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Dedifferentiation has been implicated in β cell dysfunction and loss in rodent diabetes. However, the pathophysiological significance in humans remains unclear. To elucidate this, we analyzed surgically resected pancreatic tissues of 26 Japanese subjects with diabetes and 11 nondiabetic subjects, who had been overweight during adulthood but had no family history of diabetes. The diabetic subjects were subclassified into 3 disease stage categories, early, advanced, and intermediate. Despite no numerical changes in endocrine cells immunoreactive for chromogranin A (ChgA), diabetic islets showed profound β cell loss, with an increase in α cells without an increase in insulin and glucagon double-positive cells. The proportion of dedifferentiated cells that retain ChgA immunoreactivity without 4 major islet hormones was strikingly increased in diabetic islets and rose substantially during disease progression. The increased dedifferentiated cell ratio was inversely correlated with declining C-peptide index. Moreover, a subset of islet cells converted into exocrine-like cells during disease progression. These results indicate that islet remodeling with dedifferentiation is the underlying cause of β cell failure during the course of diabetes progression in humans., Islet remodeling with dedifferentiation is a pathologic mechanism of β celldysfunction and lost during the course of progression in human type 2 diabetes.

To clarify the risk factors for suicide among university students, we collected the data of students who died of any cause from 1992 to 2017 from the accident records of the Yamaguchi University. Sociodemographic and clinical data from the health examination and medical records of the university were examined. Chi-squared analysis was used. Of the 93 students who died, 48 were suicide cases over 26 years. Overall suicide rate was 17.4/100,000 persons. No longitudinally significant difference in suicide rate was seen between the same-age population (1998-2017; 20.0) and the university students. Higher risk of suicide in students was seen among males (odds ratio [OR] =3.5, 95% confidence interval [CI]=1.49-8.22; 1992-2017), those who did not undertake a health examination in the year when they died by suicide (OR =5.82, 95% CI =2.41-14.04), and those who had usage history in the center for mental health consultations (OR =23.29, 95% CI =9.03-60.07) from 2006 to 2017. Characteristic risk factor was that they had undergone no health examination, representing unfavorable attitudes towards seeking help. We propose that the annual health examination should be used as a place for creating awareness for mental health problems.

Aims/Introduction Measurements of plaque echogenicity, the gray-scale median (GSM), were shown to correlate inversely with risk factors for cerebro-cardiovascular disease (CVD). The eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio is a potential predictor of CVD risk. In the present study, we assessed the usefulness of carotid plaque GSM values and EPA/AA ratios in atherosclerotic diabetics. Materials and Methods A total of 84 type 2 diabetics with carotid artery plaques were enrolled. On admission, platelet aggregation and lipid profiles, including EPA and AA, were examined. Using ultrasound, mean intima media thickness and plaque score were measured in carotid arteries. Plaque echogenicity was evaluated using computer-assisted quantification of GSM. The patients were then further observed for approximately 3 years. Results Gray-scale median was found to be a good marker of CVD events. On multivariate logistic regression analysis, GSM

Tumor necrosis factor-alpha (TNF-alpha) signaling through the IkappaB kinase (IKK) complex attenuates insulin action via the phosphorylation of insulin receptor substrate 1 (IRS-1) at Ser307. However, the precise molecular mechanism by which the IKK complex phosphorylates IRS-1 is unknown. In this study, we report nuclear factor kappaB essential modulator (NEMO)/IKK-gamma subunit accumulation in membrane ruffles followed by an interaction with IRS-1. This intracellular trafficking of NEMO requires insulin, an intact actin cytoskeletal network, and the motor protein Myo1c. Increased Myo1c expression enhanced the NEMO-IRS-1 interaction, which is essential for TNF-alpha- induced phosphorylation of Ser307-IRS-1. In contrast, dominant inhibitory Myo1c cargo domain expression diminished this interaction and inhibited IRS-1 phosphorylation. NEMO expression also enhanced TNF-alpha-induced Ser307-IRS-1 phosphorylation and inhibited glucose uptake. In contrast, a deletion mutant of NEMO lacking the IKK-beta-binding domain or silencing NEMO blocked the TNF-alpha signal. Thus, motor protein Myo1c and its receptor protein NEMO act cooperatively to form the IKK-IRS-1 complex and function in TNF-alpha-induced insulin resistance.

