No description available.

Background: Chronic pancreatitis (CP) often leads to recurrent pain as well as exocrine and/or endocrine pancreatic insufficiency. This study aimed to investigate the effect of pancreatic head resections on glucose metabolism in patients with CP. Methods: Patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD), Whipple procedure (cPD), or duodenum-preserving pancreatic head resection (DPPHR) for CP between January 2011 and December 2020 were retrospectively analyzed with regard to markers of pancreatic endocrine function including steady-state beta cell function (%B), insulin resistance (IR), and insulin sensitivity (%S) according to the updated Homeostasis Model Assessment (HOMA2). Results: Out of 141 pancreatic resections for CP, 43 cases including 31 PPPD, 2 cPD and 10 DPPHR, met the inclusion criteria. Preoperatively, six patients (14%) were normoglycemic (NG), 10 patients (23.2%) had impaired glucose tolerance (IGT) and 27 patients (62.8%) had diabetes mellitus (DM). In each subgroup, no significant changes were observed for HOMA2-%B (NG: p = 0.57; IGT: p = 0.38; DM: p = 0.1), HOMA2-IR (NG: p = 0.41; IGT: p = 0.61; DM: p = 0.18) or HOMA2-%S (NG: p = 0.44; IGT: p = 0.52; DM: p = 0.51) 3 and 12 months after surgery, respectively. Conclusion: Pancreatic head resections for CP, including DPPHR and pancreatoduodenectomies, do not significantly affect glucose metabolism within a follow-up period of 12 months.

Diabetes mellitus is a group of metabolic disorders that are characterized by chronic hyperglycaemia. There are currently over 460 million people living with diabetes and the incidence rate for the most common types is sharply on the rise. The hyperglycaemia and subsequently the majority of diabetic side-effects can be cured by ß-cell transplantation. There is a severe lack of donor tissue for clinical transplantations, hence ß cells derived from human pluripotent stem cells (hPSCs) offer an attractive option for obtaining the necessary cells for a ß-cell therapy. The current ß-cell differentiation protocols are lengthy, expensive and relatively inefficient. Therefore, it remains unrealistic to scale up production to obtain the necessary 1 billion cells per patient to achieve normoglycaemia. The exponential expansion of an intermediate pancreatic progenitor (PP) population would allow for significant reduction of the cost and time necessary for the production of ß-cells in vitro and, more importantly, it would allow to relatively easily obtain the number of cells necessary for clinical applications. Thus far, the reproducible expansion of suitable hPSC-derived PPs in a chemically-defined, feeder-free culture condition has not been reported. Our lab has found that a previously reported medium suitable for the temporary expansion of reprogrammed fibroblast-derived PPs could occasionally, in 20% of the cases, mediate expansion of PSC derived PPs. To elucidate the requirements for reproducible expansion, I analysed transcriptomic data from PSC-derived PPs before and following expansion. Several regulated signalling pathways were identified and from these data, I formulated nine candidate expansion conditions (C0-C8) to test. Five of these conditions were able to reproducibly expand hPSC-derived PPs. Of those five conditions, C6 was found to mediate the fastest expansion with a doubling time of 2.2 days, maintained a stable expression of the crucial bipotent trunk progenitor transcription factor (TF) markers PDX1, NKX6.1, SOX9 and FOXA2 and minimized the expression of the hepatic and intestinal markers AFP and CDX2. The C6 expanded PPs were able to further differentiate into pancreatic endocrine progenitors (PEPs) in three-dimensional (3-D) islet-sized clusters formed in micropatterned wells. Micropatterned wells offer the additional advantage of size-controlled, uniform clusters and low culture volumes compared to suspension culture bioreactors proposed for the large-scale production of such clusters, but the use of micropatterned wells has not been reported for such an application thus far. These