Thesis (doctoral)--Ludwig Maximilians-Universität zu München, 1979.

In order to develop a radioimmunoassay for rat C-peptide, rat insulinoma, which contains large quantities of insulin and was expected also to contain large quantities of C-peptide, was chosen as a starting material. However, the tissue was found not to contain extractable C-peptide. Instead, a novel peptide (rat insulinoma peptide, RIP) was isolated. Rat insulinoma peptide (RIP) which appears to be either a fragment of, or an altered rat C-peptide was isolated and purified by dialysis. The purity of this peptide was investigated using polyacrylamide gel electrophoresis with sodium dodecyl sulphate, isoelectric focussing, and high performance liquid chromatography. RIP may contain two peptides similar to each other but differing in their isoelectric points. The molecular weight of RIP was found to be 1,982 daltons by fast atom bombardment mass spectrometry giving a chain length of approximately 22 amino acid residues. From information obtained using radioimmunoaasay employing antiserum R901, RIP appears to share a common C-terminus with rat C-peptide. A radioimmunoassay for RIP was developed using the purified RIP as immunogen and for standards and tracers. An indirect enzyme linked immunosorbent assay (ELISA) for rat insulinoma peptide was developed using purified RIP for immunogen and semi-purified RIP as a standard. Rat C-peptide I and II were successfully synthesised using the technique of solid phase peptide synthesis. The crude synthetic peptides were purified by dialysis, and their purity was assessed by high performance liquid chromatography. The molecular weight of these synthetic peptides was determined by fast atom bombardment mass spectrometry to be 3,183 daltons. These two synthetic peptides can be detected by rat C-peptide I radioimmunoassay employing antiserum R901. A radioimmunoassay for rat C-peptide I was developed using synthetic rat C-peptide I for immunogen, standard and tracer. The rat C-peptide I and II antisera were shown to produce positive staining of the islets of Langerhans of normal rat pancreas.

Introduction: Insulinomas are pancreatic endocrine neoplasms with a low incidence between 1-4 cases per million per year. Case description:'A female 49 years-old with neurological and psychiatric symptoms were treated for two years as a psychiatric patient. Presented a glucose value, which reflects hypoglycemia. The patient was operated with resolution of symptoms. Conclusion: Assess all patients with psychiatric symptoms and perform a complete medical history and laboratory findings, being the most opportune glucose. / Revisión por pares

Thesis (M.D.)—-Boston University

Diabetes epidemic is underway. Beta cell dysfunction (BCF) and loss of beta cell mass (BCM) are known to be key events in its progression. Currently, there are no reliable techniques to estimate or follow the loss of BCM, in vivo. Non-invasive imaging and quantification of the whole BCM in the pancreas, therefore, has a great potential for understanding the progression of diabetes and the scope for early diagnosis for Type 2 diabetes. Glucagon-like peptide-1 receptor (GLP-1R) is known to be selectively expressed on the pancreatic beta cells and overexpressed on the insulinoma, a pancreatic neuroendocrine tumor (PNET). Therefore, this receptor is considered to be a selective imaging biomarker for the beta cells and the insulinoma. Exendin-4 is a naturally occurring analog of GLP-1 peptide. It binds and activates GLP-1R with same the potency and engages in the insulin synthesis, with a longer biological half-life. In this thesis, Exendin-4 precursor, DO3A-VS-Cys40-Exendin-4 labeled with [68Ga], [68Ga]Ga-DO3A-VS-Cys40-Exendin-4 ([68Ga]Exendin-4), was evaluated in different species models, namely, immune deficient nude mice, rats, pigs, non-human primate (NHP), and clinically in one insulinoma patient by positron emission tomography (PET), for its potential in beta cell imaging and its quantification as well as for visualizing the insulinoma. From internal dosimetry, the possible number of repetitive [68Ga]Exendin-4-PET/CT scans was estimated. Pancreatic uptake and insulinoma tumor uptake of [68Ga]Exendin-4 were confirmed to be mediated by the specific binding to the GLP-1R. Pancreatic GLP-1R could be visualized and semi-quantified, for diabetic studies, except in rats. Nonetheless, we found conflicting results regarding the GLP-1R being a selective imaging biomarker for the beta cells. PET/CT scan of the patient with [68Ga]Exendin-4 has proven to be more sensitive than the clinical neuroendocrine tracer, [11C]5-HTP, as  it could reveal small metastatic tumors in liver. The kidney was the dose-limiting organ in the entire species model, from absorbed dose estimation. Before reaching a yearly kidney limiting dose of 150 mGy and a whole body effective dose of 10 mSv, 2–4 [68Ga]Exendin-4 PET/CT scans be performed in an adult human, which enables longitudinal clinical PET imaging studies of the GLP-1R in the pancreas, transplanted islets, or insulinoma, as well as in healthy volunteers enrolled in the early phase of anti-diabetic drug development studies.

