Induction of mild hypoglycemia by islet transplantation to the pancreas.
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Animals↗
Biomedical subjects
E Samols
Publications and source records attributed to E Samols.
Interstitial insulin during euglycemic-hyperinsulinemic clamp in obese and lean individuals.
Transcapillary insulin transport has been considered a rate-limiting step of insulin action. However, direct measurement of interstitial insulin levels during physiologic levels of insulinemia have not been performed. We determined changes in interstitial insulin in eight healthy non-obese men and seven healthy obese men by microdialysis during a euglycemic-hyperinsulinemic clamp. Interstitial insulin was determined in the subcutaneous tissue of the abdomen and thigh. Steady-state insulin concentrations were reached approximately 10 minutes after the start of insulin infusion in the subcutaneous tissue of the abdomen and thigh and returned to basal levels approximately 10 minutes after the infusion was discontinued. There was no difference in the rapidity of change in interstitial insulin between obese and lean individuals at either site studied, irrespective of the pattern of fat distribution. The relative change in dialysate insulin concentration during the euglycemic clamp did not differ between obese and lean individuals at either site studied. It was also unaffected by the waist to hip ratio. The rapid change in interstitial insulin concentration could be of physiologic significance in determining the effects of changes in circulating insulin concentration. We conclude that transcapillary insulin transport in adipose tissue is unaffected by obesity and the pattern of fat distribution in healthy men. It is also concluded that when interstitial insulin is determined directly, transcapillary insulin transport is rapid and does not demonstrate a significant lag phase.
Adult↗
Glimepiride, a new once-daily sulfonylurea. A double-blind placebo-controlled study of NIDDM patients. Glimepiride Study Group.
OBJECTIVE: To compare the efficacy and safety of two daily doses of the new sulfonylurea, glimepiride (Amaryl), each as a once-daily dose or in two divided doses, in patients with NIDDM. RESEARCH DESIGN AND METHODS: Of the previously treated NIDDM patients, 416 entered this multicenter randomized double-blind placebo-controlled fixed-dose study. After a 3-week placebo washout, patients received a 14-week course of placebo or glimepiride 8 mg q.d., 4 mg b.i.d., 16 mg q.d., or 8 mg b.i.d. RESULTS: Fasting plasma glucose (FPG) and HbA1c values were similar at baseline in all treatment groups. The placebo group's FPG value increased from 13.0 mmol/l at baseline to 14.5 mmol/l at the last evaluation endpoint (P < or = 0.001). In contrast, FPG values in the four glimepiride groups decreased from a range of 12.4-12.9 mmol/l at baseline to a range of 8.6-9.8 mmol/l at endpoint (P < or = 0.001, within-group change from baseline; P < or = 0.001, between-group change [vs. placebo] from baseline). Two-hour postprandial plasma glucose (PPG) findings were consistent with FPG findings. In the placebo group, the HbA1c value increased from 7.7% at baseline to 9.7% at endpoint (P < or = 0.001), whereas HbA1c values for the glimepiride groups were 7.9-8.1% at baseline and 7.4-7.6% at endpoint (P < or = 0.001, within-group change from baseline; P < or = 0.001, between-group change from baseline). There were no meaningful differences in glycemic variables between daily doses of 8 and 16 mg or between once- and twice-daily dosing. Adverse events and laboratory data demonstrate that glimepiride has a favorable safety profile. CONCLUSIONS: Glimepiride is an effective and well-tolerated oral glucose-lowering agent. The results of this study demonstrate maximum effectiveness can be achieved with 8 mg q.d. of glimepiride in NIDDM subjects.
Blood Glucose↗
In situ binding of islet hormones in the isolated perfused rat pancreas: evidence for local high concentrations of islet hormones via the islet-acinar axis.
Insulin and somatostatin reportedly affect pancreatic acinar cell function via specific receptor binding. Theoretically peri-insular levels depend on the islet-acinar portal system, but the actual hormone levels have never been demonstrated. Rat pancreata were perfused anterogradely or retrogradely with 125I-insulin, -somatostatin, or -glucagon (each, approximately equal to 10(-11) mol/l). Tracer binding was determined from differences between influx and efflux radioactivity. Saturable binding was observed for insulin and somatostatin, but not for glucagon. Binding in the absence of unlabelled peptides was significantly higher during retrograde perfusion than during anterograde perfusion for insulin (25.9 +/- 2.6 vs 16.0 +/- 2.1%, mean +/- SD; each, n = 4; p < 0.001) and somatostatin (18.4 +/- 2.0 vs 13.6 +/- 1.2%; each, n = 3; p < 0.05). Non-specific binding was similar in both directions. These findings are attributable to endogenous hormones acting as unlabelled ligands competing with the tracers during anterograde perfusion. This conclusion was supported by the demonstration that endogenous insulin stimulation by D-glucose, but not by L-glucose, caused a decrease in labelled insulin binding only during anterograde perfusion. Displacement curves obtained during retrograde perfusion showed that interstitial concentrations of insulin and somatostatin were 7.5 x 10(-9) and 1.1 x 10(-9) mol/l, respectively. Thus, the exocrine pancreas is indeed exposed to locally high concentrations of islet hormones.