PEPs showed strong upregulation of the crucial endocrine specific TF NGN3 and around 90% were positive for NEUROD1, a downstream effector of NGN3, as determined by flow cytometry analysis. The PEPs were subsequently differentiated into insulin (INS)-producing ß-cells at around 20% efficiency. The ß-cells were also strongly expressing functionality genes such as zinc transporter 8 (ZnT8), glucokinase (GCK), prohormone convertase 1/3 (PC1/3) and sulfonylurea receptor 1 (SUR1, a subunit of KATP channel) and around 10% of them were expressing the crucial maturation marker MAFA, as determined by flow cytometry analysis of ß-cells derived from the H1INS1-GFP/MAFA-mCHERRY double reporter line generated in the lab. In summary, I have established a feeder-free, chemically defined and ‘good manufacturing practice’ (GMP)-compatible culture condition for the exponential expansion of hPSC-derived PPs that allows for the production of ß-cells at a fraction of the cost of conventional differentiation protocols. Ongoing work is being done to further optimise the expansion conditions to completely eliminate hepatic and intestinal markers and to optimise the subsequent differentiation steps in micropatterned wells to achieve a high-efficiency differentiation towards functional ß-cells. / Diabetes Mellitus ist eine Gruppe metabolischer Krankheiten, die sich durch chronische Hyperglykämie charakterisiert. Es gibt zurzeit über 460 Millionen Menschen, die mit Diabetes leben und die Inzidenzrate der häufigsten Formen steigt dramatisch. Die Hyperglykämie und die Mehrheit der daraus resultierenden diabetischen Begleiterscheinungen können durch ß Zell Transplantation geheilt werden. Da es einen enormen Gewebespendermangel für klinische Transplantationen gibt, bieten von humanen pluripotenten Stammzellen (hPSCs) stammende ß Zellen eine attraktive Option, um die notwendigen Zellen für eine ß Zell Therapie zu erhalten. Die momentanen ß Zell Differenzierungsprotokolle sind langwierig, teuer und relativ ineffizient. Deshalb bleibt eine Produktionsvergrößerung zur Gewinnung der notwenigen 1 Milliarde Zellen pro Patient zum Erreichen einer Normoglykämie unrealistisch. Die exponentielle Expansion einer intermediären pankreatischen Vorläuferpopulation (PP) würde eine signifikante Kosten und Zeitreduktion zur Produktion von ß Zellen in vitro erlauben und, noch wichtiger, würde relativ einfach ermöglichen, die notwendigen Zellzahlen für klinische Anwendungen zu erzielen. Bisher wurde von einer reproduzierbaren Expansion geeigneter, von hPSC stammenden PPs in einer chemisch definierten Zellkulturbedingung, die frei von Feeder Zellen ist, nicht berichtet. Unser Labor fand heraus, dass ein im Vorfeld veröffentlichtes Medium, welches für die vorrübergehende Expansion von reprogrammierten, von Fibroblasten stammenden PPs geeignet ist, in 20% der Fälle die Expansion von aus hPSC gewonnenen PPs herbeiführen konnte. Um die Anforderungen für eine reproduzierbare Expansion zu eruieren, analysierte ich transkriptomische Daten von aus PSC gewonnenen PPs vor und nach erfolgter Expansion. Mehrere regulierte Signalwege wurden identifiziert und von diesen Daten formulierte ich neun zu testende Kandidatenexpansionsbedingungen (C0-C8). Fünf dieser Bedingungen ermöglichten es von PSC stammende PPs reproduzierbar zu expandieren. Von diesen fünf Bedingungen war C6 die, welche die schnellste Expansion mit einer Dopplungszeit von 2.2 Tagen herbeiführte, eine stabile Expression der essenziellen Marker von bipotenten Stammvorläuferzellen, PDX1, NKX6.1, SOX9 und FOXA2, aufrechterhielt und die Expression von den hepatischen und intestinalen Markern AFP und CDX2 minimierte. Den C6 expandierten PPs war es möglich, sich in pankreatisch endokrine Vorläufer (PEP) in dreidimensionalen (3 D), inselgroßen Kluster, welche in mikrogemusterten Wells geformt wurden, zu differenzieren. Mikrogemusterte Wells bieten den zusätzlichen Vorteil von größenkontrollierten, uniformen Kluster und niedrigen Kulturvolumina im Vergleich zu Suspensionskulturbioreaktoren, welche für die Großmengenproduktion solcher