O transplante de ilhotas pancreáticas constitui uma alternativa atraente para o tratamento de diabetes tipo 1 (DM1), contudo, é limitado devido à escassez de doadores de órgãos. O papel da prolactina humana recombinante (rhPRL), que apresenta efeitos benéficos em células-beta, e seu mecanismo de ação foram investigados neste estudo. O número de células apoptóticas diminui significativamente na presença de rhPRL. Essa citoproteção envolveu diminuição da razão BCL2/BAX e inibição de caspase-8, -9 e -3. Este estudo revelou, pela primeira vez, evidência direta do efeito protetor de lactogênios contra apoptose de células-beta humanas. Levando em consideração a relação conhecida entre citocinas e DM1 e observações recentes sugerindo o papel da autofagia no desenvolvimento e prevenção do DM1, foi investigada a conexão entre citocinas (IL-1β, TNFα e IFN-γ) e autofagia em células-beta. O co-tratamento com citocinas e rapamicina, um indutor de autofagia via inibição de mTOR, não aumentou os níveis de apoptose em células INS-1E. Contudo, exposição a citocinas levou ao aumento nos níveis de autofagossomos e na relação LC3-II/LC3-I, do mesmo modo que o tratamento com rapamicina. O tratamento com citocinas também levou à diminuição dos níveis de mTOR e 4E-BP1 fosforilados. Foi demonstrada aqui, pela primeira vez, uma relação direta entre o tratamento com citocinas e a indução de autofagia em células-beta. Recentemente, surgiram novas evidências mostrando ligação entre a morte de células-beta induzida por citocinas e indução de estresse de retículo endoplasmático. Em nosso modelo, foram observados níveis diminuídos de p-mTOR e aumento da formação de autofagossomos após o tratamento com indutores de estresse de retículo. Este estudo reforça também, resultados prévios sobre a hipótese da função de indutores de estresse de retículo em promover a autofagia. Além disso, o tratamento com rhPRL aumentou os níveis de p-mTOR e levou à diminuição na formação de autofagossomos após exposição a citocinas em células-beta. Estes resultados são relevantes para a caracterização mais aprofundada das funções dos lactogênios nessas células. Sabendo-se da necessidade de células-beta humanas para estudos detalhados em células-beta, nosso grupo gerou linhagens celulares derivadas de insulinomas humanos que secretam hormônios e expressam marcadores com o mesmo padrão de seu tecido original. Estas linhagens foram caracterizadas comparando-as com culturas primárias de células-beta através de eletroforese bidimensional acoplada a espectrometria de massa. Cerca de 1.800 spots foram detectados, sendo que menos de 1% apresentou expressão diferencial. As proteínas superexpressas em ilhotas, como Caldesmon, estão envolvidas em organização do citoesqueleto, influenciando a secreção hormonal. Contrariamente, quase todas as proteínas superexpressas nas células de insulinoma, como MAGE-A2, foram descritas aqui pela primeira vez, podendo estar relacionadas à sobrevivência celular e resistência à quimioterapia. Estes resultados mostram, pela primeira vez, mudanças na expressão de proteínas relacionadas ao fenótipo alterado dos insulinomas, direcionando a pesquisa ao estabelecimento de células-beta humanas bioengenheiradas e ao desenvolvimento de novas estratégias terapêuticas para insulinomas. Coletivamente, os dados obtidos neste estudo estendem o conhecimento molecular envolvido na citoproteção induzida por rhPRL e transformação maligna de células-beta pancreáticas, contribuindo para futuras aplicações na compreensão e no tratamento do DM1 / Transplantation of pancreatic islets constitutes an alternative for type 1 diabetes (DM1); however, it is limited by the shortage of organ donors. Here, we investigated the role of recombinant human prolactin (rhPRL), shown to have beneficial effects in beta-cells, and its mechanisms of action. Apoptotic beta-cells were decreased in the presence of rhPRL, with cytoprotection involving an increase of BCL2/BAX ratio and inhibition of caspase-8, -9 and -3. This study provides new direct evidence for a protective effect of lactogens in human beta-cell apoptosis. Taking into account the known relationship between cytokines and DM1 and recent observations suggesting a role for autophagy in the development and