Background Wolfram syndrome (WFS) is a recessive neurologic and endocrinologic degenerative disorder, and is also known as DIDMOAD (Diabetes Insipidus, early-onset Diabetes Mellitus, progressive Optic Atrophy and Deafness) syndrome. Most affected individuals carry recessive mutations in the Wolfram syndrome 1 gene (WFS1). However, the phenotypic pleiomorphism, rarity and molecular complexity of this disease complicate our efforts to understand WFS. To address this limitation, we aimed to describe complications and to elucidate the contributions of WFS1 mutations to clinical manifestations in Japanese patients with WFS. Methodology The minimal ascertainment criterion for diagnosing WFS was having both early onset diabetes mellitus and bilateral optic atrophy. Genetic analysis for WFS1 was performed by direct sequencing. Principal Findings Sixty-seven patients were identified nationally for a prevalence of one per 710,000, with 33 patients (49%) having all 4 components of DIDMOAD. In 40 subjects who agreed to participate in this investigation from 30 unrelated families, the earliest manifestation was DM at a median age of 8.7 years, followed by OA at a median age of 15.8 years. However, either OA or DI was the first diagnosed feature in 6 subjects. In 10, features other than DM predated OA. Twenty-seven patients (67.5%) had a broad spectrum of recessive mutations in WFS1. Two patients had mutations in only one allele. Eleven patients (27.5%) had intact WFS1 alleles. Ages at onset of both DM and OA in patients with recessive WFS1 mutations were indistinguishable from those in patients without WFS1 mutations. In the patients with predicted complete loss-of-function mutations, ages at the onsets of both DM and OA were significantly earlier than those in patients with predicted partial-loss-of function mutations. Conclusion/Significance This study emphasizes the clinical and genetic heterogeneity in patients with WFS. Genotype-phenotype correlations may exist in patients with WFS1 mutations, as demonstrated by the disease onset.

Heterotrimeric (alphabetagamma) G(s) mediates agonist-induced stimulation of adenylyl cyclase (AC). Cholera toxin (CTx) will ADP-ribosylate the alpha-subunit of G(s) (G(s)alpha). G(s)alpha-deficient cyc(-) membranes were "stripped" of Gbeta. When the stripped cyc(-) were incubated with G(s)alpha and/or Gbetagamma, each was incorporated into the membranes independently of the other. Both G(s)alpha and Gbetagamma had to be present in the membranes, and they had to be able to form a heterotrimer in order for CTx to ADP-ribosylate G(s)alpha, indicating that the membrane bound G(s) heterotrimer is a substrate for CTx, but the G(s)alpha subunit by itself is not. When G(s)alpha was completely and irreversibly activated with GTPgammaS and incorporated into stripped cyc(-), it was a poor substrate for CTx and a weak stimulator of AC unless Gbetagamma was also incorporated. Furthermore, the level of AC stimulation corresponded to the amount of G(s) heterotrimer that was formed in the membranes from GTPgammaS-activated G(s)alpha and Gbetagamma. These data suggest that AC is stimulated by an activated G(s) heterotrimer in cell membranes.

Leptin at 1-5 nM, the concentrations observed in obese subjects, caused an increase in the active form of mitogen-activated protein kinase (MAPK) that was accompanied by increased tyrosine phosphorylation of STAT-1 and STAT-3 in a mouse pancreatic beta cell line, MIN6. Leptin also increased DNA synthesis and cell viability in MIN6 cells based on the results of [3H]-thymidine incorporation and colorimetric MTT assay, respectively. The specific MAPK-inhibitor PD98059 blocked not only the MAPK activation but also the increment in DNA synthesis and cell viability caused by leptin. Thus, leptin stimulates both the MAPK and the Janus kinase (JAK)-STAT cascade as well as inducing proliferation through the MAPK cascade in MIN6 cells. This mechanism might account, at least in part, for obesity-induced pancreatic islet hypertrophy.

