, beta-cell insulin secretion was greater than with laminin or collagen type IV individually. These results demonstrate that specific, rationally designed extracellular environments promote isolated beta-cell survival and function.     

Susceptibility of insulin-secreting hepatocytes to the toxicity of pro-inflammatory cytokines.

The liver has been suggested as a suitable target organ for reversing type I diabetes by gene therapy. Whilst gene delivery systems to the hepatocyte have yet to be optimized in vivo, whether insulin-secreting hepatocytes are resistant to the autoimmune process that kills pancreatic beta-cells has never been addressed. One of the mechanisms by which beta-cells are killed in type I diabetes is by the release of the cytokines interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) by immune cells. To test the effect of the cytokines on insulin-secreting hepatocytes in vitro we exposed the betacyte, also called the HEP G2ins/g cell which possesses cytokine receptors and can synthesize, store and secrete insulin in a regulated fashion to a glucose stimulus, to the above mentioned cytokines for 14 days. Viability of the HEP G2ins/g cells was similar to that of other liver cell lines/primary cells which were more resistant to the cytokines than the beta-cell line NIT-1. The cytokines had no adverse effect for the first six days on insulin secretion, content and mRNA levels of the HEP G2ins/g cells and insulin secretion in response to 1-h exposure to 20 mM glucose was enhanced 14-fold. Our results indicate that genetically engineered hepatocytes and primary liver cells are more resistant than pancreatic beta-cells to the adverse effects of cytokines offering hope that insulin secreting hepatocytes in vivo made by gene therapy are less likely to be destroyed by cytokines released during autoimmune destruction.     

Pulsatile intravenous insulin therapy: The best practice to reverse diabetes complications?

In the basal state and after oral ingestion of carbohydrate, the normal pancreas secretes insulin into the portal vein in a pulsatile manner. The end organ of the portal vein is the liver, where 80% of pancreatic insulin is extracted during first pass. In Type 1 diabetes, pancreatic insulin secretion is nearly or completely absent whilst in Type 2 diabetes the normal pattern is absent, abnormal, or blunted. Exogenous subcutaneous insulin treatment results in plasma insulin concentrations that are not pulsatile and a fraction of normal portal vein levels. Oral hypoglycemic agents also do not result in normal pulsatile response to a glucose load. Due to hypoglycemia risk, intensive treatment is not recommended after serious complications develop. Consequently, no conventional therapy has proved effective in treating advanced diabetes complications. Beta-cell replacement using whole pancreas or islet transplantation has been utilized to treat certain problems in Type 1 diabetic patients, but still unavailable for all diabetics. Pulsatile intravenous insulin therapy (PIVIT) is an insulin therapy, which mimics the periodicity and amplitude of normal pancreatic function. Numerous studies show PIVIT effective in preventing, reversing, and reducing the severity and progression of diabetes complications, however, the mechanisms involved with the improvement are not clearly understood. Here, we review the cellular basis of normal and abnormal insulin secretion, current treatments available to treat diabetes, the physiologic basis of PIVIT and possible mechanisms of action.     

A gene expression network model of type 2 diabetes links cell cycle regulation in islets with diabetes susceptibility

Insulin resistance is necessary but not sufficient for the development of type 2 diabetes. Diabetes results when pancreatic beta-cells fail to compensate for insulin resistance by increasing insulin production through an expansion of beta-cell mass or increased insulin secretion. Communication between insulin target tissues and beta-cells may initiate this compensatory response. Correlated changes in gene expression between tissues can provide evidence for such intercellular communication. We profiled gene expression in six tissues of mice from an obesity-induced diabetes-resistant and a diabetes-susceptible strain before and after the onset of diabetes. We studied the correlation structure of mRNA abundance and identified 105 co-expression gene modules. We provide an interactive gene network model showing the correlation structure between the expression modules within and among the six tissues. This resource also provides a searchable database of gene expression profiles for all genes in six tissues in lean and obese diabetes-resistant and diabetes-susceptible mice, at 4 and 10 wk of age. A cell cycle regulatory module in islets predicts diabetes susceptibility. The module predicts islet replication; we found a strong correlation between (2)H(2)O incorporation into islet DNA in vivo and the expression pattern of the cell cycle module. This pattern is highly correlated with that of several individual genes in insulin target tissues, including Igf2, which has been shown to promote beta-cell proliferation, suggesting that these genes may provide a link between insulin resistance and beta-cell proliferation.     