prevention of DM1, we investigated the connection between cytokines (IL-1β, TNF-α and IFN-γ) and autophagy in beta-cells. Co-treatment with cytokines and rapamycin, an inducer of autophagy through inhibition of mTOR, did not increase the apoptosis levels in INS-1E cells. However, exposure to cytokines increased the levels of autophagosome formation and LC3-II/LC3-I ratio. Treatment with cytokines also led to decreased levels of phosphorylated mTOR and 4E-BP1. We demonstrated for the first time, a direct relationship between cytokines treatment and induction of autophagy in beta-cells. Lately, new evidence point to a connection between cytokine-induced beta-cell death and endoplasmic reticulum stress. In our model, we observed that decreased levels of p-mTOR and increased autophagosome formation also ensued after treatment with endoplasmic reticulum stressors. This study also supports the previous hypothesis on the function of ER stressors in inducing autophagy. Furthermore, rhPRL treatment increased the levels of p-mTOR and decreased autophagosome formation after exposure to cytokines in beta-cells. These findings are also relevant for further characterization of lactogens functions in these cells. Considering the demand for human cells for further beta-cells studies, our group generated cell lines derived from human insulinomas which secrete hormones and express markers with the same pattern displayed by their original tissue. We set out to further characterize these lineages by comparing them to primary beta-cells using two-dimensional gel electrophoresis coupled to mass spectrometry. An average of 1,800 spots was detected with less than 1% exhibiting differential expression. Proteins upregulated in islets, such as Caldesmon, are involved in cytoskeletal organization thus influencing hormone secretion. In contrast, almost all proteins upregulated in insulinoma cells, such as MAGE-A2, first described here, could be related to cell survival and resistance to chemotherapy. Our results provide, for the first time, a molecular snapshot of the changes in expression of proteins correlated with the altered phenotype of insulinomas, prompting research towards the establishment of bioengineered human beta-cells, and the development of new therapeutic strategies for insulinomas. Collectively, the data obtained in this study extend the molecular knowledge involved in rhPRL-induced cytoprotection and malignant transformation of pancreatic beta-cells, contributing to future applications for understanding and treatment of DM1

O transplante de ilhotas pancreáticas constitui uma alternativa atraente para o tratamento de diabetes tipo 1 (DM1), contudo, é limitado devido à escassez de doadores de órgãos. O papel da prolactina humana recombinante (rhPRL), que apresenta efeitos benéficos em células-beta, e seu mecanismo de ação foram investigados neste estudo. O número de células apoptóticas diminui significativamente na presença de rhPRL. Essa citoproteção envolveu diminuição da razão BCL2/BAX e inibição de caspase-8, -9 e -3. Este estudo revelou, pela primeira vez, evidência direta do efeito protetor de lactogênios contra apoptose de células-beta humanas. Levando em consideração a relação conhecida entre citocinas e DM1 e observações recentes sugerindo o papel da autofagia no desenvolvimento e prevenção do DM1, foi investigada a conexão entre citocinas (IL-1β, TNFα e IFN-γ) e autofagia em células-beta. O co-tratamento com citocinas e rapamicina, um indutor de autofagia via inibição de mTOR, não aumentou os níveis de apoptose em células INS-1E. Contudo, exposição a citocinas levou ao aumento nos níveis de autofagossomos e na relação LC3-II/LC3-I, do mesmo modo que o tratamento com rapamicina. O tratamento com citocinas também levou à diminuição dos níveis de mTOR e 4E-BP1 fosforilados. Foi demonstrada aqui, pela primeira vez, uma relação direta entre o tratamento com citocinas e a indução de autofagia em células-beta. Recentemente, surgiram novas evidências mostrando ligação entre a morte de células-beta induzida por citocinas e indução de estresse de retículo endoplasmático. Em nosso modelo, foram observados níveis diminuídos de p-mTOR e aumento da formação de autofagossomos após o tratamento com indutores de