Animals↗
Hormone secretion from transplanted islets is dependent upon changes in islet revascularization and islet architecture.
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Animals↗
Lack of delay in hepatic insulin transit as indicated by concordance of insulin secretory and peripheral insulin pulses.
The liver is an important site of insulin metabolism and action. It has often been assumed that the liver may diminish the amplitude of the insulin secretory waveform without altering hepatic insulin transit time. However, the significant extraction and metabolism of hepatic insulin has the potential to delay hepatic insulin transit. To examine hepatic insulin transit, we studied the concordance of calculated insulin secretory peaks with peripheral insulin peaks in 12 healthy men of varying body weight and fat distribution. Adiposity was determined by percent body fat, and fat distribution by the waist to hip ratio. Arterialized peripheral venous samples for insulin and C-peptide assays were obtained every 2 minutes for 90 minutes. Pancreatic insulin secretion rates were estimated with individual C-peptide kinetics using a two-compartment model. Concordance between insulin secretory peaks and peripheral insulin peaks was assessed by the hypergeometric probability model. A significant concordance between secretory and peripheral insulin pulses was demonstrated in seven of 12 subjects (P < .00001). The mean pulse intervals for insulin secretion were similar to the mean pulse intervals for peripheral insulin. The degree of concordance between the insulin secretory peaks and peripheral insulin pulses was unrelated to adiposity or body fat distribution. Significant synchronicity exists between insulin secretory peaks and peripheral insulin peaks in healthy men. We conclude that despite significant hepatic insulin extraction and metabolism, hepatic insulin transit may not be delayed in healthy men.
Adult↗
Altered microcirculation and secretion in transplanted islets.
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Animals↗
Suppressive role of the islet-acinar axis in the perfused rat pancreas.
BACKGROUND: The stimulating effects of insulin on the exocrine pancreas are well known. The effects of other islet hormones, however, are controversial. The aim of the present study was to determine whether the islet-acinar axis, as a whole, is stimulatory or inhibitory. Because we have shown that retrograde perfusion reverses the islet-acinar directed microcirculation, retrograde perfusion was expected to remove the overall effects of islet hormones from the acinar tissue. METHODS: Rat pancreata were perfused (7 mmol/L glucose plus 3 mmol/L mixed amino acids) either anterogradely or retrogradely. Pancreatic juice flow, protein output, and amylase output were measured. RESULTS: When perfusion was switched from anterograde to retrograde, juice flow increased threefold without changes in protein and amylase output. When cerulein (10(-10) mol/L) was infused, retrograde protein and amylase responses were larger than anterograde responses (each, n = 7; 2.71 +/- 0.23 vs. 1.71 +/- 0.11 mg/40 minutes; 173 +/- 17 vs. 98 +/- 8 U/40 minutes; mean +/- SE; both, P < 0.01). Somatostatin-14 and rat pancreatic polypeptide (each, 10(-9) mol/L) reduced the retrograde protein and amylase responses, but not juice flow, to the anterograde response levels. Conversely, these peptides did not affect exocrine function during anterograde perfusion. CONCLUSIONS: A suppressive role of the islet-acinar axis via endogenous somatostatin and/or pancreatic polypeptide is suggested.
Amino Acids↗
Lack of insulin feedback inhibition in non-obese and obese men.
The existence of insulin feedback inhibition is a controversial issue. The present study adopted a novel approach to determine whether insulin feedback inhibition exists in vivo during physiologic hyperinsulinemia and if it could contribute to enhanced insulin secretion in obesity. Serial plasma insulin and C-peptide levels were determined during a basal state and a hyperinsulinemic clamp (287 pmol/min/m2) and following discontinuation of the insulin infusion under euglycemic conditions. Insulin secretion rates were derived from plasma C-peptide levels and individual C-peptide kinetics using a two-compartment model. Eight non-obese and nine obese men were recruited for the studies, which were performed in random order. Men with significant variations in glucose levels during hyperinsulinemia were excluded from the analysis. Plasma glucose levels were similar between the non-obese and obese groups during all phases of the study, and similar plasma insulin levels were achieved in both groups during euglycemic hyperinsulinemia. In obese men, C-peptide levels were significantly greater compared with non-obese men during euglycemic hyperinsulinemia (P < .05). However, neither the non-obese nor the obese group demonstrated significant suppression of insulin secretion rates during euglycemic hyperinsulinemia. Expressing the data in absolute terms or as a percent of basal did not alter the results. Moreover, there was no significant change between the non-obese and the obese group during the rapid onset and cessation of hyperinsulinemia. Under euglycemic conditions, physiologic hyperinsulinemia does not induce suppression of endogenous insulin secretion in non-obese or obese men.
