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Monday, October 28, 2019

Gene expression profiling

From Wikipedia, the free encyclopedia
 
Heat maps of gene expression values show how experimental conditions influenced production (expression) of mRNA for a set of genes. Green indicates reduced expression. Cluster analysis has placed a group of down regulated genes in the upper left corner.
 
In the field of molecular biology, gene expression profiling is the measurement of the activity (the expression) of thousands of genes at once, to create a global picture of cellular function. These profiles can, for example, distinguish between cells that are actively dividing, or show how the cells react to a particular treatment. Many experiments of this sort measure an entire genome simultaneously, that is, every gene present in a particular cell. 

Several transcriptomics technologies can be used to generate the necessary data to analyse. DNA microarrays measure the relative activity of previously identified target genes. Sequence based techniques, like RNA-Seq, provide information on the sequences of genes in addition to their expression level.

Background

Expression profiling is a logical next step after sequencing a genome: the sequence tells us what the cell could possibly do, while the expression profile tells us what it is actually doing at a point in time. Genes contain the instructions for making messenger RNA (mRNA), but at any moment each cell makes mRNA from only a fraction of the genes it carries. If a gene is used to produce mRNA, it is considered "on", otherwise "off". Many factors determine whether a gene is on or off, such as the time of day, whether or not the cell is actively dividing, its local environment, and chemical signals from other cells. For instance, skin cells, liver cells and nerve cells turn on (express) somewhat different genes and that is in large part what makes them different. Therefore, an expression profile allows one to deduce a cell's type, state, environment, and so forth.

Expression profiling experiments often involve measuring the relative amount of mRNA expressed in two or more experimental conditions. This is because altered levels of a specific sequence of mRNA suggest a changed need for the protein coded by the mRNA, perhaps indicating a homeostatic response or a pathological condition. For example, higher levels of mRNA coding for alcohol dehydrogenase suggest that the cells or tissues under study are responding to increased levels of ethanol in their environment. Similarly, if breast cancer cells express higher levels of mRNA associated with a particular transmembrane receptor than normal cells do, it might be that this receptor plays a role in breast cancer. A drug that interferes with this receptor may prevent or treat breast cancer. In developing a drug, one may perform gene expression profiling experiments to help assess the drug's toxicity, perhaps by looking for changing levels in the expression of cytochrome P450 genes, which may be a biomarker of drug metabolism. Gene expression profiling may become an important diagnostic test.

Comparison to proteomics

The human genome contains on the order of 25,000 genes which work in concert to produce on the order of 1,000,000 distinct proteins. This is due to alternative splicing, and also because cells make important changes to proteins through posttranslational modification after they first construct them, so a given gene serves as the basis for many possible versions of a particular protein. In any case, a single mass spectrometry experiment can identify about 2,000 proteins or 0.2% of the total. While knowledge of the precise proteins a cell makes (proteomics) is more relevant than knowing how much messenger RNA is made from each gene, gene expression profiling provides the most global picture possible in a single experiment. However, proteomics methodology is improving. In other species, such as yeast, it is possible to identify over 4,000 proteins in just over one hour.

Use in hypothesis generation and testing

Sometimes, a scientist already has an idea of what is going on, a hypothesis, and he or she performs an expression profiling experiment with the idea of potentially disproving this hypothesis. In other words, the scientist is making a specific prediction about levels of expression that could turn out to be false.

More commonly, expression profiling takes place before enough is known about how genes interact with experimental conditions for a testable hypothesis to exist. With no hypothesis, there is nothing to disprove, but expression profiling can help to identify a candidate hypothesis for future experiments. Most early expression profiling experiments, and many current ones, have this form which is known as class discovery. A popular approach to class discovery involves grouping similar genes or samples together using one of the many existing clustering methods such the traditional k-means or hierarchical clustering, or the more recent MCL. Apart from selecting a clustering algorithm, user usually has to choose an appropriate proximity measure (distance or similarity) between data objects. The figure above represents the output of a two dimensional cluster, in which similar samples (rows, above) and similar gene probes (columns) were organized so that they would lie close together. The simplest form of class discovery would be to list all the genes that changed by more than a certain amount between two experimental conditions. 

Class prediction is more difficult than class discovery, but it allows one to answer questions of direct clinical significance such as, given this profile, what is the probability that this patient will respond to this drug? This requires many examples of profiles that responded and did not respond, as well as cross-validation techniques to discriminate between them.

Limitations

In general, expression profiling studies report those genes that showed statistically significant differences under changed experimental conditions. This is typically a small fraction of the genome for several reasons. First, different cells and tissues express a subset of genes as a direct consequence of cellular differentiation so many genes are turned off. Second, many of the genes code for proteins that are required for survival in very specific amounts so many genes do not change. Third, cells use many other mechanisms to regulate proteins in addition to altering the amount of mRNA, so these genes may stay consistently expressed even when protein concentrations are rising and falling. Fourth, financial constraints limit expression profiling experiments to a small number of observations of the same gene under identical conditions, reducing the statistical power of the experiment, making it impossible for the experiment to identify important but subtle changes. Finally, it takes a great amount of effort to discuss the biological significance of each regulated gene, so scientists often limit their discussion to a subset. Newer microarray analysis techniques automate certain aspects of attaching biological significance to expression profiling results, but this remains a very difficult problem. 

The relatively short length of gene lists published from expression profiling experiments limits the extent to which experiments performed in different laboratories appear to agree. Placing expression profiling results in a publicly accessible microarray database makes it possible for researchers to assess expression patterns beyond the scope of published results, perhaps identifying similarity with their own work.

Validation of high throughput measurements

Both DNA microarrays and quantitative PCR exploit the preferential binding or "base pairing" of complementary nucleic acid sequences, and both are used in gene expression profiling, often in a serial fashion. While high throughput DNA microarrays lack the quantitative accuracy of qPCR, it takes about the same time to measure the gene expression of a few dozen genes via qPCR as it would to measure an entire genome using DNA microarrays. So it often makes sense to perform semi-quantitative DNA microarray analysis experiments to identify candidate genes, then perform qPCR on some of the most interesting candidate genes to validate the microarray results. Other experiments, such as a Western blot of some of the protein products of differentially expressed genes, make conclusions based on the expression profile more persuasive, since the mRNA levels do not necessarily correlate to the amount of expressed protein.