Kluster vorgeschlagen wurden. Jedoch wurde bisher über die Benutzung von mikrogemusterten Wells für solch eine Anwendung nicht berichtet. Diese PEPs zeigten eine starke Hochregulation des essenziellen, endokrin spezifischen Transkriptionsfaktors (TF) NGN3 und 90% waren positiv für NEUROD1, einem nachgelagerten Effektor von NGN3, was anhand der Analyse der Durchflusszytometrie bestimmt wurde. Darauffolgend wurden die PEPs mit einer Effizienz von etwa 20% in Insulin (INS) produzierende ß Zellen differenziert. Diese ß Zellen zeigten ebenfalls eine starke Expression von Funktionalitätsgenen wie ZnT8, GCK, PC1/3 und SUR1 und etwa 10% von ihnen exprimierten den essenziellen Maturationsmarker MAFA, wie es mittels Analyse der Durchflusszytometrie von aus einer INS-GFP/MAFA-mCHERRY Doppelreporterlinie gewonnenen ß Zellen bestimmt wurde. Zusammenfassend habe ich eine Kulturbedingung für die exponentielle Expansion von aus hPSC gewonnenen PPs etabliert, die frei von Feeder Zellen, chemisch definiert und kompatibel mit der Guten Herstellungspraxis ist, welche die Produktion von ß Zellen zu einem Bruchteil der Kosten konventioneller Differenzierungsprotokollen ermöglicht. Es wird weiterhin daran gearbeitet, die Expansionsbedingungen zu optimieren, um die hepatischen und intestinalen Marker komplett zu eliminieren und die darauffolgenden Differenziationsschritte in mikrogemusterten Wells zu verbessern, um letztendlich eine hocheffiziente Differenzierung zu funktionellen ß-Zellen zu erreichen.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Insights into the role of oxidative stress and pancreatic β-cell dysfunction in the pathogenesis of type 2 diabetes (T2D) reveals an opportunity for the development of novel therapeutics that directly protect and preserve β-cells. The protective role of dietary antioxidants, such as plant polyphenols, against oxidative stress induced diseases, including T2D, is increasingly under scrutiny. Polyphenol-rich extracts of Cyclopia spp, containing mangiferin, may provide novel therapeutics. An aqueous extract of unfermented Cyclopia maculata, containing more than 6 % mangiferin, was assessed for its protective effect in pancreatic β-cells in vitro, ex vivo and in vivo under conditions characteristic of T2D. The effect of mangiferin was also evaluated in vitro and ex vivo, with N-acetyl cysteine (NAC) as an antioxidant control. In this study, we established in vitro toxicity models in RIN-5F insulinoma cells based on conditions β-cells are exposed to in T2D; i.e. lipotoxicity, inflammation and oxidative stress conditions. To achieve this, cells were exposed to the following stressors: palmitic acid (PA), a pro-inflammatory cytokine combination and streptozotocin (STZ), respectively. Thereafter, the ability of the C. maculata extract, mangiferin and NAC to protect RIN-5F cells from the effects of these stressors was assessed by measuring β-cell viability, function and oxidative stress. Cell viability was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, adenosine triphosphate and annexin-V and propidium iodide assays. Cell function was evaluated by measuring glucose stimulated insulin secretion, cell proliferation and cellular calcium. To assess oxidative stress in the RIN-5F cells, diaminofluorescein-FM and dihydroethidium fluorescence, and superoxide dismutase enzyme activity were measured. The in vitro findings were then verified in isolated pancreatic rat islets using methods and models established in the RIN-5F experiments. The protective effect of the extract, NAC and metformin was assessed in STZ induced diabetic Wistar rats, using two treatment regimes, i.e. by treating rats with established diabetes and by pretreating rats prior to induction of diabetes by STZ. Glucose metabolism, oxidative stress and pancreatic morphology were assessed by performing an oral glucose tolerance test, measuring serum insulin, triglycerides, nitrites, catalase and glutathione. Hepatic thiobarbituric acid reactive substances and nitrotyrosine were also assessed. Immunohistochemical labelling of pancreata with