Interactions between autonomic nerves and endocrine cells of the gastroenteropancreatic system

Autonomic nervous system dysfunction in Prader-Willi syndrome

INTRODUCTION

Prader-Willi syndrome is a complex neurodevelopmental genetic disorder due to lack of paternal expression of critical imprinted genes in the 15q11.2-q13.1 chromosomal region, generally from a paternal deletion. Predominant features include infantile hypotonia, a poor suck with failure to thrive, craniofacial features, and developmental and behavioral problems including self-injury and childhood onset of obesity. In addition to severe obesity, patients with PWS present with other symptoms of autonomic nervous system dysfunction.

METHODS

We examined the features seen in Prader-Willi syndrome and searched the literature for evidence of autonomic nervous system involvement in this rare obesity-related disorder and illustrative findings possibly due to autonomic nervous system dysfunction. Additionally, we reviewed the literature in relation to childhood obesity syndromes and compared those syndromes to the syndromic obesity found in Prader-Willi syndrome.

RESULTS

We report autonomic nervous system-related symptoms associated with childhood obesity impacting features seen in Prader-Willi syndrome and possibly other obesity-related genetic syndromes. We compiled evidence of both an autonomic route for the obesity seen in PWS and other autonomic nervous system-related dysfunctions. These include decreased salvation, sleep disordered breathing, increased pain and thermal threshold instability, delayed gastric emptying, altered blood pressure readings, and pupillary constriction responses as evidence of autonomic nervous system involvement.

CONCLUSIONS

We summarized and illustrated findings of autonomic nervous system dysfunction in Prader-Willi syndrome and other obesity-related syndromes and genetic factors that may play a causative role in development.

Autonomic nervous system dysfunction in obesity and Prader-Willi syndrome: current evidence and implications for future obesity therapies

The autonomic nervous system (ANS) controls essential functions like breathing, heart rate, digestion, body temperature and hormone levels. Evidence suggests that ANS dysfunction is associated with adult and childhood obesity and plays a role in the distribution of total body fat and the development of obesity-related complications in humans. This review summarizes our current understanding of ANS involvement in the pathogenesis of obesity and Prader-Willi syndrome. Available evidence of ANS dysfunction in the control of energy balance is limited and, in some cases, contradictory. Further investigation in this area is warranted in order to better understand the important contributions of the ANS to regulation of body fat, development of obesity and its comorbidities. Results from these studies will guide the development of novel obesity therapeutics targeting specific ANS dysfunction.

VMAT2 quantitation by PET as a biomarker for beta-cell mass in health and disease

The common pathology underlying both type 1 and type 2 diabetes (T1DM and T2DM) is insufficient beta-cell mass (BCM) to meet metabolic demands. An important impediment to the more rapid evaluation of interventions for both T1DM and T2DM lack of biomarkers of pancreatic BCM. A reliable means of monitoring the mass and/or function of beta-cells would enable evaluation of the progression of diabetes as well as the monitoring of pharmacologic and other interventions. Recently, we identified a biomarker of BCM that is quantifiable by positron emission tomography (PET). PET is an imaging technique which allows for non-invasive measurements of radioligand uptake and clearance, is sensitive in the pico- to nanomolar range and of which the results can be deconvoluted into measurements of receptor concentration. For BCM estimates, we have identified VMAT2 (vesicular monoamine transporter type 2) as a biomarker and [(11)C] DTBZ (dihydrotetrabenazine) as the transporter's ligand. VMAT2 is highly expressed in beta-cells of the human pancreas relative to other cells of the endocrine and exocrine pancreas. Thus measurements of [(11)C] DTBZ in the pancreas provide an indirect measurement of BCM. Here we summarize our ongoing efforts to validate the clinical utility of this non-invasive approach to real-time BCM measurements.