Statistical analysis

Data analysis of microarrays has become an area of intense research. Simply stating that a group of genes were regulated by at least twofold, once a common practice, lacks a solid statistical footing. With five or fewer replicates in each group, typical for microarrays, a single outlier observation can create an apparent difference greater than two-fold. In addition, arbitrarily setting the bar at two-fold is not biologically sound, as it eliminates from consideration many genes with obvious biological significance. 

Rather than identify differentially expressed genes using a fold change cutoff, one can use a variety of statistical tests or omnibus tests such as ANOVA, all of which consider both fold change and variability to create a p-value, an estimate of how often we would observe the data by chance alone. Applying p-values to microarrays is complicated by the large number of multiple comparisons (genes) involved. For example, a p-value of 0.05 is typically thought to indicate significance, since it estimates a 5% probability of observing the data by chance. But with 10,000 genes on a microarray, 500 genes would be identified as significant at p < 0.05 even if there were no difference between the experimental groups. One obvious solution is to consider significant only those genes meeting a much more stringent p value criterion, e.g., one could perform a Bonferroni correction on the p-values, or use a false discovery rate calculation to adjust p-values in proportion to the number of parallel tests involved. Unfortunately, these approaches may reduce the number of significant genes to zero, even when genes are in fact differentially expressed. Current statistics such as Rank products aim to strike a balance between false discovery of genes due to chance variation and non-discovery of differentially expressed genes. Commonly cited methods include the Significance Analysis of Microarrays (SAM) and a wide variety of methods are available from Bioconductor and a variety of analysis packages from bioinformatics companies

Selecting a different test usually identifies a different list of significant genes since each test operates under a specific set of assumptions, and places a different emphasis on certain features in the data. Many tests begin with the assumption of a normal distribution in the data, because that seems like a sensible starting point and often produces results that appear more significant. Some tests consider the joint distribution of all gene observations to estimate general variability in measurements, while others look at each gene in isolation. Many modern microarray analysis techniques involve bootstrapping (statistics), machine learning or Monte Carlo methods.

As the number of replicate measurements in a microarray experiment increases, various statistical approaches yield increasingly similar results, but lack of concordance between different statistical methods makes array results appear less trustworthy. The MAQC Project makes recommendations to guide researchers in selecting more standard methods (e.g. using p-value and fold-change together for selecting the differentially expressed genes) so that experiments performed in different laboratories will agree better. 

Different from the analysis on differentially expressed individual genes, another type of analysis focuses on differential expression or perturbation of pre-defined gene sets and is called gene set analysis. Gene set analysis demonstrated several major advantages over individual gene differential expression analysis. Gene sets are groups of genes that are functionally related according to current knowledge. Therefore, gene set analysis is considered a knowledge based analysis approach. Commonly used gene sets include those derived from KEGG pathways, Gene Ontology terms, gene groups that share some other functional annotations, such as common transcriptional regulators etc. Representative gene set analysis methods include Gene Set Enrichment Analysis (GSEA), which estimates significance of gene sets based on permutation of sample labels, and Generally Applicable Gene-set Enrichment (GAGE), which tests the significance of gene sets based on permutation of gene labels or a parametric distribution.

Gene annotation

While the statistics may identify which gene products change under experimental conditions, making biological sense of expression profiling rests on knowing which protein each gene product makes and what function this protein performs. Gene annotation provides functional and other information, for example the location of each gene within a particular chromosome. Some functional annotations are more reliable than others; some are absent. Gene annotation databases change regularly, and various databases refer to the same protein by different names, reflecting a changing understanding of protein function. Use of standardized gene nomenclature helps address the naming aspect of the problem, but exact matching of transcripts to genes remains an important consideration.

Categorizing regulated genes

Having identified some set of regulated genes, the next step in expression profiling involves looking for patterns within the regulated set. Do the proteins made from these genes perform similar functions? Are they chemically similar? Do they reside in similar parts of the cell? Gene ontology analysis provides a standard way to define these relationships. Gene ontologies start with very broad categories, e.g., "metabolic process" and break them down into smaller categories, e.g., "carbohydrate metabolic process" and finally into quite restrictive categories like "inositol and derivative phosphorylation".

Genes have other attributes beside biological function, chemical properties and cellular location. One can compose sets of genes based on proximity to other genes, association with a disease, and relationships with drugs or toxins. The Molecular Signatures Database and the Comparative Toxicogenomics Database are examples of resources to categorize genes in numerous ways.

Finding patterns among regulated genes

Ingenuity Gene Network Diagram which dynamically assembles genes with known relationships. Green indicates reduced expression, red indicates increased expression. The algorithm has included unregulated genes, white, to improve connectivity.
 
Regulated genes are categorized in terms of what they are and what they do, important relationships between genes may emerge. For example, we might see evidence that a certain gene creates a protein to make an enzyme that activates a protein to turn on a second gene on our list. This second gene may be a transcription factor that regulates yet another gene from our list. Observing these links we may begin to suspect that they represent much more than chance associations in the results, and that they are all on our list because of an underlying biological process. On the other hand, it could be that if one selected genes at random, one might find many that seem to have something in common. In this sense, we need rigorous statistical procedures to test whether the emerging biological themes is significant or not. That is where gene set analysis comes in.

Cause and effect relationships

Fairly straightforward statistics provide estimates of whether associations between genes on lists are greater than what one would expect by chance. These statistics are interesting, even if they represent a substantial oversimplification of what is really going on. Here is an example. Suppose there are 10,000 genes in an experiment, only 50 (0.5%) of which play a known role in making cholesterol. The experiment identifies 200 regulated genes. Of those, 40 (20%) turn out to be on a list of cholesterol genes as well. Based on the overall prevalence of the cholesterol genes (0.5%) one expects an average of 1 cholesterol gene for every 200 regulated genes, that is, 0.005 times 200. This expectation is an average, so one expects to see more than one some of the time. The question becomes how often we would see 40 instead of 1 due to pure chance. 