insulin, glucagon and MIB-5 was used for morphological assessment. The extract improved β-cell viability, function and attenuated oxidative stress, most apparently in STZ and PA induced toxicity models comparable with NAC both in vitro and in isolated islets. Mangiferin was not as effective, showing only marginal improvement in RIN-5F cell and islet function, and oxidative stress. Pretreatment of STZ induced diabetic Wistar rats with extract was as effective as, if not better than, metformin in improving glucose tolerance, hypertriglyceridaemia and pancreatic islet morphology related to improved β-cell function. This study demonstrated that the aqueous extract of unfermented C. maculata was able to protect pancreatic β-cells from STZ and PA induced toxicity in vitro and ex vivo. In vivo, pretreatment with the extract improved glucose metabolism and pancreatic islet morphology in STZ induced diabetic Wistar rats. / AFRIKAANSE OPSOMMING: Insigte oor die rol wat oksidatiewe stres en pankreas β-sel disfunksie in die patogenese van tipe 2-diabetes (T2D) speel, bied 'n geleentheid vir die ontwikkeling van nuwe terapeutiese middels wat β-selle direk daarteen beskerm. Die beskermende rol van antioksidante in die dieët soos plantaardige polifenole teen oksidatiewe stres geinduseerde siektes soos T2D, is toenemend onder die soeklig. Polifenolryk ekstrakte van Cyclopia spp wat mangiferin bevat mag nuwe terapeutiese middels lewer. ‘n Waterekstrak van ongefermenteerde Cyclopia maculata wat meer as 6% mangiferin bevat, is ondersoek vir sy beskermende effek op pankreas ß-selle in vitro, ex vivo en in vivo teen kondisies kenmerkend aan T2D. Die effek van mangiferin is ook in vitro en ex vivo geëvalueer, met N-asetielsistien (NAC) as 'n antioksidant kontrole. In hierdie studie is in vitro toksisiteitsmodelle in RIN-5F insulinoomselle gevestig. Die modelle is gebaseer op toestande waaraan β-selle blootgestel word tydens T2D; d.w.s. lipotoksisiteit, inflammasie en oksidatiewe stres. Hiervoor is die selle aan die volgende stressors blootgestel: palmitiensuur (PA), ‘n pro-inflammatoriese sitokien mengsel en streptozotosien (STZ). Vervolgens is die vermoë van die C. maculata ekstrak, mangiferin en NAC om die RIN-5Fselle teen hierdie stressors te beskerm, beoordeel deur die meting van β-sellewensvatbaarheid, funksie en oksidatiewe stres. Sellewensvatbaarheid is bepaal met 3-(4,5-dimetielthiazol-2-yl)-2,5-difenieltetrazolium bromied, adenosientrifosfaat en anneksien-V and propidium jodied toetse. Selfunksie is geëvalueer d.m.v. glukose gestimuleerde insuliensekresie, selproliferasie en sellulêre kalsium bepaling. Oksidatiewe stres in die RIN-5Fselle is geëvalueer d.m.v. diaminofluorescein-FM en dihidroethidium fluoressensie bepalings, asook meting van superoksied dismutase ensiemaktiwiteit. Die in vitro bevindings is daarna in geїsoleerde rot pankreaseilande bevestig deur die metodes en modelle wat in die RIN-5F eksperimente gebruik is. Die antidiabetiese effekte van die ekstrak, NAC en metformien in STZ-geїnduseerde diabetiese Wistar rotte is bepaal d.m.v. twee behandlingsregimes, d.w.s. die behandeling van rotte met gevestigde diabetes of deur die behandeling voor die induksie van diabetes te begin. Glukose metabolisme, oksidatiewe stres en veranderinge in die pankreasmorfologie is ondersoek d.m.v. orale glukose toleransie toetse en die bepaling van serum insulien, trigliseriedes, nitriete, katalase en glutationien. Hepatiese tiobarbituursuur reaktiewe stowwe en nitrotirosien is ook geëvalueer. Immunohistochemiese kleuring van pankreas snitte is gebruik vir morfologiese assessering van insulien, glukagon en MIB-5. Die ekstrak het mees opvallend β-sel lewensvatbaarheid en funksie verbeter, terwyl oksidatiewe stres verminder is in die STZ- en PA-geїnduseerde toksisiteitmodelle. Bogenoemde effekte van die ekstrak in vitro en in die geїsoleerde eilande was vergelykbaar met die van NAC. Mangiferin was minder effektief, met slegs ‘n marginale verbetering in die funksie van RIN-5Fselle en eilande, asook t.o.v. oksidatiewe stres. Behandeling van die Wistar rotte met die ekstrak voor induksie van diabetes met STZ was net so effektief, of selfs beter as metformien in terme van verbeterde glukosetoleransie, trigliseriedvlakke en die morfologie van pankreas eilande wat verband gehou het met β-sel funksie. Hierdie studie het getoon dat die waterekstrak van ongefermenteerde C. maculata pankreas β-selle teen veral STZ- en PA-geїnduseerde toksisiteit in vitro en ex vivo beskerm het. In vivo het behandeling met die ekstrak voor en na induksie van diabetes, glukosemetabolisme en die morfologie van pankreas eilande in STZ-geїnduseerde diabetiese Wistar rotte verbeter.

