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Background: The 65-kD isoform of glutamic acid decarboxylase (GAD) is a major autoantigen in patients with type 1 diabetes mellitus. This trial assessed the ability of alum-formulated GAD (GAD-alum) to reverse recent-onset type 1 diabetes in patients 10 to 18 years of age., Methods: We randomly assigned 70 patients with type 1 diabetes who had fasting C-peptide levels above 0.1 nmol per liter (0.3 ng per milliliter) and GAD autoantibodies, recruited within 18 months after receiving the diagnosis of diabetes, to receive subcutaneous injections of 20 microg of GAD-alum (35 patients) or placebo (alum alone, 35 patients) on study days 1 and 30. At day 1 and months 3, 9, 15, 21, and 30, patients underwent a mixed-meal tolerance test to stimulate residual insulin secretion (measured as the C-peptide level). The effect of GAD-alum on the immune system was also studied., Results: Insulin secretion gradually decreased in both study groups. The study treatment had no significant effect on change in fasting C-peptide level after 15 months (the primary end point). Fasting C-peptide levels declined from baseline levels significantly less over 30 months in the GAD-alum group than in the placebo group (-0.21 vs. -0.27 nmol per liter [-0.62 vs. -0.81 ng per milliliter], P=0.045), as did stimulated secretion measured as the area under the curve (-0.72 vs. -1.02 nmol per liter per 2 hours [-2.20 vs. -3.08 ng per milliliter per 2 hours], P=0.04). No protective effect was seen in patients treated 6 months or more after receiving the diagnosis. Adverse events appeared to be mild and similar in frequency between the two groups. The GAD-alum treatment induced a GAD-specific immune response., Conclusions: GAD-alum may contribute to the preservation of residual insulin secretion in patients with recent-onset type 1 diabetes, although it did not change the insulin requirement. (ClinicalTrials.gov number, NCT00435981.), (2008 Massachusetts Medical Society)

Background: this study set out to examine the effects of the treatment with 1,25-dihydroxyvitamin D3 (1,25D3) [150 IU/Kg (3.75 microg/Kg) one a day, for 15 days] to non-diabetic rats and in rats rendered diabetic by a single injection of streptozotocin [65 mg/kg]., Results: treatment with 1,25D3 to non-diabetic rats did not affect the biochemical parameters measured in the plasma and urine of these animals. Likewise, insulin receptor expression in the kidney, liver, or adipose tissue and insulin-stimulated glucose transport in adipocytes from these animals were not affected either. Treatment with 1,25D3 to streptozotocin-induced diabetic rats did not correct the hyperglycemia, hypoinsulinemia, glycosuria or ketonemia induced by the diabetes, although it partially reversed the over-expression of the insulin receptor gene in the liver and adipose tissue, without altering the normal expression of this gene in the kidney. These effects were accompanied by a normalization of the number of insulin receptors without altering receptor affinity but improving the insulin response to glucose transport in adipocytes from these diabetic animals. Moreover, a computer search in the rat insulin receptor promoter revealed the existence of two candidate vitamin D response element (VDRE) sequences located at -256/-219 bp and -653/-620 bp, the first overlapped by three and the second by four AP-2-like sites., Conclusion: these genomic actions of 1,25D3 could represent beneficial effects associated with the amelioration of diabetes via mechanisms that possibly involve direct transcriptional activation of the rat insulin receptor gene. The candidate VDREs identified may respond to 1,25D3 via activation of the vitamin D receptor, although this remains to be investigated.

An animal model of post-transplant diabetes was induced in rats by treating them daily with 0.1 mg/kg body weight of tacrolimus (FK506) in two i.p. injections. Rats developed hyperglycaemia and glucose intolerance after 9 days of treatment. Pancreatic islets, isolated from treated rats on different days, showed a decreased capacity to secrete insulin in response to 20 mM glucose at days 7 and 14. This suppression of insulin secretion was preceded by a reduction of the islet insulin content on day 5 that was progressively decreasing until the end of the treatment (day 14). Islet content of insulin mRNAs, transcribed from rat insulin genes 1 and 2, was strongly suppressed, similar to the insulin content, at days 7 and 14. Islet mass was not strikingly modified by tacrolimus treatment: the DNA content was slightly decreased at the end (day 14) and the rate of islet cell apoptosis slightly increased. Tacrolimus-induced diabetes in the rat seems to be mainly provoked by a decreased insulin gene transcription with little or no alteration of islet mass. This explains that the observed suppression of all the islet and animal parameters studied was completely reversed 2 weeks after interrupting tacrolimus treatment.