Adult↗
Exocrine interstitial insulin and somatostatin in the perfused dog pancreas.
To determine whether the islet-acinar relationship is mediated microvascularly or by diffusion from islets, isolated dog pancreata were perfused anterogradely (n = 4) or retrogradely (n = 5). Interstitial fluid (ISF) was sampled utilizing a microdialysis technique. Three to five microdialysis probes were placed in the dorsal lobe of each pancreas. Insulin and somatostatin were measured in dialysate, as well as in perfusate, under both resting (5.6 mM glucose) and stimulated (12.2 mM glucose plus 20 mM arginine) conditions. During the stimulative period, retrograde ISF responses were markedly less than anterograde responses, whereas perfusate (intravascular) anterograde and retrograde responses were not different; ratios of the sum of increments above basal levels of ISF concentrations to the sum of increments of perfusate concentrations (sigma delta ISF/sigma delta perfusate) of insulin and somatostatin during anterograde vs. retrograde perfusion were 35.1 +/- 8.8 (SE; n = 9) vs. 13.8 +/- 2.8% (n = 10) and 37.1 +/- 14.2 (n = 7) vs. 8.5 +/- 4.2% (n = 9), respectively (both, P < 0.05). These data strongly suggest that these islet hormones may be delivered to the exocrine interstitial space via a directed microcirculation from the islet to the acinar tissue.
Animals↗
Relationship of insulin secretory pulses to sex hormone-binding globulin in normal men.
Insulin has emerged as a regulator of sex hormone-binding globulin (SHBG) production in vitro and in vivo. A role for insulin in regulating SHBG exists in insulin resistant states such as obesity and polycystic ovary syndrome. The relationship of in vivo insulin secretion rates to SHBG levels in healthy normal men is less well documented. Hepatic synthesis of SHBG may be influenced by quantitative insulin exposure as well as qualitative characteristics such as frequency and amplitude of insulin secretory pulses. The present study was undertaken to assess these relationships in 10 normal men. Adiposity was determined by the body mass index and fat distribution by the waist hip ratio. Peripheral insulin sensitivity was determined by the euglycemic clamp technique at an insulin infusion rate of 287 pmol/min.m2. SHBG levels were determined in the fasting state by RIA. Arterialized venous samples for C-peptide were obtained every 2 min for 90 min in the basal state. Individual C-peptide kinetics were derived after a bolus injection of biosynthetic human C-peptide and a previously validated two compartmental model. Insulin secretion rates at each time point were calculated using the plasma C-peptide values and the C-peptide kinetics. Insulin secretion rates were unrelated to SHBG concentrations (r = -0.29, P > 0.05). The insulin secretory pulse interval had a significant positive association with SHBG levels (r = 0.86, P < 0.05). Insulin secretory pulse amplitude, body mass index, waist hip ratio, and peripheral insulin sensitivity were not associated with SHBG concentrations in a regression analysis. We postulate that insulin secretory pulse frequency may be an important determinant of SHBG synthesis in normal man.
Adipose Tissue↗
Induction of angiogenesis by growth factors: relevance to pancreatic islet transplantation.
Biodegradable pellets releasing 20 ng/day of endothelial cell growth factor alpha (alpha ECGF) or a- or b-fibroblast growth factor (FGF) and 90 micrograms/day of heparin were implanted beneath the renal capsule in rats and dogs and the muscularis/serosal border of the pyloric stomach in dogs to test for angiogenesis in a potential pancreatic islet transplant site. These factors were also tested in vitro to determine whether the capillary bed of the isolated islet could be preserved. alpha ECGF was superior to a- or bFGF in promoting endothelial cell growth and capillary formation in isolated islets. Both a- or bFGF and alpha ECGF induced the development of a dense capillary bed in the dog stomach, whereas in the kidney site alpha ECGF was more effective in the rat than was a- or bFGF. Priming the isolated islet as well as the transplant site prior to islet transplantation resulted in islet blood flow being established within 3 days in contrast to 7-14 days in controls.
Animals↗
Islet hormone pulse intervals are dependent upon sampling frequency.