estresse de retículo. Este estudo reforça também, resultados prévios sobre a hipótese da função de indutores de estresse de retículo em promover a autofagia. Além disso, o tratamento com rhPRL aumentou os níveis de p-mTOR e levou à diminuição na formação de autofagossomos após exposição a citocinas em células-beta. Estes resultados são relevantes para a caracterização mais aprofundada das funções dos lactogênios nessas células. Sabendo-se da necessidade de células-beta humanas para estudos detalhados em células-beta, nosso grupo gerou linhagens celulares derivadas de insulinomas humanos que secretam hormônios e expressam marcadores com o mesmo padrão de seu tecido original. Estas linhagens foram caracterizadas comparando-as com culturas primárias de células-beta através de eletroforese bidimensional acoplada a espectrometria de massa. Cerca de 1.800 spots foram detectados, sendo que menos de 1% apresentou expressão diferencial. As proteínas superexpressas em ilhotas, como Caldesmon, estão envolvidas em organização do citoesqueleto, influenciando a secreção hormonal. Contrariamente, quase todas as proteínas superexpressas nas células de insulinoma, como MAGE-A2, foram descritas aqui pela primeira vez, podendo estar relacionadas à sobrevivência celular e resistência à quimioterapia. Estes resultados mostram, pela primeira vez, mudanças na expressão de proteínas relacionadas ao fenótipo alterado dos insulinomas, direcionando a pesquisa ao estabelecimento de células-beta humanas bioengenheiradas e ao desenvolvimento de novas estratégias terapêuticas para insulinomas. Coletivamente, os dados obtidos neste estudo estendem o conhecimento molecular envolvido na citoproteção induzida por rhPRL e transformação maligna de células-beta pancreáticas, contribuindo para futuras aplicações na compreensão e no tratamento do DM1 / Transplantation of pancreatic islets constitutes an alternative for type 1 diabetes (DM1); however, it is limited by the shortage of organ donors. Here, we investigated the role of recombinant human prolactin (rhPRL), shown to have beneficial effects in beta-cells, and its mechanisms of action. Apoptotic beta-cells were decreased in the presence of rhPRL, with cytoprotection involving an increase of BCL2/BAX ratio and inhibition of caspase-8, -9 and -3. This study provides new direct evidence for a protective effect of lactogens in human beta-cell apoptosis. Taking into account the known relationship between cytokines and DM1 and recent observations suggesting a role for autophagy in the development and prevention of DM1, we investigated the connection between cytokines (IL-1β, TNF-α and IFN-γ) and autophagy in beta-cells. Co-treatment with cytokines and rapamycin, an inducer of autophagy through inhibition of mTOR, did not increase the apoptosis levels in INS-1E cells. However, exposure to cytokines increased the levels of autophagosome formation and LC3-II/LC3-I ratio. Treatment with cytokines also led to decreased levels of phosphorylated mTOR and 4E-BP1. We demonstrated for the first time, a direct relationship between cytokines treatment and induction of autophagy in beta-cells. Lately, new evidence point to a connection between cytokine-induced beta-cell death and endoplasmic reticulum stress. In our model, we observed that decreased levels of p-mTOR and increased autophagosome formation also ensued after treatment with endoplasmic reticulum stressors. This study also supports the previous hypothesis on the function of ER stressors in inducing autophagy. Furthermore, rhPRL treatment increased the levels of p-mTOR and decreased autophagosome formation after exposure to cytokines in beta-cells. These findings are also relevant for further characterization of lactogens functions in these cells. Considering the demand for human cells for further beta-cells studies, our group generated cell lines derived from human insulinomas which secrete hormones and express markers with the same pattern displayed by their original tissue. We set out to further characterize these lineages by comparing them to primary beta-cells using two-dimensional gel electrophoresis coupled to mass spectrometry. An average of 1,800 spots was detected with less than 1% exhibiting differential expression. Proteins