[Frequency of diabetes mellitus and hyperglycemia in chagasic and non-chagasic women]

Medical records of > or = 40 years old female seen at University Hospital from June/93 to July/95 were submitted to a cross-sectional study. According to Chagas' disease tests, patients were divided into chagasic (n = 362) and controls (n = 285). Diabetes mellitus was defined on the basis of two fasting blood glucose levels > or = 140 mg/dl and hyperglycemia as fasting blood glucose > 110 mg/dl. Chagasic patients were divided into groups with the cardiac form of the disease (n = 179), with megas (n = 58), and asymptomatic (n = 125). Groups were compared by the chi 2 test, analysis of variance, Student's "t" test, and Kruskal-Wallis and Mann-Whitney tests. A significant difference was assumed when p < 0.05. Chagasic and control groups were matched for age, white color and body mass index. Diabetes mellitus was more prevalent in patients with the cardiac form of Chagas' disease than in controls, or patients with the megas or the asymptomatic form (15.1%, 7.4%, 7.4%, and 5.6%, respectively); the same was observed for hyperglycemia (37.4%, 26.7%, 25.9%, 27.2%), in agreement with the hypothesis that the reduced parasympathetic activity caused by Trypanosoma cruzi leads to relative sympathetic hyperactivity.

Plasma met-enkephalin levels in diabetic patients: influence of autonomic neuropathy

The presence of opioid peptides within pancreatic islets in several animal species and in humans suggests that these peptides could play a role in pancreatic endocrine secretion, influencing glucose metabolism. We measured plasma met-enkephalin (met-Enk) levels in eight neuropathic (four with insulin-dependent diabetes mellitus [IDDM] and four with non-insulin-dependent diabetes mellitus [NIDDM]) and eight nonneuropathic (four IDDM and four NIDDM) diabetic patients to study met-Enk secretion in diabetic patients with asymptomatic autonomic neuropathy. Plasma met-Enk levels were significantly lower in neuropathic compared with nonneuropathic patients both in the IDDM group (28.7 +/- 4.8 v 61.6 +/- 4.1 pg/mL, P < .0025) and in the NIDDM group (26.5 +/- 3.6 v 44.3 +/- 4.6 pg/mL, P < .0125). This study suggests that the presence of neuropathy in diabetic patients, even if asymptomatic, is associated with a significant decrease of plasma met-Enk levels, thus contributing to a worsening of metabolic control under stress conditions.

Intracerebroventricular administration of somatostatin octapeptide counteracts the hormonal and metabolic responses to stress in normal and diabetic dogs

Intracerebroventricular (ICV) injection of carbachol elicits hormonal and metabolic responses similar to moderate stress. In normal dogs, ICV carbachol stimulated marked counterregulatory hormone release, but altered plasma glucose only marginally because the marked increment in glucose production (Ra) was almost matched by the increment of utilization (Rd), even though plasma insulin was unchanged. In alloxan-diabetic dogs, Rd did not match Ra and plasma glucose increased substantially. Since somatostatin octapeptide (ODT8-SS) inhibits some sympathetic mechanisms of the stress response, we explored the extent to which ODT8-SS can alleviate the counterregulatory responses to stress induced by carbachol, and particularly whether it can restore glycemic control in diabetes. ODT8-SS (20 nmol) was ICV-injected (1) in normal dogs (n = 5), and (2) prior to ICV carbachol before (n = 7) and after (n = 6) the induction of alloxan-diabetes. ODT8-SS did not affect basal values, but when administered before ICV carbachol there were no significant increments in plasma epinephrine, cortisol, arginine vasopressin (AVP), insulin, glucose, or lactate. There were significant increases in norepinephrine, glucagon, Ra, Rd, and the glucose metabolic clearance rate (MCR), although they were much smaller than seen previously with ICV carbachol alone. After induction of alloxan-diabetes, Rd and MCR did not change with ICV ODT8-SS and carbachol as in normal dogs, but norepinephrine, epinephrine, glucagon, lactate, plasma glucose, and Ra increased, although with the exception of glucagon these increases were much smaller than seen previously with ICV carbachol alone. ODT8-SS administered before ICV carbachol in normal or diabetic animals resulted in increased free fatty acid (FFA) levels. The increases in glycerol were less than and those in FFA greater than seen previously with ICV carbachol alone. Since ODT8-SS does not alter basal counterregulatory hormone release but suppresses the release during stress, this is a useful probe to analyze some of the metabolic responses to stress. When the response to carbachol from our previous report is compared with the responses to carbachol + ODT8-SS, it is indicated that the stress-related increase in Ra was consistent with stimulation of the sympathetic nervous system, whereas increased Rd is related to an unknown stress-related neuroendocrine mechanism that requires a permissive effect of insulin, since it was not seen in the frankly diabetic animals. We hypothesize that the stress-induced increase in Rd occurs not only in muscle but also in adipocytes, and that the somatostatin-induced attenuation of Rd decreased FFA re-esterification and consequently markedly increased stress-induced FFA release.(ABSTRACT TRUNCATED AT 400 WORDS)