Intermittent hypoxia reverses the diurnal glucose rhythm and causes pancreatic beta-cell replication in mice

Obstructive sleep apnoea (OSA) and type 2 diabetes frequently co-exist and potentially interact haemodynamically and metabolically. However, the confounding effects of obesity have obscured the examination of any independent or interactive effects of the hypoxic stress of OSA and the hyperglycaemia of type 2 diabetes on haemodynamic and metabolic outcomes. We have developed a chronically catheterized, unhandled, lean murine model to examine the effects of intermittent hypoxic (IH) exposure and exogenous glucose infusion on the diurnal pattern of arterial blood pressure and blood glucose, as well as pancreatic beta-cell growth and function. Four experimental groups of adult male C57BL/J mice were exposed to 80 h of (1) either IH (nadir of inspired oxygen 5-6% at 60 cycles h(-1) for 12 h during light period) or intermittent air (IA; control) and (2) continuous infusion of either 50% dextrose or saline (control). IH exposure during saline infusion caused a sustained increase in arterial blood pressure of 10 mmHg (P < 0.0001), reversed the normal diurnal rhythm of blood glucose (P < 0.03), doubled corticosterone levels (P < 0.0001), and increased replication of pancreatic beta-cells from 1.5 +/- 0.3 to 4.0 +/- 0.8% bromodeoxyuridine (BrdU)-positive) beta-cells. The combined stimulus of IH exposure and glucose infusion attenuated the hypertension, exacerbated the reversed diurnal glucose rhythm, and produced the highest rates of apoptosis in beta-cells, without any additive effects on beta-cell replication. We conclude that, in contrast to the development of sustained hypertension, IH impaired glucose homeostasis only during periods of hypoxic exposure. IH acted as a stimulus to pancreatic beta-cell replication, but the presence of hyperglycaemia may increase the hypoxic susceptibility of beta-cells. This model will provide a basis for future mechanistic studies as well as assessing the metabolic impact of common comorbities in OSA, including obesity, insulin resistance and type 2 diabetes.     

IL-1beta,IFN-gamma and TNF-alpha increase vulnerability of pancreatic beta cells to autoimmune destruction

In the pathogenesis of type-1 diabetes insulin-producing beta-cells are destroyed by cellular autoimmune processes. The locality of beta-cell destruction is the inflamed pancreatic islet. During insulitis cytokines released from islet-infiltrating mononuclear cells affect beta-cells at several levels. We investigated whether cytokine-induced beta-cell destruction is associated with changes in the expression of the surface receptors intercellular adhesion molecule (ICAM)-1 and Fas. Islets from diabetes-prone and congenic diabetes-resistant BB rats were exposed to interleukin (IL)-1beta alone or in combination with interferon (IFN)-gamma plus tumour necrosis factor (TNF)-alpha. Cytokines decreased islet insulin content, suppressed glucose stimulated insulin secretion and generated enhanced amounts of nitric oxide and DNA-strand breaks. While no membrane alterations of IL-1beta treated islets cells were detectable, the cytokine combination caused damage of cell membranes. Independent of diabetes susceptibility IL-1beta treated islet beta-cells expressed a significantly increased amount of ICAM-1 on their surfaces which was not further increased by IFN-gamma+TNF-alpha. However, IL-1beta induced Fas expression was significantly enhanced only on beta-cells from diabetes-prone BB rats. From these results we suggest that IL-1beta mediates the major stimulus for ICAM-1 induction which is possibly a necessary but not sufficient step in the process of beta-cell destruction. Obviously, the additional enhancement of Fas expression on the surface of beta-cells is important for destruction. The combined action of all three cytokines induced the expression of Fas on the beta-cell surface independent of diabetes susceptibility, indicating that such a strong stimulus in vitro may induce processes different from the precise mechanisms of beta-cell destruction in vivo.     