Le diabète de type 2 (DT2) apparaît lorsque la sécrétion d’insuline par les cellules β des îlots du pancréas ne parvient plus à compenser la résistance à l’insuline des organes cibles. Parmi les médicaments disponibles pour traiter le DT2, deux classes agissent en améliorant la sensibilité à l’insuline : les biguanides (metformine) et les thiazolidinediones (pioglitazone et rosiglitazone). Des études suggèrent que ces médicaments protègent également la fonction des cellules β. Dans le but d’identifier des mécanismes par lesquels les médicaments insulinosensibilisateurs protègent les cellules β, nous avons étudié les effets aigus de la metformine et de la pioglitazone sur le métabolisme et la fonction des cellules INS 832/13, sécrétrices d’insuline et des îlots pancréatiques isolés de rats. Nous avons aussi validé in vivo avec des rats Wistar les principales observations obtenues en présence de pioglitazone grâce à des clamps glucidiques et par calorimétrie indirecte. Le traitement aigu des cellules β avec de la pioglitazone ou de la metformine inhibe la sécrétion d’insuline induite par le glucose en diminuant la sensibilité des cellules au glucose (inhibition en présence de concentrations intermédiaires de glucose seulement). Dans les mêmes conditions, les traitements inhibent aussi plusieurs paramètres du métabolisme mitochondrial des nutriments et, pour la pioglitazone, du métabolisme des lipides. Les composés affectent le métabolisme en suivant un patron d’inhibition similaire à celui observé pour la sécrétion d’insuline, que nous avons nommé « décélération métabolique ». La capacité de la pioglitazone à inhiber la sécrétion d’insuline et à ralentir le métabolisme mitochondrial de façon aigüe se confirme in vivo. En conclusion, nous avons identifié la décélération métabolique de la cellule β comme nouveau mode d’action pour les médicaments insulinosensibilisateurs. La décélération métabolique causée par les agents insulinosensibilisateurs les plus utilisés semble provenir d’une inhibition du métabolisme mitochondrial et pourrait être impliquée dans les bienfaits de ceux-ci dans un contexte de stress métabolique. Le fait que les deux agents insulinosensibilisateurs étudiés agissent à la fois sur la sensibilité à l’insuline et sur la sécrétion d’insuline, les deux composantes majeures du DT2, pourrait expliquer pourquoi ils sont parmi les agents antidiabétiques les plus efficaces. La décélération métabolique est une approche thérapeutique à considérer pour le traitement du DT2 et d’autres maladies métaboliques. / Type 2 diabetes (T2D) appears when insulin secretion by pancreatic β-cells fails to compensate for insulin resistance. Two classes of anti-diabetic drugs have been used to target insulin resistance: biguanides (metformin) and thiazolidinediones (pioglitazone and rosiglitazone). Some studies suggest that these compounds also protect β-cell function. In order to identify the mechanisms whereby insulin-sensitizing agents protect β-cell function, we used INS 832/13 insulin secreting cells and isolated pancreatic rat islets to study the acute effects of pioglitazone and metformin on β-cell metabolism and function. Key observations obtained with pioglitazone were also validated in vivo in Wistar rats with the use of glucose clamps and indirect calorimetry. In vitro, acute pioglitazone or metformin treatment inhibits glucose-induced insulin secretion by lowering β-cell sensitivity to glucose (inhibition only at sub-maximal glucose