In an earlier study, we have reported an inhibition of insulin receptor (IR) mRNA levels and insulin binding by aldosterone in U-937 human promonocytic cells. In the present extension of our studies, we demonstrate that this inhibition by aldosterone had no effects on basal glucose transport or on basal thymidine incorporation into DNA, while the cell responsiveness reflected by the maximal response to insulin was decreased by 23% for glucose transport and by 31% for DNA synthesis after the aldosterone treatment. We also prove that this inhibition of the insulin response by aldosterone is mediated by a downregulation of the levels of mineralocorticoid receptors (MRs) (50% decrease) and their mRNA (50% decrease). In addition, the mineralocorticoid antagonist spironolactone reversed the decrease in MR mRNA levels elicited by aldosterone, which suggests the involvement of this receptor in the process., (Copyright 2002 John Wiley & Sons, Ltd.)

Objectives: To investigate the use of indwelling catheters as injection aids at diabetes onset to reduce injection pain and pre-injection anxiety., Study Design: Forty-one patients aged 8.1 +/- 3.7 years (range, 1-15) participated in this open, controlled randomized study. A 10-cm VAS with faces was used for scoring. A local anesthetic cream was used before all insertions. The control group used insulin pens with standard needles. After one week, the indwelling catheter group could choose regular injections but were included in the "intention to treat" analysis., Results: Injection pain and anxiety decreased from day 1 to 15 in both groups (average, 4.1 injections/day). Pain was significantly lower for indwelling catheter injections when scored by parents (median, 1.2 cm vs 2.7 cm; P =.002), children/teenagers (0.8 cm vs 1.5 cm; P =.006), and nurses (1.4 cm vs 3.0 cm; P =.002). Parental pre-injection anxiety was also lower (1.2 cm vs 2.9 cm; P =.016). Taking injections, including inserting catheters, was found to be less problematic with an indwelling catheter (1.6 cm vs 3.3 cm;P =.009). During the 6-month follow-up, injection pain and injection problems were significantly lower in the catheter group. Mean catheter indwelling time was 3.7 days. Median pain for catheter insertion was 2.1 cm and for glucose testing was 0.9 cm. Sixteen of 20 patients continued to use indwelling catheters after 2 weeks, and 9 of 20 after 6 months., Conclusions: We found an evident relief of pre-injection anxiety and injection pain when using indwelling catheters for introducing insulin injections at the onset of diabetes.

In the present work, we demonstrate that treatment with 1,25-dihydroxyvitamin D3 for 24 hours increased in a dose-dependent manner the levels of the two major insulin receptor (IR) mRNAs (11 and 8.5 Kb) present in U-937 human promonocytic cells. These levels reached maximum values (1.8-fold 11 Kb; 1.4-fold 8.5 Kb) with the addition of 10(-8) M 1,25-dihydroxyvitamin D3. In these optimal conditions the stimulatory effect of 1,25-dihydroxyvitamin D3 was accompanied by increases in both IR capacity, and insulin responsiveness for glucose transport in these cells. Moreover, such increases appear to be mediated by an enhanced expression of the receptor for 1,25-dihydroxyvitamin D3, measured at the level of both RNA and protein. These results provide evidence of 1,25-dihydroxyvitamin D3 acting as genomic stimulator of the insulin response in the control of glucose transport.

We have studied the effect of 10(-8) M 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] on insulin binding, insulin receptor gene expression, and isotype mRNA pattern in U-937 human promonocytic cells. Binding assays indicated that 1,25-(OH)2D3 increased total receptor number without altering receptor affinity, while the dissociation rate of the hormone bound to its receptor remained unchanged. RNA blot assays indicated that 1,25-(OH)2D3 increased the levels of the two major insulin receptor mRNAs (11 and 8.5 kb) present in these cells. Experiments with the RNA synthesis inhibitor actinomycin D suggested that 1,25-(OH)2D3 did not alter the stability of total insulin receptor mRNA. Experiments with the protein synthesis inhibitor cycloheximide indicated that the increase in the amounts of this mRNA occurs as a direct response to the action of the hormone. Finally, polymerase chain reaction assays revealed that the insulin receptor mRNA isotype lacking the exon 11 (A isotype) was the only one present in both untreated and 1,25-(OH)2D3-treated U-937 cells. This indicates that 1,25-(OH)2D3 does not alter the splicing of the primary insulin receptor transcript in this cell line.