Pulsatile insulin secretion has been reported from a variety of in vivo and in vitro systems. While it is agreed that insulin pulses exist, there is little agreement concerning the basal frequency or interpulse interval either within the same species in vivo, as both long and short term pulses have been reported, or between in vivo and in vitro preparations. We propose that the frequency of sampling may have profound effects upon the calculated pulse interval. Three systems were used to test this hypothesis: 1) artificial test data were designed to produce regular pulses with an exact 11 min period, 2) perfusate insulin concentration from isolated canine pancreata sampled at 1 min intervals and 3) peripheral blood insulin concentrations from human volunteers sampled every 2 and 5 min. Pulse parameters were determined at 1, 2, 5, 20, 15, 30 and 60 min sampling intervals for each data set by the use of the computer algorithms Pulsar and Cycle Detector. The results indicate that for insulin secretory pulses, sampling frequencies longer than 2 min may result in the production of spurious pulse trains with multiple longer term pulse periods. It is concluded that islet hormone secretory pulse period calculations are dependent upon the sampling frequency.
Analysis of Variance↗
Perfusion with anti-insulin gamma globulin indicates a B to A to D cellular perfusion sequence in the pancreas of the rhesus monkey, Macaca mulatta.
The cellular sequence of intraislet vascular perfusion has been shown to be important in the regulation of islet hormone secretion in the rat and dog islet. In order to test whether a B to A to D sequence of islet cellular perfusion is also present in a nonhuman primate, pancreata from the rhesus monkey, Macaca mulatta, were isolated and perfused in vitro in the presence and absence of anti-insulin gamma globulin. In the presence of the insulin antibody, efflux concentration of insulin decreased rapidly (-95 +/- 1.8%), whereas glucagon and somatostatin concentrations increased (111 +/- 28% and 239 +/- 38%, respectively). These results suggest the presence of a B-A-D cellular sequence of vascular perfusion within the monkey islet. The present results also strongly support the hypothesis that a B-A-D sequence of islet perfusion is important in the regulation of islet hormone secretion and further emphasize the central role of the B-cell in intraislet cellular interactions. The results also suggest that, despite differences in islet anatomy, a B-A-D order of islet cellular perfusion may be the preferred functional sequence among mammalian species.
Animals↗
Body fat distribution and peripheral insulin sensitivity in healthy men: role of insulin pulsatility.
Abdominal fat distribution is associated with insulin resistance in healthy young men. Factors modulating this phenomenon remain unclear. Pulsatile insulin release has been implicated as a potential regulator of insulin action. The relationship of pulsatility of peripheral insulin levels to fat distribution and peripheral insulin sensitivity was examined in 10 healthy men. Fat distribution was determined by the waist to hip ratio. Peripheral insulin sensitivity was assessed by the euglycemic clamp at an insulin infusion rate of 287 pmol/min.m2. Pulsatility of insulin was assessed by sampling every 2 min for 90 min in the basal state. The characteristics of insulin pulses were assessed by the computer program Pulsar. The waist to hip ratio was negatively associated with insulin sensitivity (r = -0.70, P less than 0.05) and insulin pulse interval (r = -0.66, P less than 0.05). The insulin pulse interval was positively correlated with peripheral insulin sensitivity (r = 0.73, P less than 0.05). The insulin interpulse interval was the primary determinant of insulin sensitivity. The increased frequency of insulin pulses may play a role in inducing insulin resistance in individuals with abdominal fat distribution.
Abdomen↗
The vascular order of islet cellular perfusion in the human pancreas.
The vascular order of pancreatic islet cellular perfusion is important in the intraislet regulation of hormone secretion. Establishment of the sequence of interaction is fundamental to understanding the physiology and pathophysiology of the human islet. Intraislet insulin from the beta-cell regulates both net hormone secretion and pulsatile secretion from alpha- and delta-cells. In terms of vascular perfusion, the delta-cell is perfused last and does not directly affect alpha- or beta-cells in humans.
Adult↗
Impaired B-cell function after lobe-specific hemipancreatectomy.
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Analysis of Variance↗
In vitro pancreatic hormonal pulses are less regular and more frequent than in vivo.
Spontaneous in vivo cyclic secretion of insulin and glucagon displays a pulse interval of 10 +/- 0.3 (SE) min and a constant phase relationship in fasting rhesus monkeys. When pancreata from six normal rhesus monkeys were perfused in vitro, the insulin pulse interval averaged 6.3 +/- 0.23 (SE) min. Insulin, glucagon, and somatostatin displayed high-amplitude secretory pulses, and the average pulse interval did not differ among the three islet hormones. The islet pulses are less regular in vitro than in vivo, and the phase relationship among the three hormones is lost. The relative amplitude averaged 142 +/- 10, 110 +/- 18, and 81 +/- 11% of the mean hormone concentrations for insulin, somatostatin, and glucagon, respectively. Similar differences in secretory pattern were observed during perfusion of three baboon pancreata compared with the in vivo pattern in this second primate species. The data suggest that the frequency and phase relationship of the islet pulsatile secretory system is modulated by factors extrinsic to the pancreas in the intact nonhuman primate. The nature of these modulating factors remains to be established. The apparent phase independence of the three islet hormones suggests that each of the major endocrine cell types of the islet possess independent episodic secretory mechanisms.
Animals↗