Ultrastructural characterization of a regular schwann-axon-islet complex after the autograft of pancreatic fragments into the spleen of the adult dog

After autotransplantation of pancreatic fragments into the dog's spleen, the morphogenesis of the reinnervating process has evolved as an highly differentiated model, reproducing the most peculiar and systematic relationships between schwann cells, axons, and islet cells reported in the dog's islet, despite it's modulation by the restrictive conditions derived from the intrasplenic location of the dispersed pancreatic tissue. The reinnervating process is described, emphasizing the peculiar ultrastructural features and topography of the schwann cells and of the axonal network that impose the concept of a true anatomical reinnervation, which make previsible the possibility of a very selective and direct neurochemical and/or electrotonic control of the engrafted islet cells. The schwann-axon-islet complexes are a very peculiar and regular arrangement between islet cells and nervous elements and are reproduced after the autotransplant without the engrafted ganglia, whose potential but aleatory contribution could not be unequivocally characterized. Axonal profiles or schwann cells on the abundant regenerated ductal-acinar structures were not identified.

Autonomic modulation of insulin levels in foetal sheep

The autonomic nervous system plays an important part in metabolic and circulatory adaptation of the foetus to changes in its intrauterine environment and after delivery. Foetal and neonatal glucose metabolism and insulin secretion are influenced by changes in humoral catecholamine levels as they may occur during asphyxia. To assess the role of neuronal and humoral sympathetic activity in foetal endocrine pancreatic regulation, chronically catheterized foetal sheep near term were chemically sympathectomized with 6-hydroxydopamine. Experiments were carried out in unanaesthetized foetal sheep in utero in the absence of uterine contractions. Insulin and glucose levels, blood gases, acid-base status and catecholamines were measured before, during and after a 2 min occlusion of uterine blood flow caused by mechanical constriction of the maternal aorta. Pancreatic blood flow was determined using radioactive labelled microspheres. During normoxaemia, insulin levels, pancreatic blood flow and glucose transport to the organ in sympathectomized foetuses were elevated compared with intact animals, whereas glucose concentrations did not show any significant differences. After the onset of asphyxia humoral catecholamine levels rose significantly in both groups. Insulin concentrations in the plasma of both intact and sympathectomized foetuses were no longer different indicating both indirect (blood flow and humoral catecholamine related) and direct (neurally mediated) sympathetic effects on pancreatic beta cells.

Contribution of neural intrapancreatic non-cholinergic non-adrenergic mechanisms to glucose-induced insulin release in the isolated rat pancreas

In the isolated rat pancreas the effect of intrapancreatic non-adrenergic non-cholinergic nerves was examined upon insulin, glucagon and somatostatin release during perturbations of perfusate glucose. Elevation of glucose from 1.6 to 8.3 mmol/l increased insulin and somatostatin secretion and inhibited glucagon release. The first phase of insulin secretion was significantly reduced by the neurotoxin tetrodotoxin to 55% of the controls (p < 0.05). The somatostatin response was attenuated by tetrodotoxin while the change of glucagon remained unaffected. In contrast the combined adrenergic and cholinergic blockade with atropine, phentolamine and propranolol (10(-5) mol/l) did not modify the insulin, glucagon and somatostatin response. When glucose was changed from 8.3 to 1.6 mmol/l, the reduction of insulin and somatostatin release was not modified by tetrodotoxin, but stimulation of glucagon was significantly attenuated by 60-70% (p < 0.03), which was similar to the effect of combined adrenergic and cholinergic blockade. Subsequently, the effect of neural blockade was examined during more physiological perturbations of perfusate glucose levels. When glucose was changed from 3.9 to 7.2 mmol/l, tetrodotoxin also attenuated first phase insulin response by 40% while cholinergic and adrenergic blockade had no effect. The nitric oxide synthase inhibitor NG-Nitro-L-arginine-methyl-ester (L-NAME) did not alter the glucose-induced insulin response indicating that nitric oxide is not involved in this mechanism. It is concluded that neural non-adrenergic non-cholinergic mechanisms contribute to the first, but not second phase of glucose-induced insulin release. Non-adrenergic non-cholinergic effects do not participate in regulation of glucagon and somatostatin secretion under the conditions employed.(ABSTRACT TRUNCATED AT 250 WORDS)