upregulated in islets, such as Caldesmon, are involved in cytoskeletal organization thus influencing hormone secretion. In contrast, almost all proteins upregulated in insulinoma cells, such as MAGE-A2, first described here, could be related to cell survival and resistance to chemotherapy. Our results provide, for the first time, a molecular snapshot of the changes in expression of proteins correlated with the altered phenotype of insulinomas, prompting research towards the establishment of bioengineered human beta-cells, and the development of new therapeutic strategies for insulinomas. Collectively, the data obtained in this study extend the molecular knowledge involved in rhPRL-induced cytoprotection and malignant transformation of pancreatic beta-cells, contributing to future applications for understanding and treatment of DM1

Os insulinomas são os mais comuns neoplasmas endócrinos pancreáticos, constituindo cerca de 17% de todos os tumores neuroendócrinos do trato digestivo. São tumores raros, que tem, como principal manifestação clínica, a hipoglicemia, a qual é ocasionada por secreção exagerada de insulina pelo tumor. Devido ao fato de serem tumores raros, o conhecimento das mudanças genéticas associadas à iniciação e progressão desses tumores é muito limitado. Em função disto, o objetivo deste trabalho é a identificação de genes diferencialmente expressos em insulinomas benignos humanos, visando o melhor entendimento dos mecanismos moleculares do processo tumorigênico dos insulinomas e a descoberta de novos alvos moleculares para terapia. Utilizando-se a plataforma de \"bioarrays\" CodeLink foram identificados 354 genes mais expressos nos insulinomas benignos, sendo que 16% estavam envolvidos em proliferação. Dentre estes genes foram escolhidos 6 genes para validação por \"Real-Time PCR\", onde os genes SPARCL1, PRSS11 STAT4, ECRG4, ASCL1 confirmaram sua expressão diferencial nos tumores, porém a diferença do gene IGFALS não foi estatisticamente significativa. Através da técnica \"Representational Difference Analysis\", isolou-se o clone FLJ13072, como super-expresso nos insulinomas benignos quando comparado à ilhotas normais, sendo que a seqüência protéica putativa deste gene apresenta um domínio conservado de helicase, podendo estar envolvido em eventos de transcrição, tradução, reparo de DNA e remodelamento de cromatina. Uma das dificuldades encontradas no estudo dos insulinomas é a falta de linhagens celulares humanas. Por esta razão, iniciou-se o estabelecimento de culturas primárias e precoces de insulinomas humanos visando sua utilização como modelos celulares para futuros estudos funcionais dos genes identificados. / Insulinomas are the most common pancreatic endocrine neoplasms, comprising around 17% of all neuroendocrine tumors of the digestive tract. These rare tumors have hypoglycemia as the main clinical manifestation, caused by over secretion of insulin by the tumor. Based on that, the objective of this work is the identification of differentially expressed genes in human benign insulinomas, aiming at the better understanding of the molecular mechanisms of their tumorigenic process and the discovery of new molecular targets for therapeutics. Using the CodeLink bioarrays platform (GE Healthcare) 354 genes upregulated in human benign insulinomas were identified, among which, 16% are involved in cell proliferation. From these genes, 6 were chosen for validation by Real Time PCR, where SPARCL1, PRSS11, STAT4, ECRG4 and ASCL1 were shown to be upregulated in all benign tumors, however the expression difference of IGFALS gene were not statistically significant. Using the RDA (Representational Difference Analysis) methodology, the unknown gene FLJ13072 was shown to be upregulated in benign isulinomas when compared to normal pancreatic islets. The putative protein product from this gene has an helicase domain, being possibly involved in processes like transcription, translation, DNA repair and chromatin remodeling. An important drawback for the study of insulinomas is the lack of human cell lines. Because of that, the establishment of early primary cultures of human insulinomas was initiated, aiming at its use as a cell model for future functional studies of the genes identified.