According to the hypergeometric distribution, one would expect to try about 10^57 times (10 followed by 56 zeroes) before picking 39 or more of the cholesterol genes from a pool of 10,000 by drawing 200 genes at random. Whether one pays much attention to how infinitesimally small the probability of observing this by chance is, one would conclude that the regulated gene list is enriched in genes with a known cholesterol association.

One might further hypothesize that the experimental treatment regulates cholesterol, because the treatment seems to selectively regulate genes associated with cholesterol. While this may be true, there are a number of reasons why making this a firm conclusion based on enrichment alone represents an unwarranted leap of faith. One previously mentioned issue has to do with the observation that gene regulation may have no direct impact on protein regulation: even if the proteins coded for by these genes do nothing other than make cholesterol, showing that their mRNA is altered does not directly tell us what is happening at the protein level. It is quite possible that the amount of these cholesterol-related proteins remains constant under the experimental conditions. Second, even if protein levels do change, perhaps there is always enough of them around to make cholesterol as fast as it can be possibly made, that is, another protein, not on our list, is the rate determining step in the process of making cholesterol. Finally, proteins typically play many roles, so these genes may be regulated not because of their shared association with making cholesterol but because of a shared role in a completely independent process.

Bearing the foregoing caveats in mind, while gene profiles do not in themselves prove causal relationships between treatments and biological effects, they do offer unique biological insights that would often be very difficult to arrive at in other ways.

Using patterns to find regulated genes

As described above, one can identify significantly regulated genes first and then find patterns by comparing the list of significant genes to sets of genes known to share certain associations. One can also work the problem in reverse order. Here is a very simple example. Suppose there are 40 genes associated with a known process, for example, a predisposition to diabetes. Looking at two groups of expression profiles, one for mice fed a high carbohydrate diet and one for mice fed a low carbohydrate diet, one observes that all 40 diabetes genes are expressed at a higher level in the high carbohydrate group than the low carbohydrate group. Regardless of whether any of these genes would have made it to a list of significantly altered genes, observing all 40 up, and none down appears unlikely to be the result of pure chance: flipping 40 heads in a row is predicted to occur about one time in a trillion attempts using a fair coin. 

For a type of cell, the group of genes whose combined expression pattern is uniquely characteristic to a given condition constitutes the gene signature of this condition. Ideally, the gene signature can be used to select a group of patients at a specific state of a disease with accuracy that facilitates selection of treatments. Gene Set Enrichment Analysis (GSEA) and similar methods take advantage of this kind of logic but uses more sophisticated statistics, because component genes in real processes display more complex behavior than simply moving up or down as a group, and the amount the genes move up and down is meaningful, not just the direction. In any case, these statistics measure how different the behavior of some small set of genes is compared to genes not in that small set.

GSEA uses a Kolmogorov Smirnov style statistic to see whether any previously defined gene sets exhibited unusual behavior in the current expression profile. This leads to a multiple hypothesis testing challenge, but reasonable methods exist to address it.

Conclusions

Expression profiling provides new information about what genes do under various conditions. Overall, microarray technology produces reliable expression profiles. From this information one can generate new hypotheses about biology or test existing ones. However, the size and complexity of these experiments often results in a wide variety of possible interpretations. In many cases, analyzing expression profiling results takes far more effort than performing the initial experiments.

Most researchers use multiple statistical methods and exploratory data analysis before publishing their expression profiling results, coordinating their efforts with a bioinformatician or other expert in DNA microarrays. Good experimental design, adequate biological replication and follow up experiments play key roles in successful expression profiling experiments.

Amylin

From Wikipedia, the free encyclopedia
 
IAPP

Available structures
PDBOrtholog search: PDBe RCSB
Identifiers
AliasesIAPP, DAP, IAP, islet amyloid polypeptide
External IDsOMIM: 147940 MGI: 96382 HomoloGene: 36024 GeneCards: IAPP

Gene location (Human)
Chromosome 12 (human)
Chr.Chromosome 12 (human)
Chromosome 12 (human)
Genomic location for IAPP
Genomic location for IAPP
Band12p12.1Start21,354,959 bp
End21,379,980 bp
RNA expression pattern
PBB GE IAPP 207062 at fs.png
Orthologs
SpeciesHumanMouse
Entrez


Ensembl


UniProt


RefSeq (mRNA)

NM_000415
NM_001329201

NM_010491
RefSeq (protein)

NP_000406
NP_001316130

NP_034621
Location (UCSC)Chr 12: 21.35 – 21.38 MbChr 6: 142.3 – 142.3 Mb
PubMed search


Amino acid sequence of amylin with disulfide bridge and cleavage sites of insulin degrading enzyme indicated with arrows

Amylin, or islet amyloid polypeptide (IAPP), is a 37-residue peptide hormone. It is cosecreted with insulin from the pancreatic β-cells in the ratio of approximately 100:1 (insulin:amylin). Amylin plays a role in glycemic regulation by slowing gastric emptying and promoting satiety, thereby preventing post-prandial spikes in blood glucose levels.

IAPP is processed from an 89-residue coding sequence. Proislet amyloid polypeptide (proIAPP, proamylin, proislet protein) is produced in the pancreatic beta cells (β-cells) as a 67 amino acid, 7404 Dalton pro-peptide and undergoes post-translational modifications including protease cleavage to produce amylin. 