We examined a possible mechanism underlying the link between obesity and hyperinsulinemia, focusing on leptin, a peptide released from adipocytes which affects the satiety center in the brain. The leptin receptor isoforms, Ob-Ra and Ob-Rb, are present in the pancreatic beta cell line MIN6 and in rat pancreatic islets, based on RT-PCR. A 2 hr, but not a 30 min, incubation with 1 nM recombinant mouse leptin, the concentration observed in obese subjects, stimulated basal (at 5 mM glucose) insulin secretion by approximately 40% in both MIN6 and rat islets. Stimulatory effects were not observed without glucose or when the incubation medium containing 1 nM leptin had been preincubated with the immobilized leptin antibody. In contrast to the stimulatory effects on basal insulin secretion at 1 nM, the maximally stimulated insulin secretion at 25 mM glucose was not significantly changed by 1 nM leptin in isolated rat islets. In addition, 10 and 100 nM leptin exerted small but significant inhibitory effects on 16.7 mM glucose-stimulated insulin secretion. Thus, leptin acts directly on pancreatic beta cells, and stimulation of basal insulin secretion by physiological concentrations of leptin may account in part for the fasting hyperinsulinemia observed in obese subjects.

A case of myelofibrosis in association with systemic lupus erythematosus (SLE) is reported. Acute thrombocytopenia and a bleeding tendency developed in a 24-year-old woman with SLE. Bone marrow aspiration was unsuccessful due to myelofibrosis. Pulse therapy with methylprednisolone reversed both thrombocytopenia and myelofibrosis. A review of the literature revealed that the coexistence of SLE and myelofibrosis is a rare occurrence. Only 7 cases, to our knowledge, have ever been reported in detail. The present case is the 3rd in which myelofibrosis was reversed by corticosteroids.

Insulin stimulates glucose uptake in fat and muscle primarily by stimulating the translocation of vesicles containing facilitative glucose transporters, GLUT4, from intracellular compartments to the plasma membrane. Although cell surface externalization of GLUT4 is critical for glucose transport, the mechanism regulating cell surface GLUT4 remains unknown. Using a yeast two-hybrid screening system, we have screened GLUT4-binding proteins, and identified a novel glycosyl phosphatidyl inositol (GPI)-linked proteoglycan, Glypican3 (GPC3). We confirmed their interaction using immunoprecipitation and a GST pull-down assay. We also revealed that GPC3 and GLUT4 to co-localized at the plasma membrane, using immunofluorescent microscopy. Furthermore, we observed that glucose uptake in GPC3-overexpressing adipocytes was increased by 30% as compared to control cells. These findings suggest that GPC3 may play roles in glucose transport through GLUT4.

There are many clinical and experimental reports demonstrating that estrogens and insulin interact when affecting their target organs. Estrogen receptors consist of two isoforms, estrogen receptors-alpha (ER-alpha) and -beta (ER-beta), but their roles in insulin-induced glucose uptake in mature adipose tissue have yet to be clarified. To evaluate the roles of ER-alpha, expressed predominantly in adipocytes, we have investigated the effects of estradiol (E2), an ER-alpha selective agonist (PPT), and its selective antagonist (MPP) on glucose uptake and insulin action in 3T3-L1 adipocytes. 3T3-L1 adipocytes were exposed to E2 or PPT and/or MPP at different concentrations. The cells were then subjected to 2-deoxy-D-glucose transport assay, western blot analysis, or RT-PCR analysis. Treatment of these cells with E2 or PPT resulted in biphasic effects on glucose transport, that is high (10(-5) M or 3 x 10(-6) M each) and low (10(-8) M) doses produced inhibition and stimulation, respectively. The favorable effect observed at 10(-8) M of E2 was diminished by treatment with MPP. Western bolt analysis revealed that these effects of E2, PPT and MPP paralleled the level of IRS-1 tyrosine phosphorylation. However, IRS-1 serine phosphorylation, suppressor of cytokine signaling (SOCS)-1,-2,-3 and protein tyrosine phosphatase 1B (PTP1B) expression did not change compared to control subjects. Our data clearly show that ER-alpha contributes to insulin stimulated glucose uptake through regulation of the tyrosine phosphorylation of IRS-1 protein.