In this paper, the preliminary results regarding the alterations of the biological action mechanism of insulin in several types of pathological accumulations of fat, i.e. lipomas, Madelung's Lipomatosis and liposarcoma, are presented. The results indicate significant alterations both at the insulin receptor and post-receptor levels, with reduced biological activity of this hormone, which could have and inductive role in the pathogenesis of such entities.

Treatment with 5 x 10(-6) M dexamethasone stimulated insulin binding in human promonocytic U-937 cells. When curvilinear Scatchard plots were examined according to the one-site model, only changes in affinity, but not in receptor numbers, were observed. However, when the two-site model was applied, an increase in both the affinity and the number of the high affinity-low capacity sites was observed, with maximum values at 15 h. By contrast, the low affinity-high capacity sites did not undergo significant alterations. Northern blot assays revealed two insulin receptor-related mRNAs of approximately 11 and 7 kb in size. Dexamethasone increased the levels of these RNAs, following similar kinetics to those of high affinity receptor expression. This suggests that the 11 and 7 kb species carry information for high affinity insulin receptors, and that in U-937 cells the expression of this receptor subclass is primarily regulated at the mRNA level.

Male Wistar rats with chronic hyperprolactinemia induced by grafting an anterior pituitary gland under the right kidney capsule were studied as experimental model. In these animals basal plasma glucose and insulin levels were unaltered. Epididymal adipocytes from hyperprolactinemic rats showed a significant increase in insulin binding at low unlabeled insulin concentrations. This increase in insulin binding can be principally attributed to an increase in the high affinity-low capacity binding sites, as demonstrated when Scatchard analysis was interpreted in terms of two types of insulin receptors. The dissociation constants (KD1 and KD2) were not different between the groups. The apparent insulin receptor affinity was also unchanged. Moreover, a decreased sensitivity to the antilipolytic effect of insulin was also obtained in adipocytes from hyperprolactinemic rats. These findings indicate that chronic hyperprolactinemia is able to increase high affinity insulin receptors in epididymal adipocytes, but tends to diminish the antilipolytic response, suggesting a lack of coupling between insulin binding and its biological activity in male adipose tissue. Several possible mechanisms involved in the process are suggested.

Insulin binding in adipocytes from patients with a phaeochromocytoma (PH) approached that of the controls (C) at low and higher concentrations of unlabeled insulin. The apparent receptor affinity was unchanged (ED50: PH 0.50 x 10(-9) M and C 0.60 x 10(-9) M). Scatchard analysis of the binding data using the negative cooperative model revealed a 46% decrease in the total number of receptors together with no changes in both K-e (PH 0.55 x 10(9) M-1 and C 0.36 x 10(9) M-1) and K-f (PH 0.13 x 10(9) M-1 and C 0.07 x 10(9) M-1). According to the two site model, an altered proportion in the two classes of insulin binding sites was detected. This was accompanied by a catecholamine-desensitization of the adipocytes to the antilipolytic action of insulin. These events could represent a final situation of a chronic and endogenous regulation by high levels of catecholamines of insulin receptors in human adipose tissue.

The effects of an in vivo cortisol-treatment to rats (2 X 2 mg/rat/day, for one week) on insulin plasma levels, insulin binding and antilipolytic activity in rat adipose tissue were investigated. Hyperinsulinemia together with an increase in insulin degradation in the serum of cortisol-treated rats were observed. The adipocytes from cortisol-treated animals showed a statistically significant decrease in insulin binding but no change in receptor numbers [cortisol-treated 103,000 +/- 8,000 (n = 8) receptors/cell and controls 138,000 +/- 15,000 (n = 16) receptors/cell], together with unchanged receptor affinity [ED50: cortisol-treated 3 X 10(-9) M and controls 3.2 X 10(-9) M], and a decreased sensitivity to the antilipolytic effect of insulin. The evidence presented for pre-receptor, receptor and post-receptor insulin defects on the action of cortisol in isolated rat adipocytes could represent a coordinated mechanism by which cortisol exerts "insulin resistance" in this tissue.