Synthesis

ProIAPP consists of 67 amino acids, which follow a 22 amino acid signal peptide which is rapidly cleaved after translation of the 89 amino acid coding sequence. The human sequence (from N-terminus to C-terminus) is: 

(MGILKLQVFLIVLSVALNHLKA) TPIESHQVEKR^ KCNTATCATQRLANFLVHSSNNFGAILSSTNVGSNTYG^ KR^ NAVEVLKREPLNYLPL. The signal peptide is removed during translation of the protein and transport into the endoplasmic reticulum. Once inside the endoplasmic reticulum, a disulfide bond is formed between cysteine residues numbers 2 and 7. Later in the secretory pathway, the precursor undergoes additional proteolysis and posttranslational modification (indicated by ^). 11 amino acids are removed from the N-terminus by the enzyme proprotein convertase 2 (PC2) while 16 are removed from the C-terminus of the proIAPP molecule by proprotein convertase 1/3 (PC1/3). At the C-terminus Carboxypeptidase E then removes the terminal lysine and arginine residues. The terminal glycine amino acid that results from this cleavage allows the enzyme peptidylglycine alpha-amidating monooxygenase (PAM) to add an amine group. After this the transformation from the precursor protein proIAPP to the biologically active IAPP is complete (IAPP sequence: KCNTATCATQRLANFLVHSSNNFGAILSSTNVGSNTY)

Regulation

Insulin and IAPP are regulated by similar factors since they share a common regulatory promoter motif. The IAPP promoter is also activated by stimuli which do not affect insulin, such as tumor necrosis factor alpha and fatty acids. One of the defining features of Type 2 diabetes is insulin resistance. This is a condition wherein the body is unable to utilize insulin effectively, resulting in increased insulin production; since proinsulin and proIAPP are cosecreted, this results in an increase in the production of proIAPP as well. 

Although little is known about IAPP regulation, its connection to insulin indicates that regulatory mechanisms that affect insulin also affect IAPP. Thus blood glucose levels play an important role in regulation of proIAPP synthesis.

Function

Amylin functions as part of the endocrine pancreas and contributes to glycemic control. The peptide is secreted from the pancreatic islets into the blood circulation and is cleared by peptidases in the kidney. It is not found in the urine. 

Amylin's metabolic function is well-characterized as an inhibitor of the appearance of nutrient [especially glucose] in the plasma. It thus functions as a synergistic partner to insulin, with which it is cosecreted from pancreatic beta cells in response to meals. The overall effect is to slow the rate of appearance (Ra) of glucose in the blood after eating; this is accomplished via coordinate slowing down gastric emptying, inhibition of digestive secretion [gastric acid, pancreatic enzymes, and bile ejection], and a resulting reduction in food intake. Appearance of new glucose in the blood is reduced by inhibiting secretion of the gluconeogenic hormone glucagon. These actions, which are mostly carried out via a glucose-sensitive part of the brain stem, the area postrema, may be over-ridden during hypoglycemia. They collectively reduce the total insulin demand.

Amylin also acts in bone metabolism, along with the related peptides calcitonin and calcitonin gene related peptide.

Rodent amylin knockouts do not have a normal reduction of appetite following food consumption. Because it is an amidated peptide, like many neuropeptides, it is believed to be responsible for the effect on appetite.

Structure

The human form of IAPP has the amino acid sequence KCNTATCATQRLANFLVHSSNNFGAILSSTNVGSNTY, with a disulfide bridge between cysteine residues 2 and 7. Both the amidated C-terminus and the disulfide bridge are necessary for the full biological activity of amylin. IAPP is capable of forming amyloid fibrils in vitro. Within the fibrillization reaction, the early prefibrillar structures are extremely toxic to beta-cell and insuloma cell cultures. Later amyloid fiber structures also seem to have some cytotoxic effect on cell cultures. Studies have shown that fibrils are the end product and not necessarily the most toxic form of amyloid proteins/peptides in general. A non-fibril forming peptide (1–19 residues of human amylin) is toxic like the full-length peptide but the respective segment of rat amylin is not. It was also demonstrated by solid-state NMR spectroscopy that the fragment 20-29 of the human-amylin fragments membranes. Rats and mice have six substitutions (three of which are proline substitions at positions 25, 28 and 29) that are believed to prevent the formation of amyloid fibrils, although not completely as seen by its propensity to form amyloid fibrils in vitro. Rat IAPP is nontoxic to beta-cells when overexpressed in transgenic rodents.

History

IAPP was identified independently by two groups as the major component of diabetes-associated islet amyloid deposits in 1987.

The difference in nomenclature is largely geographical; European researchers tend to prefer IAPP whereas American researchers tend to prefer amylin. Some researchers discourage the use of "amylin" on the grounds that it may be confused with the pharmaceutical company.

Clinical significance

ProIAPP has been linked to Type 2 diabetes and the loss of islet β-cells. Islet amyloid formation, initiated by the aggregation of proIAPP, may contribute to this progressive loss of islet β-cells. It is thought that proIAPP forms the first granules that allow for IAPP to aggregate and form amyloid which may lead to amyloid-induced apoptosis of β-cells.

IAPP is cosecreted with insulin. Insulin resistance in Type 2 diabetes produces a greater demand for insulin production which results in the secretion of proinsulin. ProIAPP is secreted simultaneously, however, the enzymes that convert these precursor molecules into insulin and IAPP, respectively, are not able to keep up with the high levels of secretion, ultimately leading to the accumulation of proIAPP.

In particular, the impaired processing of proIAPP that occurs at the N-terminal cleavage site is a key factor in the initiation of amyloid. Post-translational modification of proIAPP occurs at both the carboxy terminus and the amino terminus, however, the processing of the amino terminus occurs later in the secretory pathway. This might be one reason why it is more susceptible to impaired processing under conditions where secretion is in high demand. Thus, the conditions of Type 2 diabetes—high glucose concentrations and increased secretory demand for insulin and IAPP—could lead to the impaired N-terminal processing of proIAPP. The unprocessed proIAPP can then serve as the nidus upon which IAPP can accumulate and form amyloid.

The amyloid formation might be a major mediator of apoptosis, or programmed cell death, in the islet β-cells. Initially, the proIAPP aggregates within secretory vesicles inside the cell. The proIAPP acts as a seed, collecting matured IAPP within the vesicles, forming intracellular amyloid. When the vesicles are released, the amyloid grows as it collects even more IAPP outside the cell. The overall effect is an apoptosis cascade initiated by the influx of ions into the β-cells.