To the Editor Thiazolidinediones are widely used in patients with type 2 diabetes. In addition to lowering plasma glucose, this class of drugs may reduce the risk of cardiovascular diseases in patients with diabetes. Despite the beneficial effect of thiazolidinediones, their use is sometimes associated with peripheral oedema. This is the most frequent adverse effect leading to discontinued treatment with thiazolidinediones in Japan. However, the mechanism by which thiazolidinediones induce oedema remains to be established. Recently, Guan et al. reported that, in a mouse model, thiazolidinediones caused fluid retention through peroxisome proliferator-activated receptor-γ stimulation of renal salt absorption mediated by epithelial Na channel (ENaC) [1]. The authors speculated that an increase in plasma volume causes thiazolidinedione-induced peripheral oedema. We, however, doubt that this is the sole cause of oedema in humans. ENaC is a sodium channel located in collecting tubules. This channel is also the site of action of the hormone aldosterone, a mineralocorticoid that increases sodium reabsorption. Primary aldosteronism is a disease caused by hypersecretion of this hormone. Due to excess sodium reabsorption, the circulating blood volume increases. The resulting headache and hypertension are well documented. However, peripheral oedema does not usually develop [2]. This is a well-known outcome of this disease. Oedema, moreover, also does not develop as a result of the increased plasma volume in the syndrome of inappropriate secretion of antidiuretic hormone [3]. Antidiuretic horomone is a pituitary hormone that activates the water channel aquaporin 2 in collecting tubules, thereby increasing water reabsorption. These observations in relation to endocrine diseases suggest that blood volume expansion is not sufficient for peripheral oedema to develop. We would like to highlight another important factor that might also be involved in the process. Previously, we reported that thiazolidinediones increase the plasma levels of vascular endothelial growth factor (VEGF) [4]. Since VEGF is a potent vascular permeability factor, an increase in VEGF levels may contribute to thiazolidinedioneinduced oedema. However, because of the difficulty of quantifying the severity of oedema, no one has demonstrated a clear correlation between peripheral oedema and plasma VEGF levels. Assessing the presence of peripheral oedema by body weight can be misleading, because thiazolidinediones increase body fat mass [5] and circulating blood volume [1]. In our previous report, for example, a weak correlation between body weight and plasma VEGF concentration was observed only in female patients, but not in male patients or groups comprising both sexes [4]. Here, we demonstrate a strong correlation between clinically apparent peripheral oedema and plasma VEGF concentration. Oedema is defined as a clinically apparent increase in the interstitial fluid volume. Thus, we judged the existence of peripheral oedema by the presence of pitting after pressure was applied to the bilateral lower extremities. We re-evaluated the clinical data collected for our previous study [4]. Briefly, a total of 30 patients with type 2 diabetes Diabetologia (2006) 49:2217–2218 DOI 10.1007/s00125-006-0313-5

To test the hypothesis that leptin secreted from adipose tissue is a mediator linking obesity and pancreatic islet hypertrophy, we examined the effects of leptin on proliferative and apoptotic responses in rat islet cells. Rat pancreatic islets were isolated and incubated with 0, 1, 5, or 75 nM leptin for 24 h under serum-deprived conditions. Cell viability was assessed with 2,5-diphenyltetrazolium bromide and trypan blue dye exclusion tests. Cell proliferation and apoptosis were evaluated with 5-bromo-2'-deoxyuridine incorporation into DNA and DNA ladder formation, respectively. Incubation for 24 h with 1 and 5 nM leptin, the concentrations observed in obese subjects, increased the viability of isolated pancreatic islet cells. Five nanomolar concentrations of leptin did not stimulate 5-bromo-2'-deoxyuridine incorporation into incubated islet cells, indicating no influence on cell proliferation, but did inhibit DNA ladder formation, a hallmark of cell apoptosis. Moreover, 5 nM leptin reduced the triglyceride content and suppressed inducible nitric oxide synthase mRNA expression in incubated islets. These results suggest that leptin increased viable cell numbers via suppression of apoptosis in isolated pancreatic islet cells under these experimental conditions. This mechanism might account at least in part for an obesity-induced increase in pancreatic beta-cell mass.