Background: Insulin is an important hormone for glucose homeostasis. It is released from β-cells in the endocrine pancreas as a response to increased concentrations of plasma glucose. The major effect of insulin is the facilitation of cellular uptake and storage of glucose as glycogen. Insulinomas are tumours that produce excessive amounts of insulin resulting in hypoglycaemia. The condition has been observed in dogs and cats and is often malignant. One part of establishing the diagnosis is confirmation of elevated concentrations of insulin in a hypoglycaemic sample. Aim: The aim of this study was to evaluate if an equine-optimized insulin ELISA (Mercodia AB, Uppsala, Sweden) is useful for analysis of insulin in canine and feline serum samples when insulinoma is suspected. Material and methods: All samples were analysed with Equine insulin ELISA. Precision, linearity and effects of haemolysis were studied. The stability of insulin was evaluated after storage in 4°C, room temperature and after repeated freezing and thawing. A reference interval was constructed for both canine and feline samples. Results: Total precision expressed as CV was 4.4 – 18.9 %. The method was linear up to at least 100 mU/L for dogs and 15 mU/L for cats. Reference interval for cats was <11.6 mU/L, due to few healthy animals no reference interval for dogs could be established. Stability was acceptable for up to four days. No effects of haemolysis were detected. Conclusion: Mercodia Equine insulin ELISA is suitable for analysis of insulin in serum from dogs and cats when suspecting insulinoma.

Pancreatic neuroendocrine tumours (PNETs) are the most common neuroendocrine tumours diagnosed in humans and dogs. Due to the highly heterogeneous nature of these tumours, definitive data are still lacking over the molecular mechanisms involved in their cancerous behaviour. This study focused on insulinoma (INS), as it is the most commonly diagnosed PNET in human and veterinary oncology. INS is an insulin-producing tumour that causes a hypoglycaemic syndrome related to the excessive insulin production. In humans, it is often a small benign neoplasm readily curable by surgical resection whereas, in dogs, INS is often malignant. Despite current treatment modalities, malignant canine and human INS have a poor prognosis as patients tend to develop metastases in liver and lymph nodes that do not respond to current therapies. From a comparative oncology perspective, the close resemblance of canine and human malignant INS makes canine INS an interesting study model for human INS. Cancer stem cells (CSCs) are critical for the engraftment and chemoresistance of many tumours. Although CSCs have been isolated from a range of solid tumours, a comprehensive characterisation of INS CSCs has not yet been reported. In this study, it was confirmed that INS CSCs can be enriched and are potential targets for novel INS therapies. Highly invasive and tumourigenic human and canine INS CSCs were successfully isolated and exhibited greater resistance to chemotherapy, which may play a significant role in the poor prognosis of this disease. To date, the mechanisms by which tumours spread and the clinical causes of chemoresistance remain only partially understood. Here, RNA-sequencing analysis was performed over a small set of canine INS tumour samples in order to identify mechanisms involved in INS carcinogenesis through different stages of the disease. Preliminary data showed that distinct gene profiles characterised early and late stage of canine INS. Interestingly, differential gene expression and gene pathways analysis, highlighted that sets of genes involved in pancreatic embryogenesis and insulin secretion were overexpressed in canine primary INS lesions compared with normal pancreas. The Notch pathway is fundamental in pancreatic embryogenesis and it has been previously associated with carcinogenesis of neuroendocrine tumours and with the CSC phenotype. Protein analysis showed that the Notch pathway is activated in both human and canine INS CSCs, particularly when treated with chemotherapy, indicating that the Notch pathway may be involved in chemoresistance. Additionally, it was demonstrated that inhibition of the Notch pathway decreased INS CSCs' survival and chemoresistance, both in vitro and in vivo. These findings provide preclinical evidence that anti-Notch therapy may improve outcomes for patients with malignant INS.