General Scheme for Amyloid Formation
 
In summary, impaired N-terminal processing of proIAPP is an important factor initiating amyloid formation and β-cell death. These amyloid deposits are pathological characteristics of the pancreas in Type 2 diabetes. However, it is still unclear as to whether amyloid formation is involved in or merely a consequence of type 2 diabetes. Nevertheless, it is clear that amyloid formation reduces working β-cells in patients with Type 2 diabetes. This suggests that repairing proIAPP processing may help to prevent β-cell death, thereby offering hope as a potential therapeutic approach for Type 2 diabetes. 

Amyloid deposits deriving from islet amyloid polypeptide (IAPP, or amylin) are commonly found in pancreatic islets of patients suffering diabetes mellitus type 2, or containing an insulinoma cancer. While the association of amylin with the development of type 2 diabetes has been known for some time, its direct role as the cause has been harder to establish. Recent results suggest that amylin, like the related beta-amyloid (Abeta) associated with Alzheimer's disease, can induce apoptotic cell-death in insulin-producing beta cells, an effect that may be relevant to the development of type 2 diabetes.

A 2008 study reported a synergistic effect for weight loss with leptin and amylin coadministration in diet-induced obese rats by restoring hypothalamic sensitivity to leptin. However, in clinical trials, the study was halted at Phase 2 in 2011 when a problem involving antibody activity that might have neutralized the weight-loss effect of metreleptin in two patients who took the drug in a previously completed clinical study. The study combined metreleptin, a version of the human hormone leptin, and pramlintide, which is Amylin’s diabetes drug Symlin, into a single obesity therapy. Finally, a recent proteomics study showed that human amylin shares common toxicity targets with beta-amyloid (Abeta), providing evidence that type 2 diabetes and Alzheimer's disease share common toxicity mechanisms.

Pharmacology

A synthetic analog of human amylin with proline substitutions in positions 25, 26 and 29, or pramlintide (brand name Symlin), was approved in 2005 for adult use in patients with both diabetes mellitus type 1 and diabetes mellitus type 2. Insulin and pramlintide, injected separately but both before a meal, work together to control the post-prandial glucose excursion.

Amylin is degraded in part by insulin-degrading enzyme.

Receptors

There appear to be at least three distinct receptor complexes that amylin binds to with high affinity. All three complexes contain the calcitonin receptor at the core, plus one of three receptor activity-modifying proteins, RAMP1, RAMP2, or RAMP3.

Insulin analog

From Wikipedia, the free encyclopedia

An insulin analog is an altered form of insulin, different from any occurring in nature, but still available to the human body for performing the same action as human insulin in terms of glycemic control. Through genetic engineering of the underlying DNA, the amino acid sequence of insulin can be changed to alter its ADME (absorption, distribution, metabolism, and excretion) characteristics. Officially, the U.S. Food and Drug Administration (FDA) refers to these as "insulin receptor ligands", although they are more commonly referred to as insulin analogs.

These modifications have been used to create two types of insulin analogs: those that are more readily absorbed from the injection site and therefore act faster than natural insulin injected subcutaneously, intended to supply the bolus level of insulin needed at mealtime (prandial insulin); and those that are released slowly over a period of between 8 and 24 hours, intended to supply the basal level of insulin during the day and particularly at nighttime (basal insulin). The first insulin analog approved for human therapy (insulin Lispro rDNA) was manufactured by Eli Lilly and Company.

Fast acting

Lispro

Eli Lilly and Company developed and marketed the first rapid-acting insulin analogue (insulin lispro rDNA) Humalog. It was engineered through recombinant DNA technology so that the penultimate lysine and proline residues on the C-terminal end of the B-chain were reversed. This modification did not alter the insulin receptor binding, but blocked the formation of insulin dimers and hexamers. This allowed larger amounts of active monomeric insulin to be available for postprandial (after meal) injections.

Aspart

Novo Nordisk created "aspart" and marketed it as NovoLog/NovoRapid (UK-CAN) as a rapid-acting insulin analogue. It was created through recombinant DNA technology so that the amino acid, B28, which is normally proline, is substituted with an aspartic acid residue. The sequence was inserted into the yeast genome, and the yeast expressed the insulin analogue, which was then harvested from a bioreactor. This analogue also prevents the formation of hexamers, to create a faster acting insulin. It is approved for use in CSII pumps and Flexpen, Novopen delivery devices for subcutaneous injection.

Glulisine

Glulisine is rapid acting insulin analog from Sanofi-Aventis, approved for use with a regular syringe, in an insulin pump. Standard syringe delivery is also an option. It is sold under the name Apidra. The FDA-approved label states that it differs from regular human insulin by its rapid onset and shorter duration of action.

Long acting

Detemir insulin

Novo Nordisk created insulin detemir and markets it under the trade name Levemir as a long-lasting insulin analogue for maintaining the basal level of insulin. The basal level of insulin may be maintained for up to 20 hours, but the time is affected by the size of the injected dose. This insulin has a high affinity for serum albumin, increasing its duration of action.

Degludec insulin

This is an ultralong-acting insulin analogue developed by Novo Nordisk, which markets it under the brand name Tresiba. It is administered once daily and has a duration of action that lasts up to 40 hours (compared to 18 to 26 hours provided by other marketed long-acting insulins such as insulin glargine and insulin detemir).

Glargine insulin

Sanofi-Aventis developed glargine as a longer-lasting insulin analogue, and markets it under the trade name Lantus. It was created by modifying three amino acids. Two positively charged arginine molecules were added to the C-terminus of the B-chain, and they shift the isoelectric point from 5.4 to 6.7, making glargine more soluble at a slightly acidic pH and less soluble at a physiological pH. Replacing the acid-sensitive asparagine at position 21 in the A-chain by glycine is needed to avoid deamination and dimerization of the arginine residue. These three structural changes and formulation with zinc result in a prolonged action when compared with biosynthetic human insulin. When the pH 4.0 solution is injected, most of the material precipitates and is not bioavailable. A small amount is immediately available for use, and the remainder is sequestered in subcutaneous tissue. As the glargine is used, small amounts of the precipitated material will move into solution in the bloodstream, and the basal level of insulin will be maintained up to 24 hours. The onset of action of subcutaneous insulin glargine is somewhat slower than NPH human insulin. It is clear solution as there is no zinc in formula.