concentrations). The same treatments also inhibit parameters of nutrient mitochondrial metabolism and, in the case of pioglitazone, parameters of lipid metabolism. Both compounds alter metabolism following a pattern similar to that observed with insulin secretion, a pattern that we label “metabolic deceleration”. Pioglitazone also acutely inhibits insulin secretion and slows down mitochondrial metabolism in vivo. In conclusion, we identified metabolic deceleration of the pancreatic β-cell as a new mode of action for insulin-sensitizing agents. Pioglitazone and metformin both seem to cause metabolic deceleration of the β-cell via inhibition of mitochondrial metabolism. This mode of action could participate in the beneficial effects of these compounds in the context of metabolic stress. The fact that these drugs affect both insulin sensitivity and insulin secretion, the two major components of T2D, may explain why they are among the most powerful anti-diabetic agents. Metabolic deceleration is a new therapeutic approach worth considering for the treatment of T2D and other metabolic diseases.

L’insuffisance rénale chronique (IRC) se définit par un défaut de filtration glomérulaire et est associée à plusieurs désordres. La perturbation de l’homéostasie glucidique en fait partie. L’homéostasie glucidique est contrôlée principalement par l’insuline, soit l’hormone sécrétée en réponse au glucose par les cellules bêta-pancréatiques contenues dans les îlots de Langerhans. La préservation de la fonction de la cellule bêta est essentielle au maintien de l’homéostasie glucidique. Il a été démontré que la sécrétion de l'insuline est altérée au cours l'IRC, cependant les mécanismes demeurent peu connus. Au cours de l’IRC, l’accumulation chronique de toxines urémiques pourrait contribuer à la défaillance de la cellule bêta. L’urée est une toxine urémique majeure et sa toxicité a été récemment rapportée dans plusieurs tissus. Le but de ce mémoire était donc de vérifier le rôle de l’urée dans la dysfonction de la cellule bêta-pancréatique au cours de l’IRC. Nous avons démontré que l’exposition des îlots de souris à des concentrations pathologiques d’urée entraîne une diminution de la sécrétion d’insuline via l’augmentation du stress oxydant et des O-glycosylations. Ce défaut est dû à une perturbation du métabolisme intracellulaire du glucose. Entre autres, nous avons observé une baisse de la glycolyse associée à la réduction de l’activité enzymatique de la phosphofructokinase-1. Ces résultats démontrent un effet toxique direct de l’urée sur la sécrétion d’insuline et permettent de mieux comprendre le mécanisme de dysfonction de la cellule bêta-pancréatique au cours de l’IRC. / Chronic kidney disease (CKD) is defined as a glomerular filtration defect and is associated with many disorders. Impaired glucose homeostasis is one of them. Glucose homeostasis is maintained in part by insulin, which is the hormone secreted by the pancreatic beta cells from the islets of Langerhans in response to glucose. The preservation of beta cell function is essential to maintain glucose homeostasis. It has been demonstrated that insulin secretion is altered during CKD; however, the underlying mechanisms remain unknown. In CKD, chronic accumulation of uremic toxins could contribute to beta cell dysfunction. Urea is a major uremic toxin and its toxicity has been recently reported in many tissues. The purpose of this master project was to ascertain the role of urea in pancreatic beta cell dysfunction during CKD. We have demonstrated that exposure of mouse islets to pathological concentrations of urea leads to diminution of insulin secretion via an increase in oxidative stress and O-glycosylation. This defect is due to disturbed intracellular glucose metabolism. Among others, we have observed a reduction in glycolysis associated with a decrease in the activity of phosphofructokinase-1. These results demonstrate a direct toxic effect of urea on insulin secretion and contribute to a better understanding of mechanisms of pancreatic beta cell dysfunction during CKD.

