Glucose-induced secretion of ACTH-like products by rat pancreatic islets

Diabetes mellitus: a risk factor for pancreatic cancer?

The relationship between pancreatic cancer (PC) and diabetes is controversial. While some investigators assume that type II diabetes is a predisposition to PC, recent data argue that diabetes and altered glucose metabolism are a consequence of PC, and yet, the clinical presentation of the altered glucose metabolism in these patients varies considerably. Around 70% of patients with PC have impaired glucose tolerance (IGT) or frank diabetes. Of these, nearly 60% show an improvement of IGT or diabetes after surgery, whereas the rest show only mild or no improvement. It appears that biologically there are three types of PC: (1) PC not associated with IGT or diabetes; (2) PC associated with IGT or diabetes in which the abnormality improves postoperatively; (3) PC associated with IGT or diabetes in which the abnormality does not improve postoperatively. Based on our own studies, we suggest that the reason for impaired glucose metabolism in most patients is the alteration of islet cells either by the carcinogen directly, or by diabetogenic substances released by cancer cells. The extent of the islet alteration (i.e. focal or diffuse) may determine whether the removal of tumor alone can improve the metabolic alteration. The elucidation of the mechanism is of immense importance for providing an early tumor marker and for developing preventative or therapeutic modalities.

Diabetes and its relationship to pancreatic carcinoma

INTRODUCTION

The mechanism of impaired glucose metabolism that develops in most patients with pancreatic cancer (PC) is obscure and the association between PC and diabetes is controversial. According to the published data, about 70% of patients with PC have an impaired glucose tolerance (IGT) or frank diabetes, whereas 30% do not. Up to 60% of the patients with IGT or diabetes show improvement in glucose metabolism after surgery, whereas other patients show only mild or no improvement.

AIM

To investigate our theory that there are three types of PC: 1) PC not associated with IGT or diabetes (IGT- subtype, approximately 20-30%); 2) PC associated with IGT or diabetes (IGT+ subtype, approximately 70-80%), in which the abnormality improves postoperatively (IGT+/- subtype, approximately 40-60%); or 3) PC associated with IGT or diabetes that does not improve after the tumor resection (IGT+/+ subtype, approximately 40-60%).

METHODOLOGY AND RESULTS

The review of the literature and our own experience, which is the subject of this article, suggests that the reason for impaired glucose metabolism in most patients is the alteration of islet cells, from which, in our view, cancer cells develop. There is a good possibility that the altered islet cells, and/or tumors derived from them, produce diabetogenic substances. The extent of the islet alteration (i.e., focal or diffuse) may determine whether the removal of the tumor alone can improve the metabolic alteration.

CONCLUSION

The elucidation of the mechanism is of immense importance for providing an early tumor marker and for developing preventative and therapeutic modalities.

PP/PYY cells from endocrine pancreas of the scincid lizard Eumeces inexpectatus synthesize ACTH- and alpha-MSH-like molecules

The endocrine pancreas of the scincid lizard Eumeces inexpectatus secretes four major hormones, insulin, glucagon, somatostatin, and pancreatic polypeptide (PP); in addition, other peptides and neuropeptides, often colocalized in one of the principal cell types (A, B, D, and PP), were detected by light and ultrastructural immunocytochemistry. In particular, the pancreas is rich in peptide tyrosine tyrosine (PYY), ACTH, and alpha-MSH immunoreactivity. When single- and double-immunolabeled serial sections were compared for immunostaining for PP, PYY, ACTH, and alpha-MSH, there was broad coincidence with PP, termed PP/PYY, cells in view of the extensive colocalization of these two peptides. Furthermore, ultrastructural morphometric studies revealed similar secretory granules for PP immunoreactive (ir) and ACTH ir cells, while the endocrine cells express pro-opiomelanocortin (POMC) mRNA, indicating an active, extrapituitary synthesis of the POMC-derived peptides in these cells. In conclusion, the presence of POMC-derived peptides in the endocrine pancreatic cells suggests that they may regulate insulin secretion.

Evidence for the paracrine action of islet-derived corticotropin-like peptides on the regulation of insulin release

In view of recent evidence for the endogenous synthesis of proopiomelanocortin (POMC) by pancreatic islets, we have assessed (1) the release of POMC-derived corticotropin (ACTH)-like peptides (ACTH-LP) from isolated perifused rat islets, and (2) the potential paracrine modulatory effect on insulin output of these putative secretagogues. Islets perifused at a glucose concentration of 3.3 mmol/L secreted ACTH-LP at 0.15 +/- 0.005 ng/islet/10 min, which was increased by 17-fold at 16.7 mmol/L glucose. Islets statically incubated with different concentrations of medium glucose plus synthetic 1-39ACTH at 55 pmol/L showed a significant increase of insulin release at 8 (by 79%) and 16 (by 119%) mmol/L glucose, but not at 4 mmol/L. To determine the possible cis-directed effects of these endogenously released islet ACTH-LP on insulin secretion, we either blocked their biological action by immunoneutralization with an ACTH-specific antiserum or prevented their receptor interaction by addition of the ACTH-inhibiting polypeptide (CIP) to the incubation medium. In the presence of 16.7 mmol/L glucose, the rate of insulin output decreased by approximately 25% upon exposure to the antiserum and by approximately 50% in the presence of CIP. The foregoing observations would therefore suggest that both (1) the elaboration of ACTH-LP by isolated perifused islets and (2) the stimulation of islet insulin release by exogenous 1-39ACTH in static incubation occur as a function of glucose concentration in the incubation medium, and that (3) the newly-secreted endogenous ACTH-LP operate in a cis mode to enhance islet insulin output in a manner analogous to that of exogenously added ACTH species. These results strongly support the view that islet-elaborated ACTH-LP are important physiological paracrine modulators of insulin secretion.