Comparison with other insulins

NPH

NPH (Neutral Protamine Hagedorn) insulin is an intermediate-acting insulin with delayed absorption after subcutaneous injection, used for basal insulin support in diabetes type 1 and type 2. NPH insulins are suspensions that require shaking for reconstitution prior to injection. Many people reported problems when being switched to intermediate acting insulins in the 1980s, using NPH formulations of porcine/bovine insulins. Basal insulin analogs were subsequently developed and introduced into clinical practice to achieve more predictable absorption profiles and clinical efficacy.

Animal insulin

The amino acid sequence of animal insulins in different mammals may be similar to human insulin (insulin human INN), there is however considerable viability within vertebrate species. Porcine insulin has only a single amino acid variation from the human variety, and bovine insulin varies by three amino acids. Both are active on the human receptor with approximately the same strength. Bovine insulin and porcine insulin may be considered as the first clinically used insulin analogs (naturally occurring, produced by extraction from animal pancreas), at the time when biosynthetic human insulin (insulin human rDNA) was not available. There are extensive reviews on structure-relationship of naturally occurring insulins (phylogenic relationship in animals) and structural modifications. Prior to the introduction of biosynthetic human insulin, insulin derived from sharks was widely used in Japan. Insulin from some species of fish may be also effective in humans. Non-human insulins have caused allergic reactions in some patients related to the extent of purification, formation of non-neutralising antibodies is rarely observed with recombinant human insulin (insulin human rDNA) but allergy may occur in some patients. This may be enhanced by the preservatives used in insulin preparations, or occur as a reaction to the preservative. Biosynthetic insulin (insulin human rDNA) has largely replaced animal insulin.

Modifications

Before biosynthetic human recombinant analogues were available, porcine insulin was chemically converted into human insulin. Chemical modifications of the amino acid side chains at the N-terminus and/or the C-terminus were made in order to alter the ADME characteristics of the analogue. Semisynthetic insulins were clinically used for some time based on chemical modification of animal insulins, for example Novo Nordisk enzymatically converted porcine insulin into semisynthetic 'human' insulin by removing the single amino acid that varies from the human variety, and chemically adding the human amino acid.

Normal unmodified insulin is soluble at physiological pH. Analogues have been created that have a shifted isoelectric point so that they exist in a solubility equilibrium in which most precipitates out but slowly dissolves in the bloodstream and is eventually excreted by the kidneys. These insulin analogues are used to replace the basal level of insulin, and may be effective over a period of up to 24 hours. However, some insulin analogues, such as insulin detemir, bind to albumin rather than fat like earlier insulin varieties, and results from long-term usage (e.g. more than 10 years) are currently not available but required for assessment of clinical benefit.

Unmodified human and porcine insulins tend to complex with zinc in the blood, forming hexamers. Insulin in the form of a hexamer will not bind to its receptors, so the hexamer has to slowly equilibrate back into its monomers to be biologically useful. Hexameric insulin delivered subcutaneously is not readily available for the body when insulin is needed in larger doses, such as after a meal (although this is more a function of subcutaneously administered insulin, as intravenously dosed insulin is distributed rapidly to the cell receptors, and therefore, avoids this problem). Zinc combinations of insulin are used for slow release of basal insulin. Basal insulin support is required throughout the day representing about 50% of daily insulin requirement, the insulin amount needed at mealtime makes up for the remaining 50%. Non hexameric insulins (monomeric insulins) were developed to be faster acting and to replace the injection of normal unmodified insulin before a meal. There are phylogenetic examples for such monomeric insulins in animals.

Carcinogenicity

All insulin analogs must be tested for carcinogenicity, as insulin engages in cross-talk with IGF pathways, which can cause abnormal cell growth and tumorigenesis. Modifications to insulin always carry the risk of unintentionally enhancing IGF signalling in addition to the desired pharmacological properties. There has been concern with the mitogenic activity and the potential for carcinogenicity of glargine. Several epidemiological studies have been performed to address these issues. Recent study result of the 6.5 years Origin study with glargine have been published.

Criticism

A meta-analysis in 2007 of numerous randomized controlled trials by the international Cochrane Collaboration found "only a minor clinical benefit of treatment with long-acting insulin analogues (including two studies of insulin detemir) for patients with diabetes mellitus type 2" while others have examined the same issue in type 1 diabetes. Subsequent meta-analyses undertaken in a number of countries and continents have confirmed Cochrane's findings. 

In 2007, Germany's Institute for Quality and Cost Effectiveness in the Health Care Sector (IQWiG) reached a similar conclusion based on absence of conclusive double-blind comparative studies. In its report, IQWiG concluded that there is currently "no evidence" available of the superiority of rapid-acting insulin analogs over synthetic human insulins in the treatment of adult patients with type 1 diabetes. Many of the studies reviewed by IQWiG were either too small to be considered statistically reliable and, perhaps most significantly, none of the studies included in their widespread review were blinded, the gold-standard methodology for conducting clinical research. However, IQWiG's terms of reference explicitly disregard any issues which cannot be tested in double-blind studies, for example a comparison of radically different treatment regimes. IQWiG is regarded with skepticism by some doctors in Germany, being seen merely as a mechanism to reduce costs. But the lack of study blinding does increase the risk of bias in these studies. The reason this is important is because patients, if they know they are using a different type of insulin, might behave differently (such as testing blood glucose levels more frequently, for example), which leads to bias in the study results, rendering the results inapplicable to the diabetes population at large. Numerous studies have concluded that any increase in testing of blood glucose levels is likely to yield improvements in glycemic control, which raises questions as to whether any improvements observed in the clinical trials for insulin analogues were the result of more frequent testing or due to the drug undergoing trials.

In 2008, the Canadian Agency for Drugs and Technologies in Health (CADTH) found, in its comparison of the effects of insulin analogues and biosynthetic human insulin, that insulin analogues failed to show any clinically relevant differences, both in terms of glycemic control and adverse reaction profile.