2型糖尿病一级亲属不同糖耐量者第一时相胰岛素分泌功能的变化

目的：探讨胰岛素分泌功能和胰岛素抵抗（IR）在2型糖尿病（T2DM）发生、发展中的作用。 方法： T2DM一级亲属正常糖耐量（NGT+）组32例，T2DM一级亲属糖耐量异常（IGT+）组36例，新诊断的T2DM组35例，计算各组的第一时相胰岛素分泌功能指数（AIR3-5）及胰岛素敏感性指数（SIM），与无糖尿病家族史的正常糖耐量（NGT-）组（38例）比较。 结果： T2DM一级亲属T2DM组、IGT+和NGT+组AIR3-5均低于NGT-组（P值分别为<0.01、<0.01、＜0.05）；T2DM组和IGT+组SIM均低于NGT-组（均P<0.01），而NGT+组SIM值与NGT-组比较无统计学差异（P>0.05）。结论： 胰岛素分泌功能缺陷可能是T2DM发病的始动因素。当发展为IGT及T2DM时，胰岛素分泌功能进一步降低，并伴有胰岛素敏感性的降低。     

肥胖对不同糖耐量者第一时相胰岛素分泌功能的影响

 目的： 探讨肥胖对不同糖耐量人群第一时相胰岛素分泌功能的影响。方法： 无糖尿病家族史的正常糖耐量者(正常对照,NC)38例、2型糖尿病一级亲属正常糖耐量(NGT)者32例、糖调节受损(IGR)者67例及新诊断的2型糖尿病(T2DM)患者35例参与本试验。这4个组再分为超重/肥胖及正常体重2个亚组。各组均行静脉葡萄糖耐量试验（IVGTT）和口服葡萄糖-胰岛素释放试验（OG-IRT）,计算第一时相胰岛素分泌功能指数(AlR3-5)及胰岛素敏感性指数（ISI）,分析肥胖对不同糖耐量人群胰岛β细胞功能及胰岛素抵抗的影响。结果： NC超重/肥胖亚组较正常体重亚组AIR3-5显著升高（P<0.05）,其余3对亚组间比较差异均无统计学意义（均P>0.05）。超重/肥胖亚组ISI较正常体重亚组有降低趋势,其中IGR两亚组间比较差异无统计学意义（P>0.05）,其余3对亚组间比较差异均有统计学意义（均P<0.05）。ISI与体重指数和腰围在各组均呈负相关（P<0.05）,与AIR3-5在NC组呈负相关（P<0.05）,而在其余各组均呈正相关（均P<0.05）。结论： 肥胖对不同糖耐量人群胰岛β细胞分泌功能影响各不相同。无糖尿病家族史的正常糖耐量者随着胰岛素抵抗的加重,第一时相胰岛素分泌功能代偿性增加,而2型糖尿病一级亲属正常糖耐量者、糖调节受损者和2型糖尿病患者则不能代偿性增加。     

Oxidative stress and beta-cell dysfunction

Diabetes mellitus type 1 and 2 (T1DM and T2DM) are complex multifactorial diseases. Loss of beta-cell function caused by reduced secretory capacity and enhanced apoptosis is a key event in the pathogenesis of both diabetes types. Oxidative stress induced by reactive oxygen and nitrogen species is critically involved in the impairment of beta-cell function during the development of diabetes. Because of their low antioxidant capacity, beta-cells are extremely sensitive towards oxidative stress. In beta-cells, important targets for an oxidant insult are cell metabolism and K_ATP channels. The oxidant-evoked alterations of K_ATP channel activity seem to be critical for oxidant-induced dysfunction because genetic ablation of K_ATP channels attenuates the effects of oxidative stress on beta-cell function. Besides the effects on metabolism, interference of oxidants with mitochondria induces key events in apoptosis. Consequently, increasing antioxidant defence is a promising strategy to delay beta cell failure in (pre)-diabetic patients or during islet transplantation. Knock-out of K_ATP channels has beneficial effects on oxidant-induced inhibition of insulin secretion and cell death. Interestingly, these effects can be mimicked by sulfonylureas that have been used in the treatment of T2DM for many years. Loss of functional K_ATP channels leads to up-regulation of antioxidant enzymes, a process that depends on cytosolic Ca²⁺. These observations are of great importance for clinical intervention because they show a possibility to protect beta-cells at an early stage before dramatic changes of the secretory capacity and loss of cell mass become manifest and lead to glucose intolerance or even overt diabetes.     