Troglitazone is one of the thiazolidinediones, a new class of oral antidiabetic compounds that are ligands of peroxisome proliferator–activated receptor-γ. This study on vascular endothelial growth factor (VEGF), also known as vascular permeability factor, was prompted by our clinical observation that the characteristics of troglitazone-induced edema were very similar to those caused by vascular hyperpermeability. When Japanese diabetic patients were screened for plasma VEGF, we found levels to be significantly (P < 0.001) increased in troglitazone-treated subjects (120.1 ± 135.0 pg/ml, n = 30) compared with those treated with diet alone (29.2 ± 36.1 pg/ml, n = 10), sulfonylurea (25.8 ± 22.2 pg/ml, n = 10), or insulin (24.6 ± 19.0 pg/ml, n = 10). Involvement of troglitazone in increased VEGF levels was further supported by the plasma VEGF levels in five patients before treatment (20.2 ± 7.0 pg/ml), after 3 months of troglitazone treatment (83.6 ± 65.9 pg/ml), and 3 months after discontinuation (28.0 ± 11.6 pg/ml). We further demonstrated that troglitazone, as well as rosiglitazone, at the plasma concentrations observed in patients, increased VEGF mRNA levels in 3T3-L1 adipocytes. VEGF is an angiogenic and mitogenic factor and is currently considered the most likely cause of neovascularization and hyperpermeability in diabetic proliferative retinopathy. Although increased VEGF may be beneficial for subjects with macroangiopathy and troglitazone is currently not available for clinical use, vascular complications, especially diabetic retinopathy, must be followed with great caution in subjects treated with thiazolidinediones.

Aims/hypothesis. To explain the mechanisms whereby mutations in the HNF-1α gene cause insulin secretory defects. Methods. A truncated mutant HNF-1α (HNF-1α288 t) was overexpressed in hepatoma cells (HepG2) and murine insulinoma cells (MIN6) using a recombinant adenovirus system and expression of the HNF-1α target genes and insulin secretion were examined. Results. Expression of phenylalanine hydroxylase and α1-antitrypsin genes, the target genes of HNF-1α, was suppressed in HepG2 cells by overexpression of HNF-1α288 t. In MIN6 cells, overexpression of HNF-1α288 t did not change insulin secretion stimulated by glucose (5 mmol/l and 25 mmol/l) or leucine (20 mmol/l). Potentiation of insulin secretion by arginine (20 mmol/l, in the presence of 5 mmol/l or 25 mmol/l glucose) was, however, reduced (p < 0.0001 and p = 0.027, respectively). Similarly reduced responses were observed when stimulated with homoarginine. Expression of the cationic amino acid transporter-2 was not reduced and insulin secretory response to membrane depolarization by 50 mmol/l KCl was intact. Conclusion/interpretation. The HNF-1α288 t, which is structurally similar to the mutant HNF-1α expressed from the common MODY3 allele, P291fsinsC, exerts a dominant negative effect. Suppression of HNF-1α in MIN6 cells severely impaired potentiation of insulin secretion by arginine, whereas glucose-stimulated and leucine-stimulated insulin secretion was intact. Our findings delineate the complex nature of beta-cell failure in patients with MODY3. This cell model will be useful for further investigation of the mechanism of insulin secretory defects in these patients. [Diabetologia (1999) 42: 887–891]

The effects of angiotensin II (A II) and ANP on spontaneously active neurons in the subfornical organ (SFO), anteroventral third ventricle (AV3V) and supraoptic (SON) and paraventricular nucleus (PVN) were investigated using slice preparations and extracellular recordings. Application of A II (10(-7)M) excited the neural activity of 66% of the SFO neurons, 28% of the AV3V neurons and 44% of the SON neurons. The threshold concentration to produce responses in SFO and AV3V neuron was less than 10(-10)M, while that in SON neurons was 10(-9)M. The excitatory effects of A II were reversibly antagonized by saralasin and persisted after synaptic blockade in a low Ca2+ and high Mg2+ medium. Application of ANP (10(-7)M) inhibited the neural activity of 41% of the AV3V neurons, 22% of the PVN neurons and only 14% of the SFO neurons but had no effect on SON neurons. The threshold concentration for ANP in the AV3V was 10(-11)M. Interestingly, ANP inhibited A II induced excitation in most of the SFO neurons (87%), while ANP had little effects on their spontaneous firing rates. These results show that both peptides of A II and ANP have direct central actions on hypothalamic neurons although ANP can not directly influence magnocellular neurons, suggesting that these blood borne peptides are detected in the SFO and AV3V and that they are acting as a neurotransmitter or a neuromodulator in the central nervous system to regulate water homeostasis.