Timeline

  • 1922 Banting and Best use bovine insulin extract on human
  • 1923 Eli Lilly and Company (Lilly) produces commercial quantities of bovine insulin
  • 1923 Hagedorn founds the Nordisk Insulinlaboratorium in Denmark forerunner of Novo Nordisk
  • 1926 Nordisk receives Danish charter to produce insulin as a non-profit
  • 1936 Canadians D.M. Scott and A.M. Fisher formulate zinc insulin mixture and license to Novo
  • 1936 Hagedorn discovers that adding protamine to insulin prolongs the effect of insulin
  • 1946 Nordisk formulates Isophane porcine insulin a.k.a. Neutral Protamine Hagedorn or NPH insulin
  • 1946 Nordisk crystallizes a protamine and insulin mixture
  • 1950 Nordisk markets NPH insulin
  • 1953 Novo formulates Lente porcine and bovine insulins by adding zinc for longer-lasting insulin
  • 1978 Genentech develop biosynthesis of recombinant human insulin in Escherichia coli bacteria using recombinant DNA technology
  • 1981 Novo Nordisk chemically and enzymatically converts porcine insulin to 'human' insulin (Actrapid HM)
  • 1982 Genentech synthetic 'human' insulin approved, in partnership with Eli Lilly and Company, who shepherded the product through the U.S. Food and Drug Administration (FDA) approval process
  • 1983 Lilly produces biosynthetic recombinant "rDNA insulin human INN" (Humulin)
  • 1985 Axel Ullrich sequences the human insulin receptor
  • 1988 Novo Nordisk produces synthetic, recombinant insulin ("insulin human INN")
  • 1996 Lilly Humalog "insulin lispro INN" approved by the U.S. Food and Drug Administration
  • 2003 Aventis Lantus "glargine" insulin analogue approved in USA 
  • 2004 Sanofi Aventis Apidra insulin "glulisine" analogue approved in the USA.
  • 2006 Novo Nordisk's Levemir "insulin detemir INN" analogue approved in the USA-
  • 2013 Novo Nordisk's Tresiba "insulin degludec INN" analogue approved in Europe (EMA with additional monitoring)

Beta cell

From Wikipedia, the free encyclopedia
 
Beta cell
Details
LocationPancreatic islet
FunctionInsulin secretion
Identifiers
Latinendocrinocytus B; insulinocytus
THH3.04.02.0.00026

Beta cells (β cells) are a type of cell found in pancreatic islets that synthesize and secrete insulin and amylin. Beta cells make up 50–70% of the cells in human islets. In patients with type I or type II diabetes, beta-cell mass and function are diminished, leading to insufficient insulin secretion and hyperglycemia.

Function

The primary function of a beta cell is to produce and release insulin and amylin. Both are hormones which reduce blood glucose levels by different mechanisms. Beta cells can respond quickly to spikes in blood glucose concentrations by secreting some of their stored insulin and amylin while simultaneously producing more.

Insulin Synthesis

Beta cells are the only site of insulin synthesis in mammals. As glucose stimulates insulin secretion, it simultaneously increases proinsulin biosynthesis, mainly through translational control.

The insulin gene is first transcribed into mRNA and translated into preproinsulin. After translation, the preproinsulin precursor contains an N-terminal signal peptide that allows translocation into the rough endoplasmic reticulum (RER). Inside the RER, the signal peptide is cleaved to form proinsulin. Then, folding of proinsulin occurs forming three disulfide bonds. Subsequent to protein folding, proinsulin is transported to the Golgi apparatus and enters immature insulin granules where proinsulin is cleaved to form insulin and C-peptide. After maturation, these secretory vesicles hold insulin, C-peptide, and amylin until calcium triggers exocytosis of the granule contents.

Through translational processing, insulin is encoded as a 110 amino acid precursor but is secreted as a 51 amino acid protein.

Insulin Secretion

A diagram of the Consensus Model of glucose-stimulated insulin secretion
The Consensus Model of glucose-stimulated insulin secretion. Courtesy of user: BQUB17-PlanaCampas. No changes were made to the original image. (CC BY-SA 4.0)
 
In beta cells, insulin release is stimulated primarily by glucose present in the blood. As circulating glucose levels rise such as after ingesting a meal, insulin is secreted in a dose-dependent fashion. This system of release is commonly referred to as glucose-stimulated insulin secretion (GSIS). There are four key pieces to the "Consensus Model" of GSIS: GLUT2 dependent glucose uptake, glucose metabolism, KATP channel closure, and the opening of voltage gated calcium channels causing insulin granule fusion and exocytosis.

Voltage-gated calcium channels and ATP-sensitive potassium ion channels are embedded in the plasma membrane of beta cells. These ATP-sensitive potassium ion channels are normally open and the calcium ion channels are normally closed. Potassium ions diffuse out of the cell, down their concentration gradient, making the inside of the cell more negative with respect to the outside (as potassium ions carry a positive charge). At rest, this creates a potential difference across the cell surface membrane of -70mV.

When the glucose concentration outside the cell is high, glucose molecules move into the cell by facilitated diffusion, down its concentration gradient through the GLUT2 transporter. Since beta cells use glucokinase to catalyze the first step of glycolysis, metabolism only occurs around physiological blood glucose levels and above. Metabolism of the glucose produces ATP, which increases the ATP to ADP ratio.

The ATP-sensitive potassium ion channels close when this ratio rises. This means that potassium ions can no longer diffuse out of the cell. As a result, the potential difference across the membrane becomes more positive (as potassium ions accumulate inside the cell). This change in potential difference opens the voltage-gated calcium channels, which allows calcium ions from outside the cell to diffuse in down their concentration gradient. When the calcium ions enter the cell, they cause vesicles containing insulin to move to, and fuse with, the cell surface membrane, releasing insulin by exocytosis into the hepatic portal vein.

Other Hormones Secreted

  • C-peptide, which is secreted into the bloodstream in equimolar quantities to insulin. C-peptide helps to prevent neuropathy and other vascular deterioration related symptoms of diabetes mellitus. A practitioner would measure the levels of C-peptide to obtain an estimate for the viable beta cell mass.
  • Amylin, also known as islet amyloid polypeptide (IAPP). The function of amylin is to slow the rate of glucose entering the bloodstream. Amylin can be described as a synergistic partner to insulin, where insulin regulates long term food intake and amylin regulates short term food intake.