O Diabetes mellitus (DM) do tipo 1 é uma doença causada pela destruição, por mecanismo auto-imune, das células beta das ilhotas pancreáticas, produtoras de insulina. O tratamento convencional da doença é realizado por meio de injeções diárias de insulina exógena. O transplante de ilhotas pancreáticas inclui-se, atualmente, como uma das alternativas terapêuticas à insulinoterapia. Entretanto, para atingir a insulino-independência, é necessário transplantar um grande número de ilhotas por paciente. O conhecimento do mecanismo de proliferação das células beta pode possibilitar a realização do transplante a partir da expansão celular ex vivo. A glicose é um dos principais indutores da proliferação de células beta. Neste trabalho, foi estabelecida e executada a tecnologia de isolamento e purificação de ilhotas pancreáticas humanas, visando sua estimulação com glicose. Para identificar genes regulados por glicose nestas ilhotas, foi utilizada a técnica de hibridização subtrativa SSH, associada ao rastreamento da biblioteca através de macroarranjos de DNA. Num primeiro rastreamento, foram identificados dois fragmentos gênicos induzidos pela glicose. Um destes apresentou homologia com uma proteína hipotética humana de função desconhecida e o segundo com o receptor de polipetídeo pancreático. Este trabalho permitiu a identificação de novos genes regulados pela glicose em ilhotas pancreáticas humanas, os quais podem estar relacionados à proliferação celular deste tecido. / Type 1 Diabetes mellitus (T1DM) is caused by autoimmune destruction of the insulin-producing pancreatic islet b-cells. Treatment is generally approached by daily subcutaneous injections of exogenous insulin. Nowadays, pancreatic islet transplantation is considered as an effective alternative treatment to insulin therapy. However, in order to reach insulin-independence, a large number of islets is required for each patient. Knowledge of the mechanisms regulating islet b-cell proliferation may allow ex-vivo b-cell expansion prior to transplant. Glucose is considered one of the main inducers of islet b-cells proliferation. We established and executed the technology of human islet isolation and purification. The islets were then stimulated in culture with glucose. In order to identify glucose-regulated genes in cultured human islets, we utilized the suppression subtractive hybridization (SSH) method, followed by cDNA library screening by DNA macroarrays. Preliminary screening allowed us to isolate two cDNAs displaying glucose regulation, one of which is similar to a human hypothetical protein of unknown function and the other shows similarity to the pancreatic polypeptide receptor. This work allowed identification of glucose-regulated genes in human pancreatic islets, which may be related to cell proliferation in this tissue.

