Beta cell mass in diabetes: a realistic therapeutic target?

Metabolic consequences of a 50% partial pancreatectomy in humans

AIMS/HYPOTHESIS

Partial pancreatectomy is frequently performed in patients with pancreatic tumours or chronic pancreatitis, but little is known about the metabolic impact of this intervention. We examined the effects of approximately 50% partial pancreatectomy on glucose homeostasis and insulin secretion.

METHODS

Fourteen patients with chronic pancreatitis, ten patients with pancreatic carcinoma and 13 patients with benign pancreatic tumours or extra-pancreatic masses (control group) underwent 240 min oral glucose tolerance tests before and after pancreatic tail-resection (n = 12), duodenopancreatectomy (n = 19) or duodenum-preserving pancreatic-head resection (n = 6).

RESULTS

Partial pancreatectomy led to a reduction in post-challenge insulin excursions by 49% in chronic pancreatitis patients, 52% in carcinoma patients and 55% in controls (p < 0.05). Nevertheless, post-challenge glucose concentrations were transiently ameliorated after surgery (p < 0.001). In the control participants, pancreatic-head resection caused a transient reduction of post-challenge glycaemia, whereas pancreatic-tail resection increased both fasting and post-challenge glycaemia (p < 0.05). Insulin sensitivity was highest in chronic pancreatitis patients before surgery (p < 0.01), but remained unchanged by the partial pancreatectomy. High pre-operative body weight and elevated fasting glucose levels were associated with poor glycaemic control after surgery.

CONCLUSIONS/INTERPRETATION

Insulin secretion is diminished after pancreatic-head and -tail resection, but post-challenge glucose concentrations can be ameliorated after pancreatic-head resection. These data highlight the unequal impact of different surgical procedures on glucose control and suggest that obesity and high pre-operative glucose levels should be considered as risk factors for the development of hyperglycaemia after pancreatic surgery.

An update on preventive and regenerative therapies in diabetes mellitus

Type 1A (immune-mediated) and type 2 diabetes mellitus are two of the most common severe chronic illnesses, affecting over 230 million people worldwide with an estimated global prevalence of 5.1%. Although type 1 and type 2 diabetes differ greatly in modes of pathogenesis, these illnesses share a common pathology and consequences characterized by loss of functional beta-cell mass and subsequent dysregulation of carbohydrate and lipid metabolism. Since therapy for diabetes and the associated complications poses enormous public health and economic burdens, novel preventive and regenerative therapies have emerged in the past decade with the aim to preserve beta-cell mass and delay the onset of diabetes. The goal of this review is to provide a comprehensive overview of current efforts in the fight against diabetes, and attempts to document all strategies that have emerged in clinical studies within the past 25 years. First, strategies to identify individuals at risk, ranging from whole-genome scans to autoantibody screening, will be discussed. Second, novel approaches to prevent or delay the onset of disease will be covered. Particular focus is given on emerging strategies for individuals at risk for type 1 diabetes that target T-cell regulation and induction of tolerance, while new pharmaceutical concepts in combination with lifestyle interventions are discussed within the scope of type 2 diabetes prevention. Lastly, important efforts to halt disease progression with emphasis on beta-cell regeneration are presented.

Anti-diabetic Agents in Type 2 Diabetes: A Review of New Data Presented and Discussed on the EASD meeting in Rome, 2008

The results of a number of large trials and the arrival of new glucose-lowering drugs are changing the scene of diabetes care in patients with type 2 diabetes. The results of the ADVANCE and ACCORD trials have shown that strict glycemic control does not improve macrovascular outcome. Consequently, the importance of duration of disease, presence of cardiovascular disease and risk of hypoglycemia, have been brought again into focus as considerations in designing individual treatment plans.. New drugs related to the incretin system have emerged in the past year, and these may decrease certain risks of classic glucose-lowering drugs. However, we have to be aware of the possibility of yet unknown longer-term risks from newly developed drugs. The new insights from the trials presented on the EASD meeting 2008 and the emerging information on the new drugs are used in this paper to start defining the contours of prospective new treatment strategies.

The hyperbolic effect of density and strength of inter beta-cell coupling on islet bursting: a theoretical investigation

BACKGROUND

Insulin, the principal regulating hormone of blood glucose, is released through the bursting of the pancreatic islets. Increasing evidence indicates the importance of islet morphostructure in its function, and the need of a quantitative investigation. Recently we have studied this problem from the perspective of islet bursting of insulin, utilizing a new 3D hexagonal closest packing (HCP) model of islet structure that we have developed. Quantitative non-linear dependence of islet function on its structure was found. In this study, we further investigate two key structural measures: the number of neighboring cells that each beta-cell is coupled to, nc, and the coupling strength, gc.

RESULTS

BETA-cell clusters of different sizes with number of beta-cells nbeta ranging from 1-343, nc from 0-12, and gc from 0-1000 pS, were simulated. Three functional measures of islet bursting characteristics--fraction of bursting beta-cells fb, synchronization index lambda, and bursting period Tb, were quantified. The results revealed a hyperbolic dependence on the combined effect of nc and gc. From this we propose to define a dimensionless cluster coupling index or CCI, as a composite measure for islet morphostructural integrity. We show that the robustness of islet oscillatory bursting depends on CCI, with all three functional measures fb, lambda and Tb increasing monotonically with CCI when it is small, and plateau around CCI = 1.

CONCLUSION

CCI is a good islet function predictor. It has the potential of linking islet structure and function, and providing insight to identify therapeutic targets for the preservation and restoration of islet beta-cell mass and function.