Clinical significance

Type 1 Diabetes

Type 1 diabetes mellitus, also known as insulin dependent diabetes, is believed to be caused by an auto-immune mediated destruction of the insulin producing beta cells in the body. The destruction of these cells reduces the body's ability to respond to glucose levels in the body, therefore making it nearly impossible to properly regulate glucose and glucagon levels in the bloodstream. The body destroys 70–80% of beta cells, leaving only 20–30% of functioning cells. This can cause the patient to experience hyperglycemia, which leads to other adverse short-term and long-term conditions. The symptoms of diabetes can potentially be controlled with methods such as regular doses of insulin and sustaining a proper diet. However, these methods can be tedious and cumbersome to continuously perform on a daily basis.

Type 2 Diabetes

Type 2 diabetes mellitus, also known as non insulin dependent diabetes and as chronic hyperglycemia, is caused primarily by genetics and the development of metabolic syndrome. The beta cells can still secrete insulin but the body has developed a resistance and its response to insulin has declined. It is believed to be due to the decline of specific receptors on the surface of the liver, adipose, and muscle cells which lose their ability to respond to insulin that circulates in the blood. In an effort to secrete enough insulin to overcome the increasing insulin resistance, the beta cells increase their function, size and number. Increased insulin secretion leads to hyperinsulinemia, but blood glucose levels remain within their normal range due to the decreased efficacy of insulin signaling. However, the beta cells can become overworked and exhausted from being overstimulated, leading to a 50% reduction in function along with a 40% decrease in beta-cell volume. At this point, not enough insulin can be produced and secreted to keep blood glucose levels within their normal range, causing overt type 2 diabetes.

Insulinoma

Insulinoma is a rare tumor derived from the neoplasia of beta cells. Insulinomas are usually benign, but may be medically significant and even life-threatening due to recurrent and prolonged attacks of hypoglycemia.

Medications

Many drugs to combat diabetes are aimed at modifying the function of the beta cell.
  • Sulfonylureas are insulin secretagogues that act by closing the ATP-sensitive potassium channels, thereby causing insulin release. These drugs are known to cause hypoglycemia and can lead to beta-cell failure due to overstimulation. Second-generation versions of sulfonylureas are shorter acting and less likely to cause hypoglycemia.
  • GLP-1 receptor agonists stimulate insulin secretion by simulating activation of the body's endogenous incretin system. The incretin system acts as an insulin secretion amplifying pathway.
  • DPP-4 inhibitors block DPP-4 activity which increases postprandial incretin hormone concentration, therefore increasing insulin secretion.

Research

Experimental Techniques

Many researchers around the world are investigating the pathogenesis of diabetes and beta-cell failure. Tools used to study beta-cell function are expanding rapidly with technology.

For instance, transcriptomics have allowed researchers to comprehensively analyze gene transcription in beta-cells to look for genes linked to diabetes. A more common mechanism of analyzing cellular function is calcium imaging. Fluorescent dyes bind to calcium and allow in vitro imaging of calcium activity which correlates directly with insulin release. A final tool used in beta-cell research are in vivo experiments. Diabetes mellitus can be experimentally induced in vivo for research purposes by streptozotocin or alloxan, which are specifically toxic to beta cells. Mouse and rat models of diabetes also exist including ob/ob and db/db mice which are a type 2 diabetes model, and non-obese diabetic mice (NOD) which are a model for type 1 diabetes.

Type 1 Diabetes

Research has shown that beta cells can be differentiated from human pancreas progenitor cells. These differentiated beta cells, however, often lack much of the structure and markers that beta cells need to perform their necessary functions. Examples of the anomalies that arise from beta cells differentiated from progenitor cells include a failure to react to environments with high glucose concentrations, an inability to produce necessary beta cell markers, and abnormal expression of glucagon along with insulin.

In order to successfully re-create functional insulin producing beta cells, studies have shown that manipulating cell-signal pathways in early stem cell development will lead to those stem cells differentiating into viable beta cells. Two key signal pathways have been shown to play a vital role in the differentiation of stem cells into beta cells: the BMP4 pathway and the kinase C. Targeted manipulation of these two pathways has shown that it is possible to induce beta cell differentiation from stem cells. These variations of artificial beta cells have shown greater levels of success in replicating the functionality of natural beta cells, although the replication has not been perfectly re-created yet.

Studies have shown that it is possible to regenerate beta cells in vivo in some animal models. Research in mice has shown that beta cells can often regenerate to the original quantity number after the beta cells have undergone some sort of stress test, such as the intentional destruction of the beta cells in the mice subject or once the auto-immune response has concluded. While these studies have conclusive results in mice, beta cells in human subjects may not possess this same level of versatility. Investigation of beta cells following acute onset of Type 1 diabetes has shown little to no proliferation of newly synthesized beta cells, suggesting that human beta cells might not be as versatile as rat beta cells, but there is actually no comparison that can be made here because healthy (non-diabetic) rats were used to prove that beta cells can proliferate after intentional destruction of beta cells, while diseased (type-1 diabetic) humans were used in the study which was attempted to use as evidence against beta cells regenerating, which in reality tells us literally nothing whatsoever. 

It appears that much work has to be done in the field of regenerating beta cells. Just as in the discovery of creating insulin through the use of recombinant DNA, the ability to artificially create stem cells that would differentiate into beta cells would prove to be an invaluable resource to patients suffering from Type 1 diabetes. An unlimited amount of beta cells produced artificially could potentially provide therapy to many of the patients who are affected by Type 1 diabetes.

Type 2 Diabetes

Research focused on non insulin dependent diabetes encompasses many areas of interest. Degeneration of the beta cell as diabetes progresses has been a broadly reviewed topic. Another topic of interest for beta-cell physiologists is the mechanism of insulin pulsatility which has been well investigated. Many genome studies have been completed and are advancing the knowledge of beta-cell function exponentially. Indeed, the area of beta-cell research is very active yet many mysteries remain.

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