The angiotensin II (AII) sensitivity of neurons in the supraoptic nucleus (SON), subfornical organ (SFO) and the region near the anteroventral part of the third ventricle (AV3V) was investigated using extracellular recording in the rat brain slice preparation by adding AII (10 −10 –10 −6 M) to the perfusion medium. Forty seven (44%) of 106 SON neurons, 62 (66%) of 94 SFO neurons and 28 (33%) of 86 AV3V neurons were excited by AII. One cell was inhibited by AII in the SON and one in the SFO. The threshold concentration to evoke responses in the SON neurons was approximately 10 −9 M, but nuerons in the SFO and AV3V showed clear excitatory responses to AII at 10 −10 M. In the SON, 18 (40%) of 45 phasic firing neurons (putative vasopressin neurons) and 29 (48%) of 61 nonphasic firing neurons (including putative oxytocin neurons) were excited by AII. The excitatory effect of AII was reversibly antagonized by a specific antagonist saralasin and persisted after synaptic blockade in medium with low [Ca 2+ ] and high [Mg 2+ ]. We conclude that AII can stimulate both vasopressin and oxytocin release, acting directly upon SON neurons and also that both the SFO and AV3V are important receptive sites for AII (although the SFO is relatively more sensitive) which contributes SON input and modulates release of these hormones.

To determine the oxytocin (OXT) sensitivity of neurons in the supraoptic nucleus (SON), extracellular recordings were made from the rat hypothalamic slice preparation. OXT added to the bathing medium (3 X 10(-7) M) excited 13 (93%) of 14 cells which fired continuously (average 4.9 +/- 0.7 spikes/s) and 26 (81%) of 32 cells which fired slowly and irregularly (average 1.4 +/- 0.4 spikes/s). By contrast, only 2 (8%) of 26 phasically firing neurons were excited and none of the SON cells tested were inhibited. The excitation was reversibly antagonized by a synthetic OXT analogue, 1-deamino-[2-(O-methyltyrosine), 4-valine, 8-D-arginine]vasopressin. The results suggest that OXT exerts predominantly excitatory effects in the SON and that putative OXT cells are more likely to be affected than putative vasopressin cells.

VIP content in the rat pineal gland and cyclic AMP accumulation in response to VIP in the daily light and dark cycle were examined. VIP content in the pineal varied significantly during the day and night; the content decreased during exposure to light and was lowest at the onset of darkness, 6 p.m. (mean +/- SE, 23 +/- 5 pg/pineal), and increased during the night and was highest at the onset of light, 6 a.m. (72 +/- 12 pg/pineal). Response of cyclic AMP accumulation to VIP varied with a periodicity inversely related to the daily light and dark cycle of VIP content; cyclic AMP accumulation in response to 10(-7) M VIP increased in proportion to periods of exposure to light and peaked at 6 p.m., and decreased with the onset of darkness.

Extracellular recordings were made from neurons in the caudal ventrolateral medulla in urethane-chloralose-anesthetized rats. Stimulation of the paraventricular nucleus (PVN) in the hypothalamus evoked antidromic action potentials in 71 neurons. On the basis of antidromic spike latencies, these neurons could be divided into fast- (24 neurons) and slow-conducting cell groups (47 neurons). Slow-conducting cells showed irregular and slow spontaneous discharges, while a majority of the fast-conducting cells did not show spontaneous discharges. The spontaneous activity of slow-conducting cells was suppressed by i.v. clonidine administration. The effects of clonidine could be consistently reversed by administration of the alpha 2-adrenergic antagonist, yohimbine. The responses by clonidine and yohimbine remained unimpaired in baroreceptor-denervated rats. Vagus nerve stimulation produced an excitation in 80% of slow-conducting cells tested. Baroreceptor activation induced by i.v. administration of phenylephrine inhibited about half of slow-conducting cells tested. Similar elevation of blood pressure in baroreceptor-denervated rats did not show any effect. These physiological and pharmacological properties of slow-conducting cells were similar to those previously reported for catecholaminergic cells in other parts of the brain. The results show the existence of two different populations among neurons in the caudal ventrolateral medulla which project directly to the PVN, and suggest that the presumed A1 catecholaminergic cells are involved in the afferent pathway from cardiovascular baroreceptors and the vagus nerve to the PVN.