The R6/2 transgenic mouse model of Huntington's disease develops diabetes due to deficient beta-cell mass and exocytosis

Diabetes frequently develops in Huntington's disease (HD) patients and in transgenic mouse models of HD such as the R6/2 mouse. The underlying mechanisms have not been clarified. Elucidating the pathogenesis of diabetes in HD would improve our understanding of the molecular mechanisms involved in HD neuropathology. With this aim, we examined our colony of R6/2 mice with respect to glucose homeostasis and islet function. At week 12, corresponding to end-stage HD, R6/2 mice were hyperglycemic and hypoinsulinemic and failed to release insulin in an intravenous glucose tolerance test. In vitro, basal and glucose-stimulated insulin secretion was markedly reduced. Islet nuclear huntingtin inclusions increased dramatically over time, predominantly in beta-cells. beta-cell mass failed to increase normally with age in R6/2 mice. Hence, at week 12, beta-cell mass and pancreatic insulin content in R6/2 mice were 35+/-5 and 16+/-3% of that in wild-type mice, respectively. The normally occurring replicating cells were largely absent in R6/2 islets, while no abnormal cell death could be detected. Single cell patch-clamp experiments revealed unaltered electrical activity in R6/2 beta-cells. However, exocytosis was virtually abolished in beta- but not in alpha-cells. The blunting of exocytosis could be attributed to a 96% reduction in the number of insulin-containing secretory vesicles. Thus, diabetes in R6/2 mice is caused by a combination of deficient beta-cell mass and disrupted exocytosis.     

Inherent beta-cell dysfunction induced by transgenic expression of allogeneic major histocompatibility complex class I antigen in islet cells.

Insulin-dependent diabetes mellitus (IDDM) is generally believed to be an autoimmune disease resulting from T-cell dysfunction that produces beta-cell damage, but it is conceivable that some forms of IDDM are not immunologically mediated. The effect of the expression of a foreign transgenic MHC class I antigen (H-2Kb), restricted to pancreatic islet beta-cells, was tested in vitro and in nude (athymic) mice to determine whether beta-cell dysfunction was due to non-immune mechanisms. The models used clearly excluded immune involvement in beta-cell damage. Fetal pancreas from transgenic and littermate control mice was maintained in organ culture for up to 18 days and insulin secretion into the medium assessed. For the initial 3-4 days in vitro, fetal control and transgenic pancreas secreted similar amounts of insulin, but thereafter insulin secretion by the transgenic tissue decreased in comparison with the controls. When the cultured pancreas was transplanted into nude mice, the transgenic issue produced smaller grafts than the control pancreas, but there was wide variation in graft size. Expression of H-2Kb antigens in beta-cells of nude transgenic mice also resulted in early-onset diabetes. The insulin content in the pancreas of young H-2Kb transgenic euthymic mice, (previously shown not to have insulitis), was reduced but glucagon content was normal. The reduction in in vivo insulin production was similar chronologically to the reduced insulin production by transgenic islets in vitro. These data confirm the non-immune loss of beta-cell function in MHC-transgenic mice and they may be a model for atypical Type I diabetes.     