<p>Population pharmacokinetic-pharmacodynamic (PK-PD) models can be fitted using nonlinear mixed effects modelling (NONMEM). This is an efficient way of learning about drugs and diseases from data collected in clinical trials. Identifying covariates which explain differences between patients is important to discover patient subpopulations at risk of sub-therapeutic or toxic effects and for treatment individualization. Stepwise covariate modelling (SCM) is commonly used to this end. The aim of the current thesis work was to evaluate SCM and to develop alternative approaches. A further aim was to develop a mechanistic PK-PD model describing fasting plasma glucose, fasting insulin, insulin sensitivity and beta-cell mass.</p><p>The lasso is a penalized estimation method performing covariate selection simultaneously to shrinkage estimation. The lasso was implemented within NONMEM as an alternative to SCM and is discussed in comparison with that method. Further, various ways of incorporating information and propagating knowledge from previous studies into an analysis were investigated. In order to compare the different approaches, investigations were made under varying, replicated conditions. In the course of the investigations, more than one million NONMEM analyses were performed on simulated data. Due to selection bias the use of SCM performed poorly when analysing small datasets or rare subgroups. In these situations, the lasso method in NONMEM performed better, was faster, and additionally validated the covariate model. Alternatively, the performance of SCM can be improved by propagating knowledge or incorporating information from previously analysed studies and by population optimal design.</p><p>A model was also developed on a physiological/mechanistic basis to fit data from three phase II/III studies on the investigational drug, tesaglitazar. This model described fasting glucose and insulin levels well, despite heterogeneous patient groups ranging from non-diabetic insulin resistant subjects to patients with advanced diabetes. The model predictions of beta-cell mass and insulin sensitivity were well in agreement with values in the literature.</p>

Population pharmacokinetic-pharmacodynamic (PK-PD) models can be fitted using nonlinear mixed effects modelling (NONMEM). This is an efficient way of learning about drugs and diseases from data collected in clinical trials. Identifying covariates which explain differences between patients is important to discover patient subpopulations at risk of sub-therapeutic or toxic effects and for treatment individualization. Stepwise covariate modelling (SCM) is commonly used to this end. The aim of the current thesis work was to evaluate SCM and to develop alternative approaches. A further aim was to develop a mechanistic PK-PD model describing fasting plasma glucose, fasting insulin, insulin sensitivity and beta-cell mass. The lasso is a penalized estimation method performing covariate selection simultaneously to shrinkage estimation. The lasso was implemented within NONMEM as an alternative to SCM and is discussed in comparison with that method. Further, various ways of incorporating information and propagating knowledge from previous studies into an analysis were investigated. In order to compare the different approaches, investigations were made under varying, replicated conditions. In the course of the investigations, more than one million NONMEM analyses were performed on simulated data. Due to selection bias the use of SCM performed poorly when analysing small datasets or rare subgroups. In these situations, the lasso method in NONMEM performed better, was faster, and additionally validated the covariate model. Alternatively, the performance of SCM can be improved by propagating knowledge or incorporating information from previously analysed studies and by population optimal design. A model was also developed on a physiological/mechanistic basis to fit data from three phase II/III studies on the investigational drug, tesaglitazar. This model described fasting glucose and insulin levels well, despite heterogeneous patient groups ranging from non-diabetic insulin resistant subjects to patients with advanced diabetes. The model predictions of beta-cell mass and insulin sensitivity were well in agreement with values in the literature.

Chronic hyperlipidemia (lipotoxicity) and hyperglycemia (glucotoxicity) have recently been shown to induce Endoplasmic Reticulum (ER) stress, which may contribute to pancreatic beta-cell dysfunction in type 2 diabetes. This thesis examined the involvement of ER stress in beta-cell lipotoxicity and glucotoxicity. Although chronic treatment with saturated free fatty acids (FFA) in vitro induced ER stress, altering ER stress by increasing or knocking-down GRP78 chaperone expression had no effect on apoptosis induction. Conversely, overexpression of ER chaperones rescued the reduction in proinsulin protein levels caused by chronic exposure to high glucose, although it had no effect on the decreased insulin mRNA levels and proinsulin translation rate. Thus, ER stress is likely not the main mechanism involved in saturated FFA-induced beta-cell apoptosis in vitro, but it may contribute to glucotoxic effects on proinsulin levels. These findings have increased our understanding of the link between ER stress and beta-cell dysfunction in type 2 diabetes.