We studied insulin binding and action in adipocytes from female rats with chronic hyperprolactinemia induced by grafting an anterior pituitary gland under the right kidney capsule. Normal basal insulin plasma levels were detected. An increase in insulin binding due to an increased number of receptors was observed (grafted: 193,000 +/- 13,000 (6) receptors/cell vs. controls: 136,000 +/- 17,000 (6) receptors/cell, P less than 0.05). No changes in receptor affinity were detected (ED50 grafted: 2.3 X 10(-9) M and ED50 controls: 1.6 X 10(-9) M). The antilipolytic activity of insulin was significantly decreased in adipocytes from rats with hyperprolactinemia, indicating an insulin-resistant state in these animals. These findings suggest that the chronic hyperprolactinemic state can modify receptor and post-receptor insulin events in rat parametrial adipose tissue.

Insulin binding and the effect of insulin on the transport of 3-O-methylglucose, lipogenesis from glucose, glucose oxidation and lipolysis was studied in fat cells of adrenalectomised rats and of a control group of sham-operated rats. The serum insulin level of the adrenalectomised rats (0.7 ng/ml) was lower than that of the controls (1.6 ng/ml). In adrenalectomised rats as compared to sham-operated rats the insulin concentrations causing half-maximal effect were reduced by 50% in lipogenesis and antilipolysis and by 30% in glucose transport. The increase in sensitivity to submaximal insulin concentrations was not observed in glucose oxidation. The maximal responsiveness was unchanged in all test systems. The increase in sensitivity in three of the four studied insulin effects may be related to the 37% increase in the binding capacity of fat cells from adrenalectomised compared with sham-operated rats. The unchanged sensitivity with respect to glucose oxidation indicates possible post-receptor modulation. When adrenalectomised rats were substituted with either insulin or cortisol serum insulin levels were elevated above normal; however, the changes in the receptor were prevented in the cortisol supplemented rats and only partially in the insulin supplemented rats. The observation suggests, that the insulin receptor is regulated not only by the serum insulin level but also by cortisol.

Male Wistar rats of the third generation of rats drinking 200 micrograms Ni2+/mL as NiCl2 in their drinking water were studied. Basal plasma glucose and insulin levels were unchanged. Epididymal adipocytes from Ni2(+)-fed rats showed an increased insulin binding with a slight increase in apparent insulin affinity (ED50: Ni2(+)-fed rats 2.8 x 10(-9) M and controls 5 x 10(-9) M) with no change in insulin receptor numbers (Ni2(+)-fed rats 143,000 +/- 12,000 (6) receptors/cell and controls 126,000 +/- 13,000 (5]. Moreover, a decreased sensitivity to the antilipolytic response of insulin was also observed in adipocytes from Ni2(+)-fed rats. These events could represent actions of Ni2+ both at the receptor and post-receptor insulin levels. Several possible mechanisms involved in the process are suggested.

Human adipocytes from patients with chronic endogenous hypercortisolism (Cushing's syndrome) showed a statistically significant decrease in insulin binding at low unlabelled-insulin concentrations but no change in receptor numbers (Cushing's 180,000 +/- 48,000 (3) receptors/cell and controls 189,000 +/- 30,000 (7)) together with a fourfold decrease in apparent receptor affinity (ED50: Cushing's 2.25 x 10(-9) M and controls 0.57 x 10(-9) M) and a decreased sensitivity to the antilipolytic effect of insulin. These events could represent the final situation of a chronic and endogenous regulation by high levels of cortisol of insulin receptors in human adipose tissue.

The relationship among plasma insulin disappearance, insulin binding to specific receptors in fat cells and antilipolytic insulin activity in streptozotocin-diabetic rats has been studied. Male Wistar rats were injected streptozotocin (65 mg/kg body weight) or saline by cardiac puncture. Decreased insulin levels and increased insulin degradation together with an increase in insulin binding were found in diabetic rats. The increase in insulin binding was related to an increase in the number of insulin receptors rather than to a change in receptor affinity. These findings at the pre-receptor and receptor levels could be correlated with an increase in antilipolytic insulin activity. However our results suggest that the mechanism for insulin action occurred through a potentiation of the norepinephrine lipolytic activity.