Hyperinsulinemia; a mediator of decreased food intake and weight loss in anorexia nervosa and major depression

Decreased food intake and weight loss are seen in eating and depressive disorders. No satisfactory pathophysiological mechanisms have been proposed to explain those findings. While it should be kept in mind that the etiology of those diseases is still unclear, it seems reasonable to propose that the maintenance of anorectic behavior in the eating disorders as well as the decreased food intake of major depression, leading to continued weight loss seen in both conditions, are either caused or mediated by insulin in levels which are elevated but insufficient to cause hypoglycemia. A brief review is made of the role of insulin in satiety and in the control of body weight, and of the newly available techniques to accurately quantify secretion, hepatic extraction, and post-hepatic delivery rates of insulin. Neural, metabolic, and endocrine stimuli affect insulin secretion. The hypothesis is therefore compatible with several etiologic factors leading to hyperinsulinemia in anorexia nervosa and major depression, and resulting in decreased food intake and weight loss.

Clinical aspects of diabetic neuropathies

Diabetic neuropathy is a common complication of diabetes that may be associated both with considerable morbidity (painful polyneuropathy, neuropathic ulceration) and mortality (autonomic neuropathy). The epidemiology and natural history of diabetic neuropathy is clouded with uncertainty, largely due to confusion in the definition and measurement of this disorder. We have reviewed a variety of the clinical manifestations associated with somatic and autonomic neuropathy and discussed current views related to the management of the different abnormalities. Although unproven, the best evidence suggests that near normal control of blood glucose in the early years following onset of diabetes may help delay the development of clinically significant nerve impairment. Intensive therapy to achieve normalization of blood glucose may also lead to reversibility of early diabetic neuropathy, but again this is unproven. Our ability to manage successfully the many different manifestations of diabetic neuropathy depends ultimately on our success in uncovering the pathogenic processes underlying this disorder. The recent resurgence of interest in the vascular hypothesis, for example, has opened up new avenues of investigation for therapeutic intervention. Paralleling our increased understanding of the pathogenesis of diabetic neuropathy, there must be refinements in our ability to measure quantitatively the different types of defects that occur in this disorder. These tests must be validated and standardized to allow comparability between studies and more meaningful interpretation of study results.

Insulin, glucagon and somatostatin secretion by cultured islets from normal and diabetic hamsters

The interhormonal relationship within the pancreatic islets have been studied by previous investigators, but the cellular interplay and the sequence of events in the islet cell's response to stimulators has remained unclear. In the present study, pancreatic islets were isolated by collagenase digestion from normal and streptozotocin-diabetic hamsters the latter being maintained with insulin treatment. The diabetic animals were used to provide A- and B-cell enriched islets. The islets from normal and diabetic hamsters were cultured in medium 199 plus 10% fetal calf serum with 0.8 or 5 mg/ml glucose. The cultures were maintained for up to seven days with medium changes every third day. At specified intervals, media were collected and assayed for insulin, glucagon and somatostatin. Our results showed the expected increased insulin secretion by the B-cells in response to high glucose. However, after two days of culture accumulative insulin secretory response was reduced and at the end of seven days was less than the insulin produced in low glucose medium. Glucagon secretion by the A-cells was similar for low and high glucose media for the entire culture period. Somatostatin secretion by D-cells was stimulated by high glucose but was attenuated after 2 days. No correlation could be found between the concentration of hormone in the media and a possible effect on a specific islet secretion. However, the fact that insulin secretion by islets cultured in high glucose was decreased after two days may indicate a refractoriness produced by persistent hyperglycemia. Islets isolated from diabetic animals secreted more glucagon and less insulin than control islets. Somatostatin secretion was the same in both groups. It was concluded that paracrine relationships were relatively insignificant in the regulation of islet secretion in a prolonged culture environment and persistent high glucose reduced the B-cell response to glucose stimulation.