Hypoxic damage to pancreatic beta cells--the hidden link between sleep apnea and diabetes

Despite a large body of epidemiologic and clinical evidence suggesting that sleep disordered breathing is an independent risk factor for development of type 2 diabetes (T2DM), the underlying pathogenesis of altered glucose metabolism in sleep apnea remains to be unraveled. While previous studies have proposed some causal pathways linking sleep apnea with T2DM through increased insulin resistance and deterioration in insulin sensitivity, there has been a particular lack of research into sleep apnea-related alterations in pancreatic beta-cell function.Drawing upon our previous observation that sleep apnea is independently associated with an increased basal pancreatic beta-cell function in adults with normal glucose metabolism [1], the idea presented here suggests that sleep apnea imposes an excessive demand for insulin secretion, which may lead to progressive pancreatic beta-cell failure in high-risk individuals. Specifically, we hypothesize that in addition to diabetogenic effects of acute hypoxic activation of the sympathetic nervous system, the chronic intermittent hypoxemia represses the expression of key genes regulating biosynthesis of pancreatic proinsulin convertases with a resultant progressive decrease in their catalytic activity. The long-term hypoxic damage to pancreatic beta-cells may thus contribute to progression of glucose dysregulation in persons with untreated sleep apnea over time.Strategies to prevent and decrease the high prevalence and associated morbidity of T2DM are critically needed. The ideas and hypotheses presented here address the unexplored pathophysiological mechanisms underlying the potential causal link between sleep apnea and T2DM. Future hypotheses-testing will seek to delineate the role of sleep apnea in the development of T2DM, probe the underlying molecular mechanisms for pancreatic beta-cell dysfunction in sleep apnea, and obtain information on clinical, epidemiologic, and other factors responsible for protecting individuals from alterations in insulin-glucose homeostasis. These results could further be utilized in testing genetic susceptibilities and various therapy modalities to prevent pancreatic beta-cell dysfunction and maintain normal glucose status in persons with sleep apnea in the long term.     

Streptozotocin-induced pancreatic insulitis in mice. Morphologic and physiologic studies.

Pancreatic insulitis and diabetes mellitus were induced in Charles River CD-1 mice with five subdiabetogenic injections of streptozotocin. Plasma glucose and immunoreactive insulin levels were measured and animals were sacrificed at intervals for morphologic studies of pancreatic islets and measurements of extractable pancreatic immunoreactive insulin. Light microscopy revealed striking insulitis, 5 to 6 days after streptozotocin injections, with cell necrosis and eventual islet atrophy due to beta-cell necrosis, and numerous type C viruses within many of the surviving beta-cells. Light microscopic immunoperoxidase stains of islet cell hormones and electron microscopy identified relatively increased numbers of alpha- and delta-cells within the atrophic islets 6 and 12 months after streptozotocin injections. Plasma glucose, plasma immunoreactive insulin, and extractable pancreatic immunoreactive insulin measurements documented the persistence of profound hyperglycemia, as well as the reduction of plasma and pancreatic immunoreactive insulin levels. Immunofluorescence studies demonstrated the absence of circulating islet cell antibodies during both the acute and chronic stages of the syndrome. The pathogenesis of this model of insulin-deficient diabetes is believed to be a cell-mediated autoimmune reaction directed against pancreatic beta-cells altered by subdiabetogenic injections of streptozotocin. The importance of the increased number of type C viruses within surviving beta-cells remains obscure.     

Endoplasmic reticulum stress signaling in pancreatic beta-cells

Pancreatic beta-cells are specialized for the production and regulated secretion of insulin to control blood-glucose levels. Increasing evidence indicates that stress-signaling pathways emanating from the endoplasmic reticulum (ER) are important in the maintenance of beta-cell homeostasis. Under physiological conditions, ER stress signaling has beneficial effects on beta-cells. Timely and proper activation of ER stress signaling is crucial for generating the proper amount of insulin in proportion to the need for it. In contrast, chronic and strong activation of ER stress signaling has harmful effects, leading to beta-cell dysfunction and death. Therefore, to dissect the molecular mechanisms of beta-cell failure and death in diabetes, it is necessary to understand the complex network of ER stress-signaling pathways. This review focuses on the function of the ER stress-signaling network in pancreatic beta-cells.