Different effects of octreotide by continuous night infusion at increasing rate or by evening injections at different times on morning hyperglycemia and growth hormone levels in insulin-dependent diabetic patients

Beta cell primary cilia mediate somatostatin responsiveness via SSTR3

Somatostatin is a paracrine modulator of insulin secretion and beta cell function with pleotropic effects on glucose homeostasis. The mechanism of somatostatin-mediated communication between delta and beta cells is not well-understood, which we address in this study via the ciliary somatostatin receptor 3 (SSTR3). Primary cilia are membrane organelles that act as signaling hubs in islets by virtue of their subcellular location and enrichment in signaling proteins such as G-protein coupled receptors (GPCRs). We show that SSTR3, a ciliary GPCR, mediates somatostatin suppression of insulin secretion in mouse islets. Quantitative analysis of calcium flux using a mouse model of genetically encoded beta cell-specific GCaMP6f calcium reporter shows that somatostatin signaling alters beta cell calcium flux after physiologic glucose stimulation, an effect that depends on endogenous SSTR3 expression and the presence of intact primary cilia on beta cells. Comparative in vitro studies using SSTR isoform antagonists demonstrate a role for SSTR3 in mediating somatostatin regulation of insulin secretion in mouse islets. Our findings support a model in which ciliary SSTR3 mediates a distinct pathway of delta-to-beta cell regulatory crosstalk and may serve as a target for paracrine modulation.

Circadian Variation in Efficacy of Medications

Although much has been learned about circadian clocks and rhythms over the past few decades, translation of this foundational science underlying the temporal regulation of physiology and behavior to clinical applications has been slow. Indeed, acceptance of the modern study of circadian rhythms has been blunted because the phenomenology of cyclic changes had to counteract the 20th century dogma of homeostasis in the biological sciences and medicine. We are providing this review of clinical data to highlight the emerging awareness of circadian variation in efficacy of medications for physicians, clinicians, and pharmacists. We are suggesting that gold-standard double-blind clinical studies should be conducted to determine the best time of day for optimal effectiveness of medications; also, we suggest that time of day should be tracked and reported as an important biological variable in ongoing clinical studies hereafter. Furthermore, we emphasize that time of day is, and should be considered, a key biological variable in research design similar to sex. In common with biomedical research data that have been historically strongly skewed toward the male sex, most pharmaceutical data have been skewed toward morning dosing without strong evidence that this is the optimal time of efficacy.

Expression of the five different somatostatin receptor subtypes in endocrine cells of the pancreas

Knowledge concerning tissue-specific expression of the five somatostatin receptor subtypes is of great importance in understanding their physiological function. We developed rabbit polyclonal antibodies specific for each human somatostatin receptor subtype and report our results concerning the expression in normal endocrine pancreatic cells. The antibodies were produced by immunizing rabbits with fragments specific for the five cloned somatostatin receptor subtypes. Colocalization of these somatostatin receptors with the four major islet hormones--insulin, glucagon, somatostatin, and pancreatic polypeptide--was studied in normal human endocrine pancreatic cells, using double-immunofluorescence staining. High expression of somatostatin receptor subtypes 1, 3, and 4 was found in all endocrine pancreatic cells. Somatostatin receptor subtype 2 was frequently expressed in alpha and beta cells, whereas expression was low in pancreatic polypeptide cells and intermediate in delta cells. Somatostatin receptor subtype 5 was expressed in most beta and delta cells but almost absent in alpha and pancreatic polypeptide cells. There is a variability in the normal expression of somatostatin receptor subtypes among the different human endocrine pancreatic cells. Knowledge of this expression and the physiological function mediated by these receptors will be valuable in the future when considering treatment of endocrine disorders.

Elevated serum growth hormone in a patient with Type 1 diabetes: a diagnostic dilemma

The biochemical confirmation of acromegaly is rarely difficult and is based on an elevated fasting serum growth hormone (GH) concentration, which fails to suppress in response to an oral glucose load. Impaired glucose tolerance and Type 2 diabetes are common in patients with acromegaly, however the development of acromegaly in a patient with pre-existing Type 1 diabetes has not been well documented. Poorly controlled Type 1 diabetes in non-acromegalic patients is associated with dysregulation of the hypothalamic-GH/insulin-like growth factor-1 (IGF-1) axis, leading to elevation of serum GH concentrations. Therefore the diagnosis of acromegaly in a Type 1 diabetic patient may be fraught with practical difficulties in performing and interpreting the results of an oral glucose tolerance test (OGTT) and other biochemical investigations. When, in addition, the clinical and radiological features of acromegaly are equivocal, the clinician is faced with a formidable diagnostic challenge. In this paper we report such a case, review the pathophysiology of hypersomatotrophinaemia in poorly controlled Type 1 diabetes, and recommend a diagnostic algorithm for the investigation of acromegaly in patients with diabetes.