Glucoregulatory effects of bombesin in lean and genetically obese hyperglycaemic (ob/ob) mice

1. Plasma glucose and insulin responses to bombesin were examined in 12-15-week-old 12 hr fasted lean and genetically obese hyperglycaemic (ob/ob) mice. 2. Bombesin (1 mg/kg ip) produced a prompt but transient increase of plasma insulin in lean mice (maximum increase of 50% at 5 min), and a more slowly generated but protracted insulin response in ob/ob mice (maximum increase of 80% at 30 min). Plasma glucose concentrations of both groups of mice were increased by bombesin (maximum increases of 40 and 48% respectively in lean and ob/ob mice at 15 min). 3. When administered with glucose (2 g/kg ip), bombesin (1 mg/kg ip) rapidly increased insulin concentrations of lean and ob/ob mice (maximum increases of 39 and 63% respectively at 5 min). Bombesin did not significantly alter the rise of plasma glucose after exogenous glucose administration to these mice. 4. The results indicate that bombesin exerts an insulin-releasing effect in lean and ob/ob mice. The greater insulin-releasing effect in ob/ob mice renders bombesin a possible component of the overactive entero-insular axis in the ob/ob mutant, especially if it acts within the islets as a neurotransmitter or paracrine agent.

Morphological and functional aspects of pancreatic islet innervation

Pancreatic islets are collections of 4 functionally-related endocrine cells distributed nonrandomly in the pancreas. Their major physiological actions center about the regulation of metabolic homeostasis. Experimental evidence shows that, in addition to circulating substates, the islets are controlled by outflow from the central nervous system communicated through autonomic nerves. Islet cells also interact with one another via hormonal messengers and, possibly, electrotonic impulses producing a complex--yet well-controlled--system for the integration of numerous types of signals. This paper is a brief review of some of the numerous interactions between the autonomic nervous system and the endocrine pancreas. Particular emphasis is placed on the role of recently discovered autonomic factors and newly recognized autonomic centers in the brain.

Glucose and insulin response to conditioned feeding in lean and genetically obese hyperglycemic (ob/ob) mice

The study reported here investigated the role of neuroendocrine reflexes in the stimulation of insulin secretion associated with feeding in lean and genetically obese hyperglycemic (ob/ob) mice. Twenty-week-old mice were conditioned over four weeks to restricted feeding periods of consecutively seven, four and two hours a day. Basal plasma glucose concentrations before feeding were raised in conditioned lean mice but lowered in conditioned ob/ob mice, with normalization of glycemia in ob/ob mice by four weeks. Conditioned mice consumed more food during the feeding period than control mice prefasted for the same time. Although the quantity of food consumed was less than the normal 24-hour intake of age-matched mice fed ad libitum, body weights were well maintained, indicating adaptations of metabolic efficiency or energy expenditure or both. During the feeding period, conditioned mice displayed a markedly enhanced plasma insulin response accompanied by a smaller increase in plasma glucose despite the consumption of more food. An anticipatory rise in plasma insulin was not evident when food was withheld during the prescribed two-hour feeding period after four weeks of conditioning. The results demonstrate that basal glucose concentrations were normalized in ob/ob mice but raised in lean mice by the restricted conditioned feeding procedure. Basal insulin concentrations and body weights were not significantly altered, but conditioning to expect food augmented the insulin response initiated by feeding in both lean and ob/ob mice.

Effects of adrenal demedullation combined with chemical sympathectomy on cold-induced responses of endocrine pancreas in rats

Adrenal demedullation combined with chemical sympathectomy with 6-hydroxydopamine (ACS) lowered plasma glucagon and insulin levels in rats. Acute cold exposure increased plasma glucagon in both ACS and control rats, while it increased plasma insulin only in ACS rats. ACS rats responded to cold with a smaller increase in plasma glycerol and a more pronounced elevation of plasma free fatty acids.

The cholinergic innervation of human pancreatic islets

The cholinergic innervation of pancreatic islets was investigated in the human using operatory samples. In order to analyze the nature of stained cholinergic nerve fibers some specimens were incubated in a solution containing 6-hydroxydopamine (6-HDA) to obtain a selective degeneration of adrenergic nerves. Cholinergic nerve fibers are present in human pancreatic islets, and appear to be organized in an external peri-insular plexus. Some nerve fibers from the peri-insular plexus enter the islets and seem to innervate directly various types of endocrine insular elements. The 6-HDA treatment does not alter the distribution pattern of cholinergic nerve fibers within pancreatic islets.